Low Birth Weight Preterm Infants Research Articles

Omega 3 Fatty Acids in Enteral Nutrition for Very Low Birth Weight Preterm Infants: A Systematic Review (P11-085-19)

ObjectivesTo investigate the evidence for the effect of omega 3 fatty acids via enteral nutrition on identified outcomes in the very low birthweight preterm infant population. MethodsA literature search was conducted in EMBASE, CINAHL, Cochrane Central, PubMed databases for the period of January 1980-November 2017 for all peer-reviewed articles examining preterm infant nutrition. A multidisciplinary volunteer expert Workgroup and staff screened articles according to defined inclusion criteria (randomized controlled trials, enteral fed preterm infants < 1500 gm, economically developed nations). Data was extracted and risk of bias was evaluated for each included article using the Academy’s Quality Criteria Checklist and Cochrane’s Risk of Bias Tool. Data was summarized and conclusion statements were developed and graded for each identified outcome using the GRADE framework and Academy methodology. ResultsThe search identified in 25,264 articles, and six studies published in 13 articles were included. Two included studies had low risk of bias. Remaining studies had bias in the following Cochrane domains: attrition (2), detection (3), selection (2), performance (2), and reporting (1). Eleven conclusion statements were developed, 4 were graded as good, 2 as fair, 5 as limited. Though evidence quality describing the effect of 64mg of omega 3s daily on mortality and retinopathy of prematurity was good, there were no significant effects reported [RR (95% CI) was 1.31 (0.88 to 1.96) and 0.96 (0.61, 1.50), respectively]. Similarly, there were no significant effects found for type of fat intake by VLBW infants on bronchopulmonary disease, atopy, necrotizing enterocolitis, anthropometrics, neuro- or visual development or gastrointestinal health. ConclusionsThis systematic review revealed high heterogeneity amongst interventions, including in feeding types (formula, formula or human milk, or human milk), mode of supplementation, and amount and composition of supplement (DHA, EPA, ARA, MCT). Funding SourcesAcademy of Nutrition and Dietetics.

Assessment of Hematological Scoring System (HSS) in Early Diagnosis of Neonatal Sepsis in Neonatal Intensive Care Units

Although there have been several advancements in the diagnosis of neonatal sepsis, it still remains a major challenge, as there is no specific and sensitive marker for the timely diagnosis. Frequent incidence of noninfectious conditions that resemble to the clinical picture of neonatal sepsis, primarily in very low birth weight preterm infants, that complicates the identification of neonatal sepsis.The present study was undertaken to assess the significance of the hematological scoring system (HSS) for early detection of neonatal sepsis in total 42 cases with blood culture proven neonatal sepsis of 102 clinically diagnosed neonates admitted to the Neonatal Intensive Care Units (NICU) in El Menoufia and El Kalyoubia governorates hospitals versus 30 age matched healthy controls. The following HSS parameters were found to be significant for the early diagnosis of neonatal sepsis; Total WBC count, Total PMN count, Immature PMN count, I:T PMN ratio and Platelet count while the most sensitive parameters was degenerative changes and toxic granulation in PMNL.

Macronutrients in Enteral Nutrition for VLBW Preterm Infants: Systematic Reviews for an Evidence-Based Nutrition Guideline (P11-084-19)

ObjectivesNutrition guidelines for preterm infants based on systematic reviews are lacking. To address this need, the National Institute of Health and the Academy of Nutrition and Dietetics (AND) initiated a two phase project. Phase I: Convene stakeholders to identify topic areas and questions for preterm infant nutrition care. Phase II: Conduct scoping and systematic reviews, and develop evidence- based guidelines. This abstract presents summarized results of conducted macronutrient systematic reviews for the Very Low Birth Weight (VLBW) Preterm Infant Guideline. MethodsThe workgroup conducted scoping and systematic reviews. Identified macronutrient intake articles were categorized into the following subtopics: protein amount, protein type, fat amount, fat type, energy, breastmilk fortification, formula enrichment, and pasteurization. Inclusion criteria was limited to preterm infants < 1500 gm in developed nations. The workgroup participated in development of research questions, quality assessment of included articles using the Academy’s Quality Criteria Checklist and Cochrane’s Risk of Bias tools, synthesis and summarization of evidence, and development and grading of conclusion statements. ResultsA total of 65 research questions were developed. Forty one studies published in 48 articles were included in the macronutrient subtopic; 47% were greater than 10 years old, and 32% greater than 20 years old. Thirteen studies had a low risk of bias (32%), 28 with selection bias (60%), 15 performance bias (32%), 13 attrition bias (28%), 3 reporting bias (6%), and 10 detection bias (21%). Approximately half of the studies (48%) demonstrated risk of bias in two or more Cochrane domains. The majority of conclusions statements (83%) were graded as limited due to quality, sample size, and wide confidence intervals; 7 conclusion statements graded as fair; and 4 graded as good. ConclusionsThe macronutrient systematic reviews highlight the wide variety of studied nutrition interventions for VLBW preterm infants. Heterogeneity between study interventions and reported outcomes increased difficulty in summarizing data and making strong, evidence-based recommendations. Funding SourcesAcademy of Nutrition and Dietetics.

Analysis of clinical features, pathogen distribution and outcome of 229 children with neonatal sepsis

Objective To analyze the clinical features, etiology and outcome of neonatal sepsis, and to clarify the characteristics of early-onset sepsis and late-onset sepsis, which may provide clinical evidence for early diagnosis and treatment of neonatal sepsis. Methods Two hundred and twenty-nine cases of neonatal sepsis who were hospita-lized in the First Neonatal Wards, Shengjing Hospital Affiliated to China Medical University First Neonatal Wards from June 2013 to June 2016, and according to the onset time, they were divided into the early-onset sepsis (EOS) group and the late-onset sepsis(LOS) group, and SPSS 20.0 statistical software was used for comparative analysis of the data concerning the general situation, clinical manifestation, laboratory examination, pathogen distribution, complications and outcome between 2 groups, and Logistic stepwise regression was used to detect multiple factors. Results Sixty-eight patients (29.69%) were in the EOS group, and among them the full-term infants with normal weight accounted for 51.5%; 161 cases (70.31%) were in the LOS group with extremely low birth weight premature infants occupying 52.2%.The mothers with gestational hypertension, after the birth of mechanical ventilation, parenteral nutrition(>3 d), indwelling peripherally inserted central catheters (>5 d) had significant correlations with sepsis(all P 0.05). Procalcitonin and CRP had higher sensitivity in the diagnosis of sepsis.EOS was given priority to Gram-positive bacteria, which was far more common coagulase negative staphylococcus [26.5%(18/68 cases)], and LOS was due to mainly Gram-negative bacteria and the main pathogens were klebsiella pneumoniae in 86 cases (53.4%). The mortality in the EOS group was significantly higher than that in the LOS group[7.4%(5/68 cases) vs.2.5%(4/161 cases)], but the difference was not statistically significant (χ2=4.72, P>0.05). Conclusions Because time of neonatal sepsis onset time is different, the clinical characteristics, the distribution of etiology and outcome also show some differences, and full-terms often have EOS which is more common in the premature babies with LOS.There are various high risk factors for sepsis in perinatal and postnatal period.Therefore, early and timely diagnosing the neonatal sepsis has great significance in reducing the mortality of neonatal sepsis. Key words: Infant, newborn; Sepsis, early-onset; Sepsis, late-onset; Clinical characteristic; Etiology

Iron Deficiency and Iron Homeostasis in Low Birth Weight Preterm Infants: A Systematic Review.

Iron is an essential micronutrient that is involved in many functions in humans, as it plays a critical role in the growth and development of the central nervous system, among others. Premature and low birth weight infants have higher iron requirements due to increased postnatal growth compared to that of term infants and are, therefore, susceptible to a higher risk of developing iron deficiency or iron deficiency anemia. Notwithstanding, excess iron could affect organ development during the postnatal period, particularly in premature infants that have an immature and undeveloped antioxidant system. It is important, therefore, to perform a review and analyze the effects of iron status on the growth of premature infants. This is a transversal descriptive study of retrieved reports in the scientific literature by a systematic technique. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were adapted for the review strategy. The inclusion criteria for the studies were made using the PICO (population, intervention, comparison, outcome) model. Consequently, the systematic reviews that included studies published between 2008–2018 were evaluated based on the impact of iron status on parameters of growth and development in preterm infants.

Rate of rise of total serum bilirubin in very low birth weight preterm infants.

To assess the postnatal rate of rise (ROR) of total serum bilirubin (TSB) in very low birth weight (VLBW) preterm infants, to determine risk factors associated with a rapid rise (>90th percentile), and to compare ROR and hour-specific TSB at postnatal 12-48 h with data of term infants retrieved from the literature. Retrospective analysis of 2430 routine TSB concentrations obtained between birth and initiation of phototherapy in 483 VLBW infants. TSB increased by a median (interquartile range) ROR of 0.15 (0.11-0.19) mg/dL/h. The 50th percentile of TSB was below the 40th percentile of (near-)term counterparts at 12-48 h. TSB ROR correlated with the age at initiation (RS = -0.687; p < 0.001) and the duration (RS = 0.444; p < 0.001) of phototherapy. ROR >90th percentile (>0.25 mg/dL/h) was associated with lower gestational ages [27.2 (25.4-29.3) vs. 28.4 (26.4-30.4) weeks], lower birth weights [978 (665-1120) vs. 1045 (814-1300) g], and lower 5-min Apgar scores [7 (7-8) vs. 8 (7-9)]. ROR of TSB is an indicator for early and prolonged phototherapy. While hour-specific TSB and ROR at 12-48 h are lower than those reported for (near-)term infants, TSB appears to rise more rapidly in infants with low gestational age, low birth weight, and low 5-min Apgar score.

Oxygen therapy in premature low birth weight infants is associated with capillary loss and increases in blood pressure: a pilot study

Low birth weight (LBW) and premature birth are known risk factors for future cardiovascular disease and in particular essential hypertension (EH). Capillary rarefaction (CR) is an established hallmark of EH and is known to occur in individuals with a history of LBW. We previously reported that LBW infants do not have CR at birth but rather increased capillary density (CD). We hypothesized that LBW infants undergo a process of accelerated CR in early life, triggered in part by oxygen therapy. We studied 26 LBW infants, of whom 10 infants received oxygen therapy, and compared them to 14 normal birth weight (NBW) infants. We measured CD at 1, 5 and 10 days after birth and again after 40 weeks adjusted gestational age equivalent to birth at full term. We confirmed that LBW infants had higher CD at birth compared to NBW infants and found that significant structural CR occurred at term age in LBW infants who had received oxygen therapy (mean difference −22 capillaries/field, p = 0.007) and in those who did not receive oxygen therapy (mean difference −29 capillaries/field, p < 0.001) compared to baseline at birth. Both LBW groups showed a significant rise in BP at 40 weeks adjusted term age and the rise in systolic (mean difference 24 mm Hg, p < 0.0001) and diastolic BP (mean difference 14 mm Hg, p < 0.001) was more pronounced in the oxygen treated group compared to the nonoxygen group (mean difference 14 mm Hg, p = 0.043 and mean difference = 9 mm Hg p = 0.056 respectively). In conclusion, oxygen therapy in premature LBW infants may induce significant increases in their BP in early life.

Admission hypothermia, neonatal morbidity, and mortality: evaluation of a multicenter cohort of very low birth weight preterm infants according to relative performance of the center.

This prospective cohort study aimed to assess the association of admission hypothermia (AH) with death and/or major neonatal morbidities among very low birth weight (VLBW) preterm infants based on the relative performance of 20 centers of the Brazilian Network of Neonatal Research. This is a retrospective analysis of prospectively collected data using the database registry of the Brazilian Network on Neonatal Research. Center performance was defined by the relative mortality rate using conditional inference trees. A total of 4356 inborn singleton VLBW preterm infants born between January 2013 and December 2016 without malformations were included in this study. The centers were divided into two groups: G1 (with lower mortality rate) and G2 (with higher mortality rate). Crude and adjusted relative risks (RR) and 95% confidence intervals (95%CI) were estimated by simple and multiple log-binomial regression models. An AH rate of 53.7% (19.8-93.3%) was significantly associated with early neonatal death in G1 (adjusted RR 1.41, 95% CI 1.09-1.84) and G2 (adjusted RR 1.29, 95%CI 1.01-1.65) and with in-hospital death in G1 (adjusted RR 1.29, 95%CI 1.07-1.58). AH was significantly associated with a lower frequency of necrotizing enterocolitis (adjusted RR 0.58, 95%CI 38-0.88) in G2.Conclusion: AH significantly associated with early neonatal death regardless of the hospital performance. In G2, an unexpected protective association between AH and necrotizing enterocolitis was found, whereas the other morbidities assessed were not significantly associated with AH. What is Known: • Admission hypothermia is associated with early neonatal death. • The association of admission hypothermia with major neonatal morbidities has not been fully established. What is New: • Admission hypothermia was significantly associated with early neonatal and in-hospital death in centers with the lowest relative mortality rates. • Admission hypothermia was not associated with major neonatal morbidities and with in-hospital death but was found to be a protective factor against necrotizing colitis in centers with the highest relative mortality rates.

Prevalence of metabolic syndrome-like at 2 years of corrected age in very low birth weight preterm infants and associated factors

ObjectiveTo assess the prevalence of metabolic syndrome‐like symptoms in a population of preterm infants with very low birth weight (<1500g) at 2 years of corrected age and identify the occurrence of associated risk factors. MethodsCross‐sectional study during a five‐year period, including preterm infants born with very low birth weight evaluated at 2 years of corrected age. Metabolic syndrome‐like symptoms was defined by the presence of three or more of these criteria: abdominal circumference≥90th percentile, fasting blood glucose≥100mg/dL, triglycerides≥110mg/dL, HDL cholesterol≤40mg/dL, and blood pressure≥90th percentile. ResultsA total of 214 preterm infants with birth weight<1500g were evaluated. The prevalence of metabolic syndrome‐like symptoms at 2 years of corrected age was 15.1%. Arterial hypertension was present in 57.5%, HDL≤40mg/dL in 29.2%, hypertriglyceridemia in 22.6%, and abdominal circumference above the 90th percentile in 18.8%. Only 3.7% had hyperglycemia. The presence of periventricular leukomalacia was an independent risk factor for arterial hypertension at this age (OR 2.34, 95% CI: 0.079–0.69, p=0.008). Overweight and obesity at 2 years of corrected age were independently associated with metabolic syndrome‐like symptoms (OR 2.75, 95% CI: 1.19–6.36, p=0.018). ConclusionMetabolic syndrome‐like symptoms can be observed in very low birth weight preterm infants as early as 2 years of corrected age. Overweight and early‐onset obesity are significant risk factors for metabolic syndrome‐like symptoms, which deserves appropriate intervention for this high‐risk population.

Cytokines and matrix metalloproteinases in premature infants with necrotizing enterocolitis

Necrotizing enterocolitis (NEC) is a major cause of the morbidity and high mortality in preterm infants. With the ELISA method there were determined cytokine concentrations of the transforming growth factor-β (TGF-β), macrophage inflammatory protein1β (MIP-1β), matrix metalloproteinases (MMP-2, -3, -8, -9) and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) in low birthweight (LBW) premature infants with NEC. There were examined 68 infants at the conservative and surgical stages of NEC. In all patients on admission at 3rd and 7th day of the treatment the concentration of these compounds was determined in blood serum and tissues from damaged ileum and colon. There were established divergent differences in TGF-β content (reduction by 1,9-3 times) and MIP-1β (1.3-1.5 fold increase) in serum as compared with the control. More pronounced changes in the blood concentrations of these biomarkers in patients at the surgical stage of the NEC due to a decrease in TGF-β content, a significant increase in MIP-1β concentrations, MMP-8, TIMP-1 and the lack of the decrease in their content in the course of treatment, are associated with the severe course of NEC in LBW premature infants and prove to be indices of the unfavorable course of NEC, which requires to revise and optimize the therapeutic approach timely in such patients.

A computer-aided diagnosis system for plus disease in retinopathy of prematurity with structure adaptive segmentation and vessel based features

Retinopathy of Prematurity (ROP) is a blinding disease affecting the retina of low birth-weight preterm infants. Accurate diagnosis of ROP is essential to identify treatment-requiring ROP, which would help to prevent childhood blindness. Plus disease, which characterizes abnormal twisting, widening and branching of the blood vessels, is a significant symptom of treatment requiring ROP. In this paper, we have developed and evaluated a computer-based analysis system for objective assessment of plus disease in ROP, which best mimics the clinical method of disease diagnosis by identifying unique vessel based features. The proposed system consists of an initial segmentation stage, which will efficiently extract blood vessels of varying width and length by utilizing structure adaptive filtering, connectivity analysis and image fusion. The paper proposes the usage of additional retinal features namely leaf node count and vessel density, to portray the abnormal growth and branching of the blood vessels and to complement the commonly used features namely tortuosity and width. The test results show a better classification of plus disease in terms of sensitivity (95%) and specificity (93%), emphasizing the superiority of the proposed segmentation algorithm and vessel-based features. An additional advantage of the proposed system is that the process of selection of relevant vessels for feature extraction is fully automated, which makes the system highly useful to the non-physician graders, owing to the unavailability of a sufficient number of ROP specialists.

Reduced environmental stimuli is associated with improved insulin-like growth factor-1 levels and physical growth in very low birth weight premature infants.

Standard environmental features of the neonatal intensive care unit (NICU) may be stressful and not optimal for the maturation of very low birth weight premature infants (VLBWPIs). The present study investigated whether structured no-touch periods and reducing periods of light and sound stimulation may influence the developmental indices of VLBWPIs. Between June 2012 and June 2013, 60 consecutive VLBWPIs were equally apportioned to either an experimental or control group. The groups were statistically comparable with regard to sex ratio, gestational age and birth weight. Each group received routine nursing care, but infants in the experimental group were additionally cared for in a separate room with 3 h of rest every 8 h, and reduced light and sound from staff and instruments. At 7 and 14 days following birth, plasma insulin-like growth factor 1 (IGF-1) levels of the experimental group were significantly higher than that of the control group. Furthermore, at day 7 and 14, the body weight and crown-to-heel lengths were significantly increased in the experimental group compared with the control group. In summary, during the first 2 weeks following birth, the reduction of touch, sound and light stimulation in the NICU were associated with higher plasma IGF-1 levels and physical growth of VLBWPIs. These results may have implications for the better management of VLBWPIs in the NICU.

Kangaroo mother care as compared to standard care for the management of preterm low birth weight babies

Kangaroo mother care as compared to standard care for the management of preterm low birth weight babies

Segmental absence of intestinal musculature in an extremely low birthweight preterm infant

Abstract Background The segmental absence of intestinal musculature is a rare clinical entity, usually manifested in the neonatal period. It is more frequent in preterm infants, particularly in very low birthweight infants. Typically, there are intestinal perforation or intestinal obstruction symptoms. Case presentation The authors report a case of a 30-week-gestational age extremely low birthweight newborn who presented, on the fourth day of life, with a progressively acute abdomen and radiological findings suggestive of intestinal perforation. An emergency laparotomy with segmental ileal resection was performed; intestinal perforation was not confirmed. The histopathological examination of the resected distended bowel revealed an area of severe hypoplastic muscularis propria (with remaining layers intact). Conclusion Preoperative diagnosis of segmental absence of intestinal musculature is extremely difficult; its definitive diagnosis relies solely on the histopathological examination. The clinicians and pathologists should be aware of this rare condition, the treatment and prognosis of which differs from the more common necrotising enterocolitis.

Central diabetes insipidus: A rare complication of IVH in a very low birth weight preterm infant

A 710 g male infant was born at a referring hospital at a gestational age of 23 weeks and 2 days via vaginal delivery and was transferred to our facility at 14 days of age. His delivery was complicated by the breech presentation with difficult head extraction. The infant's initial course was significant for respiratory distress syndrome, grade III-IV intraventricular hemorrhage (IVH), acute kidney injury, and large PDA. On the day of life 29, a gradual increase in serum sodium level refractory to increasing total fluid volume was noted. The combination of persistent hypernatremia (150-160 mmol/l), polyuria (8.4 ml/kg/hr), high plasma osmolality (323 mosm/kg), hyposthenuria (75 mosm/kg) and an undetectable serum ADH (<0.8 pg/ml) confirmed the diagnosis of central diabetes insipidus (CDI). Serum sodium and urine output decreased and urine osmolality increased after subcutaneous DDAVP administration.CDI is an uncommon cause of hypernatremia in the neonatal period. The diagnosis can be difficult as excessive urine output and high serum sodium can often be attributed to high insensible water loss in the extremely premature newborn. CDI in our patient was thought to be due to grade III-IV IVH complicated by post-hemorrhagic hydrocephalus.In conclusion, the diagnosis of central DI should be considered as a complication of severe IVH in the extremely premature neonate who demonstrates persistent hypernatremia, polyuria, decreased urine osmolality, and increased plasma osmolality. Serum ADH levels can be helpful in confirming the central origin of DI and subcutaneous desmopressin can be an effective treatment in the preterm infant.

Safety and immunogenicity of pneumococcal conjugate vaccines in preterm infants

ABSTRACTIntroduction: The introduction of pneumococcal conjugate vaccines (PCVs) in the routine immunization program has resulted in a significant decline in invasive pneumococcal diseases (IPD) around the world. Preterm infants are a special group at a high risk of invasive infection by encapsulated bacteria. However, their slow growth accrual and prolonged hospital stay frequently lead to delays in immunization, which contributes to their risk for severe infections.Areas covered: Authors reviewed the published immunogenicity and safety of the use of PCVs in preterm infants.Expert opinion: PCVs are safe and effective for use in low birth weight and in-hospital preterm infants. Local and systemic reactions are similar for both term and preterm populations. Reports were inconsistent on the risk of apnea, therefore hospitalized extremely premature infants should be kept under observation for at least 48 h after immunization.

Prevention of meconium obstruction in very low birth weight preterm infants

IntroductionDelayed meconium expulsion is a cause of bowel obstruction in the extremely premature newborn (<28 WGE) weighing less than 1500g at birth. ObjectiveTo evaluate the efficacy of conservative treatment in the prevention of meconium obstruction in very-low-birth-weight preterm infants. MethodDescriptive and retrospective study performed at the Neonatal Intensive Care Unit of a tertiary level hospital. All very-low-birth-weight preterm infants who were born during the study period, from August 2016 to January 2017, and who had meconium obstruction were included. ResultsA sample of 42 newborn infants was obtained. Regarding the expulsion of meconium, 57.1% of the sample spontaneously ejected meconium, while 42.9% received different treatments. Of these, 72.2% were treated with saline enemas, 16% with acetylcysteine enemas, 16% with Gastrografin® and none required surgical treatment. ConclusionConservative treatment seems to be an effective therapeutic measure for the prevention of meconium obstruction in very-low-birth-weight preterm infants since it achieved the expulsion of meconium without having to apply surgical treatment.

Meconium-stained amniotic fluid as a risk factor for necrotizing enterocolitis in very low-birth weight preterm infants: a retrospective cohort study

Objective: To evaluate whether meconium-stained amniotic fluid (MSAF) is a risk factor for necrotizing enterocolitis (NEC) in very-low-birth-weight preterm infants.Materials and methods: The retrospective study was conducted at the Neonatal Diagnosis and Treatment Center of the Children’s Hospital of Chongqing Medical University from January 2010 to October 2016. The maternal and neonatal characteristics in cases of very low-birth weight infants born prior to 34 weeks of gestation were collected and compared between the MSAF and non-MSAF groups.Results: In the present study, 461 medical records of very low-birth-weight preterm infants were reviewed. A total of 41 (8.9%) infants were born to mothers with MSAF; in all, 180 infants were included in the study. Demographic characteristics and neonatal complications in the MSAF (n = 30) and non-MSAF groups (n = 150) were compared. A higher incidence of NEC (26.7% versus 10%, χ2 = 4.825, p = .028) was found in the MSAF group than in the non-MSAF group. Logistic regression analysis showed that MSAF (OR = 3.385, 95% CI: 1.349–8.492, p = .009) and sepsis (OR = 3.538, 95% CI: 1.442–8.679, p = .006) were independent risk factors for NEC.Conclusions: MSAF might be a risk factor for NEC in very-low-birth-weight infants. MSAF and sepsis contribute to the development of NEC.

Early prediction of feed intolerance in very low birth weight preterm infants using superior mesenteric artery blood flow velocity

Objective: To evaluate the utility of superior mesenteric artery (SMA) flow velocity post feeding for predicting time to achieve full enteral feeds in very low birth weight (VLBW) neonates.Subjects: In this prospective cohort study preterm VLBW infants were followed until they achieved full enteral feeding.Results: There was no significant difference between prefeed and post feed SMA flow measurements in study subjects. At baseline, it was observed that Small for gestational age (SGA) babies had a significantly lower peak systolic velocity. Time-averaged mean velocity (TAMV) was significantly lower in SGA babies at baseline, 15, 30, 45, and 60 min post feed, but there were no within-group differences noted over time.Conclusion: SMA blood flow velocity measured pre-feed and post-feed times do not correlate with the time to achieve full enteral feeding in very low birth weight neonates. The clinical significance of lower Peak systolic velocity (PSV) and TAMV in SGA infants is unclear.

Feeding practice influences gut microbiome composition in very low birth weight preterm infants and the association with oxidative stress: A prospective cohort study

Knowledge about the development of the preterm infant gut microbiota is emerging and is critical to their health. Very-low-birth-weight (VLBW; birth weight, <1500 g) infants usually have special dietary needs while showing increased oxidative stress related to intensive care. This prospective cohort study assessed the effect of feeding practice on gut microbiome development and oxidative stress in preterm infants.Fecal samples were collected from each infant in the early (1–2 weeks of enteral feeding) and late (2–4 weeks of enteral feeding) feeding stages. We performed high-throughput sequencing of V3–V4 regions of the 16S rRNA gene to analyze the fecal microbiome composition of 20 VLBW preterm infants and to determine the association of gut bacterial composition with feeding practice using an oxidative stress marker (urinary F2-isoprostane). Our results showed that feeding practices in the late stage significantly influenced the gut microbiome composition and oxidative stress in preterm infants. Preterm infants fed human milk + human milk fortifier and only formula diets showed a significant increase in F2-isoprostane levels (P < 0.05) compared with those fed human milk + formula diet. The gut microbiome of the infants fed the human milk + Human milk fortifier diet showed the lower relative abundance of Veillonella (P < 0.05) compared with that of the infants fed the human milk + formula diet. The gut microbiome of the infants fed the only formula diet showed the lowest microbial diversity and the highest relative abundance of Terrisporobacter (P < 0.05) compared with the gut microbiome of the infants fed the other diets. Correlation network analysis showed that urinary F2-isoprostane level was positively correlated with Terrisporobacter and Enterobacteriaceae abundance (P < 0.05) in the preterm infants.In conclusion, these data suggest that feeding practice affects the bacterial diversity and composition in the gut microbiome and is associated with oxidative stress in VLBW preterm infants.