Margarita Thanhaeuser

Probiotics ( Lactobacillus acidophilus and Bifidobacterium bifidum ) prevent NEC in VLBW infants fed breast milk but not formula

Background:Specific probiotics prevent necrotizing enterocolitis (NEC). A mixture of lactobacilli and bifidobacteria (Infloran) was highly effective in Asian very-low-birth-weight (VLBW) infants. We analyzed the effect of Infloran on NEC, NEC severity, and the influence of enteral feedings (breast milk vs. formula) on NEC prevention in a cohort of European VLBW infants.Methods:Infloran was implemented for routine use at our department. VLBW infants receiving probiotics were prospectively followed (2010–2012) and compared with historic controls (2008–2009). Data on NEC, neonatal morbidity, feeding tolerance, and descriptive parameters on NEC cases were analyzed.Results:Infloran had no statistically significant impact on NEC (controls: 24/233 (10.3%); probiotics: 16/230 (7%); P = 0.2). However, NEC was significantly reduced in infants of the probiotics group who were fed any breast milk (20/179 (11.2%) vs. 10/183 (5.5%); P = 0.027), whereas it was ineffective in infants exclusively fed formula (4/54 (7.4%) vs. 6/44 (13.6%); P = 0.345). Occurrence of severe NEC (IIIb), time until full feeds, and gastric residuals were similar.Conclusion:Infloran was of lower efficacy in a European VLBW cohort and showed a reduction of NEC only in infants fed breast milk. Future studies should investigate the influence of feeding formula or breast milk on the effect of probiotics.

Human Milk Analyser shows that the lactation period affects protein levels in preterm breastmilk.

This study measured the composition of preterm human breastmilk, particularly the protein content, with the MIRIS Human Milk Analyser, compared our results with published values and determined the relationship between protein content and lactation period.

Administration of Fortifier by Finger Feeder During Breastfeeding in Preterm Infants

Objective To evaluate the acceptance, adherence, and feasibility of fortifier administration by finger feeder during breastfeeding and to determine weight, length, and head circumference gains after discharge for preterm infants. Design Observational pilot study. Setting A Level III NICU and its outpatient clinic in Vienna, Austria. Participants Infants born at younger than 34 weeks gestation were included. Methods Mothers were screened in a tertiary NICU and trained by certified lactation consultants to administer fortifier with a finger feeder during breastfeeding. Data on finger feeder use at home were collected by self‐reported feeding diaries and questionnaires. Results In total, data from 24 mother–infant dyads were analyzed. The acceptance rate was 67%. In 41.7%, more than 50% of meals were fortified. Mothers did not report problems in preparation, but 33% of the infants stopped latching on or drooled milk during finger feeder use. Conclusion Use of a finger feeder to administer fortifier to preterm infants enabled mothers to exclusively breastfeed their infants and meet their nutritional needs. The development of further methods to augment preterm infant nutrition that do not interfere with breastfeeding is of great interest.

Starting enteral nutrition with preterm single donor milk instead of formula affects time to full enteral feeding in very low birthweight infants

This study compared the impact of using either single donor breastmilk or formula to start enteral feeding in preterm infants, on the time to full enteral feeding, growth and morbidity. The milk was provided by other preterm mothers.

A Mixed Lipid Emulsion for Prevention of Parenteral Nutrition Associated Cholestasis in Extremely Low Birth Weight Infants: A Randomized Clinical Trial

Objectives To examine whether a mixed lipid emulsion reduces the incidence of parenteral nutrition associated cholestasis (PNAC) in extremely low birth weight (ELBW, <1000 g) infants. Study design This double‐blind randomized trial of 230 ELBW infants (June 2012‐October 2015) was performed at a single level IV neonatal intensive care unit. Patients received either a mixed lipid emulsion composed of soybean oil, medium chain triglycerides, olive oil, and fish oil‐(intervention) or a soybean oil‐based lipid emulsion (control) for parenteral nutrition. The primary outcome measure was PNAC (conjugated bilirubin >1.5 mg/dL [25 &mgr;mol/L] at 2 consecutive measurements). The study was powered to detect a reduction of PNAC from 25% to 10%. Results Reasons for noneligibility of 274 infants screened were refusal to participate (n = 16), death (n = 10), withdrawal of treatment (n = 5), higher order multiples (n = 9), and parents not available for consent (n = 4). Intention to treat analysis was carried out in 223 infants (7 infants excluded after randomization). Parenteral nutrition associated cholestasis was 11 of 110 (10.1%) in the intervention and 18 of 113 (15.9%) in the control group (P = .20). Multivariable analyses showed no statistically significant difference in the intention to treat (aOR 0.428, 95% CI 0.155‐1.187; P = .10) or per protocol population (aOR 0.457, 95% CI 0.155‐1.347; P = .16). There was no statistically significant effect on any other neonatal morbidity. Conclusions The incidence of parenteral nutrition associated cholestasis was not significantly reduced using a mixed lipid emulsion in ELBW infants. Trial Registration ClinicalTrials.gov NCT01585935.

PS-181 Probiotics (infloran®) For Nec Prevention: Influence Of Enteral Nutrition

Background Probiotics may protect from necrotizing enterocolitis (NEC). Former studies in Asian populations have shown that Infloran® - a mixture of Lactobacillus acidophilus and Bifidobacterium infantis - decreases NEC by 80% in very low birth weight (VLBW) infants. Therefore, we implemented Infloran® at our department in 2010. The objectives of our study were to determine the influence of the probiotic Infloran® on NEC incidence, NEC severity and the influence of enteral nutrition in a Caucasian population compared to a historic control group. Material and methods Since 2010, VLBW infants born Results 230 infants were included (mean gestational age: 27+2, birth weight: 900g) and compared with 233 controls (28+5, 980g). After implementation of Infloran® NEC decreased by 32% (10.3% before vs. 7% after implementation of probiotics, p = 0.092 – corrected for confounding variables birth weight and gestational age). Probiotics had no influence on NEC severity. A NEC reduction was shown in breast fed infants only and not in formula fed infants. Discussion The effect of Infloran® was less effective in our Caucasian population than expected. Interestingly, NEC incidence was not reduced in exclusively formula fed infants. The inefficacy in this subgroup is alarming. Therefore, the impact of enteral nutrition on probiotic effects should be explored in further prospective randomised controlled trials.

Can Sequential Coagulation Monitoring Predict Major Haemorrhage in Extremely Low Birth Weight Infants

INTRODUCTION  Bleeds such as intra-ventricular (IVH) and pulmonary haemorrhage (PH) are life-threatening events in extremely low birth weight (ELBW) infants. Serial coagulation monitoring by measuring the international normalized ratio (INR) with small volume samples might facilitate early diagnosis and possibly prevent major bleeds. MATERIALS AND METHODS  This was a prospective longitudinal study performed in ELBW infants, who received serial INR monitoring by point of care testing during their first 30 days of life. The primary objective was to explore whether INR monitoring could predict major bleeding events (IVH, PH). Secondary objectives were mortality and feasibility in this patient population. RESULTS  A total of 127 ELBW infants were stratified into a bleeding and a non-bleeding group. Bleeding events occurred in 31% (39/127) of the infants, whereupon 24% developed IVH and 9% PH. Infants in the bleeding group were 4 days younger at birth (p = 0.05) and had a substantially higher mortality rate of 26% versus 5% in controls (p = 0.005). Median INR during the first 3 days before a bleeding event was 1.55 (95% confidence interval [CI]: 1.39-1.74) compared with the control group with 1.45 (95% CI: 1.44-1.58; p = 0.81). Platelet counts were significantly lower in the bleeding group on the 3rd day and during the 2nd to 4th week of life. DISCUSSION  Serial coagulation monitoring by an INR point of care testing is feasible in ELBW infants but could not predict bleeding events. Further studies with daily monitoring of INR and platelet counts during the first days of life might be able to more precisely detect a risk of major haemorrhage in ELBW infants.

MIRIS – an adequate method to measure fortified breast milk?

Human milk (HM) is unique and the gold standard for feeding neonates. HM contains insufficient quantity of protein for preterm infants. Therefore, a new supplement (Aptamil Protein+®-Milupa/Danone) was developed.