Objective To evaluate the effect of an oral stimulation program in preterm on the performance in the first oral feeding, oral feeding skills and transition time from tube to total oral intake. Study ...designer Double-blind randomized clinical trial including very preterm newborns. Congenital malformations, intracranial hemorrhage grade III or IV, bronchopulmonary dysplasia, and necrotizing enterocolitis were excluded. Intervention group (GI) received an oral stimulation program of tactile extra-, peri-, and intraoral tactile manipulation once a day for 15 minutes, during a 10-day period. Control group (GII) received sham procedure with same duration of time. Feeding ability was assessed by a speech-language pathologist blinded to group assignment. The classification of infants' oral performance was determined by Oral Feeding Skills (OFS). Neonates were monitored until hospital discharge. Results Seventy-four (37 in each group) were randomized. Mean gestational ages and birth weights were 30#177;1.4 and 30#177;1.5 weeks, and 1,452#177;330g and 1,457#177;353g for intervention and control groups, respectively. Infants in the intervention group had significantly better rates than infants in the control group on: mean proficiency (PRO) (41.5%#177;18.3 vs. 19.9%#177;11.6 (p0.001)), transfer rate (RT) (2.3 mL/min and 1.1 mL/min (p0.001)) and overall transfer (OT) (57.2%#177;19.7 and 35.0%#177;15.7 (p0.001)). Median transition time from tube to oral feeding was 4 (3-11) and 8 (7-13) days in intervention and control groups, respectively (p = 0.003). Intake of breast milk was found to reduce transition time from tube feeds to exclusive oral feeding (p0.001, HR 1.01, 95%CI 1.005-1.019), but the impact of the study intervention remained significant (p = 0.007, HR 1.97, 95%CI 1.2-3.2). Conclusion Infants who were breast-fed and an oral stimulation program proved beneficial in reducing transition time from tube feeding to oral feeding. Trial registration ClinicalTrials.gov number NCT03025815.
The purpose was identify an association between meconium microbiome, extra-uterine growth restriction, and head circumference catch-up. Materials and methods: Prospective study with preterm infants ...born <33 weeks gestational age (GA), admitted at Neonatal Unit and attending the Follow-Up Preterm Program of a tertiary hospital. Excluded out born infants; presence of congenital malformations or genetic syndromes; congenital infections; HIV-positive mothers; and newborns whose parents or legal guardians did not authorize participation. Approved by the institution's ethics committee. Conducted 16S rRNA sequencing using PGM Ion Torrent meconium samples for microbiota analysis. Results: Included 63 newborns, GA 30±2.3 weeks, mean weight 1375.80±462.6 grams, 68.3% adequate weight for GA at birth. Polynucleobacter (p = 0.0163), Gp1 (p = 0.018), and Prevotella (p = 0.038) appeared in greater abundance in meconium of preterm infants with adequate birth weight for GA. Thirty (47.6%) children reached head circumference catch-up before 6 months CA and 33 (52.4%) after 6 months CA. Salmonella (p<0.001), Flavobacterium (p = 0.026), and Burkholderia (p = 0.026) were found to be more abundant in meconium in the group of newborns who achieved catch-up prior to 6th month CA. Conclusion: Meconium microbiome abundance was related to adequacy of weight for GA. Meconium microbiome differs between children who achieve head circumference catch-up by the 6th month of corrected age or after this period.
Premature infants, given their limited reserves, heightened energy requirements, and susceptibility to nutritional deficits, require specialized care. Aim: To examine the complex interplay between ...nutrition and neurodevelopment in premature infants, underscoring the critical need for tailored nutritional approaches to support optimal brain growth and function. Data sources: PubMed and MeSH and keywords: preterm, early nutrition, macronutrients, micronutrients, human milk, human milk oligosaccharides, probiotics AND neurodevelopment or neurodevelopment outcomes. Recent articles were selected according to the authors’ judgment of their relevance. Specific nutrients, including macro (amino acids, glucose, and lipids) and micronutrients, play an important role in promoting neurodevelopment. Early and aggressive nutrition has shown promise, as has recognizing glucose as the primary energy source for the developing brain. Long-chain polyunsaturated fatty acids, such as DHA, contribute to brain maturation, while the benefits of human milk, human milk oligosaccharides, and probiotics on neurodevelopment via the gut-brain axis are explored. This intricate interplay between the gut microbiota and the central nervous system highlights human milk oligosaccharides’ role in early brain maturation. Conclusions: Individualized nutritional approaches and comprehensive nutrient strategies are paramount to enhancing neurodevelopment in premature infants, underscoring human milk’s potential as the gold standard of nutrition for preterm infants.
Therapeutic hypothermia reduces cerebral injury and improves the neurological outcome secondary to hypoxic ischemic encephalopathy in newborns. It has been indicated for asphyxiated full-term or ...near-term newborn infants with clinical signs of hypoxic-ischemic encephalopathy (HIE).
A search was performed for articles on therapeutic hypothermia in newborns with perinatal asphyxia in PubMed; the authors chose those considered most significant.
There are two therapeutic hypothermia methods: selective head cooling and total body cooling. The target body temperature is 34.5°C for selective head cooling and 33.5°C for total body cooling. Temperatures lower than 32°C are less neuroprotective, and temperatures below 30°C are very dangerous, with severe complications. Therapeutic hypothermia must start within the first 6h after birth, as studies have shown that this represents the therapeutic window for the hypoxic-ischemic event. Therapy must be maintained for 72h, with very strict control of the newborn's body temperature. It has been shown that therapeutic hypothermia is effective in reducing neurologic impairment, especially in full-term or near-term newborns with moderate hypoxic-ischemic encephalopathy.
Therapeutic hypothermia is a neuroprotective technique indicated for newborn infants with perinatal asphyxia and hypoxic-ischemic encephalopathy.
A hipotermia terapêutica reduz a lesão cerebral e melhora o desfecho neurológico de recém-nascidos após insulto hipóxico isquemico. Indicada para recém-nascidos a termo ou próximo do termo com evidência de asfixia perinatal e Encefalopatia Hipóxico Isquemica (EHI).
Foi feita uma procura no PubMed por publicações sobre hipotermia terapêutica em recém-nascidos com asfixia perinatal e selecionadas aquelas julgadas mais relevantes pelos autores.
Há duas técnicas de resfriamento corpórea: hipotermia seletiva da cabeça e hipotermia corpórea total. A temperatura de resfriamento deve ser 34,5°C para seletiva de cabeça e 33,5°C para corpórea total; temperaturas inferiores a 32°C são menos neuroprotetoras e abaixo de 30°C há efeitos adversos sistêmicos graves. Indica-se o início da hipotermia terapêutica até 6 horas após o nascimento, pois estudos evidenciaram que esta é a janela terapêutica da agressão hipóxico e isquêmica. A hipotermia deve ser mantida por 72horas com rigorosa monitorização da temperatura corporal do recém-nascido. A hipotermia tem sido efetiva em reduzir seqüelas neurológicas, principalmente em recém-nascidos de termo ou próximo do termo com encefalopatia hipóxico isquêmica moderada e em melhorar o prognóstico em longo prazo dos recém-nascidos com EHI.
A hipotermia terapêutica é uma técnica neuroprotetora indicada para recém-nascidos com asfixia perinatal.
To determine the differences in preterm infants' stool microbiota considering the use of exclusive own mother's milk and formula in different proportions in the first 28 days of life.
The study ...included newborns with GA ≤ 32 weeks divided in 5 group according the feeding regimen: 7 exclusive own mother's milk, 8 exclusive preterm formula, 16 mixed feeding with >70% own mother's milk, 16 mixed feeding with >70% preterm formula, and 15 mixed 50% own mother's milk and preterm formula. Exclusion criteria: congenital infections, congenital malformations and newborns of drug addicted mothers. Stools were collected weekly during the first 28 days. Microbial DNA extraction, 16S rRNA amplification and sequencing were performed.
All groups were similar in perinatal and neonatal data. There were significant differences in microbial community among treatments. Approximately 37% of the variation in distance between microbial communities was explained by use of exclusive own mother´s milk only compared to other diets. The diet composed by exclusive own mother´s milk allowed for greater microbial richness (average of 85 OTUs) while diets based on preferably formula, exclusive formula, preferably maternal milk, and mixed of formula and maternal milk presented an average of 9, 29, 23, and 25 OTUs respectively. The mean proportion of the genus Escherichia and Clostridium was always greater in those containing formula than in the those with maternal milk only.
Fecal microbiota in the neonatal period of preterm infants fed with exclusive own mother's milk presented increased richness and differences in microbial composition from those fed with different proportions of formula.
Despite increased efforts, the diverse etiologies of Necrotizing Enterocolitis (NEC) have remained largely elusive. Clinical predictors of NEC remain ill-defined and currently lack sufficient ...specificity. The development of a thorough understanding of initial gut microbiota colonization pattern in preterm infants might help to improve early detection or prediction of NEC and its associated morbidities. Here we compared the fecal microbiota successions, microbial diversity, abundance and structure of newborns that developed NEC with preterm controls. A 16S rRNA based microbiota analysis was conducted in a total of 132 fecal samples that included the first stool (meconium) up until the 5th week of life or NEC diagnosis from 40 preterm babies (29 controls and 11 NEC cases). A single phylotype matching closest to the
family correlated strongly with NEC. In DNA from the sample with the greatest abundance of this phylotype additional shotgun metagenomic sequencing revealed
and
as the dominating taxa. These two taxa might represent suitable microbial biomarker targets for early diagnosis of NEC. In NEC cases, we further detected lower microbial diversity and an abnormal succession of the microbial community before NEC diagnosis. Finally, we also detected a disruption in anaerobic microorganisms in the co-occurrence network of meconium samples from NEC cases. Our data suggest that a strong dominance of
and/or
, low diversity, low abundance of
, as well as an altered microbial-network structure during the first days of life, correlate with NEC risk in preterm infants. Confirmation of these findings in other hospitals might facilitate the development of a microbiota based screening approach for early detection of NEC.
To 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.
Cross-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.
A 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).
Metabolic 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.
Avaliar a prevalência de síndrome metabólica “like” em população de crianças prematuras com muito baixo peso de nascimento (< 1500 gramas) aos dois anos de idade corrigida e identificar a ocorrência de fatores de risco associados.
Estudo transversal que incluiu prematuros nascidos durante um período de cinco anos com muito baixo peso de nascimento, avaliados aos dois anos de idade corrigida. A síndrome metabólica “like” foi definida pela presença de três ou mais desses critérios: circunferência abdominal ≥ percentil 90, glicemia de jejum ≥ 100mg/dL, triglicerídeos ≥ 110mg/dL, colesterol HDL ≤ 40mg/dL e pressão arterial ≥ percentil 90.
Foram avaliados 214 prematuros abaixo de 1.500 gramas. A prevalência de síndrome metabólica “like” aos dois anos de idade corrigida foi 15,1%. Hipertensão arterial esteve presente em 57,5%, HDL ≤ 40mg/dL em 29,2%, hipertrigliceridemia em 22,6% e aumento da circunferência abdominal acima do percentil 90 em 18,8%. Apenas 3,7% apresentaram hiperglicemia. A presença de leucomalácia periventricular foi um fator de risco independente para hipertensão arterial nessa idade (OR 2,34; IC 95% 0,079-0,69; p=0,008); sobrepeso e obesidade aos dois anos de idade corrigida foram independentemente associados com síndrome metabólica “like” (OR 2,75, IC 95% CI 1,19-6,36; p=0,018).
Síndrome metabólica “like” ocorre em prematuros de muito baixo peso tão precocemente quanto dois anos de idade corrigida. Sobrepeso e obesidade de início precoce são fatores de risco significativos para síndrome metabólica “like”, merecem intervenção apropriada para essa população de alto risco.
This study aimed to review the prevalence of developmental coordination disorder (DCD) in individuals born preterm and systematically explore this prevalence according to gestational age and ...different assessment cut-offs and compare it to full-term peers. The eligibility criteria were observational and experimental studies reporting the prevalence of DCD in preterm individuals. A systematic search was performed in databases from inception until March 2022. Two independent reviewers performed the selection. Study quality assessment was performed using the checklists from Joanna Briggs Institute (JBI). Data analysis was performed on Excel and Review Manager Software 5.4. Among the 1774 studies identified, 32 matched the eligibility criteria. The pooled estimate rate of the DCD rate in preterm was 21% (95% confidence interval CI 17.8-24.3). The estimate rates were higher as gestational age decreased, and preterm children are two times more likely to have DCD than their full-term peers risk ratio (RR) 2.2 (95% CI 1.77-2.79). The limitation was high heterogeneity between studies; the assessment tools, cut-off points and age at assessment were diverse. This study provided evidence that preterm children are at higher risk for DCD than full-term children, and the risks increased as gestational age decreased.
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