Ravisha Srinivasjois

Prebiotic Supplementation in Full-term Neonates: A Systematic Review of Randomized Controlled Trials

OBJECTIVE To systematically review randomized controlled trials evaluating the efficacy and safety of prebiotic supplementation in full-term neonates. DATA SOURCES Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and CINAHL databases and proceedings of relevant conferences. STUDY SELECTION Eleven of 24 identified trials (n = 1459) were eligible for inclusion. Intervention Trials comparing formula milk supplemented with or without prebiotics, commenced at or before age 28 days and continued for 2 weeks or longer. MAIN OUTCOME MEASURES Stool colony counts (bifidobacteria, lactobacilli, and pathogens), pH, consistency, frequency, anthropometry, and symptoms of intolerance. RESULTS Six trials reported significant increases and 2 reported a trend toward increases in bifidobacteria counts after supplementation. Meta-analysis estimated significant reduction in stool pH in infants who received prebiotic supplementation (weighted mean difference, -0.65; 95% confidence interval, -0.76 to -0.54; 6 trials). Infants who receive a supplement had slightly better weight gain than did controls (weighted mean difference, 1.07 g; 95% confidence interval, 0.14-1.99; 4 trials) with softer and frequent stools similar to breastfed infants. All but 1 trial reported that prebiotic supplementation was well tolerated. In that trial, diarrhea (18% vs 4%; P = .008), irritability (16% vs 4%; P = .03), and eczema (18% vs 7%; P = .046) were reported more frequently by parents of infants who received prebiotic supplements. CONCLUSIONS Prebiotic-supplemented formula is well tolerated by full-term infants. It increases stool colony counts of bifidobacteria and lactobacilli and results in stools similar to those of breastfed neonates without affecting weight gain. Larger trials with long-term follow-up are needed to determine whether these short-term benefits are sustained.

Prebiotic supplementation in preterm neonates: Updated systematic review and meta-analysis of randomised controlled trials

BACKGROUND & AIMS Regular administration of prebiotic oligosaccharides promote beneficial gut flora in infants. We aimed to systematically review randomized controlled trials evaluating the safety and efficacy of prebiotic oligosaccharide supplementation in preterm infants ≤ 37 weeks of gestation. METHODS Available studies from Medline, Embase, comparing formula milk supplemented with or without prebiotics, reporting on safety and the incidence of necrotising enterocolitis (NEC), late onset sepsis, feed tolerance, physical growth and various stool characteristics were eligible. RESULTS 7 trials (n = 417) were included. Five trials (n = 345) reported on the incidence of NEC, 3 trials (n = 295) reported on the incidence of late onset sepsis. Meta-analysis revealed a pooled RR (95% CI) of 1.24 (0.56-2.72) for NEC, 0.81 (0.57-1.15), p 0.23 for the risk of late onset sepsis. 3 individual trials (n = 295) did not observe any improvement in time to enteral feeds post intervention. Meta-analysis indicated a statistically significant difference in the growth of bifidobacteria in the oligosaccharide group with a weighted mean difference of 0.53 (95% CI: 0.33, 0.73) *10(6) colonies/g, p < 0.00001. A reduction in stool viscosity and pH was also observed. None of the trials reported life threatening adverse effects. CONCLUSIONS Supplementation with prebiotic oligosaccharides was safe and did not result in decreased incidence of NEC, late onset sepsis and time to full enteral feeds but resulted in a significantly higher growth of beneficial microbes.

Prebiotic supplementation of formula in preterm neonates: a systematic review and meta-analysis of randomised controlled trials

BACKGROUND & AIMS Review the efficacy and safety of prebiotic oligosaccharide supplementation of formula in reducing the incidence of NEC and sepsis; study its effect on growth, gut colonisation and stool characteristics in preterm neonates < or =37 weeks. METHODS The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL databases and proceedings of relevant conferences were searched. Only randomised control trials using prebiotic supplemented vs unsupplemented formula milk commenced within 28 days of life and continued for > or =2 weeks were included in the review. RESULTS Only one trial reported that NEC did not occur in any of the enrolled neonates. Others did not report on NEC or sepsis. All trials reported anthropometric parameters. Meta-analysis showed no significant effect on weight gain between the two groups. The two trials reporting on stool flora showed a statistically significant increase in bifidobacterial counts in the prebiotic supplemented group (Weighted mean difference (WMD)=0.53; 95% CI: 0.33, 0.73) logCFU/g of stool. CONCLUSION Prebiotic supplemented formula increased stool colony counts of bifidobacteria and lactobacilli in preterm neonates without adversely affecting weight gain.

Association of Gestational Age at Birth with Reasons for Subsequent Hospitalisation: 18 Years of Follow-Up in a Western Australian Population Study.

Background Preterm infants are at a higher risk of hospitalisation following discharge from the hospital after birth. The reasons for rehospitalisation and the association with gestational age are not well understood. Methods This was a retrospective birth cohort study of all live, singleton infants born in Western Australia between 1st January 1980 and 31st December 2010, followed to 18 years of age. Risks of rehospitalisation following birth discharge by principal diagnoses were compared for gestational age categories (<32, 32–33, 34–36, 37–38 weeks) and term births (39–41weeks). Causes of hospitalisations at various gestational age categories were identified using ICD-based discharge diagnostic codes. Results Risk of rehospitalisation was inversely correlated with gestational age. Growth-related concerns were the main causes for rehospitalisation in the neonatal period (<1 month of age) for all gestational ages. Infection was the most common reason for hospitalisation from 29 days to 1 year of age, and up to 5 years of age. Injury-related hospitalisations increased in prevalence from 5 years to 18 years of age. Risk of rehospitalisation was higher for all preterm infants for most causes. Conclusions The highest risks of rehospitalisation were for infection related causes for most GA categories. Compared with full term born infants, those born at shorter GA remain vulnerable to subsequent hospitalisation for a variety of causes up until 18 years of age.

Cytomegalovirus-associated ileal stricture in a preterm neonate.

Abstract:  Gastrointestinal (GI) manifestations of post‐natally acquired cytomegalovirus (CMV) in preterm neonates can vary from mild diarrhoea to severe necrotising enterocolitis. However, the suspicion of CMV‐related GI disease remains low. Mild CMV disease localised to the GI tract may go undiagnosed initially until a more obvious complication such as strictures manifest. A case of CMV‐associated enteritis in an extremely preterm neonate is presented. The diagnosis was established after the histopathology of the surgical specimen showed the presence of CMV inclusion bodies. Testing the stool specimen for CMV to establish the diagnosis when the pathology is limited to the GI tract is also discussed.

Hospital admissions and gestational age at birth: 18 Years of follow up in Western Australia

BACKGROUND Infants born moderate to late preterm are twice as likely to be rehospitalised within the first few weeks following discharge from the birth admission. It is not understood how rehospitalisation risk changes with age or how risks have changed over time. METHODS A retrospective birth cohort study of all live, singleton births in Western Australia 1 January 1980-31 December 2010, without congenital anomalies, followed to 18 years of age. Rehospitalisation rates for gestational age categories (<28, 28-31, 32-33, 34-36, 37-38 and ≥42 weeks) were compared with term births (39-41 weeks) using negative binomial regression. To assess whether rehospitalisation risk changed with age or over time, analyses were conducted for different age intervals and for 5-year birth cohorts. RESULTS Rehospitalisation rates were higher up to 18 years for all preterm and early term categories including early term (37-38 weeks) [130.2/1000 person-years at risk (pyr); 95% confidence interval 129.1, 131.4]; late preterm (34-36 weeks) (164.2/1000 pyr; 161.1, 167.4), and post-term (≥42 weeks) (115.3/1000 pyr; 111.7, 119.0) compared with term births (109.1/1000 pyr; 108.5, 109.7). The effect of gestational age on rehospitalisation was highest during the first year of life and declined by adolescence [e.g. 34-36 weeks: rate ratio = 2.10 (2.04, 2.15) for 29 days-1 year; 1.14 (1.11, 1.18) for 12-18 years]. The risk of rehospitalisation up to 1 year of age has declined since 1980, except for those born <32 weeks. CONCLUSIONS Rehospitalisation risk is greater for singleton children born at all gestational ages compared with those born full term. This effect of gestational age on rehospitalisation is highest in the first year post-discharge, but has almost disappeared by adolescence.

Biracial couples and adverse birth outcomes: a systematic review and meta‐analyses

Background. Differences in birth outcomes such as low birthweight (LBW), preterm births (PTB), stillbirth, differences in birthweight in Black vs. White race are well known. Infants born to biracial parents (mother and father from either Black or White races) also experience higher adverse birth outcomes. Objective. To systematically review and meta‐analyze birth outcomes among parents of mixed racial background compared to parents of same race. Search strategy. Medline, Embase, CINAHL and bibliographies of identified articles were searched for English language studies. Selection criteria. Studies reporting association between parental mixed racial status and LBW, PTB, or small‐for‐gestational age (SGA) outcomes were included. Data collection and analyses. After exclusion of duplicate cohorts in different publications, data from White mother–Black father (WMBF), Black mother–White father (BMWF) and Black mother–Black father (BMBF) groups were compared with the White mother–White father (WMWF) group. Results. Eight English language studies from of 26 335 596 singleton births were included and reviewed. Compared to the WMWF group, the adjusted odds ratio (95% confidence intervals) were: (a) low birthweight; 1.21 (1.10–1.33) for WMBF, 1.75(1.64–1.87) for BMWF, and 2.08 (1.81–2.38) for BMBF; (b) preterm births; 1.17 (1.05–1.31) for WMBF, 1.37 (1.18–1.59) for BMWF, and 1.78 (1.59–2.00) for BMBF; and (c) stillbirths; 1.43 (0.92–2.21) for WMBF, 1.51 (1.09–2.08) for BMWF, and 1.85 (1.47–2.32) for BMBF. Conclusion. Biracial status of parents was associated with higher risk for adverse pregnancy outcomes than both White parents but lower than both Black parents, with maternal race having a greater influence than paternal race on pregnancy outcomes.

Probiotic supplementation in children with autism spectrum disorder

A mother of a 4 year old with autism spectrum disorder (ASD) attends the paediatric outpatient clinic. Her son has significant behavioural difficulties, tantrums that are difficult to control, an obsession with spinning wheels and sensory difficulties. She has heard and read about the advantages of probiotic supplementation (PS) in ASD. She wants to know if her son should be given probiotics to improve his behaviour. You wonder if there is any evidence that regular PS improve behaviour in children with ASD. Structured clinical question: In children with proven ASD (patient), does supplementation with any probiotic microorganism/s (intervention) compared with placebo/none (comparator) improve behaviour (outcome) in the short term? Search strategy and outcome—secondary sources: The Cochrane Central Register of Controlled Trials (CENTRAL, the Cochrane library, Issue 2, 2012) was searched in …

Use of laryngeal mask airway in near-term and term neonates during resuscitation: Is it effective and safe?

A scenario where laryngeal mask airway was used for successful resuscitation of a late preterm neonate after failed bag and mask ventilation and unsuccessful endotracheal intubation is presented. A summary of available evidence regarding the safety and efficacy of the use of laryngeal mask airway during neonatal resuscitation is also presented.

Antenatal steroid administration in medically uncomplicated pregnancy beyond 37 weeks of gestation for the prevention of neonatal morbidities prior to elective caesarean section: a systematic review and meta-analysis of randomised controlled trials

Abstract Background: Elective caesarean section is associated with an increased risk of respiratory morbidity and admission to special care nursery even at full-term gestation. Aim: To systematically review the efficacy of antenatal steroid administration to prevent neonatal morbidity at full-term. Only randomised and quasirandomised controlled trials were selected. Methods: Standardised methodology as described by the Cochrane neonatal review group was used for data collection and analysis. Results: A total of three randomised controlled trials (N = 2740 patients) were included in the review. Meta-analysis of the published data was carried out. A significant decrease in the risk of respiratory distress syndrome (odds ratio (OR) 0.40 (95%CI: 0.23–0.71, p < 0.001), risk of transient tachypnoea of newborn (OR 0.37 (95%CI: 0.25–0.56, p < 0.00001)), risk of admission to special care nursery (OR 0.53 (95%CI: 0.37–0.76, p < 0.0007)) were observed. Conclusion: Although antenatal steroid administration prior to elective caesarean section demonstrated significant benefit in the prevention of neonatal morbidities; however, one need to be cautious before it can be routinely administered because of the paucity of long-term safety data.