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Background and Aims

Although approximately 8% of the Danish birth cohort with gestational age (GA) ≥35 weeks are admitted to a neonatal ward shortly after birth, evidence is inadequate regarding implications for breastfeeding. We aimed to investigate the associations between neonatal ward admission and exclusive breastfeeding (EBF) 1 and 4 months postpartum stratified by GA divided in late-preterm (GA 35-36 weeks), early-term (GA 37-38 weeks) and term (GA >38 weeks) infants.

Methods

A register-based, cohort study including all live-born infants in Denmark in 2014-2015 with GA ≥35 weeks. All Danish parents receive free home visits by health visitors throughout their infants’ first year, and from these visits data on EBF are reported to The Children’s Database. We linked EBF data with other registers held by Statistics Denmark. Multiple logistic regression analyses were used to estimate the associations between neonatal ward admission and EBF stratified by GA, adjusted for confounders.

Results

The study population comprised 106,559 infants. The odds of EBF 1 and 4 months postpartum were decreased in the group admitted to the neonatal ward. However, among late-preterm infants (n=3,135) neonatal ward admission was associated with increased odds of EBF 1 month postpartum (1.30; 95%CI 1.12-1.51), as opposed to among early-term (n=19,135; 0.89; 95%CI 0.83-0.94) and term infants (n=84,289; 0.84; 95%CI 0.77-0.92). The trend seemed to persist 4 months postpartum.

Conclusions

Neonatal ward admission is associated with decreased EBF among early-term and term infants, whereas the opposite is the case for late-preterm infants, indicating that this group benefits from approaches to breastfeeding support in neonatal wards.

Background and Aims

Nutrition is a cornerstone of postnatal care in extremely preterm infants. This study aimed to evaluate the efficacy and safety of a standardized feeding protocol on nutritional intakes and growth among infants < 29 weeks gestation.

Methods

121 infants participated in a randomized controlled trial (the ImNuT trial, NCT03555019) at Oslo University Hospital. A standardized feeding protocol was implemented to reduce variations in nutritional practice and ensure accommodation to international guidelines on enteral and parenteral nutrition. Detailed information on actual nutritional intakes, growth and biochemistry was prospectively collected and assessed from birth to 36 weeks postmenstrual age (PMA).

Results

Median (range) gestational age and birth weight were 26⁺⁶ (22⁺⁶, 28⁺⁶) weeks and 798 (444, 1485) g. Energy and macronutrient intakes progressively increased from birth through transition to exclusive enteral feeds (Fig.1a-c). Parenteral nutrition was weaned at median (IQR) day 11 (9, 14) when nutritional requirements were met by exclusively enteral feeds. Infants exhibited median (IQR) weight loss of 7.8% (5.7, 11.6) and regained birth weight at day 8 (7, 11). Average velocity in weight, length and HC from birth to 36 weeks PMA were in accordance with target growth rates, median (IQR) 15.8 (14.7, 17.7) g/kg/d, 1.1 (0.98, 1.3) cm/week and 0.82 (0.83, 0.89) cm/week. At 36 weeks PMA, only 3% of infants exhibited moderate growth faltering (decline in z-score weight > 1.2 from birth) and none severe.

Conclusions

The standardized feeding protocol was well tolerated, ensured nutrient intakes in line with recommendations and prevented growth faltering in infants < 29 weeks gestation.

Background and Aims

Gastric residual measurement, the evaluation of stomach contents, is routinely performed prior to feeding preterm infants. Historically, large residuals have been seen as an indication of necrotising enterocolitis. Residual measurement may lead to a diagnosis of feed intolerance, leading to withholding feeds delaying achievement of full feeds.

Our aim was to investigate if the exclusion of routine checks of gastric residuals would impact the time to full enteral feeding in preterm infants.

Methods

A multicentre randomised controlled trial was performed. Clinically stable infants between 26+0 and 30+6 weeks gestation, appropriate for gestational age and <1.5kg were eligible.

Infants were randomized to intervention arm (no monitoring of gastric aspirates) or control arm (routine care). Primary outcome was achievement of full enteral feeds (100ml/kg/day) by day 5. Secondary outcomes: withholding of feeds, duration of central access and parenteral nutrition, incidence of complications of prematurity.

Results

Eighty-eight infants were included in an intention to treat analysis, 45 in intervention arm and 43 in control arm with no imbalances in baseline characteristics.

Regarding the primary outcome, 33 (73.3%) infants in the intervention group and 32 (74.4%) infants in the control group reached full feeds by day 5 of life (p=0.91). There was no difference in median time to full feeds or any of the predefined secondary outcomes.

Conclusions

There was no difference in time to full feeds when gastric residuals assessment was excluded. In the absence of clinical benefit it may be appropriate to only monitor residuals when clinical concern arises.

Background and Aims

Aim of this study was to examine whether two different timepoints of introduction of solid foods in preterm infants have an impact on ferritin and other hematologic parameters important for iron status in the first year of life.

Methods

The study is a secondary outcome analysis of a prospective, randomized, two arm intervention trial of very low birth weight (VLBW) infants randomized to an early (10-12^th week of life corrected age) or a late (16-18^th week of life corrected age) complementary feeding group. Blood samples were taken at 6 weeks, 6 months, and 12 months corrected age. Infants were supplemented with iron polymaltose (2-3 mg/kg/day) until iron rich solid foods were fed on a regular basis.

Results

In total, data of 89 infants of the early group and 88 infants of the late group were available for analysis. The primary outcome ferritin showed no differences between groups throughout the first year of life, as did all other parameters (hematocrit, erythrocyte indices, transferrin, transferrin saturation, soluble transferrin receptor, iron). At 12 months corrected age, incidence of iron deficiency (serum ferritin <12 mcg/L) was significantly higher in the early feeding group.

Conclusions

The timepoint of introduction of solid foods had no impact on ferritin levels and other hematologic parameters important for iron status in the first year of life of VLBW preterm infants but showed a higher incidence of iron deficiency at 12 months corrected age in the early feeding group.

Background and Aims

Although it has been described that preterm infants have a high risk of developing feeding problems after discharge there is a lack of population-based studies in infants born extremely preterm. The objectives of this study were to assess the incidence of feeding problems up to 2.5 years post discharge among a population-based cohort of infants born extremely preterm in Sweden (EXPRESS), and identify perinatal risk factors for later feeding problems.

Methods

Data on clinical diagnoses related to feeding problems were obtained from the Swedish Patient Register for all 432 infants from the EXPRESS cohort who took part in the follow-up programme. The main outcome was feeding problems and/or underweight at 2.5 years.

Results

We found that 66 infants (19%) had feeding problems after discharge up until 2.5 years and/or underweight at 2.5 years. The strongest risk factors for feeding problems were the number of days treated with mechanical ventilation during the first eight postnatal weeks, with an OR of 1.59 (CI 95% 1.286-1.976) and the Clinical Risk Index for Babies-score, with an OR of 1.14 (CI 95% 1.034-1.261). A ROC analysis showed that a duration of more than ten days in mechanical ventilation had the highest sensitivity and specificity for predicting post discharge feeding problems.

Conclusions

Diagnosed feeding problems are common in infants born extremely preterm. The strongest perinatal risk factor for later feeding problems was early treatment with mechanical ventilation lasting for more than ten days. Identifying infants at risk of post discharge feeding problems might be useful for targeting of nutritional support.

Background and Aims

Slow growth is common in very preterm infants, partially due to insufficient provision of protein and energy. We aimed to analyze how this can be impacted by variability in macronutrient content of human milk.

Methods

Mothers and Very Premature Infants were eligible if milk production was over baby’s feeding volumes and the infant was free from underlying or other life-threatening conditions. Composition aliquots from 24-hour milk pools were measured with a mid-infrared analizer (MIRIS Human Milk Analyzer®, Uppsala, Sweden) on weeks 1, 2 and 4 and a single morning sample on week 3. Patients received standard fortification. Milk intakes and supplementation were extracted from clinical charts. Calculations were based on that week´s measurement or an estimation from reference values. Data analysis was carried out with SPSS (Social Package for Social Sciences) v25.

Results

117 mothers and 130 infants (20 twins) participated. Mean gestational age was 28.7±2.3 and mean birth weight 1163±383g. By week 4, milk was the sole source of nutrition in 95% of patients. From those on exclusive enteral nutrition on day 28 (71/72 ≥1000g and 44/46 <1000g), between one quarter (<1000g) and one third (≥1000g) were receiving an enteral protein supply under the ESPGHAN recommendations (Figure 1), while this was 15% in ELBW and 27% in ≥1000g in the case of energy.

Conclusions

Under standard fortification protocols, very preterm infants often receive nutrient supplies below ESPGHAN recommendations.