Objective: The purpose of this randomized pilot study was to collect preliminary data regarding the feasibility and effects of early initiation of milk expression on the onset of lactogenesis stage II and milk volume in mothers of very low birth weight (VLBW) infants.Study Design: Twenty women were randomized to initiate milk expression within 60 min (group 1) or 1 to 6 h (group 2) following delivery. Milk volume and timing of lactogenesis stage II was compared between groups using Wilcoxon's rank sum tests.Result: Group 1 produced statistically significantly more milk than group 2 during the first 7 days (P ¼ 0.05) and at week 3 (P ¼ 0.01). Group 1 also demonstrated a significantly earlier lactogenesis stage II (P ¼ 0.03). Conclusion:Initiation of milk expression within 1 h following delivery increases milk volume and decreases time to lactogenesis stage II in mothers of VLBW infants.

Background: Feeding breastmilk to premature infants decreases morbidity but is often limited owing to an insufficient milk supply and delayed attainment of lactogenesis stage II. Early initiation of milk expression following delivery has been shown to increase milk production in mothers of very low-birth-weight (VLBW) infants. Although recommendations for milk expression in this population include initiation within 6 hours following delivery, little evidence exists to support these guidelines. This study compared milk volume and timing of lactogenesis stage II in mothers of VLBW infants who initiated milk expression within 6 hours following delivery versus those who initiated expression after 6 hours. Subjects and Methods: Forty mothers of VLBW infants were grouped according to when they initiated milk expression following delivery. Group I began milk expression within 6 hours, and Group II began expression after 6 hours. Milk volume was measured daily for the first 7 days and on Days 21 and 42. Timing of lactogenesis stage II was determined through mothers' perceptions of sudden breast fullness. Results: Group I produced more breastmilk during the initial expression session and on Days 6, 7, and 42. No difference in timing of lactogenesis stage II was observed. When mothers who began milk expression prior to 1 hour following delivery were removed from analysis, benefits of milk expression within 6 hours were no longer apparent. Conclusions: Initiation of milk expression within 6 hours following delivery may not improve lactation success in mothers of VLBW infants unless initiated within the first hour.

This study explored effects of exposure to maternal voice on short-term outcomes in very low birth weight preterm infants cared for within an neonatal intensive care unit (NICU) without an ongoing program of developmental care. Using a comparative design, 53 infants born during their 27th to 28th postmenstrual week were sampled by convenience. Experimental groups were exposed to maternal voice during two developmental time periods. Group 1 listened to a recording of their mothers reciting a rhyme from 28 to 34 postmenstrual weeks. Group 2 waited 4 weeks and heard the recording from 32 to 34 weeks. The control group received routine care. The primary analysis of combined experimental groups compared to the control group revealed that the experimental infants experienced significantly fewer episodes of feeding intolerance and achieved full enteral feeds quicker compared to the control group. Further, in an analysis evaluating all three groups separately, it was noted that Group 1 experienced significantly fewer episodes of feeding intolerance compared to the control group. Study findings warrant further investigation of exposure to maternal voice and the developmental timing at which exposure is begun.

2016-12-23T18:47:23

The American Academy of Pediatrics recommends that extremely preterm infants receive mother’s own milk (MOM) when available or pasteurized donor breast milk (DBM) when MOM is unavailable. The goal of this study was to determine whether DBM could be inoculated with MOM from mothers of preterm infants to restore the live microbiota (RM). Culture dependent and culture independent methods were used to analyze the fluctuations in the overall population and microbiome, respectively, of DBM, MOM, and RM samples over time. Using MOM at time = 0 (T0) as the target for the restoration process, this level was reached in the 10% (RM-10) and 30% (RM-30) mixtures after 4 h of incubation at 37°C, whereas, the larger dilutions of 1% (RM-1) and 5% (RM-5) after 8 h. The diversity indexes were similar between MOM and DBM samples, however, different genera were prevalent in each group. Interestingly, 40% of the bacterial families were able to expand in DBM after 4 h of incubation indicating that a large percentage of the bacterial load present in MOM can grow when transferred to DBM, however, no core microbiome was identified. In summary, the microbiome analyses indicated that each mother has a unique microbiota and that live microbial reestablishment of DBM may provide these microbes to individual mothers’ infants. The agreement between the results obtained from the viable bacterial counts and the microbiome analyses indicate that DBM incubated with 10–30% v/v of the MOM for 4 h is a reasonable restoration strategy.

IMPORTANCE Evaluating prefeed gastric residuals is considered routine care but has little supporting evidence. OBJECTIVE To determine the effect of omitting prefeed gastric residual evaluation on nutritional outcomes in extremely preterm infants. DESIGN, SETTING, AND PARTICIPANTS This single-center randomized clinical trial compared the omission of gastric residual evaluation with prefeed gastric residual evaluation. Infants were recruited from a level 4 neonatal intensive care unit and were enrolled from October 17, 2013, to October 8, 2016, and then followed up for 6 weeks after birth. Eligible participants were infants born at 32 or fewer weeks' gestation with a birth weight of 1250 g or less; they were enrolled within 72 hours after birth and within 24 hours after feeding initiation. All participants (N = 143) were included in the modified intent-to-treat analysis, which was conducted from March to July 2018. INTERVENTIONS The residual group underwent prefeed gastric residual evaluation; the no residual group did not. Feeding decisions were made according to nutritional guidelines, and infants received only human milk. MAIN OUTCOMES AND MEASURES The primary outcome was weekly enteral nutrition intake in mL/kg for 6 weeks after birth. RESULTS Of 143 infants, 74 (51.7%) were randomized to undergo gastric residual evaluation (residual group) and 69 (48.3%) to omitted gastric residual evaluation (no residual group). The residual group comprised an even number of male and female infants (37 [50.0%]) with a mean (SD) gestational age of 27.1 (2.4) weeks and a mean (SD) birth weight of 888.8 (206.6) grams, whereas the no residual group had more male infants (36 [52.17%]), a mean (SD) gestational age of 27 (1.2) weeks, and a mean (SD) birth weight of 915.2 (180) grams. The no residual group had feedings that advanced more quickly compared with the residual group (mean weekly increase, 20.7 mL/kg/d vs 17.9 mL/kg/d; P = .02) and consumed more feedings at weeks 5 (137.2 [95% CI, 128.6-145.8]; P = .03) and 6 (141.6 [95% CI, 133.2-150.0]; P = .03). Among the secondary outcomes, the no residual group had higher mean estimated log weights (7.01 [95% CI, 6.99-7.02] vs 6.98 [95% CI, 6.97-7.00]; P = .03), had fewer episodes of abdominal distention (0.59 [95% CI, 0.34-1.01] vs 1.79 [95% CI, 1.27-2.53]; P = .001), and were discharged 8 days earlier (4.21 [95% CI, 4.14-4.28] vs 4.28 [95% CI, 4.19-4.36]; P = .01). Odds for necrotizing enterocolitis (0.058 [95% CI, 0.018-0.190] vs 0.026 [95% CI, 0.006-0.109]), death (0.004 [95% CI, 0.0003-0.046] vs 0.012 [95% CI, 0.001-0.131]), late-onset sepsis (0.970 [95% CI, 0.67-1.40] vs 1.38 [95% CI, 0.97-1.94]), and ventilator-associated pneumonia (0.084 [95% CI, 0.033-0.214] vs 0.056 [95% CI, 0.019-0.168]) were similar between groups. CONCLUSIONS AND RELEVANCE Among extremely preterm infants, the omission of gastric residual evaluation increased the delivery of enteral nutrition as well as improved weight gain and led to earlier hospital discharge; these results may translate into evidence-ba...

Objective Little information exists regarding gastric residual (GR) evaluation prior to feedings in premature infants. The purpose of this study was to compare the amount of feedings at 2 and 3 weeks of age, number of days to full feedings, growth and incidence of complications between infants who underwent RGR (routine evaluation of GR) evaluation versus those who did not. Study Design Sixty-one premature infants were randomized to one of two groups. Group 1 received RGR evaluation prior to feeds and Group 2 did not. Result There was no difference in amount of feeding at 2 (P =0.66) or 3 (P= 0.41) weeks of age, growth, days on parenteral nutrition or complications. Although not statistically significant, infants without RGR evaluation reached feeds of 150 ml kg−1 per day 6 days earlier and had 6 fewer days with central venous access. Conclusion Results suggest RGR evaluation may not improve nutritional outcomes in premature infants.

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