Feed Volume Research Articles

The Read Feed Volume 50, Issue 1

The Read Feed Volume 50, Issue 1

Design and test of reel speed control system for soybean combine harvester in the strip intercropping mode

At present, the speed of the reel of soybean combine harvester is mainly adjusted manually, and basically does not have the ability to automatically adjust the speed of the reel according to changes in crops or working speed. In the maize-soybean strip intercropping mode, soybean plants are densely planted. During harvesting, the feeding rate increases, making it even more necessary to adjust the reel speed according to the growth status of the crops. This article uses PLC as the main control platform to design a reel speed control system for the existing combine harvester. Tests have shown that the control system can meet the requirements for reel speed control. The relative error of the reel control system’s speed test is 2.6%, the relative error of the operating speed is 6.77%, and the maximum relative error of the automatic control of the reel speed is 5.38%. Compared with traditional reel, it reduces header loss by 2.12%. The soybean combine harvester reel speed control system designed in this article can realize automatic adjustment of the reel speed, reduce feeding losses caused by changes in crop height, changes in feed volume, and untimely adjustment of the reel, and can reduce header loss, increased crop yield.

The impact of an enteral formula with food-derived ingredients on dietetic practice at a specialist children's hospital in the UK: Retrospective study.

Blended tube feeds are reported to be better tolerated in some children compared to standard commercial enteral formulas, allowing children to normalise feeding by having similar foods as the rest of the family. However, a blended tube feed is contraindicated in patients who are immunocompromised or require post-pyloric feeding as a result of a food safety risk. Other contraindications for blended diet include children who require continuous pump feeding via gastrostomy or nasogastric feeding tube (< 12 Fr) and fluid restrictions. To meet the demands of consumers, manufacturers have developed enteral formulas with food-derived ingredients (EFI). Commercially available EFIs are relatively novel in the UK. The present study aimed to monitor the implementation of an EFI by dietitians in a specialist children's hospital. A single-centre retrospective study was conducted to monitor the dietetic practice of commencing a commercially available EFI (Compleat® paediatric; Nestlé Health Science; 1.2 kcal/ml with 14% food-derived ingredients). Using electronic medical notes, data were collected on all children who commenced an EFI via an enteral feeding tube in a specialist paediatric hospital between August 2022 and December 2023. Data were gathered on demographics (age, sex and primary diagnosis), anthropometric measurements (weight-for-age Z-score and height-for-age Z-score), feed regimens (feed volume, feeding route, mode of feeding [continuous, bolus]), gastrointestinal symptoms (gastro-oesophageal reflux, vomiting, abdominal discomfort, constipation and loose stools) and geographical discharge area for children on home enteral nutrition. Seventy children were included in the analysis. The mean ± SD age was 4.7 ± 6 years. The median admission weight-for-age Z-score was -1.50. The most common primary diagnosis was a neurological impairment in 37/70 (47%) children. Most children were fed via a percutaneous endoscopic gastrostomy 31/70 (44%) and 8/70 (11%) of the children fed directly into the jejunum. The most common reason being gastrointestinal symptoms, 58/70 (83%). The most common gastrointestinal symptom reported before commencing an EFI was loose stools in 22/58 (38%) children. Within 7 days of commencing an EFI, there was reported improvement in gastrointestinal symptoms in all categories. In total, 42/70 children were discharged on an EFI. In our specialist children's hospital, EFI is primarily implemented by dietitians in children who are already established on an enteral formula displaying gastrointestinal symptoms. However, dietitians are increasingly implementing an EFI as their first-line whole protein enteral formula. Furthermore, an EFI was also implemented as a compromise to a blended diet.

Enteral Nutrition in Neonates on Inotropic Support Admitted to a Tertiary Neonatal Intensive Care Unit: A Prospective Cohort Study.

Background Early initiation of enteral feeding in neonates on inotropic support may improve clinical outcomes compared to intravenous fluids, but the safety and optimal inotrope levels for enteral nutrition remain unclear. This study aims to assess the early initiation of enteral feeding versus intravenous fluids in newborns on inotrope support andto compare the clinical outcome in terms of hospital stay, morbidity, and mortalityin neonates with enteral feed versus intravenous (IV) fluid group on inotropes. It also focuses on evaluating the safety of enteral nutrition in neonates with inotropic support and determining the cutoff levels of the inotropes at which enteral feed is well tolerated. Methodology A prospective cohort study was conducted at a tertiary care center in northern Karnataka from June 2022 to December 2023. Neonates born after 28 weeks or more of gestation or weighing more than 1000 grams with fluid nonresponsive shock were enrolled for the study. Neonates with gastrointestinal comorbidities or birth weight below 1000 grams, younger than 28 weeks of gestation, and with lethal congenital malformations were excluded. Eligible neonates were enrolled by the investigator into enteral and intravenous fluid groups at the clinical discretion of the treating neonatologist. Enteral feeding commenced with expressed breast milk or milk from milk bankafter 6 hours of stable circulation while the intravenous fluid group received no feed initially. Inotropes were tapered upon stable circulation with feed volumes adjusted based on tolerance. The data obtained was entered into a Microsoft Excel sheetand statistical analyses were performed using IBM SPSS Statistics software, version 20. The results were presented as mean, standard deviation counts, percentagesand diagrams. For normally distributed continuous variables between the two groups, they were compared using an independent sample t-test. For not normally distributed variables, the Mann-Whitney U test was used. Categorical variables between the two groups were compared using the chi-square test and Fisher's exact test and p<0.05 was considered statistically significant. Results The study included 142 neonates (71 per group). The enteral nutrition grouphad a higher percentage (62; 87.32%) of improved and discharged neonates than the intravenous fluid group(56; 78.87%).The mean time to reach full feeds was significantly lower in the enteral nutrition group (6.04 days) as compared to the intravenous fluid group (9.78 days), with a p-value of < 0.0001. Similarly, the duration of neonatal intensive care unit (NICU) stay was significantly shorter for enteral nutrition group (7.38 days) compared to intravenous fluid group (11.37 days), also with a p-value of < 0.0001. Three patients (4.22%) chose to get discharged against medical advice in the enteral nutrition group while five patients (7.04%) did the same in the intravenous fluid group. The death rate was also higher among intravenous fluid group (10; 10.08%) compared to enteral nutrition group (6; 8.45%).Independent samples t-test showed significant differences in time to reach full feed and duration of NICU stay between cases and controls. Conclusion Neonates receiving enteral feeds had significantly shorter NICU stays, suggesting improved clinical management. Adrenaline (0.1 mcg/kg) with dobutamine (10 mcg/kg) emerged as the optimal inotrope combination for feed tolerance.

PSIV-24 Evaluation of different colostrum feeding volumes on serum immunoglobulin G concentration and metabolic profiles of calves in high altitude area

Abstract Qinghai-Tibet Plateau is the highest plateau in the world, reputed as “the roof of the world” and “the world’s third pole”. Its ecological environment is characterized by low atmospheric oxygen pressure, cold, and limited feed supplies. This study aimed to investigate the serum immunoglobulin G (IgG) concentration and metabolic profiles of calves in high altitude area (3,650 m) fed different volumes of colostrum [8, 12, or 15% of birth body weight (BW)] using untargeted metabolomics strategies. Neonatal Holstein hybrid heifer calves (n = 44) were randomly divided into 1 of the 3 colostrum feeding amounts: 8% of birth BW (Low volume, L), 12% of birth BW (Middle volume, M), and 15% of birth BW (High volume, H) in colostrum. To safeguard the efficiency of colostrum intake, the colostrum was fed to calves within 0.5 h and 6 h after birth. The serum samples at 24 h after birth were collected for IgG concentration determination by indirect enzyme-linked immunosorbent assay (ELISA) and for LC-MS/MS metabonomic analysis. As the volumes of colostrum increased, there was a linearly increased in the serum IgG concentration (P &amp;lt; 0.01). Differential metabolites were selected according to the following 3 conditions: minimum fold change (FC) &amp;gt; 2, P-value &amp;lt; 0.01 in single-dimensional statistical analysis, and variable importance in projection (VIP) &amp;gt; 1 in the OPLS-DA model. Multivariate statistical analyses were performed to visualize differences among groups. Based on the screening criteria, a total of 3 differential metabolites (22 alpha-Hydroxy-campesterol, N-Myristoyl Histidine, and Calcitetrol) were detected between L and M, of which all differential metabolites were down-regulated. Six differential metabolites were detected between M and H, of which PC[P-18:1(11Z)/18:1(12Z)-2OH(9,10)] was up-regulated and 5 differential metabolites including 1-arachidonoyl-2-hydroxy-sn-glycero-3-phosphate, propanoyl phosphate, ascorbic acid 6-palmitate, 20-hydroxyecdysone, and 6’’’-deamino-6’’’-hydroxyparomomycin II were down-regulated. There were 28 differed metabolites (including leucyl-tryptophan, calcitetrol, 3’’-Oxoribostamycin) between L and H, of which 9 differential metabolites were up-regulated and 19 differential metabolites were down-regulated (Figure 1). Based on KEGG metabolic enrichment pathway analysis and pathway topology analysis, porphyrin metabolism was identified as the most impacted pathway between L and H (Figure 2). In conclusion, increasing colostrum volumes significantly increased serum IgG concentrations at 24 h after birth, favoring the success of the transfer of passive immunity. Alterations in serum metabolome of calves in the Qinghai-Tibet Plateau fed different volumes of colostrum were successfully revealed by untargeted metabolomics. The role of the identified differential metabolites and enriched pathway in the transfer of passive immunity in calves at high altitude deserves further investigation. Keywords: calf, colostrum volumes, high altitude area

Research of real-time corn yield monitoring system with DNN-based prediction model.

The real-time monitoring of corn yield by a combine harvester is a critical data source for constructing the yield histogram, which significantly benefits precision management and decision-making in modern precision agriculture. While widely used, the current photoelectric sensor-based yield monitoring method has limitations. It detects the corn height on each scraper and calculates the yield through a geometric formula. However, it neglects the noticeable difference in the corn stacking patterns affected by factors such as feeding volume, terrain, and driving speed. This oversight often results in low accuracy and poor stability in the prediction of corn yield, highlighting the need for a more advanced approach. To resolve this, we employ EDEM discrete element simulation to demonstrate the large difference of corn stacking patterns on the scraper of the elevator corresponding to feeding volume. Then, we develop a real-time monitoring system on our self-developed double elevator testing rig for carrying out a composite dataset for training three machine learning algorithm-based models, namely Deep Neural Networks (DNN), Gradient Boosting Machine (GBM), and Random Forest (RF). Importantly, these models have undergone rigorous validation under various feeding volumes, ensuring their robustness and reliability. The auxiliary elevator speed is meticulously set at 150r/min, 225r/min, and 450r/min, providing a comprehensive performance assessment. The results denote that the DNN model performs best and is stable, with a coefficient of determination (R2) of 0.998, root mean square error (RMSE) of 0.526, and mean absolute error (MAE) of 0.425. The paper also performs field experiments to test the proposed three prediction models and the system. The results also denote the DNN-based prediction model's best performance for the lowest relative error of 2.29% and the highest average accuracy of 97.85%. Consequently, the proposed real-time corn yield monitoring system achieves high accuracy and reliability for the combine harvester applications.

Survey of vitamin D supplementation practices in extremely preterm infants.

Most extremely preterm (EP) infants are vitamin D deficient (serum 25-hydroxyvitamin D levels below 20 ng/mL), and optimal supplementation practices for EP infants remain unknown. Our objective is to assess current vitamin D supplementation practices in U.S. neonatal intensive care units (NICU) for EP infants to provide baseline information for the design of future clinical trials. We conducted an online survey to study vitamin D intake and supplementation practices in U.S. NICUs caring for EP infants. Descriptive statistics compared responses by affiliation and level of care. We analyzed responses from 253 NICUs, representing the majority of academic and level IV centers. Nearly all centers (97%) provided enteral vitamin D supplementation during the NICU stay, with 400 IU/day as the most common dosage (77%). Over half (56%) used feeding volume to initiate supplementation, with 71% of centers starting after achieving at least 120 ml/kg/day. Additionally, 94% of NICUs reported prescribing a vitamin D supplementation at discharge. Most NICUs in the U.S. supplement EP infants with 400 IU/day of enteral vitamin D. Clinical trials of vitamin D supplementation comparing the most common regimen to earlier and higher doses are needed to identify adequate regimens for EP infants. Despite the prevalence of vitamin D deficiency in extremely preterm (EP) infants at birth, optimal levels and supplementation strategies remain debated. Recent studies have suggested benefits of early high-dose vitamin D supplementation (800 IU/day) for reducing complications like bronchopulmonary dysplasia, infections, and disability. There is US center variation in timing and dose of vitamin D supplementation, being the most common regimen 400 IU/d started after established feedings (≥120 ml/kg/day). These findings inform and highlight the need for clinical trials of usual vs. early, higher-dose vitamin D supplementation to advance clinical outcomes and define desirable blood levels of EP infants.

Physicochemical properties and in vitro release of formononetin nano-particles by ultrasonic probe-assisted precipitation in four polar organic solvents

Although formononetin has a considerable biological activity, its therapeutic use is limited by its low solubility. Formononetin was dissolved in ethanol, methanol, N, N-dimethylformamide (DMF), and dimethyl sulfoxide (DMSO) in this investigation, the antisolvent precipitation procedure with the assistance of an external ultrasonic probe was used to manufacture the formononetin nano-particles. The ideal parameters for response surface BBD optimization are as follows: feed volume flow rate of 6 mL/min; ultrasonic power of 860 W; and liquid-liquid ratio of 1:12.5. The formononetin nano-particles have a smaller particle diameter than raw sample; the lowest size can be as small as (329 ± 1.99) nm, which is 45 times smaller than raw. An in vitro digestion test using a solution that simulated intestinal solution revealed that the release rate of the nano-particle was 1.75 times than that of the raw formononetin. The formononetin nano-particles generated by the aforementioned four solvents have the following order of diameter: ethanol > methanol > DMF > DMSO. This study provided a technical reference for the functional food components in deep processing.

Production of C2−C4 Olefins with Fischer‐Tropsch‐Synthesis: The Effect of Cu Promoter Loading on an Fe−Cu−K/SiO2 Catalyst

AbstractIn this study we focus on the iron‐based catalyst to produce C2−C4 olefin hydrocarbons via the high‐temperature Fischer‐Tropsch synthesis. Promoters have a significant impact on catalyst stability, activity, and product selectivity. Therefore, we investigated the effect of the Cu promoter in an Fe−Cu−K/SiO2 catalyst. We compared the catalyst without Cu and 1, 2, 3, 4, and 5 wt % Cu loadings. The overall catalyst activity increased from 0 to 3 wt % Cu loading and started to decrease at 4 and 5 wt % Cu loadings. Although overall catalyst activity had an optimum with 3 and 4 wt % Cu loading, the Cu loading had a negligible effect on product selectivity. However, when compared to a non‐Cu promoted catalyst, the Cu addition increased the selectivity towards olefinic C2−C4 hydrocarbons. The Fischer‐Tropsch experiments were performed in a tubular reactor system at 300 °C, 21 bar and H2 : CO=2 at different feed volume flows, with hydrogen activation. According to the performed temperature‐programmed dynamic chemisorption analysis, the Cu promoter assisted the iron reduction, and the lower overall activity to 0–2 wt % Cu loading might relate to insufficient dissociated H surface species, rather than the availability of C from dissociated CO.

Incidence and Factors Associated with Breastfeeding at Six Months in Very-Low-Birthweight Infants: A Single-Center Prospective Study

Objective: Primary objective was to determine success rate of breastfeeding (BF) at 6-month-postnatal age (PNA). Secondary objective was to explore factors associated with unsuccessful BF at 6-month-PNA in very-low-birthweight (VLBW) infants. Materials and Methods: Single-center, prospective, observational study was conducted. Inclusion criteria were discharged VLBW infants and maternal desire for BF. We conducted telephone interviews to assess feeding type and volume every 2 months until 12-month-PNA and reasons for BF cessation. Results: Eighty-nine VLBW infants were included. Mean (±standard deviation) maternal age was 31.4 ± 6.5 years. Median [P25, P75] gestational age was 29.0 [28.0, 31.5] weeks. At 6-month-PNA, 22 infants (24.7%) were exclusively breastfed, which decreased to 2 infants (2.2%) by 12 months. Rate of successful BF at 6 months was 55.1%. After controlling for potential confounders, factors associated with unsuccessful BF at 6 months were male [aOR (95% CI) 3.2 (1.1, 9.4), p = 0.04], longer hospitalization stays [aOR 1.0 (1.0, 1.1), p = 0.02], born via cesarean section [aOR 4.1 (1.1, 15.4), p = 0.04], maternal education below bachelor's degree [aOR 4.0 (1.1, 14.0), p = 0.03], and introduction of additional feeding types at hospital discharge [aOR 3.8 (1.2, 12.2), p = 0.03]. Main reason for unsuccessful breastfeeding at 6 months was inadequate milk supply (77.5%). Conclusion: Fifty-five percent of VLBW infants retained successful BF at 6 months. Main reason for unsuccessful BF was inadequate milk supply.

A multicenter randomized controlled trial comparing three-times-a-day intermittent enteral postural feeding to continuous enteral feeding among mechanically ventilated patients in intensive care

BACKGROUND AND AIMSPrevious randomized controlled trials (RCTs) comparing intermittent feeding versus continuous feeding used different methods, employed shorter fasting intervals, ignored patients’ posture in bed during feeds, and showed mixed results. Prolonged fasting intervals are hypothesized to have several benefits. Additionally, there is evidence for more efficient gastric emptying in the right lateral position. In this multicenter RCT, we aimed to compare the effects of three-times-a-day gastric feeding while in the right lateral tilt position (intermittent postural feeding) versus standard continuous gastric feeding (standard feeding) on gastrointestinal intolerance and mortality among mechanically ventilated patients in ICU. METHODSAdult ICU patients with gastric feeding tube in-situ and requiring invasive mechanical ventilation were randomized to either intermittent postural feeding group or to the standard feeding group. The feeding formula, target daily feed volume and posture turns were determined as per standard practice for all patients. Primary outcome was an incidence rate per 100 patient-days of gastrointestinal intolerance, a composite outcome of vomiting, diarrhea or constipation. Secondary outcomes were all-cause hospital mortality, gastrointestinal intolerance-free days, ventilator-free days, episodes of vomiting or diarrhea per patient, and mean diet volume ratio (diet received/ diet prescribed). RESULTSAt five multidisciplinary ICUs, 120 mechanically ventilated, adult ICU patients (median age 65 years, 60% males) were randomly allocated to intermittent postural feeding (n=61) and standard feeding (n=59). The primary outcome did not differ between intermittent feeding arm versus standard arm (8.5, 95% confidence interval (CI): 5.9-11.8, versus 6.2, 95% CI: 4.1-9.1 per 100 patient-days; p =0.23). Gastrointestinal intolerance-free days until day 14 were similar (6 [2-8] versus 5 [2-10]; p =0.68) in both groups. Number of episodes per patient of vomiting, diarrhea, or constipation also did not differ in between groups. All-cause hospital mortality between intermittent feeding arm versus standard arm was 20% versus 31% (p=0.17). There were no significant between-group differences in any of the other secondary outcomes. CONCLUSIONSIntermittent gastric feeds delivered three-times-a-day while in the right lateral tilt position among mechanically ventilated patients was as well tolerated as the continuous enteral feeding. A definitive RCT to assess other clinically important outcomes is justified. Trial registrationACTRN12616000212459 https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365526&isReview=true

Faktor-faktor yang Mempengaruhi Volume Penjualan Pakan Ternak di PT Japfa Comfeed Indonesia, Tbk. Unit Makassar

Product sales strategies are supported by technology that makes it easy for consumers to buy a product. According to Sulastri (2014) sales volume is the level of sales obtained by the company for a certain period in units (units/total/rupiah). The purpose of this study was to determine what are the factors that affect the sales volume of animal feed at PT. Japfa Comfeed Indonesia, Tbk. Makassar Unit. Feed is a single or mixed food material, both processed and unprocessed, which is given to animals for survival, reproduction and breeding. This research was conducted in April and July 2023, which took place at PT Japfa Comfeed Indonesia. Based on this, this research uses qualitative data so that in collecting data interviews with 30 respondents are conducted. The results of this study indicate that when viewed simultaneously or as a whole the factors that affect the sales volume of animal feed at PT. Japfa Comfeed Indonesia, Tbk. Makassar Unit, namely demand and supply, fluctuating feed prices, upward trends in raw material prices, and demand on holidays. However, after several data analysis tests, only demand and supply and the trend of rising raw material prices have a very strong (significant) influence on the volume of animal feed sales.

Feed industry: transfer of new technologies

Relevance – the industry for production of compound feed for farm animals is the main link in the structure of the AIC, located in the middle of all production and technological connections of the livestock products market. Over the past decade, quite high indicators have been achieved in feed production in the republic. The main components are the increase in consumption of grain fodder by livestock industry, increase in production volume of the main components of feed preparation, and optimization of the procurement of raw materials. The goal is to show the realities and prospects for increasing the potential of feed industry in Kazakhstan, the need for effective strategies based on intensification and innovative technology renewal. Methods – comparative, statistical, system analysis, logical generalization. Results - the authors state that enterprises that have become the main suppliers of raw materials for livestock sector have a number of economic difficulties that do not allow them to meet the growing needs of agroindustrial production and create reserves for large-scale export of combined feed and livestock products to the world market, in particular in countries of the Middle East. There is a significant dependence of feed production on cereals, since the key type of raw material source is 5 grade grain (coarse). Therefore, it is necessary to expand the area under these crops to obtain the required volumes of grain mixtures and feed. It is noted that one of the main promising areas of innovative activity remains the issue of reducing cost of operating equipment and energy costs. Conclusions - organization of highly efficient feed production segment in the country is necessary for proportional and balanced development of grain processing enterprises - main components of grain and meat product subcomplexes and the links between them. It is necessary to increase the capacity of large production enterprises to provide feed products on industrial scale, and also to apply technologies based on the use of grass flour and molasses from grains, which contain a high proportion of elements with high energy value, which can significantly increase the efficiency of raising livestock and reduce product costs.

Early and exclusive enteral nutrition in infants born very preterm

ObjectiveTo characterise the effects of early and exclusive enteral nutrition with either maternal or donor milk in infants born very preterm (280/7–326/7 weeks of gestation).DesignParallel-group, unmasked randomised controlled trial.SettingRegional, tertiary...

Developing a tool to assess the health-related quality of life in calves with respiratory disease: tool refinement and construct validity testing

Bovine respiratory disease (BRD) is a major source of morbidity and mortality in calves and detection of the disease can be challenging. Diagnostic tools for BRD are typically based on the assessment of clinical signs. As experience of disease is associated with a poor quality of life and this poor emotional experience can be expressed in observable behaviour patterns, a quality-of-life approach might identify new indicators of disease. Health-related quality of life (HRQOL) approaches are widely used in human medicine but are rarely used in livestock. This study aimed to refine and validate an HRQOL tool for calves with BRD that had been created in a previous study. The tool contained 13 items/indicators across two domains (clinical signs and behavioural expression). One hundred preweaned dairy-bred calves were scored daily using the HRQOL tool and also using the industry-recognised Wisconsin health score as a ‘gold standard’. The score assigned to each of the 13 items of the HRQOL tool was summed to give an accumulated HRQOL score for each calf/day. To refine the tool, the items within the tool were compared to each other to identify high levels of correlation or redundancy. This resulted in the retention of three items within the clinical signs domain (body and head posture, respiratory effort and ear carriage) and four within the behavioural expression domain (vigour, movement to feed, motivation at feed and volume of feed consumed). To determine whether the refined HRQOL tool could successfully differentiate sick from healthy animals, the Wisconsin score was used to create two matched groups of 28 ‘sick’ and 28 ‘healthy’ calves. There was a significant difference in the HRQOL scores between the two groups (H = 14.09, df = 1, P = 0.000) suggesting that the new tool could differentiate between ‘healthy’ and ‘sick’ calves. In terms of the two domains, there was a significant difference (P < 0.001) between the ‘healthy’ and ‘sick’ calves for the overall HRQOL tool score for the clinical signs domain, but there was no significant difference (P = 0.154) between ‘healthy’ and ‘sick’ calves in the overall HRQOL score for the behavioural expression domain; however, the combined tool was the most accurate. Overall, this study has demonstrated that the new HRQOL tool can differentiate between sick and healthy calves. Some or all of the indicators could be used alongside existing disease-detection tools for preweaned calves. However, future work would be needed to validate this HRQOL tool in other production systems.

Clinical Outcomes of Slow versus Rapid Enteral Feeding Advancement in Very Low Birth Weight Neonates at a Tertiary Care Center

In India, every year around 3.5 million babies are born premature, accounting for almost 13% of total livebirths in the country as compared to 5% to 7% incidence in the West. Preterm is defined as babies born before 37 weeks ofpregnancy. The rapidity of feed volume increments involves controversies like faster weight gain, shorter hospital stays, therisk of necrotizing enterocolitis and vice versa. Methods: The present study was a randomized controlled trial conducted fromJune 1, 2018 to October 31, 2019. All infants in the study were randomized to slow and rapid feeding protocols by a stratifiedblock randomization sequence of 2, 4, 6 blocks. Group 1 or the slow advancement group included 64 newborns babies andGroup 2 or the rapid advancement group included 69 newborns babies. Results: The average weight gain in Group 1 was4.41 ± 0.9 g and in Group 2 it was 6.33 ± 1.3 g, the difference was statistically significant (p &lt; 0.02). Sixty out of 64 newbornsregained birth weight within 16.87 ± 0.9 days in Group 1, while 64 out of 69 newborns regained birth weight within 13.63 ±0.9 days in Group 2. The difference was statistically significant. Increment in the mean occipitofrontal circumference perweek was 0.29 ± 0.27 cm Group 1, while in Group 2 it was 0.42 ± 0.05 cm; the difference was statistically significant. Meanaverage length increment per week was found to be 0.55 ± 0.04 cm and 0.69 ± 0.05 cm in Group 1 and Group 2, respectively,the difference was statistically significant (p &lt; 0.005). The mean duration of hospital stay was 27.47 ± 3.33 days in Group 1while in Group 2, the duration of stay was 23.15 ± 2.22 days, the difference was statistically significant. Conclusion: Ourstudy supports enteral nutrition by rapid enteral feeding regimen in stable preterm neonates with very low birth weight

Increasing the Volume of Delivered Enteral Feeds Using a Volume-Based Feeding Protocol in a Neuroscience Intensive Care Unit.

Iatrogenic malnutrition is a significant burden to patients, clinicians, and health care systems. Compared with well-nourished patients, underfed patients (those who receive less than 80% of their daily energy requirement) have more adverse outcomes related to nutritional status. Volume-based protocols allow for catch-up titrations, are consistently superior to rate-based protocols, and can be implemented in most settings. This project was conducted in an 8-bed neuroscience intensive care unit in which up to 41% of patients who required enteral feeding were underfed. This quality improvement clinical practice change project used a before-and-after design to evaluate (1) the effect of implementing a volume-based feeding protocol on the delivery of enteral feeds and (2) the effect of a nutrition-based project on staff members' attitudes regarding nutrition in critical care. The effectiveness of a volume-based feeding titration protocol was compared with that of a rate-based feeding protocol for achieving delivery of at least 80% of prescribed nutrition per 24-hour period. Staff members' attitudes were assessed using a survey before and after the project. During 241 enteral feeding days (n = 40 patients), the percentage of delivered enteral feeding volume and the percentage of days patients received at least 80% of the prescribed volume increased after volume-based feeding was implemented. After project implementation, 74 staff members reported increased emphasis on nutrition delivery in their practice and a higher level of agreement that nutrition is a priority when caring for critically ill patients. Using a volume-based feeding protocol with supplemental staff education resulted in improved delivery of prescribed enteral feeding.

Recurrent hyponatremia in neonate: a case of renal salt wasting syndrome

BackgroundRenal salt wasting (RSW) is primarily seen with central nervous disorders and is characterized by hyponatremia, elevated urinary sodium excretion, increased urine output, and hypovolemia. Although there have been reports of RSW in children, it has not been reported in newborns.Case presentationA term (38 weeks 2 days) female weighing 2060 g, born via normal vaginal delivery, to a primi-gravida mother, was admitted to our neonatal intensive care unit. At birth, the baby was non-vigorous, had aspirated meconium, and required bag-and-mask ventilation following which the baby cried. The child was put on CPAP and inotropes for respiratory distress and shock, respectively, along with first-line antibiotics. Over the next few days, the child was weaned off CPAP, inotropes were stopped, and feeds were started. On postnatal day (PND) 8, the baby developed repeated episodes of seizures requiring two-antiepileptics followed by midazolam infusion, had shock requiring inotropes, and also had a tense anterior fontanelle with altered sensorium and tone changes, for which mannitol and 3% saline were given. Antibiotics were upgraded, and neuroimaging (MRI) revealed left basal-ganglia bleed with intraventricular extension and cerebral venous thrombosis. The baby showed gradual clinical improvement with the above measures and was restarted on feeds. However, from PND-19 onwards the baby had repeated episodes of hyponatremia requiring 3% saline infusions, progressive weight loss, and polyuria. Considering RSW, urine sodium was done which was high (110 mmol/L). For polyuria and weight loss, feed volume was increased, whereas, for hyponatremia, table salt was added to the expressed breast milk (1 gm × tds). Subsequently, all the serum sodium values remained within normal limits, and the baby started gaining weight and was discharged on similar advice (PND 38). On further follow-up, table salt was gradually decreased in the feeds and was stopped after 1 month of discharge with normal serum sodium values.ConclusionManagement of recurrent hyponatremia in a neonate is challenging. Despite its rarity, RSW in newborns should be considered a differential.

Transcutaneous auricular vagus nerve stimulation may benefit from the addition of N-acetylcysteine to facilitate motor learning in infants of diabetic mothers failing oral feeds.

This study aims to determine if pretreating with enteral N-acetylcysteine (NAC) improves CNS oxidative stress and facilitates improvement in oromotor skills during transcutaneous auricular nerve stimulation (taVNS) paired with oral feedings in infants of diabetic mothers (IDMs) who are failing oral feeds. We treated 10 IDMs who were gastrostomy tube candidates in an open-label trial of NAC and taVNS paired with oral feeding. NAC (75 or 100 mg/kg/dose) was given by nasogastric (NG) administration every 6 h for 4 days, then combined with taVNS paired with 2 daily feeds for another 14 days. NAC pharmacokinetic (PK) parameters were determined from plasma concentrations at baseline and at steady state on day 4 of treatment in conjunction with magnetic resonance spectroscopic (MRS) quantification of CNS glutathione (GSH) as a marker of oxidative stress. We compared increases in oral feeding volumes before and during taVNS treatment and with a prior cohort of 12 IDMs who largely failed to achieve full oral feeds with taVNS alone. NAC 100 mg/kg/dose every 6 h NG resulted in plasma [NAC] that increased [GSH] in the basal ganglia with a mean of 0.13 ± 0.08 mM (p = 0.01, compared to baseline). Mean daily feeding volumes increased over 14 days of NAC + taVNS compared to the 14 days before treatment and compared to the prior cohort of 12 IDMs treated with taVNS alone. Seven IDMs reached full oral feeds sufficient for discharge, while three continued to have inadequate intake. In IDM failing oral feeds, NAC 100 mg/kg/dose every 6 h NG for 4 days before and during taVNS paired with oral feeding increased CNS GSH, potentially mitigating oxidative stress, and was associated with improving functional feeding outcomes compared to taVNS alone in a prior cohort. This represents a novel approach to neuromodulation and supports the concept that mitigation of ongoing oxidative stress may increase response to taVNS paired with a motor task.

Infant Formula with 50% or More of Palmitic Acid Bound to the sn-2 Position of Triacylglycerols Eliminate the Association between Formula-Feeding and the Increase of Fecal Palmitic Acid Levels in Newborns: An Exploratory Study.

The binding ratio of palmitic acid (PA) at the sn-2 position of triacylglycerols in infant formulas is lower than that in breast milk, resulting in higher levels of fecal PA. Even if the ratio is increased to 40-50%, fecal PA levels in formula-fed infants remain higher than those in breast-fed infants. In Japan, infant formulas with 50% or more of PA bound to sn-2 (high sn-2 PA milk) are commercially available; however, their effects on PA excretion have not been investigated. Therefore, this observational study aimed to preliminarily evaluate whether the feeding volume of high sn-2 PA milk is significantly associated with fecal total/soaped PA levels in newborns. Infant formulas were classified as high (≥50% of PA bound to sn-2) or low sn-2 (<50%) PA milk. Associations between feeding volume of high or low sn-2 PA milk and fecal PA levels were evaluated using multiple regression analysis models. The results showed that the feeding volume of low sn-2 PA milk was positively associated with fecal total/soaped PA levels, while there was no significant association between those of high sn-2 PA milk and fecal total/soaped PA levels. Our preliminary study suggests that high sn-2 PA milk may reduce increased fecal PA levels in formula-fed newborns.