Marc Collin

Standardized Slow Enteral Feeding Protocol and the Incidence of Necrotizing Enterocolitis in Extremely Low Birth Weight Infants.

BACKGROUND Compared with early enteral feeds, the delayed introduction and slow advancement of enteral feedings to reduce the incidence of necrotizing enterocolitis (NEC) are not well studied in extremely low birth weight (ELBW) infants. OBJECTIVE To study the effects of a standardized slow enteral feeding (SSEF) protocol in ELBW infants. METHODS ELBW infants who followed an SSEF protocol (September 2009 to December 2012) were compared with a similar group of historical controls (January 2003 to July 2009). Short-term outcomes between the 2 groups were compared by propensity score (PS) analysis. RESULTS One hundred twenty-five infants in the SSEF group were compared with 294 historical controls. Compared with the controls, feeding initiation day, full enteral feeding day, parenteral nutrition (PN) days, and total central line days were longer in the SSEF group. There was no significant difference in overall NEC (5.6% vs 11.2%, respectively; P = .10) or surgical NEC (1.6% vs 4.8%, respectively; P = .17) between the SSEF group and controls. However, in infants with birth weight <750 g, NEC (2.1% vs 16.2%, respectively; P < .01) or combined NEC/death (12.8% vs 29.5%, respectively; P = .03) was significantly less in the SSEF group compared with controls. In infants who survived to discharge, there was no significant difference in the discharge weight or length of stay in PS-adjusted analysis. CONCLUSIONS An SSEF protocol significantly reduces the incidence of NEC and combined NEC/death in infants with birth weight <750 g. Despite taking longer to achieve full enteral feeding on this protocol, surviving ELBW infants demonstrated comparable weight gain at discharge without prolonging their hospital stay.

Early and late postnatal identification of isolated lenticulostriate vasculopathy in preterm infants: associated findings.

OBJECTIVES: To determine the incidence, possible etiologies, and neurodevelopmental outcome of premature infants (<35 weeks) with isolated lenticulostriate vasculopathy (LSV).STUDY DESIGN: In a retrospective case-control design, we reviewed the medical records of all premature infants who were admitted to our neonatal intensive care unit between 1996 and 2000.RESULTS: The prevalence of LSV was 4.6% (21 of 453). Patients with late LSV (detected after 10 days of age) had less exposure than controls to prenatal steroids [42.8% (6 of 14) vs. 92.8% (13 of 14), respectively; p<0.01], and prenatal antibiotics [42.8% (6 of 14) vs. 85.7% (12 of 14), respectively; p=0.01]. Fifty-seven percent (8 of 14) of patients with late LSV had a low Apgar score vs. 14.2% (2 of 14) of the control group (p=0.01). Patients with LSV also had more muscle tone abnormalities than controls at 6 months of age [33.3% (5 of 15) vs. 5.2% (1 of 19), respectively; p=0.03].CONCLUSION: Patients with late LSV have less exposure to antenatal steroids and antibiotics, lower Apgar scores, and abnormal muscle tone at 6 months of age.

Human Milk Analysis Using Mid-Infrared Spectroscopy

BACKGROUND The composition of human milk is known to vary with length of gestation, stage of lactation, and other factors. Human milk contains all nutrients required for infant health but requires fortification to meet the needs of low-birth-weight infants. Without a known nutrient profile of the mothers milk or donor milk fed to a baby, the composition of the fortified product is only an estimate. Human milk analysis has the potential to improve the nutrition care of high-risk newborns by increasing the information about human milk composition. Equipment to analyze human milk is available, and the technology is rapidly evolving. This pilot study compares mid-infrared (MIR) spectroscopy to reference laboratory milk analysis. METHODS After obtaining informed consent, we collected human milk samples from mothers of infants weighing <2 kg at birth. Duplicate samples were analyzed for macronutrients by MIR and by reference laboratory analysis including Kjeldahl for protein, Mojonnier for fat, and high-pressure liquid chromatography for lactose. Intraclass correlation coefficients, Bland-Altman scatter plots, and paired t tests were used to compare the two methods. RESULTS No significant differences were detected between the macronutrient content of human milk obtained by MIR vs reference laboratory analysis. CONCLUSIONS MIR analysis appears to provide an accurate assessment of macronutrient content in expressed human milk from mothers of preterm infants. The small sample size of this study limits confidence in the results. Measurement of lactose is confounded by the presence of oligosaccharides. Human milk analysis is a potentially useful tool for establishing an individualized fortification plan.

Perspectives of Physician Parents in the NICU

Sixty-four physician parents of infants cared for in the neonatal intensive care unit (NICU) were mailed a survey inquiring about privacy, emotional state, and communication. Fifty-seven (89%) physician parents responded. Forty-six (81%) infants were preterm. Responses were not associated with illness severity or hospital length of stay. Most respondents believed their infant received good care and achieved a good outcome, but suggestions to enhance communication were common, and their consideration may improve NICU care. Most physician parents believed their experience made them more empathetic and compassionate. Further investigation into the reasons for this may help to enhance future medical education.

Staff perceptions of challenging parent–staff interactions and beneficial strategies in the Neonatal Intensive Care Unit

To characterise neonatal intensive care unit (NICU) staff perceptions regarding factors which may lead to more challenging staff–parent interactions, and beneficial strategies for working with families with whom such interactions occur.

A comparison of manual versus automated saturation of peripheral oxygenation in the neonatal intensive care unit

Abstract Background: It is vital to maintain the saturation of peripheral oxygenation (SpO2) in a targeted range in extremely premature infants to improve survival without significant morbidities. Objectives: To compare manual versus automated monitor documentations of daily upper and lower values of SpO2 in premature infants. Methods: In a prospective observational study, the highest and lowest daily SpO2 manually recorded values from electronic medical records were compared with automatically recorded values from bedside cardiorespiratory monitors. Results: Eighteen infants were monitored for 605 patient days, with a mean birth weight of 859 ± 183 g, and gestational age of 26.0 ± 1.3 wks. Within the lowest SpO2 values, manually recorded values were consistently higher than the simultaneous automatically recorded monitor values. The highest SpO2 point differences in documentation was seen in patients with SpO2 range ≤ 70% (16 ± 13 points), followed by 71–80% (10 ± 7 points) and 81–90% (7 ± 4 points); p < 0.01. Conclusions: The difference between manually and automatically recorded SpO2 is large in lower SpO2 ranges and small in higher SpO2 ranges. Automated oxygen administering systems should be considered to reduce potential errors.

Considering Human Milk Variability in the Nutritional Management of Low-Birth-Weight Infants

Human milk is the preferred feeding for babies but requires fortification to meet the needs of low-birth-weight infants. Human milk is known to vary with length of gestation and state of lactation. We describe the degree of variability both between mothers and within a mother’s own milk supply in the setting of the neonatal intensive care unit. Aliquots from 24-hour supplies of human milk from mothers of infants weighing <2 kg at birth who were between 2 and 6 weeks of life were analyzed for lactose, bioavailable protein, and fat using a mid-infrared milk analyzer. Variability was estimated for each macronutrient by calculating the coefficient of variation (%) and was significantly less within one mother than between mothers (P < .05). The variability in macronutrient content between mothers supports the use of human milk analysis when establishing a nutritional management plan for low-birth-weight infants. Low variability within a mother’s own milk supply suggests that weekly analysis is sufficient to es...

Maternal Mental Health and Parenting Stress After the Birth of a Very Low Birthweight Infant |[dagger]| 1337

There is little information detailing how families adapt to the experience of VLBW birth and subsequent caregiving demands. Mothers of high risk (HR) VLBW infants with BPD (n = 122), low risk (LR) VLBW infants without BPD (n = 84), and term (T) infants were folowed longitudinally from birth at 8, 12, 24, and 36 months (corrected ages). At each visit standardized normative measures of child development (Bayley Scales), maternal psychological distress (Brief Symptom Inventory), parenting stress (Parenting Stress Index), and (at 2 and 3 years) family impact (Impact on Family Scale) were given to assess the relationship of high/low risk VLBW birth on maternal and family stress. Groups did not differ in sex, race, socioeconomic status, or age. Group differences over time were assessed using repeated measures MANOVAS, with significant group and time (all Fs 3.5, ps <.05) effects found on all outcomes. Maternal psychological symptoms were elevated for both HR and LR groups neonatally but by 2 and 3 years, LR mothers had the lowest levels of symptoms, while HR mothers reported greater distress. Parenting stress did not differ until 3 years when HR mothers reported greater stress related to child characteristics. After the neonatal period, LR mothers did not differ from T mothers on any measure except for financial stress at 2 years, while HR mothers reported higher stress in family impact domains. Severity of maternal mental health symptoms was inversely related to child developmental outcome at all ages for HR mothers. These findings indicate that the psychosocial impact of VLBW birth varies with the medical risk, developmental outcome, and age of the infant.

Predictors of Perforation in Necrotizing Enterocolitis |[dagger]| 1090

Objective: Reliance on abdominal radiographs to diagnose intestinal perforation secondary to necrotizing enterocolitis in premature infants may delay operative intervention and increase the short and longterm complications. The objective of the study was to determine whether clinical and hematological alterations predict impending perforation in neonates with necrotizing enterocolitis.

PRESCHOOL TESTING: A SENSITIVE PREDICTOR OF SUBSEQUENT SCHOOL PROBLEMS IN CHILDREN WITH 88

While many extremely low birth weight (ELBW; 2 other scores between 1-2 S.D. below the mean) and DISCREPANT(average cognitive score but any other scores between 1-2 S.D. below the mean). All 37 children in these 3 groups were predicted to have school problems (sensitivity 97%). 6/37 did not have school problems as well as 16/17 children with all average or above preschool test scores (specificity 73%). These data indicate that even mild deficits present at preschool are likely to persist or worsen with school demands. While many do well, pediatricians and parents should ensure that all ELBW children are tested prior to school entry to determine educational needs.