Kamlesh Macwan

Randomized trial of very low birth weight infants receiving higher rates of infusion of intravenous fat emulsions during the first week of life.

OBJECTIVE. The goal was to determine whether very low birth weight infants could tolerate higher rates of infusion of intravenous fat emulsion during the first week of life and maintain their serum triglyceride levels at ≤200 mg/dL. METHODS. This was a randomized, controlled trial of 110 infants who were classified as appropriate for gestational age and had birth weights between 750 g and 1500 g. The primary clinical outcome was serum triglyceride levels; secondary outcomes also were monitored. RESULTS. One hundred infants completed the study (experimental group: N = 48; control group: N = 52). Infants in the experimental group had significantly higher energy intake for the entire 7-day study period and achieved 90 kcal/kg per day (1 kcal = 4.184 kJ) significantly sooner (7.38 ± 3.381 days vs 9.44 ± 3.578 days). Triglyceride levels for infants in the experimental group remained significantly higher for the first 5 days of life. Fifteen percent of infants in the experimental group but only 4% of infants in the control group developed hypertriglyceridemia. Ten percent of infants in the control group but no infants in the experimental group required insulin therapy. Forty-two percent of infants in the experimental group and 17% of infants in the control group remained at ≥10th percentile for weight for age. Fourteen percent of infants in the control group but no infants in the experimental group developed necrotizing enterocolitis. Twenty-three percent of infants in the control group but only 6% of infants in the experimental group developed retinopathy of prematurity. There were no significant differences in other outcomes. CONCLUSIONS. Very low birth weight infants can tolerate higher rates of infusion of intravenous fat emulsion solutions during the first week of life without significant adverse events.

Transpyloric feeding in gastroesophageal-reflux-associated apnea in premature infants.

Objective: The aetiological role of gastroesophageal reflux in apnea of prematurity is controversial. We hypothesized that transpyloric feeds, which decreases reflux and aspiration, will not be associated with decrease in reflux‐related apnea.

Risk Factors That May Predispose Premature Infants to Increased Incidence of Necrotizing Enterocolitis

The objective of this study was to determine if there are any common “risk factors” that could assist clinicians in identifying premature infants who are at greater risk for developing necrotizing enterocolitis (NEC). This was a retrospective study of infants admitted to the neonatal intensive care unit at Children’s Hospital of Illinois, Peoria. In total, 384 charts were reviewed. Seventy-eight infants diagnosed with NEC were compared to 246 infants who did not have NEC. Maternal risk factors, infant demo-graphics, incidence of sepsis, H2 blockers prescribed, temperature, anemia, and day-of-life gut priming and enteral feedings were compared between the two groups for significant differences. Univariate tests and logistic regression demonstrated that mothers of infants who developed NEC had a higher incidence of premature rupture of membranes. Significantly more males developed NEC than females. African American infants had a higher incidence of developing NEC than white infants. Infants who developed NE...

Reinfusion of Succus Entericus Into the Mucous Fistula Decreases Dependence on Parenteral Nutrition in Neonates

Background. Neonates who undergo surgery and have an ostomy with a creation of a mucous fistula are at nutritional risk, especially if the ostomy placement is proximal and the remaining bowel is not being used. Total parenteral nutrition (TPN) is used to maintain the neonatal nutritional status, but long-term use is associated with increased morbidities. The concept of reinfusing succus entericus into the mucous fistula to decrease the neonate’s dependence on TPN has been limited to case reports. Methods. This is a retrospective cohort study documenting the effectiveness of reinfusing succus entericus into the mucous fistula for neonates admitted to the neonatal intensive care unit (NICU). The authors’ primary hypothesis was that neonates who had succus entericus reinfused into the mucous fistula had decreased dependence on TPN. Results. Of the premature infants receiving mucous fistula feedings, 65% had TPN discontinued, whereas 67% of the term infants had TPN discontinued. The type of ostomy affected th...

Decreasing Birth Weight May Predispose Premature Infants to Increased Mortality From Necrotizing Enterocolitis

The objective of this study was to determine if there are any “risk factors” that could assist clinicians in identifying premature infants who are at greater risk for mortality when developing necrotizing enterocolitis (NEC). This was a retrospective study of infants admitted to the neonatal intensive care unit (NICU) at Children’s Hospital of Illinois, Peoria. Seventy-eight patients were diagnosed with NEC and were divided into 2 groups: NEC-survived versus NEC-died. Maternal risk factors, infant demographics, birth weight, incidence of sepsis, histamine-2 (H2) receptor blockers prescribed, temperature, anemia, and day of life when trophic feedings were begun and when enteral feedings were advanced were compared for significant differences. Univariate tests demonstrated that mothers of infants who died from NEC had a higher incidence of premature rupture of membranes. A premature infant’s decreasing birth weight significantly increased the risk for NEC-related mortality. Premature infants who received early trophic feedings had less NEC-related mortality, but this finding was not significant. Other conditions such as maternal risk factors, H2 blockers in total parenteral nutrition, enteral feedings, and temperature were not significant. Logistic regression indicated that a premature infant’s birth weight significantly increased his or her probability of dying from NEC while adjusting for other variables. A premature infant’s birth weight could be used by clinicians as a tool to identify patients at greater risk for NEC-related mortality. Although the true etiology of NEC remains unclear, early initiation of trophic feedings with colostrum may be the best defense for preventing the onset of this devastat- ing disease.

Adding Dietary Green Beans to Formula Resolves the Diarrhea Associated With a Bowel Resection in Neonates

Background. Traditionally, dietary fiber has been empirically added to infant formulas to improve feeding intolerance for those infants diagnosed with intestinal failure (IF) or short-bowel syndrom...

A Randomized Trial of Micropreemies Receiving Higher Amounts of Intravenous Fat Emulsion During the First Week of Life

Objective. The goal of this study was to determine if micropreemies could tolerate higher infusion rates of intravenous fat emulsions (IVFEs) during the first week of life by maintaining their serum triglyceride levels at 201 g/dL) during the first week of life compared with only 44.4% of the infants in the control group. The experimental group experienced a lower weight loss of 8.6% ± 3.10% as compared with 16.22% ± 8.04% in the control group during the first week of life. Initially, the experimental group was given significantly higher infusion rates of IVFEs, but at the end of the week, the control group was receiving significantly higher infusion rates of IVFEs. Calorie intake was significantly better initially for the experimental group, but because of the incidences of hypertriglyceridemia and a reduction of IVFEs, the control group had significantly better calorie intake at the end of the study period. Conclusions. Micropreemies do not tolerate initial higher infusion rates of IVFEs during the first week of life because of their potential risk for developing hypertriglyceridemia.