Growth of Very Preterm Infants in a Low-Resourced Rural Setting after Affiliation with a Human Milk Bank

Chia-Huei Chen,Hui-Ya Chiu,Lin Kang,Yung-Chieh Lin,Szu-Chia Lee,Hung-Yang Chang,Shang-Po Shen,Yen-Ju Chen,Jui-Hsing Chang

doi:10.3390/children9010080

Chia-Huei Chen, Hui-Ya Chiu + Show 7 more

Open Access

https://doi.org/10.3390/children9010080

Copy DOI

Abstract

The extrauterine growth restriction (EUGR) of very preterm infants has been associated with long-term complications and neurodevelopmental problems. EUGR has been reported at higher rates in low resource settings. There is limited research investigating how metropolitan human milk banks contribute to the growth outcomes of very preterm infants cared in rural areas. The setting of this study is located at a rural county in Taiwan and affiliated with the Taiwan Southern Human Milk Bank. Donor human milk was provided through a novel supplemental system. A renewal nutritional protocol was initiated as a quality improvement project after the affiliated program. This study aimed to compare the clinical morbidities and growth outcome at term equivalent age (TEA) of preterm infants less than 33 weeks of gestational age before (Epoch-I, July 2015–June 2018, n = 40) and after the new implementation (Epoch-II, July 2018–December 2020, n = 42). The Epoch-II group significantly increased in bodyweight z-score at TEA ((−0.02 ± 1.00) versus Epoch-I group (−0.84 ± 1.08), p = 0.002). In multivariate regression models, the statistical difference between two epochs in bodyweight z-score changes from birth to TEA was still noted. Modern human milk banks may facilitate the nutritional protocol renewal in rural areas and improve the growth outcomes of very preterm infants cared for. Establishing more distribution sites of milk banks should be encouraged.

Highlights

Extrauterine growth restriction (EUGR), defined as an anthropometric measure that is lower than the 10th percentile, is prevalent and occurs in the majority of very preterm infants [1]
This study primarily aimed to review the growth outcome of very preterm infants at term equivalent age (TEA, post-menstrual age 37 to 42 weeks) before and after the quality improvement (QI) of the renewal nutritional protocol related to the affiliation with an human milk bank (HMB) [28]
The prevalence of late-onset sepsis (LOS) was higher in the Epoch-I group (31% vs. 2.4%, p < 0.001) (Table 1). In this QI project coordinated with an HMB, we found a significant decreasing prevalence of EUGR and ∆z-score of body weight (BW) of very preterm infants at TEA after implementing a standardized nutritional protocol with intensive nutritional supplementation and Early trophic feeding (ETF)

Summary

Introduction

Extrauterine growth restriction (EUGR), defined as an anthropometric measure that is lower than the 10th percentile, is prevalent and occurs in the majority of very preterm infants [1]. EUGR has been linked to intrauterine growth restriction, maternal preeclampsia, low gestational age (GA), feeding intolerance, delay in first enteral feeding, and inadequate nutritional supplement [1,7,8,9,10,11]. The benefits of implementation of an HMB in NICUs have been reported by several studies (Table S1) [22,23,24,25,26].

Objectives

Methods

Results

Conclusion