Late-Onset Septicemia in a Norwegian National Cohort of Extremely Premature Infants Receiving Very Early Full Human Milk Feeding

Abstract

ABSTRACT. Objectives. To investigate the occurrence of and risk factors for late-onset septicemia (LOS) in a national cohort of extremely premature infants who received very early full human milk feeding.Methods. A prospective study of all infants born in Norway in 1999 and 2000 with gestational age of <28 weeks or birth weight of <1000 g was performed. Extensive clinical information, including data on feeding practices and episodes of septicemia, was collected on predefined forms. LOS was defined as growth of bacteria or fungi in blood cultures in conjunction with clinical symptoms consistent with systemic infection occurring after day 6 of life. Cox regression models, including models allowing for time-dependent covariates, were applied in the analysis of LOS.Results. Of 464 eligible infants, 462 (99.6%) were enrolled and 405 (87.7%) survived until day 7. LOS was diagnosed for 80 (19.7%). The predominant pathogens were coagulase-negative staphylococci, followed by Candida spp. Case fatality rates associated with septicemia were 10% in general and 43% for Candida spp septicemia. Necrotizing enterocolitis or bowel perforation was diagnosed for 19 infants (4%). Enteral feeding with human milk was initiated within the third day for 98% of patients, and 92% were receiving full enteral feeding (FEF) with human milk within the third week. Both high Clinical Risk Index for Babies scores and an umbilical venous catheter in situ at 7 days of age significantly predicted LOS. However, the overall most influential risk factor for LOS was the number of days without establishment of FEF with human milk, with an adjusted relative risk of 3.7 (2.0 -6.9) for LOS if FEF was not established within the second week of life.Conclusions. The incidence and case fatality rate of septicemia for this cohort of extremely preterm infants were lower than values in comparable studies. The main difference, compared with other studies, was the feeding practice, and the data suggest that very early FEF with human milk significantly reduces the risk of LOS among extremely premature infants. L ate-onset septicemia (LOS) remains an important cause of death, morbidity, and long-term sequelae among premature infants. 1-9 The reported incidence of LOS among infants with birth weight (BW) of Ͻ1500 g ranges between 16 and 30%, [1][2][3][4]8,9 approaching 50% among infants with BW of Ͻ1000 g, 8 and case fatality rates are high (17-21%). [1][2][3]8 Gram-positive bacterial flora, mainly coagulase-negative staphylococci (CONS), has dominated bloodstream recovery for some years. 1,5,10,11 However, among the smallest infants, systemic fungal infections have become a major problem, with high case fatality rates and high rates of severe sequelae among survivors. 7 For these patients, the risk of invasive infection is high, dependent on a number of clinical factors, and inversely related to BW and gestational age (GA). [1][2][3][4]8,9 Enteral feeding with human milk is generally regarded as beneficial 12,13 and may reduce the incidence of necrotizing enterocoli...

Early human milk feeding is associated with a lower risk of necrotizing enterocolitis in very low birth weight infants

“…[13][14][15][16]22 These findings suggest that similar to the effect of donor HM, mothers' own milk is associated with a decreased risk of NEC, and the association appears to be present even if HM is not the exclusive source of enteral nutrition. Our observation that HM proportion of enteral feeding in the first 2 weeks is protective against NEC is also consistent with the findings of Ronnestad et al, 23 who reported an NEC rate of 2.2% in a sample of 464 extremely low birth weight infants (birth weight <1000 g). During the study period, 98% of the infants received HM exclusively (either own mother's milk, donor HM, or both), and 96% were fed within the first 3 days of life.…”

Prevalence of breast-feeding in the Norwegian Mother and Child Cohort Study and health service-related correlates of cessation of full breast-feeding

“…Human milk contains numerous immunological components that directly protect infants. Studies have shown that exclusive breast-feeding reduces the risk of infectious diseases in the respiratory, gastrointestinal and urinary tracts (4)(5)(6)(7)(8) , and that it protects premature children from neonatal sepsis and necrotizing enterocolitis (9)(10)(11) . In addition, the immunological components of human milk support the development and maturation of the infant's own immune system, which may explain some of the longterm health benefits observed in breast-fed children (12) .…”

The Development of Donated Breast Milk Banks in Russia: Necessity and Possibilities. Survey Results Within the Pilot Project of a Donated Breast Milk Bank Powered by the Federal State Budgetary Scientific Institution «scientific Centre of Children’s Heal

“…Однако многим авторам удается про-демонстрировать высокую эффективность применения донорского молока по сравнению с молочными смеся-ми. Так, согласно результатам трех метаанализов, про-веденных в период с 2003 по 2007 г., основным пре- [19] показано, что корм-ление свежесцеженным материнским молоком так же, как и донорским, уменьшает риск развития позднего сепсиса у детей с экстремально низкой массой тела при рождении. Однако при последующем анализе эти дан-ные подтвердились только относительно материнского молока [20].…”