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Enteral Feeds (enteral + feed)
Selected AbstractsAudit of feeding practices in babies <1200 g or 30 weeks gestation during the first month of lifeJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 7-8 2006Barbara E Cormack Aim: In 2002, the composition of the breast milk fortifier used in our hospital changed, giving increased protein and energy. We therefore decided to prospectively audit nutritional management in our unit and to compare nutritional intake and growth in our babies with published data. Methods: Data were prospectively collected over a 3-month period on infants <1200 g or 30 weeks gestation. Prescribed and delivered volumes of all parenteral and enteral fluids were recorded. Babies were weighed as per unit protocol. Results: Thirty-four infants met the audit criteria. Data are median (range). After the first week of life, energy and protein intakes were 147 (78,174) kcal/kg/day and 3.9 (2.1,4.8) g/kg/day respectively. Daily weight gain was 17 (,3.2,35.4) g/kg and was significantly associated with both energy and protein intakes (P < 0.001). However, standard deviation scores for weight fell from 0.15 (,1.9,2.0) at birth to ,1.0 (,2.9,0.8) by 36 weeks corrected age. Time to commencing enteral feeds was 1 (1,3) day and to full enteral feeds was 8 (5,28) days. One infant was diagnosed with necrotising enterocolitis and eight with chronic lung disease. Mean protein intake was significantly lower in babies with chronic lung disease (P = 0.005). Conclusion: Overall, nutritional intakes and weight gain in this cohort of babies lie within the recommended ranges, although protein intakes in the smallest babies are at the lower end of the range. Enteral feeds are introduced early and advanced rapidly, but we have a low incidence of necrotising enterocolitis. However, babies still fell across weight centiles, suggesting that actual intakes for these tiny babies may be inadequate. [source] Gastroschisis: Early enteral feeds may improve outcomeJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 5 2000M Sharp Objective: Population-based retrospective review of gastroschisis from 1986 to 1996. Methods: This was a retrospective review of gastroschisis. Seventy cases were identified from the Birth Defects Registry of Western Australia (WA). Hospital medical records of live-born cases were reviewed. Results: The live-born incidence of gastroschisis in WA was 2.1 per 10 000 live births for the period 1986,96. The incidence in mothers aged less than 20 years was 8.3-fold that of women aged over 30 years (P < 0.0001). The incidence rate for the period 1995,96 was over twice the rate for 1986,88. Age at first enteral feed was significantly related with length of hospital stay and duration of total parental nutrition (TPN). Each day delay in commencing enteral feed was associated with an increase in hospital stay of 1.05 days and an increase in TPN duration of 1.06 days. The method of delivery of the infant, age at repair, length of anaesthetic time, duration of postoperative paralysis and gestational age was not associated with length of stay or TPN duration. The data were divided into two cohorts: (i) 1986,90; and (ii) 1991,96. There was a statistically significant reduction in hospital stay from a geometric mean of 45.7 (1986,90) to 22.9 days (1991,96). Conclusions: Gastroschisis has a favourable outlook, with 89.7% survival of live births. Over the 10 year period studied, there has been a reduction in length of hospital stay and duration of TPN. The age at which the infant is first fed enteral feeds appears to be important in affecting the length of hospital stay and the duration of TPN, with delays associated with a longer hospital stay and longer TPN duration. [source] Intestinal flora in very low-birth weight infantsACTA PAEDIATRICA, Issue 11 2009Markus V. Björkström Abstract Aim:, To study the early faecal microbiota in very low-birth weight infants (VLBW, <1500 g), possible associations between faecal microbiota and faecal calprotectin (f-calprotectin) and to describe the faecal microbiota in cases with necrotizing enterocolitis (NEC) before diagnosis. Methods:, Stool samples from the first weeks of life were analysed in 48 VLBW infants. Bacterial cultures were performed and f-calprotectin concentrations were measured. In three NEC cases, cultures were performed on stool samples obtained before diagnosis. Results:, Bifidobacteria and lactobacilli were often identified in the first stool sample, 55% and 71% of cases, respectively within the first week of life. A positive correlation between lactic acid bacteria (LAB) and volume of enteral feed was found. Other bacteria often identified were Escherichia coli, Enterococcus and Staphyloccus sp. F-calprotectin was not associated with any bacterial species. All NEC cases had an early colonization of LAB. Prior to onset of disease, all cases had a high colonization of non- E. coli Gram-negative species. Conclusion:, In contrast to the previous studies in VLBW infants, we found an early colonization with LAB. We speculate that this may be due to early feeding of non-pasteurized breast milk. [source] Audit of feeding practices in babies <1200 g or 30 weeks gestation during the first month of lifeJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 7-8 2006Barbara E Cormack Aim: In 2002, the composition of the breast milk fortifier used in our hospital changed, giving increased protein and energy. We therefore decided to prospectively audit nutritional management in our unit and to compare nutritional intake and growth in our babies with published data. Methods: Data were prospectively collected over a 3-month period on infants <1200 g or 30 weeks gestation. Prescribed and delivered volumes of all parenteral and enteral fluids were recorded. Babies were weighed as per unit protocol. Results: Thirty-four infants met the audit criteria. Data are median (range). After the first week of life, energy and protein intakes were 147 (78,174) kcal/kg/day and 3.9 (2.1,4.8) g/kg/day respectively. Daily weight gain was 17 (,3.2,35.4) g/kg and was significantly associated with both energy and protein intakes (P < 0.001). However, standard deviation scores for weight fell from 0.15 (,1.9,2.0) at birth to ,1.0 (,2.9,0.8) by 36 weeks corrected age. Time to commencing enteral feeds was 1 (1,3) day and to full enteral feeds was 8 (5,28) days. One infant was diagnosed with necrotising enterocolitis and eight with chronic lung disease. Mean protein intake was significantly lower in babies with chronic lung disease (P = 0.005). Conclusion: Overall, nutritional intakes and weight gain in this cohort of babies lie within the recommended ranges, although protein intakes in the smallest babies are at the lower end of the range. Enteral feeds are introduced early and advanced rapidly, but we have a low incidence of necrotising enterocolitis. However, babies still fell across weight centiles, suggesting that actual intakes for these tiny babies may be inadequate. [source] Randomized controlled trial of oral versus intravenous fluid supplementation on serum bilirubin level during phototherapy of term infants with severe hyperbilirubinaemiaJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 2 2002N-Y Boo Objective: To compare the rates of decrease in serum bilirubin levels in severely jaundiced healthy term infants given oral or intravenous fluid supplementation during phototherapy. Methods: A randomized controlled study was carried out in the neonatal intensive care unit (NICU) of Hospital Universiti Kebangsaan Malaysia over a 12-month period. Fifty-four healthy term infants with severe hyperbilirubinemia were randomized to receive either solely enteral feeds (n = 27) or both enteral and intravenous (n = 27) fluid during phototherapy. Results: There were no significant differences in the mean birthweight, mean gestational age, ethnic distribution, gender distribution, modes of delivery and types of feeding between the two groups. Similarly, there was no significant difference in the mean indirect serum bilirubin (iSB) level at the time of admission to the NICU between the enteral (359 ± 69 ,mol/L [mean ± SD]) and intravenous group (372 ± 59 ,mol/L; P = 0.4). The mean rates of decrease in iSB during the first 4 h of phototherapy were also not significantly different between the enteral group (10.4 ± 4.9 ,mol/L per h) and intravenous group (11.2 ± 7.4 ,mol/L per h; P = 0.6). There was no significant difference in the proportion of infants requiring exchange transfusion (P = 0.3) nor in the median duration of hospitalization (P = 0.7) between the two groups. No infant developed vomiting or abdominal distension during the study period. Conclusion: Severely jaundiced healthy term infants had similar rates of decrease in iSB levels during the first 4 h of intensive phototherapy, irrespective of whether they received oral or intravenous fluid supplementation. However, using the oral route avoided the need for intravenous cannulae and their attendant complications. [source] A randomized trial of enteral feeding volumes in infants born before 30 weeks' gestationJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 6 2000C A Kuschel Objective: To compare the effect of two volumes of enteral feeds on postnatal growth in infants born before 30 weeks gestation. Methodology: Fifty-four infants, less than 30 weeks gestational age, who reached full enteral feeds were randomized to remain on 150 mL/kg per day (150 group) or increase to 200 mL/kg per day (200 group). The primary outcome measure was growth at 35 weeks corrected gestational age (CGA). Results: There were no statistically significant differences in demographic or clinical parameters between the study groups at commencement of the study, although there was a trend for infants in the 150 group to be lighter (895 g vs 1020 g, P = 0.27). Milk intakes were increased in 43% of the infants in the 150 group, whereas 54% of the infants in the 200 group required reduced intakes. Infants in the 200 group had greater daily weight gains (16.7 g/kg per day vs 15.2 g/kg per day, P = 0.047) and at 35 weeks CGA were heavier (2020 g vs 1885 g, P = 0.014) and had a greater arm fat area (282 mm2vs 218 mm2, P = 0.009). There was no difference in length or head circumference at 35 weeks CGA, and no difference in any growth parameter at 1 year of age. Morbidity was not different between the groups. Conclusions: The individual milk volume requirements for adequate weight gain without significant adverse effects vary between 150 and 200 mL/kg per day in extremely premature infants. For many infants in both groups, the assigned target volume was not appropriate. Increased milk intakes (and therefore higher caloric and mineral intakes) are associated with increased daily weight gains and a greater weight at 35 weeks CGA. The weight gain may be due to an increase in fat deposition. [source] Gastroschisis: Early enteral feeds may improve outcomeJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 5 2000M Sharp Objective: Population-based retrospective review of gastroschisis from 1986 to 1996. Methods: This was a retrospective review of gastroschisis. Seventy cases were identified from the Birth Defects Registry of Western Australia (WA). Hospital medical records of live-born cases were reviewed. Results: The live-born incidence of gastroschisis in WA was 2.1 per 10 000 live births for the period 1986,96. The incidence in mothers aged less than 20 years was 8.3-fold that of women aged over 30 years (P < 0.0001). The incidence rate for the period 1995,96 was over twice the rate for 1986,88. Age at first enteral feed was significantly related with length of hospital stay and duration of total parental nutrition (TPN). Each day delay in commencing enteral feed was associated with an increase in hospital stay of 1.05 days and an increase in TPN duration of 1.06 days. The method of delivery of the infant, age at repair, length of anaesthetic time, duration of postoperative paralysis and gestational age was not associated with length of stay or TPN duration. The data were divided into two cohorts: (i) 1986,90; and (ii) 1991,96. There was a statistically significant reduction in hospital stay from a geometric mean of 45.7 (1986,90) to 22.9 days (1991,96). Conclusions: Gastroschisis has a favourable outlook, with 89.7% survival of live births. Over the 10 year period studied, there has been a reduction in length of hospital stay and duration of TPN. The age at which the infant is first fed enteral feeds appears to be important in affecting the length of hospital stay and the duration of TPN, with delays associated with a longer hospital stay and longer TPN duration. [source] Body composition and its components in preterm and term newborns: A cross-sectional, multimodal investigationAMERICAN JOURNAL OF HUMAN BIOLOGY, Issue 1 2010Irfan Ahmad A prospective, cross-sectional, observational study in preterm and term infants was performed to compare multimodal measurements of body composition, namely, limb ultrasound, bone quantitative ultrasound, and dual X-ray absorptiometry (DXA). One hundred and two preterm and term infants appropriate for gestational age were enrolled from the newborn nursery and neonatal intensive care unit. Infants were included when they were medically stable, in an open crib, on full enteral feeds and within 1 week of anticipated discharge. Correlations among the various measurements of body composition were performed using standard techniques. A comparison between preterm infant (born at 28,32 weeks) reaching term to term-born infants was performed. Limb ultrasound estimates of cross-sectional areas of lean and fat tissue in a region of tissue (i.e., the leg) were remarkably correlated with regional and whole-body estimates of fat-free mass and fat obtained from DXA suggesting the potential usefulness of muscle ultrasound as an investigative tool for studying aspects of body composition in this fragile population. There was a weak but significant correlation between quantitative ultrasound measurements of bone strength and DXA-derived bone mineral density (BMD). Preterm infants reaching term had significantly lower body weight, length, head circumference, muscle and fat cross-sectional area, bone speed of sound, whole-body and regional lean body mass, fat mass, and BMD compared to term-born infants. Current postnatal care and nutritional support in preterm infants is still unable to match the in-utero environment for optimal growth and bone development. The use of relatively simple bedside, noninvasive body composition measurements may assist in understanding how changes in different components of body composition early in life affect later growth and development. Am. J. Hum. Biol. 2010. © 2009 Wiley-Liss, Inc. [source] | ||||||||||