Objective To test the hypothesis that total energy expenditure would be significantly higher in ELBW infants near discharge compared with healthy term infants. Study design This study was designed to determine total energy expenditure and body composition in a group of ELBW infants nearing discharge on full volume enteral feedings of fortified breast milk or post-discharge formula (Neosure™) (n=10, birth weight 0.8±0.1kg, gestation 26±0.8 wk, age at study 68±9 d, postconceptional age 36±1wk) and compare them with healthy term newborns all receiving breast milk (n=14, birth weight 3.5±0.5 kg, gestation 39.0±1.4 wk, age at study 2.3±1 d). Body composition and total energy expenditure were measured using the doubly labeled water method over a 7 day period. Results The total energy expenditure for ELBW infants was significantly higher than in term infants (89±22 kcal/kcal/kg/day vs. 58±19 kcal/kg/d (p≤0.001)). Total energy expenditure normalized to fat free mass was also significantly greater in ELBW infants (98±3 kcal/kg/d compared with 73±20 kcal/kg/d (p ≤0.01)). Conclusions Rates of total energy expenditure in ELBW infants nearing discharge are greater than normal healthy term infants. Higher energy intakes in the ELBW infants compensated for the higher rates of total energy expenditure in the ELBW infants.
Background: Neonatal opioid withdrawal syndrome (NOWS) is a significant and growing health problem that affects more than 23,000 infants annually, with an estimated hospital cost of more than $720 million. Purpose: The purpose of this study was to examine factors associated with the need to initiate medication for the treatment of NOWS. Methods: A retrospective review of medical records was conducted of 204 infants born to mothers who used opioids during pregnancy from April 2011 to September 2017. Associations between maternal, infant, and environmental factors and the need for neonatal pharmacological management were examined using χ2, t tests, and regression analysis. Results: Of 204 neonates exposed to opioids prenatally, 121 (59%) developed symptoms of NOWS, requiring treatment with morphine. Neonates requiring morphine had significantly higher gestational ages (37.7 weeks vs 36.4 weeks; P < .001), and mothers were present at the neonate's bedside for a lower proportion of their total hospital stay (57% vs 74% of days; P < .001). Maternal factors associated with the need for neonatal medication treatment included the mother's reason for opioid use (P = .014), primary type of opioid used (P < .001), tobacco use (P = .023), and use of benzodiazepines (P = .003). Implications for Practice: This research provides information regarding the proportion of infants exposed to opioids prenatally who develop NOWS that requires treatment, as well as maternal, infant, and environmental factors associated with the need for neonatal medication use. Implications for Research: Future research is needed to examine these relationships prospectively in a larger and more diverse sample.
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