Nutritional Catch-Up

This is my attempt to catch up with some interesting publications from the last few weeks, about nutritional interventions and necrotizing enterocolitis.

Karagol BS, Zenciroglu A, Okumus N, Polin RA: Randomized controlled trial of slow vs rapid enteral feeding advancements on the clinical outcomes of preterm infants with birth weight 750–1250 g. Journal of Parenteral and Enteral Nutrition 2013, 37(2):223-228. 92 babies of 750-1250g birth weight were randomized to a feeding regime which increased by 20 mL/kg/d or 30 mL/kg/d. Although there weren’t any very tiny babies in this study, the results are consistent with all the small number of other prospective studies, that is, there is no effect of how we feed babies on Necrotizing Enterocolitis or other complications. The only effect of feeding babies faster is to get them fed faster! They get off IV feeding more quickly.

Ramani M, Ambalavanan N: Feeding practices and necrotizing enterocolitis. Clinics in Perinatology 2013, 40(1):1-10. That is the opinion also of the authors of this nice review article, they also note ‘Human milk compared with formula reduces the incidence of NEC. Feeding practices do not increase the incidence of NEC in preterm infants. There is no evidence supporting continuous versus intermittent tube feedings in preterm infants… Human milk-based fortifier compared with bovine-based fortifier may reduce the incidence of NEC but additional studies are required.’

That article is part of an issue of Clinics in Perinatology which is all about NEC.

Moore JE: Newer monitoring techniques to determine the risk of necrotizing enterocolitis. Clinics in Perinatology 2013, 40(1):125-134. This one, for example, is about monitoring techniques such as NIRS, a good review which motes that there is little current evidence that we can predict NEC with any of the techniques, but that there is hope for the future.

Stoltz Sjöström E, Öhlund I, Ahlsson F, Engström E, Fellman V, Hellström A, Källén K, Norman M, Olhager E, Serenius F et al: Nutrient intakes independently affect growth in extremely preterm infants: Results from a population-based study. Acta Paediatrica 2013. This population based study tries to answer the question ‘is the poor growth of very sick babies due to their inability to use the nutrition that they are given, or are they just not given enough?’ The answer is that we don’t give them enough, and even after correcting for severity of illness, nutritional intakes were the most important factor in poor growth. Give them more.

Neubauer V, Griesmaier E, Pehböck-Walser N, Pupp-Peglow U, Kiechl-Kohlendorfer U: Poor postnatal head growth in very preterm infants is associated with impaired neurodevelopment outcome. Acta Paediatrica 2013, 102(9):883-888. This is one of the consequences of poor nutrition. Smaller heads. Which are associated with poorer development.

Valentine CJ, Morrow G, Pennell M, Morrow AL, Hodge A, Haban-Bartz A, Collins K, Rogers LK: Randomized controlled trial of docosahexaenoic acid supplementation in midwestern U.S. Human milk donors. Breastfeeding medicine : the official journal of the Academy of Breastfeeding Medicine 2013, 8(1):86-91. This RCT shows that there is little DHA in breast milk of donors to a milk bank in Ohio, but supplementing the mothers increases their milk DHA content, and increases the DHA received by the baby to within an acceptable range (whatever that is) and certainly suggests that it might be a valuable thing to do, if we can prove that clinical outcomes are improved, which is certainly a possibility.

About Keith Barrington

I am a neonatologist and clinical researcher at Sainte Justine University Health Center in Montréal
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