Effects of early administration of buccal colostrum on reducing late onset sepsis among preterm in neonatal intensive care: Quasi-experimental, cohort study

Abstract

IntroductionPreterm infants are at a particularly high risk of late onset sepsis (LOS), that can lead to death, increased morbidities, prolonged hospital stay, increased cost of care, and worse long-term outcomes among survivors. Administration of buccal colostrum in the first few days of life is safe, feasible, prophylactic measure against sepsis, Necrotizing Enterocolitis (NEC) and ventilator associated pneumonia. PurposeThe purpose of this study was to evaluate the effects of Early Administration of Buccal Colostrum on preterm infants’ outcomes, including the incidence of late onset sepsis in the Neonatal Intensive Care (NICU). MethodologyThis is a quasi-experimental, retrospective-prospective, clinical trial study, that took place in the NICU of Dubai Hospital, Dubai Health Authority (DHA), in the United Arab Emirates between January 2018–April 2020. The sample consisted of preterm-neonates who were selected and assigned into two groups; experimental and control. A purposive sample that met the inclusion criteria of babies born at 34 weeks and below, and whose parents were willing to participate in this study were included. AnalysisThe sample consisted of 175 preterm neonates. Neonates in Group 1 (n = 134) received buccal colostrum within 48 h, while neonates in Group 2 (n = 41) did not. Of the neonates in (Group 1) who received colostrum within 48 h, 5 (3.7%) had late onset sepsis and 129 (96.3%) did not. On the other hand, neonates in Group 2 who did not receive colostrum within 48 h, almost half 19 (46.3%) also developed late onset sepsis and 22 (53.7%) did not (p = .001). In terms of mortality, Group 1 neonates who received colostrum within 48 h in had a survival rate of 98.5% (132). While in Group 2, 3 (7.3%) neonatal deaths occurred, and 38 (92.7%) neonates were alive 28 days after birth. Despite the death rate in Group 2 being higher compared to Group 1, the results are not statistically significant (p = . 0.085). Fisher's exact test showed that the ratio of deaths in neonates who received colostrum within 48 h in Group 1 and also developed sepsis was 1 neonatal death: 4 alive. While 3 neonates in Group 2 who did not receive Colostrum within 48 h and developed sepsis and died. These results were statistically significant with (p = .001). Neonatal deaths were higher in neonates who did not receive colostrum within 48 h and who also developed sepsis. ConclusionThis study reported strong evidence to support the proposed clinical benefits of early administration of buccal colostrum. The results also demonstrated differences in the incidence of developing LOS and proven sepsis in preterm infants who did not received buccal colostrum, compared to the infants who received buccal colostrum soon after birth. While no differences were seen in infants’ clinical outcomes in terms of direct mortality, the results did show that early administration of buccal colostrum was associated with better outcomes in neonates who also developed sepsis.