Incidence Of NEC Research Articles

Probiotics for prevention of necrotizing enterocolitis in preterm infants

AbstractBackgroundNecrotizing enterocolitis (NEC) and nosocomial sepsis are associated with increased morbidity and mortality in preterm infants. Through prevention of bacterial migration across the mucosa, competitive exclusion of pathogenic bacteria, and enhancing the immune responses of the host, prophylactic enteral probiotics (live microbial supplements) may play a role in reducing NEC and the associated morbidity.ObjectivesTo compare the efficacy and safety of prophylactic enteral probiotics administration versus placebo or no treatment in the prevention of severe NEC or sepsis, or both, in preterm infants.Search methodsFor this update, searches were made of MEDLINE (1966 to October 2013), EMBASE (1980 to October 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (2013, Issue 10), and abstracts of annual meetings of the Society for Pediatric Research (1995 to 2013).Selection criteriaOnly randomized or quasi‐randomized controlled trials that enrolled preterm infants < 37 weeks gestational age or < 2500 g birth weight, or both, were considered. Trials were included if they involved enteral administration of any live microbial supplement (probiotics) and measured at least one prespecified clinical outcome.Data collection and analysisStandard methods of The Cochrane Collaboration and its Neonatal Group were used to assess the methodologic quality of the trials and for data collection and analysis.Main resultsTwenty‐four eligible trials were included. Included trials were highly variable with regard to enrolment criteria (that is birth weight and gestational age), baseline risk of NEC in the control groups, timing, dose, formulation of the probiotics, and feeding regimens. In a meta‐analysis of trial data, enteral probiotics supplementation significantly reduced the incidence of severe NEC (stage II or more) (typical relative risk (RR) 0.43, 95% confidence interval (CI) 0.33 to 0.56; 20 studies, 5529 infants) and mortality (typical RR 0.65, 95% CI 0.52 to 0.81; 17 studies, 5112 infants). There was no evidence of significant reduction of nosocomial sepsis (typical RR 0.91, 95% CI 0.80 to 1.03; 19 studies, 5338 infants). The included trials reported no systemic infection with the supplemental probiotics organism. Probiotics preparations containing either lactobacillus alone or in combination with bifidobacterium were found to be effective.Authors' conclusionsEnteral supplementation of probiotics prevents severe NEC and all cause mortality in preterm infants. Our updated review of available evidence strongly supports a change in practice. Head to head comparative studies are required to assess the most effective preparations, timing, and length of therapy to be utilized.PLAIN LANGUAGE SUMMARYProbiotics for prevention of necrotizing enterocolitis in preterm infantsNecrotizing enterocolitis (NEC) is a serious disease that affects the bowel of premature infants in the first few weeks of life. Although the cause of NEC is not entirely known, milk feeding and bacterial growth play a role. Probiotics (dietary supplements containing potentially beneficial bacteria or yeast) have been used to prevent NEC. Our review of studies found that the use of probiotics reduces the occurrence of NEC and death in premature infants born weighing less than 1500 grams. There is insufficient data with regard to the benefits and potential adverse effects in the most at risk infants weighing less than 1000 grams at birth.

Non-steroidal anti-inflammatory drugs (NSAIDs) in the management of patent ductus arteriosus (PDA) in preterm infants and variations in attitude in clinical practice: a flight around the world.

The primary objective of this review is to verify if there are differences in the diagnostic and therapeutic strategies in cases of PDA employed in different NICUs that might help explain the different percentages of duct closure, surgical ligation and outcome in these vulnerable patients. The secondary objective is to document if the selection of a specific NSAID and/or the way of administration are based on factors such as costs and local availability of drugs, as well as influenced by clinical and haemodynamic parameters, potential risks, local experience and the existing literature. Data Sources were MEDLINE, EMBASE, Cochrane Library and analysis of the most important papers were performed. We examined a total of 89 trials including 15,657 neonates (with gestational ages between 22 and 35 weeks and study weights between 380 and 2500 g), due to the lack of homogeneity of case studies it was not possible to standardize for gestational age and weight. To simplify, the studies we considered were subdivided into 5 groups corresponding to 5 tables: 1- INDO-prophylaxis (15 trials); 2- IBU-prophylaxis (11 trials); 3- INDO-therapy (18 trials); 4- IBU-therapy (16 trials); 5- IBU vs INDO therapy (29 trials). Each table reports the journal, the reference, the type of study, the number of neonates enrolled, the drugs used, management after failure of the first cycle, percentage of duct closure and adverse effects. Treatment with indomethacin is prescribed prevalently in the United States and Canada. According to the data collected, prolonged treatment and administration of high doses would appear to be more effective. The early administration of indometacin has been associated with gastrointestinal bleeding, renal insufficiency, altered cerebral self-regulation and, especially when administered together with postnatal steroids, it has been correlated with isolated intestinal perforation. Ibuprofen treatment is preferred in Europe but it may be associated with nephrotoxicity and an increase in BDP and ROP, although less frequently compared to indometacin. Indometacin is associated with major nephrotoxicity, as well as with a higher incidence of NEC, intestinal perforations and a reduced cerebral blood flow. Despite this, the administration of ibuprofen does not appear to be without short- and long-term renal adverse effects.

Reducing necrotizing enterocolitis in very low birth weight infants using quality-improvement methods.

ObjectiveDue to a rise in necrotizing enterocolitis (NEC, stage ≥2) among very low birth weight (VLBW, birth weight <1500g) infants from 4% in 2005-6 to 10% in 2007-8, we developed and implemented quality improvement (QI) initiatives. The objective was to evaluate the impact of QI initiatives on NEC incidence in VLBW infants.Study DesignIn September 2009 we developed a NEC QI multidisciplinary team that conducted literature reviews and reviewed practices from other institutions to develop a feeding protocol, which was implemented in December 2009. The team tracked intervention compliance and occurrence of NEC stage ≥2. In May 2010 we reviewed our nasogastric tube practice and relevant literature to develop a second intervention that reduced nasogastric tube indwelling time. The infants were divided into three groups: baseline (Jan 2008-Nov 2009, n219), QI phase 1 (Dec 2009-May 2010, n62), and QI phase 2 (June 2010-Nov 2011, n170).ResultThe NEC incidence did not decrease after implementation of the feeding protocol in QI phase 1 (19.4%), but did decline significantly after changing nasogastric tube management in QI phase 2 (2.9%). Multivariable logistic regression analysis demonstrated a significant relationship between QI phase and the incidence of NEC.ConclusionQI initiatives were effective in decreasing NEC incidence in our high human milk-feeding NICU. Nasogastric tube bacterial contamination may have contributed to our peak in NEC incidence.

Probiotics and Synbiotics in Necrotizing Enterocolitis: Where Are We?

Preterm neonates are susceptible to complications, including necrotizing enterocolitis, a leading cause of morbidity and mortality. Probiotics are live microorganisms, that when administered in adequate amounts, confer a health benefit to the host. Current evidence suggests that probiotics are effective in decreasing the incidence of NEC in preterm infants. Nondigestible oligosaccharides ‘prebiotics’ have a positive impact on the micro biota and represent another potential preventative therapy. The combination of probiotics and prebiotics is known as Synbiotics. Probiotics have numerous health benefits, and immune modulation and micro biota restoration are among the basic mechanisms leading to these benefits. Despite the widespread administration of probiotics to preterms in many countries, its adoption as a protocol in North America has been limited. The aim of this article is to review the current evidence and to update health care professionals on the use of probiotics and synbiotics in improving intestinal health, and in preventing NEC in preterm infants.

Tracking Nutritional Protein Management in the Preterm Infant Using Vermont‐Oxford Benchmarks (LB318)

Background: Extrauterine growth failure occurs in 80 to 100% of extremely low birth weight infants, and it is recognized that these infants require more protein than has typically been provided to them in the NICU. This is of particular concern, as poor NICU growth is associated with poor developmental outcome. However, there is a need to balance providing higher protein intake with the metabolic consequences of doing so. Over the past 7 years, we have instituted practices to improve protein intake in our preterm infants and have used the Vermont Oxford Network (VON) data as a benchmark to evaluate our success. Objective: To describe the impact of nutritional strategies to increase protein intake on growth and clinical outcomes in preterm infants. Methods: Data was collected from Northshore University Hospital (NS), a Level 3 NICU in suburban Chicago. Growth outcomes and the incidence of NEC were recorded from 2006-2013 (avg. 586 patients/year) and compared to data from Level 3 NICU’s in the VON. Increasing protein intake may result in metabolic intolerance and incidence of Bicitra treatment was recorded after our implementation of a higher protein acidified liquid human milk fortifier (ALHMF) product in 2011-12. Results: After the introduction of high protein preterm formulas, fewer infants were discharged below the 10th percentile in head circumference on Fenton growth curves, as well as lower rates of NEC (Figure). We observed a similar pattern for weight at discharge. In the 6 months preceding the ALHMF, 8.9% of infants (weight <2kg) received Bicitra vs. 2.4% in the first 5 months after ALHMF introduction. Conclusion: It appears all recommended interventions improved incidence of extrauterine growth failure and higher protein formula/fortifier had the most pronounced effects. Moreover, higher protein was safe and well tolerated.

To determine whether duration of antibiotic exposure is an independent risk factor for NEC in NICU

Introduction: Necrotising enterocolitis is one of the major surgical emergencies of neonates admitted to NICU. The widespread use of antibiotics in the neonatal intensive care unit (NICU) population may contribute to gut colonization leading to NEC. This study helps in knowing about antibiotic exposure leading to NEC in the NICU. Thus helps in control of NEC. Materials and Methods: A case control study of 84 neonates admitted to NICU was done over a period of 12months at Sri Adichuchanagiri Hospital and Research Centre. Out of these, 28 were cases which had received antibiotics. A detailed examination of the neonates was done to see the correlation between receiving antibiotics and NEC. Results: The incidence of NEC was 5.9% of the neonates admitted to NICU.A significant relation between the use of antibiotics and development of NEC was found. The mean duration of onset of symptoms was 7days.The most common symptom among those affected was abdominal distension. Conclusion: The rampant use of antibiotics in NICU without any specific protocol or guidelines could indirectly harm the baby.NEC has a significant contribution in neonatal deaths and the use of antibiotics unreasonably could be one of the causative factors in acquiring NEC and thus should be used with caution.

Bovine lactoferrin supplementation for prevention of necrotizing enterocolitis in very-low-birth-weight neonates: a randomized clinical trial

NEC is a common and severe complication in premature neonates, particularly those with very-low-birth-weight (VLBW, <1500 g at birth). Probiotics including lactobacillus rhamnosus GG (LGG) proved effective in preventing NEC in preterm infants in several RCTs. Lactoferrin, a mammalian milk glycoprotein involved in innate immune host defences, can reduce the incidence of NEC in animal models, and its action is enhanced by LGG. We tried to assess whether bovine lactoferrin (BLF), alone or with the probiotic LGG, has a similar effect in human infants, something that has not yet been studied. An international, multicenter, randomized, double-blind, placebo-controlled trial conducted from October 1st, 2007 through July 31st, 2010. Thirteen Italian and New Zealand tertiary neonatal intensive care units. 743 VLBW neonates were assessed until discharge for development of NEC. Infants were randomly assigned to receive orally either BLF (100 mg/day) alone (group LF; n = 247) or with LGG (at 6×10(9) CFU/day; group BLF + LGG; n = 238), or placebo (Control group; n = 258) from birth until day 30 of life (45 for neonates <1000 g at birth). ≥ stage 2 NEC; death-and/or-≥ stage 2 NEC prior to discharge. Demographics, clinical and management characteristics of the 3 groups were similar, including type of feeding and maternal milk intakes. NEC incidence was significantly lower in groups BLF and BLF + LGG [5/247 (2.0%)] and 0/238 (0%), respectively] than in controls [14/258 (5.4%)] (RR = 0.37; 95% CI: 0.136-1.005; p = 0.055 for BLF vs. control; RR = 0.00; p < 0.001 for BLF + LGG vs. control). The incidence of death-and/or-NEC was significantly lower in both treatment groups (4.0% and 3.8% in BLF and BLF + LGG vs. 10.1% in control; RR = 0.39; 95% CI: 0.19-0.80; p = 0.008. RR = 0.37; 95% CI: 0.18-0.77; p = 0.006, respectively). No adverse effects or intolerances to treatment occurred. Compared with placebo, BLF supplementation alone or in combination with LGG reduced the incidence of ≥ stage 2 NEC and of death-and/or ≥ stage 2 NEC in VLBW neonates. BLF might be a promising strategy to prevent NEC in NICU settings. Further data on larger sample sizes are warranted before BLF can be widespreadly used in clinical settings. ISRCTN53107700-http://www.controlled-_trials.com/ISRCTN53107700.

Http://www.omicsgroup.org/journals/pulmonary-agenesis-with-dextrocardia-and-hypertrophic-cardiomyopathy-first-case-report-2167-0897.1000141.php?aid=26283

Background: Last two decades have witnessed a steady improvement in the quality of perinatal care in India. Better understanding of the pathophysiology and newer treatment strategies like antenatal steroid, surfactant use, newer modes of ventilation and stringent aseptic measures have contributed to the improved survival of very low birth weight babies. Methods: In a prospective cohort study conducted in a tertiary care center over two years period (October 2011- September 2013), 744 VLBW babies (birth weight <1500 g) were assessed for gestational age, maturity, maternal risk factors and administration of antenatal steroids. Morbidities like birth asphyxia, sepsis, jaundice, respiratory distress syndrome, intraventricular haemorrhage, necrotisingenterocolitis, apnoea, pulmonary haemorrhage and patent ductusarteriosus were noted. Screening for retinopathy of prematurity and hearing impairment was done. Outcome in terms of survival till discharge was recorded. Results: Out of 744 VLBW babies, 496 (66.67%) survived till discharge. Maternal risk factors associated with birth of VLBW babies were primiparity (58.06%), poor socio economic status (40.86%), multiple gestations (36.83%), PROM (26.34%), hypertension (13.44%) and under nutrition (12.36%). Jaundice (43.31%), apnoea (26.34%), birth asphyxia (20.43%), RDS (19.89%) and sepsis (18.82%) were found to be significant morbidities. Mortality was higher among males (20.43%) than females (12.9%). None below 27 weeks of gestation and birth weight of 800 g survived. RDS was the main cause of death (46.15%) followed by birth asphyxia (23%), sepsis (19.2%) and IVH (11.5%). Antenatal steroid improved the survival (72.9%) and reduced the incidence of RDS, NEC and IVH. ROP was detected in 30.49% VLBW babies. 33.3 % of the survivors failed in the initial hearing screening. Conclusions: Higher birth weight, gestational age, female sex and antenatal steroids improved survival amongst VLBW babies. Antenatal steroids reduced incidence of RDS, NEC and IVH when preterm delivery was inevitable. Judicial use of supplemental oxygen and blood products prevent development of ROP.

Rapid Versus Slow Advancement of Feeds in Preterm Babies Less than 34 Weeks in Incidence of NEC and Feed Intolerance

Objective: To evaluate whether preterm neonates less than 34 weeks at birth receiving rapid enteral feeding advancement at 25-30 ml/kg/day and those receiving slow enteral feeding advancement at 15-20 mL⁄kg⁄day to attain full feeding (180 ml/kg/day) are atincrease in the incidence of necrotizing enterocolitis or feed intolerance. Study design: Retrospective cohort study. Setting: Level III Neonatal Unit in Southern India Subjects: Neonates born at <34 weeks of gestational age and admitted to the NICU during study period were enrolled. Outcome: Mortality and major morbidity - NEC as per Bell staging, incidence of feedintolerance. Results: Both groups had similar baseline characteristics. The average gain in weight, length and head circumference were significantly lower in the slow feeding group as compared rapid feeding group. The mean days to reach birth weight was less in rapid feeding group; 12.43 vs. 15.46 in slow feeding group (p=0.04). It was inferred that duration of hospital stay (22.58 vs. 31.34 days) and parenteral nutrition( 8.69 vs. 11.18 days) was less in rapid feeding group as compared to slow feeding group (p= 0.04). Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation Rapid feeding group does not have increased episodes of feed intolerance or NEC (5 vs. 6 cases) compared to slow feeding group. Conclusions: Our study support enteral nutrition by rapid enter

Can Higher PEEP and FiO2 with Bubble CPAP Reduce Need for Invasive Ventilation in Preterm Babies with Respiratory Distress Syndrome?

Objectives: To evaluate the clinical course and outcome in preterm babies with RDS using higher PEEP and FiO2 as appropriate on bubble CPAP as the primary mode of respiratory support. CPAP failure and oxygen requirement by 28 days of life were primary outcome. Incidence of pneumothorax, hypotension, NEC, IVH and ROP and survival till discharge were thesecondary outcomes measured. Method: Preterm babies (gestation 26 to 36 weeks) admitted to tertiary level NICU (both inborn and outborn) with RDS were managed with bubble CPAP as a primary mode of respiratory support. Higher pressure upto 8-10 cm of water and FiO2 upto 80-100% was given (if required) during CPAP. Results: Total 73 neonates were studied, out of which 52% received antenatal steroids and 54.8% received surfactant. Overal CPAP success rate was 95.9% with success in severe, moderate and mild RDS cases 84.6%, 97.5% and 100% respectively. Among <28 week age-group, 85.7% cases were successful. Peak CPAP pressure of ≥ 8cm water was given to 21.4% babies in success group. Conclusions: Bubble CPAP may be considered as a primary mode of respiratory support in RDS even in very preterm and ELBW babies irrespective of the severity. Early CPAP and surfactant, peak pressure upto 8-10 cm H2O and FiO2 100% with trained and committed staff with 1:1 care can lead to higher success rate. CPAP is safe even in very preterm infants with RDS and associated with lesser lung injury and other complications.

Treatment Outcomes of Infants With Cyanotic Congenital Heart Disease Treated With Synbiotics

The goal was to investigate the effect of orally administered synbiotics on outcome of infants with cyanotic congenital heart disease (CCHD). A prospective, blinded, randomized controlled trial was conducted to evaluate the effect of synbiotics on outcome of infants with CCHD. The infants with CCHD were assigned randomly to 2 groups. Infants in the study group were given synbiotic (Bifidobacterium lactis plus inulin) added to breast milk or mixed feeding until discharge or death. Infants in the placebo group were fed with breast milk or mixed feeding. The outcome measurements were nosocomial sepsis, necrotizing enterocolitis (NEC; Bell stage ≥ 2), length of NICU stay, and death. A total of 100 infants were enrolled in the trial: 50 in each arm. There were 9 cases of culture-proven sepsis (18%) in the placebo group and 2 cases (4%) in the synbiotic group (P = .03). Length of NICU stay did not differ between the groups (26 [14-36] vs 32 days [20-44], P = .07]. There were 5 cases of NEC (10%) in the placebo group and none in the synbiotic group (P = .03). The incidence of death was lower in synbiotic group (5 [10%] of 50 vs 14 [28.0%] of 50, respectively; P = .04). Synbiotics administered enterally to infants with CCHD might reduce the incidence of nosocomial sepsis, NEC, and death.

Stimulating erythropoiesis in neonates

Stimulating erythropoiesis in neonates

Breastfeeding the preterm infant

Due to its peculiar nutritional and non-nutritional contents, which include long-chain polyunsatured fatty acids (LC-PUFA), prebiotics, immunological factors, hormones and growth factors, breast milk shows significant advantages over infant formulas in nourishing preterm infants. Better neurocognitive outcomes, which are reported to persist far beyond the early childhood, have been largely observed in breastfed preterm infants; a role of LC-PUFA in promoting neural and retinal development is assumed. As far as the gastrointestinal tract is concerned, several evidences have reported a dose-related reduction in NEC incidence among preterm infants fed on human milk. Moreover, the higher amount of immunological factors as secretory IgA within preterm breast milk might play a remarkable role in reducing the overall infections. Despite breastfeeding in preterm infants is generally linked with lowered growth rates which might potentially affect neurocognitive outcomes, the beneficial effects of human milk on neurodevelopment prevail. Fortified human milk might better fulfill the particular nutritional needs of preterm infants. However, as breast milk fortification is difficult to carry out after the achievement of full oral feeding, some concerns on the nutritional adequacy of exclusive breastfeeding during hospitalization as well as after discharge have been raised. Finally, breastfeeding also entails maternal psychological beneficial effects, as promoting the motherhood process and the mother-child relationship, which could be undermined in those women experiencing preterm delivery. Proceedings of the 9th International Workshop on Neonatology · Cagliari (Italy) · October 23rd-26th, 2013 · Learned lessons, changing practice and cutting-edge research

Protective function of FoxP3+ regulatory T cells in experimental necrotizing enterocolitis (P1010)

Abstract Necrotizing enterocolitis (NEC) results from severe intestinal inflammation in premature infants. FoxP3+ regulatory T cells (Tregs) are central to gut homeostasis. While Tregs are reduced in the ileums of premature infants with NEC, it is unknown whether they play a critical function in preventing NEC. This study investigated Treg development in newborn rat pups and their function in regulating experimental NEC induction. Utilizing a rat model of experimental NEC, the ontogeny of T cells and Tregs in newborn pups was characterized by flow cytometry. To investigate the functions of Tregs, newborn pups were given Tregs harvested from adult rats prior to NEC induction to assess clinical improvement and mechanisms of immune regulation. The results revealed that there were few Treg numbers in the terminal ileums of newborn rats and 8-fold reduction after NEC (p=0.002). Adoptive transfer of Tregs significantly improved weight loss, survival from 53% to 88%, and NEC incidence from 87% to 35% (p&amp;lt;0.05). The Tregs suppressed the upregulation of costimulatory molecule CD80 on dendritic cells and inhibited the trafficking of effector cells from leaving the MLN. These findings suggest that there is a developmental delay in Tregs which contributes to the excessive inflammatory state in NEC. Adoptive transfer of Tregs attenuates the induction of NEC by regulating DCs and modulating effector cell trafficking. Treg immunotherapy has a therapeutic potential in the prevention of NEC.

Amniotic fluid stem cells improve survival and enhance repair of damaged intestine in necrotising enterocolitis via a COX-2 dependent mechanism

ObjectiveNecrotising enterocolitis (NEC) remains one of the primary causes of morbidity and mortality in neonates and alternative strategies are needed. Stem cells have become a therapeutic option for other intestinal...

Comparison of prolonged low volume milk and routine volume milk on incidence of necrotizing enterocolitis in very low birth weight neonates

Objective: Advancing feedings too rapidly may increase the risk of necrotizing enterocolitis. Few studies have been performed to compare the incidence of NEC from different methods of feeding. Our objective was to compare the results of prolonged low volume milk versus routine volume milk increase on incidence of NEC in VLBW neonates. Methodology: This study included Premature VLBW neonates admitted to the NICU at Alzahra and Shahid Beheshti Hospitals in Isfahan, between September 2011 and November 2012. On the day that the attending neonatologist chose to begin feedings, study infants were randomly assigned to be fed using minimal (group M) or advancing volumes (group A). Infants of group M who were randomized to minimal volumes were fed 20 mL/kg/d for 7 days in 2-hour cycles consisting of a 20-minutes of gavage of milk or formula followed by about two hours of fasting. After 7 days, feeding volumes for infants were increased by 20 mL/kg/d until a volume of 150 mL/kg/d was achieved and maintained. Infants who were randomized to advancing volumes (group A) were fed with initial 20 mL/kg/d using the same strategy as for infants fed minimal volumes. Then on day two, feeding volumes were increased to 40 mL/kg/d, until a volume of 150 mL/kg/d was achieved. In both groups feeding characteristics, such as milk volumes, gastric residuals, abdominal distension, postnatal ages when full enteral feedings were achieved, NEC and death were recorded daily. Results: Eighty two neonates completed the study. Only three infant (8.57%) which had been placed in minimal volume group developed suspected NEC, as compared to 12 neonates (25.53%) who were fed advancing volumes. Incidence of milk intolerance and the need for milk cessation was significantly greater in group A than group M. Infants who had been placed in advancing volume group reached full enteral feeding volumes sooner than infants who had been placed in minimal volume group. But average hospital discharge age and average weights at 30 days of life were similar between two groups. Conclusion: Due to the potential risks of NEC in preterm infants and based on this study feeding strategy (prolonged low milk volume in newborn babies) could be suggested for VLBW neonates. Further studies are needed to confirm these findings.

282 Maternal Preeclampsia is Associated with Increased Risk of Necrotizing Enterocolitis in Preterm Infants

ObjectiveThe aim of this study was to evaluate the effect of maternal preeclampsia on development and severity of NEC in premature infants.MethodsThis study consisted 2 groups of preterm infants (≤37...

102 Randomized, Controlled Trial of Slow Versus Rapid Enteral Feeding Advancements on the Clinical Outcomes of Preterm Infants 750–1250g

ObjectiveTo evaluate the effect of slow versus rapid rates of advancement of enteral feed volumes upon the clinical outcomes in preterm infants with 750–1250g birth weight.Study DesignA total of 92...

1377 Necrotizing Enterocolitis in Multiple Gestations: Comparison with Singletons

NEC is one of the most important surgical disease in the first few days after birth. The aim of this study is to describe incidence of Necrotizing enterocolitis in multiple...

1798 Clinical Outcomes of Very-Low-Birth-Weight Infants who Receive Non-Invasive Ventilatory Support

AimTo evaluate the clinical outcomes of very-low-birth-weight infants received non-invasive ventilation at delivery room (DR) and NICU.MethodsThis prospective cohort study included infants born before 29 weeks’, and infants born at...