Aspirates Of Preterm Infants Research Articles

Nursing practice of routine gastric aspiration in preterm infants and its link to necrotizing enterocolitis: is the practice still clinically relevant?

The practice of routine gastric residual aspiration in preterm infants remains controversial, with conflicting evidence regarding its impact on necrotizing enterocolitis (NEC). As front-line caregivers, nurses play a vital role in gastric aspiration procedures and must be informed by evidence. This quasi-experimental nursing study aimed to assess whether gastric aspiration is clinically relevant in reducing the risk of NEC in preterm infants.A total of 250 preterm infants from two NICUs in Egypt were allocated to the gastric aspiration (n = 125) and non-aspiration (n = 125) groups. Feeding practices, gastric residuals, and incidence/severity of NEC were compared between groups according to modified Bell’s criteria. Risk factors were analyzed using multivariate regression. There were no significant baseline differences between the groups. The gastric residual attributes and feeding outcomes did not differ substantially from aspiration. The overall incidence of NEC was 14–15%, with no significant differences in the odds of onset or progression of NEC by stage between the groups. Lower gestational age and birth weight emerged as stronger predictors of NEC. Routine gastric aspiration does not appear to directly prevent or reduce the severity of NEC in this population. Although gastric residuals retain clinical importance, study findings question assumptions that aspiration protects against NEC and informs nursing practice. Evidence-based feeding protocols must continually evolve through ongoing research on modifiable risk factors for this devastating intestinal disease in preterm infants.

Nurses' and Physicians' Rationale Behind Clinical Performance and Interpretation of Routine Prefeed Gastric Aspiration in Preterm Infants: A Cross-sectional Study.

This study aims at understanding the rationale behind performing prefeed gastric aspirations in preterm infants, how nurses and physicians interpret the gastric aspiration and variations between them, and illuminating potential barriers for omitting routine prefeed aspiration. Nurses and physicians from all Danish neonatal intensive care units completed a questionnaire. Of 682 participants, the majority (94%) indicated that they routinely performed prefeed aspiration, primarily to check the feeding tube placement (nurses: 88%, physicians: 46%). Nurses feared necrotizing enterocolitis when observing a large gastric residual (GR) volume (31%) and green-stained GR (63%). Fewer nurses relative to physicians had "no worries" related to large volumes (15% vs 34%) or green-stained GR (14% vs 24%, both P < .01). More nurses than physicians intended to pause enteral feeding when observing green-stained GR (31% vs 16%, P < .01) and more nurses were concerned of completely omitting routine gastric aspirations (90% vs 46%, P < .05). The rationale behind the clinical use of GR volume and color as markers of necrotizing enterocolitis and feeding intolerance differs markedly between nurses and physicians in Denmark. If routine prefeed gastric aspiration should be omitted, special focus on information about early signs of necrotizing enterocolitis and methods to check tube placement is needed.

From Mum to Bum: An Observational Study Protocol to Follow Digestion of Human Milk Oligosaccharides and Glycoproteins from Mother to Preterm Infant.

The nutritional requirements of preterm infants are challenging to meet in neonatal care, yet crucial for their growth, development and health. Aberrant maturation of the gastrointestinal tract and the microbiota could affect the digestion of human milk and its nutritional value considerably. Therefore, the main objective of the proposed research is to investigate how the intestinal microbiota of preterm and full-term infants differ in their ability to extract energy and nutrients from oligosaccharides and glycoproteins in human milk. This pilot study will be an observational, single-center study performed at the Neonatal Intensive Care Unit at Isala Women and Children’s Hospital (Zwolle, The Netherlands). A cohort of thirty mother–infant pairs (preterm ≤30 weeks of gestation, n = 15; full-term 37–42 weeks of gestation, n = 15) will be followed during the first six postnatal weeks with follow-up at three- and six-months postnatal age. We will collect human milk of all mothers, gastric aspirates of preterm infants and fecal samples of all infants. A combination of 16S rRNA amplicon sequencing, proteomics, peptidomics, carbohydrate analysis and calorimetric measurements will be performed. The role of the microbiota in infant growth and development is often overlooked yet offers opportunities to advance neonatal care. The ‘From Mum to Bum’ study is the first study in which the effect of a preterm gut microbiota composition on its metabolic capacity and subsequent infant growth and development is investigated. By collecting human milk of all mothers, gastric aspirates of preterm infants and fecal samples of all infants at each timepoint, we can follow digestion of human milk from the breast of the mother throughout the gastrointestinal tract of the infant, or ‘From Mum to Bum’.

Routine prefeed gastric aspiration in preterm infants: a systematic review and meta-analysis.

Despite lack of evidence, the practice of routine prefeed gastric residue aspiration before the next feed is common. Recent studies suggest that this practice might be even harmful. Therefore, we aimed to evaluate the effect of avoiding routine prefeed gastric residue aspiration as compared to routine aspiration, on various clinical outcomes in preterm infants. We searched five different electronic databases (MEDLINE, EMBASE, Web of Science, CINAHL, and Cochrane Library) until March 8, 2021. Only randomized controlled trials comparing the practice of routine prefeed gastric aspiration with no routine aspiration in preterm infants were considered eligible. The random-effects meta-analysis was done using RevMan 5.3 software. Of the 894 unique records identified by our search, we included 6 studies (451 participants) in the review. There was no significant difference in the incidence of necrotizing enterocolitis (RR 0.80; 95% CI 0.31 to 2.08; 421 participants in 5 trials). Avoiding routine prefeed aspiration was associated with achieving full enteral feeds earlier (MD - 3.19 days, 95% CI - 4.22 to - 2.16), shorter duration of hospitalization (MD - 5.32 days; 95% CI - 10.25 to - 0.38), and lower incidence of late-onset sepsis (RR 0.77; 95% CI 0.60 to 0.99). Time to regain birth weight, days of total parenteral nutrition or central venous line usage, culture-positive sepsis, and all-cause mortality did not differ between the two groups.Conclusion: In the absence of other signs of feed intolerance, routine prefeed gastric residue aspiration should be avoided in preterm infants.Prospero registration number: CRD42020197657 What is Known: • Though, routine prefeed aspiration before next feed is a common practice in preterm gavage-fed infants. • Recent study suggests that the omission of routine gastric residual evaluation led to improved weight gain and earlier hospital discharge. What is New: • Low- to moderate-quality evidence suggest that avoiding routine prefeed gastric residue monitoring helps in the reduction of late-onset sepsis, achieving full enteral feeds earlier, and earlier discharge from the hospital. • Abandoning the practice of routine prefeed aspiration in absence of other signs of feed intolerance in preterm low birthweight neonates is safe.

Does selective evaluation of gastric aspirates in preterm infants influence time to full enteral feeding?

The use of routine gastric aspiration in the assessment of feeding intolerance is widespread in neonatal practice. Our article seeks to answer the clinical question, 'In premature infants receiving feeds via nasogastric or orogastric tube [P], does routine evaluation of gastric aspirates [I] compared with selective evaluation of gastric aspirates [C] reduce the time taken to establish full feeds without complications [O]?' Articles were identified through MEDLINE and reference lists from the sources found were reviewed for additional publications. Three papers were critically appraised and National Health and Medical Research Centre grades of level of evidence have been assigned to each. We found limited evidence to either support or reject the practice of routine gastric aspiration in preterm infants. There were no increases in the rates of significant complications in studies underpowered for this outcome. The decision to perform routine or selective gastric aspiration should be determined by individual centres. A large scale randomised controlled trial would be of significant benefit in determining the value of routine gastric aspiration in preterm infants.

Do we control gastric residuals unnecessarily in premature newborns? AGRA study: avoidance of gastric residual aspiration

Aspiration and evaluation of gastric residuals are commonly performed interventions before each feeding in intensive care units, especially in very low birthweight infants. However, there is no sufficient evidence about...

Effects of maternal heart sounds on pain and comfort during aspiration in preterm infants.

This study aimed to evaluate the effects of providing prerecorded maternal heart sounds on the level of pain and comfort that are experienced by preterm infants during aspiration. This was a randomized controlled trial. Preterm infants (N = 62) who were receiving care or treatment at a neonatal intensive care unit were eligible for participation in this study. Infants in the intervention group (n = 32) were provided with prerecorded maternal heart sounds before, during, and after aspiration, whereas the infants in the control group (n = 30) received routine care. For the collection of the data, the "Preterm Infant Information Form" was used to record natal and postnatal information of the preterm infant, the "Premature Infant Pain Profile," assessed the level of pain, and the "Premature Infant Comfort Scale," assessed the level of comfort. There was a significant difference observed between the groups' pain levels during aspiration; however, the difference was not significant before and after aspiration. Furthermore, there was a significant difference observed between the groups' comfort levels prior to aspiration before and during aspiration; however, the difference was not significant after aspiration. Intervention with maternal heart sounds during aspiration effectively reduced pain and provided comfort to the premature infants.

Development of a Dysphagia Screening Test for Preterm Infants (DST-PI).

ObjectiveTo explore both the early prediction and diagnosis of dysphagia in preterm infants as an important developmental aspect as well as the prevention of respiratory complications, we developed the simple and-easy-to-apply Dysphagia Screening Test for Preterm Infants (DST-PI) to predict supraglottic penetration and subglottic aspiration.MethodsFifty-two infants were enrolled in a videofluoroscopic swallowing study (VFSS) due to clinical suspicions of dysphagia. Thirteen items related to supraglottic penetration or subglottic aspiration were initially selected from previous studies for the DST-PI. Finally, 7 items were determined by linear logistic regression analysis. Cutoff values, sensitivity, specificity, and the area under the ROC curve (AUC) of the DST-PI for predicting supraglottic penetration or subglottic aspiration were calculated using a ROC curve. For inter-rater reliability, the kappa coefficient was calculated.ResultsSeven items were selected: ‘gestational age,’ ‘history of apnea,’ ‘history of cyanosis during feeding,’ ‘swallowing pattern,’ ‘coughs during or after feeding,’ ‘decreased oxygen saturation within 3 minutes of feeding,’ and ‘voice change after feeding.’ The Spearman correlation coefficient between the DST-PI and the penetration-aspiration scale (PAS) was 0.807 (p<0.001). The sensitivity and specificity at different cutoff values for detecting supraglottic penetration and subglottic aspiration were 96.6% and 76.9% at 3.25, and 88.9% and 75.8% at 6.25, respectively.ConclusionThe DST-PI is a valid and reliable dysphagia screening test for supraglottic penetration or subglottic aspiration in preterm infants that is easy to apply in a clinical context.

Molecular Detection of Ureaplasma Urealyticum and Ureaplasma Parvum Colonization in Preterm Infants with Respiratory Distress Syndrome

Background: Early neonatal acquisition of Ureaplasma urealyticum (U. urealyticum) and Ureaplasma parvum (U. parvum), in the 1 st 24 hours after birth and during passage of an infected maternal birth canal, have been linked to the development of respiratory diseases in premature newborns as a result of respiratory tract colonization. However, the role of these pathogens in the development of respiratory distress syndrome (RDS) still needs more clarification. Objectives: In this study we aimed to search for U. urealyticum and U. parvum in tracheal aspirates of premature infants with RDS by species-specific PCR assays and to evaluate the short term outcome of preterm infants with positive results. Methodology: Tracheal aspirate fluid samples from 35 preterm neonates with RDS with a mean gestational age of (32.76±2.48) weeks were collected within the first 24 hours after birth and analyzed for detection of U. urealyticum and U. parvum by species-specific PCR assays targeting urease gene subunits and adjoining spacer regions. Results: Ureaplasma spp. was detected in the tracheal aspirate of 6 (17%) preterm infants with RDS. Among these 6 positive cases; 5 (83%) were positive for U. parvum while only 1 case (17%) was positive for U. urealyticum. The preterm infants with positive results for Ureaplasma spp. had statistically significant higher degree of RD depending on the chest X ray grading results and longer durations of ventilation and hospitalization. Conclusions: Limited by the relatively small sample size, this work can be considered as a pilot study indicating a possible association between the severity of RDS in preterm infants and respiratory tract (RT) colonization with Ureaplasma spp. particularly U.parvum.

A Retrospective Examination of Prandial Aspiration in Preterm Infants

PurposeWe conducted this retrospective study to identify potential signs of aspiration in preterm infants based on crib-side nursing documentation.Study Design and MethodsA total of 2,590 bottle-feedings were examined for signs of distress across 41 preterm infants who were referred for a swallowing evaluation. All infants underwent either a videofluoroscopic swallow study (VSS) or upper gastrointestinal study (GIS). Physiologic and behavioral warning signs were coded across feedings 10 days prior to the imaging study. Presence or absence of documented aspiration during VSS/GIS was coded for each infant.ResultsDistress signs were documented in seven percent of oral feeding attempts. Aspiration was more common when the crib-side nurse documented coughing (LR+, 8.77; 95% CI, .99–77.09), compromised oxygen saturation levels (LR+, 2.15; CI, .86–5.47), and tachypnea (LR+, 2.15; CI, .28–3.01) during bottle-feeding.Clinical ImplicationsEvidence-based distress signs that signal increased suspicion for prandial aspiration will facilitate correct clinical judgments at crib-side. Early identification and prevention of prandial aspiration improves health outcomes for preterm infants.

Usefulness of the lecithin/sphingomyelin ratio and uselessness of phosphatidylglycerol determinations in tracheal aspirates of preterm infants.

Usefulness of the lecithin/sphingomyelin ratio and uselessness of phosphatidylglycerol determinations in tracheal aspirates of preterm infants.