Elena Legnani

A thickened formula does not reduce apneas related to gastroesophageal reflux in preterm infants.

Background: Apnea of prematurity (AOP) occurs frequently in preterm infants and a variable proportion of AOP can be induced by gastroesophageal reflux (GER). Conservative treatment, including dietary modifications, should be the first-line approach for both GER and GER-related apneas in this population. Objectives: To evaluate the efficacy of a starch-thickened preterm formula (PF) in reducing the frequency of apneas related to GER. Methods: Preterm infants with AOP were studied by combined impedance and pH monitoring and polysomnography. The 6-hour study period included two feeds, one of a commercially available PF and one of the same formula thickened with amylopectin (TPF). GER indexes, apneas and GER-related apneas detected after TPF and PF feeds were compared by Wilcoxon signed-rank test. Results: 24 infants were studied. During 140 h of registration, 289 apneas (147 after TPF and 142 after PF; p = 0.876), and 861 GER episodes (400 after TPF and 461 after PF; p = 0.465) were recorded. No difference in the number of AOP was found between TPF and PF. A significant reduction in acid exposure was found after TPF; there was no influence on non-acid GER indexes. The frequency of GER-related apneas did not differ between TPF and PF. Conclusions: A formula thickened with amylopectin did not reduce the number of AOP or GER-related apneas. It reduced acid GER features but had no effect on non-acid GER indexes. Future research should focus on exploring different conservative strategies to treat GER-related apneas in preterm infants.

Lack of efficacy of a starch-thickened preterm formula on gastro-oesophageal reflux in preterm infants: a pilot study

Background: Gastro-oesophageal reflux (GOR) is common in preterm infants; conservative interventions (i.e. dietary changes) should represent the first-line approach. Aim: To evaluate by combined pH and impedance monitoring (pH-MII) the effect of a new preterm formula thickened with amylopectin (TPF) on GOR features in symptomatic preterm infants. Methods: Twenty-eight symptomatic preterm newborns underwent a 24-hour pH-MII; each baby received eight meals (four of TPF and four of a preterm formula [PF]). GOR indexes (number, acidity, duration and height of GORs) after TPF and PF meals were compared by Wilcoxon Signed Ranks Test. Viscosity of PF and TPF was measured. Results: TPF significantly decreased the number of acid GORs detected by pH-monitoring (TPF vs. PF: median 20 vs. 24.5, p = 0.009), while it had no influence on Reflux Index (RIpH), nor on acid and non-acid GOR indexes detected by MII, GOR physical features, and GOR height. TPF’s viscosity was extremely higher than PF’s, and further increased at pH 3 after the addition of pepsin. Conclusions: The new formula was found to reduce the number of acid GORs detected by pH-monitoring; it did not reduce neither total oesophageal acid exposure nor non-acid GORs. At present its extended clinical use cannot be recommended.

Intravenous immunoglobulin to treat neonatal alloimmune haemolytic disease

Objective: To compare the efficacy of intravenous immunoglobulin (IVIg) and exchange transfusion (EXT) on rhesus haemolytic disease of the newborn (Rh-HDN) and evaluate treatment-related side effects. Methods: Retrospective chart review of two cohorts of newborns with Rh-HDN, treated with (Group 2) or without (Group 1) IVIg. Length of phototherapy, number of EXT, IVIg infusions, intrauterine and top-up red blood cells transfusions, need and permanence of umbilical venous catheter, and length of hospital stay, as well as treatment-related adverse events, were evaluated. Results: Charts of 88 newborns were reviewed (34 in Group 1, 54 in Group 2). Infants in Group 2 received a significantly lower number of EXT, had a lower risk of neurological impairment and needed an umbilical venous catheter for shorter, but required longer phototherapy, longer length of hospital stay, and more top-up transfusions. EXT was associated with a high number of adverse events. Two newborns treated with IVIg developed necrotizing enterocolitis (NEC). Conclusions: IVIg appear as an effective alternative to EXT, reducing the risk of neurological impairment and complications related to EXT. However, side effects of IVIg treatment (higher need of top-up transfusions and longer hospital stay) should be taken into account and the risk of NEC should be carefully monitored during treatment.

Does the Use of Pacifier Affect Gastro-Esophageal Reflux in Preterm Infants?

UNLABELLED This crossover study showed that non-nutritive sucking, provided with a pacifier in 30 preterm infants, had no effect on acid and nonacid gastro-esophageal reflux evaluated by esophageal pH-impedance, and thus may be reasonably used in preterm neonates with symptoms of gastro-esophageal reflux. TRIAL REGISTRATION ClinicalTrials.gov: NCT02023216.

1334 Effects of Intrapartum Antibiotic Prophylaxis on Newborn Microbiota

Background and Aims Group B Streptococcus (GBS) early-onset bacterial sepsis is an important cause of neonatal morbidity and mortality. In the last decade, after the introduction of intrapartum antibiotic prophylaxis in pregnant women during labor and delivery, the sepsis-associated death rates have declined. The aim of this study is to evaluate the effects of antibiotic treatment of pregnant women GBS-positive on early colonization of bacteria in the newborn gut, which is known to be related to immunity development. Methods Thirty-four vaginal delivered and breastfed newborns were enrolled; 17 had mothers GBS-positive treated with 2g of Ampicillin and 17 had mothers GBS-negative (control group). Two-hundred milligrams faeces were collected for each subject and processed for DNA extraction, performed with QIAamp DNA Stool Mini Kit [Qiagen, Cat. No. 51504]. Lactobacillus spp., Bidobacterium spp., Bacteroides fragilis group, C. difficile and E. coli quantification was obtained with real-time PCR. Data of microbial counts were subjected to one-way variance analisys in order to evidence significant differences between treated and control group of newborns. Results Antibiotic therapy reduced the intestinal colonization of Bifidobacterium: 5.51 Log(CFU/g) in treated samples against 7.07 Log(CFU/g) in control samples; P<0.05. All the others microbial genera and species analysed were not affected by the maternal treatment with Ampicillin. Conclusions Preliminary results showed a decrease of early Bifidobacterium count in the microbiota of newborns; the clinical meaning or the effect on newborn immunity need to be investigated with larger studies.

PO-0599 Effects Of Non-nutritive Sucking On Gastroesophageal Reflux In Symptomatic Preterm Infants

Background The therapeutic management of gastroesophageal reflux (GER) in preterm infants still represents a controversial issue among neonatologists. To date, different non-pharmacological strategies, such as body positioning, milk thickening or changes of feeding modalities, have been proposed. However, the effects of non-nutritive sucking (NNS) on GER features, detected by multiple intraluminal impedance (MII), have not yet been evaluated in preterm newborns symptomatic for GER. Patients and methods Nineteen preterm newborns (GE ≤ 33 weeks) with GER symptoms underwent a 24-hours pH-MII monitoring. During this period, each infant received eight meals, four followed by NNS, applied by means of pacifier, and four not. Differences in GER features (number of episodes, acidity, duration and height reached) between NNS and non-NNS postprandial periods were evaluated by Wilcoxon signed-rank test. Results No significant difference in GER features between NNS and non-NNS periods was found. However, postprandial periods without NNS resulted in a slight increase in the mean duration of acid GER episodes (NNS vs. NON-NNS, median values: 51.15 vs. 88.20 sec, p 0.159). Consequently, during NNS periods the time of esophageal acid exposure was reduced (NNS vs. NON-NNS, median values: 3.54 vs. 6.15%, p 0.171). Conclusions According to our results, NNS administration during postprandial periods seems to have no significant effects on GER features in symptomatic preterm infants. However, during NNS periods we observed a slight, though not significant, reduction in the duration of acid GER, which plays a relevant role in the development of GERD. Further larger evaluations are needed to eventually confirm these preliminary data.

Fortification of Human Milk for Preterm Infants

Human milk is the best feeding choice for preterm infants, as it offers protection against sepsis and other infections (particularly diarrhoea and acute otitis media) [1] and against necrotizing enterocolitis (NEC) [2], thanks to its various bioactive and immunomodulatory components. Furthermore, human milk feeding is related to long-term improved neurocognitive development [3]. It has a beneficial role in facilitating and improving adaptation to extrauterine life; its components also have the effect of promoting psychomotor and behavioural development [4].

346 Effects of Bolus and Continuous Enteral Feeding on Splanchnic and Cerebral Tissue Oxygenation Evaluated by Near Infrared Spectroscopy

Background and Aims Bolus and continuous tube feeding represent the most frequently used enteral feeding techniques in preterm infants, but the best strategy is not yet established. Near-Infrared-Spectroscopy (NIRS) provides a noninvasive monitoring of splanchnic oxygenation, which may play a role in the multifactorial pathophysiology of necrotizing enterocolitis (NEC). The aim of this study is to evaluate by NIRS the effects of bolus and continuous enteral feeding on splanchnic and cerebral oxygenation in preterm infants with normal feeding tolerance. Methods Eighteen healthy preterms (GA 27–32 weeks), tolerating at least 100 ml/kg-1/day-1 of fortified human milk or preterm formula, underwent a 6-hours simultaneous monitoring of cerebral and splanchnic oxygenation using NIRO-200 oximeter. Sensors were placed on frontal and sub-umbilical region. During the monitoring they randomly received a 10-minutes bolus meal and a 3 hours continuous meal. Recorded values of cerebral and splanchnic Tissue Oxygenation Index (TOI) were clustered in 5-minutes intervals and compared between different feeding techniques using Wilcoxon Signed Ranks Test. Statistical significance was set at p≤0.05. Results Splanchnic oxygenation significantly decreased (p<0.05) during continuous feeding, from 1.30’ hour after the beginning to almost the end of the feed. No differences were found on cerebral oxygenation. Conclusions To the best of our knowledge, this is the first study comparing the effect of different feeding techniques on splanchnic and cerebral oxygenation in preterms. A significant reduction in splanchnic oxygenation was observed during continuous enteral. A possible role of these findings on the multifactorial NEC pathogenesis remains to be investigated.

High-Dose Intravenous Immunoglobulin (IVIG) in Rhesus Haemolytic Disease (RHD)

Background and Aims: RHD is characterized by haemolysis and hyperbilirubinaemia due to Rh-incompatibility. Recently, AAP guidelines recommended high-dose IVIg as an alternative to exchange transfusion (EXT). The aim of this study was to compare clinical outcome of RHD patients before and after the introduction of IVIg.Methods: A chart-review of 88 Coombs-positive RHD patients (1999-2009) was performed. Patients were divided into two groups, treated before (Group A[GA]-n°35) and after (Group B[GB]-n°53) the introduction of IVIg, respectively. Number of EXT and RBC transfusions, need and days of permanence of umbilical catheter (UC), duration of hospitalization and phototherapy; maximum bilirubinaemia, changes in bilirubinaemia over time, and morbidity were compared in the two groups.Results: GB-patients had lower EXT need (13% vs 82% in GA, p=0.000), UC need (58% vs 97%, p=0.001) and UC days (mean 2.8/patient vs 4.6, p=0.001), higher need of RBC transfusions (mean 0.9/patient vs 0.2, p=0.000), longer hospitalization (mean 12.1 days/patient vs 6.9, p=0.000) and longer phototherapy (mean 7.6 days/patient vs 4.5, p=0.000). No significant difference in maximum bilirubinaemia was found; in GB-patients bilirubinaemia overcame neurological-risk value for shorter period (mean 55.4 hours/patients vs 74.6, p=0.047). 43.9% GA-patients had thrombocytopenia, 21.9% hypocalcaemia, 4.9% hypomagnesaemia, 19.5% UC-related complications, and 9.8% adverse reactions during EXT. Two infants in GB developed NEC.Conclusions: High-dose IVIg in RHD patients reduced EXT need, UC need and permanence time, and risk of hyperbilirubinaemia-related neurological damage. However, IVIg-treated patients needed longer hospitalization, longer phototherapy, and had increased need of RBC transfusions.