Randomized Controlled Trial of Oropharyngeal Colostrum Administration in Very‐low‐birth‐weight Preterm Infants

Ferreira, Daniela Monteiro; Oliveira, Ana Carolina de Morais; Leves, Débora V de; de, Érica B; Fatureto, Giovana G; Navarro, N.; Afonso, Nathália G; Santiago, Fernanda Maria; Mineo, José Roberto; Sopelete, Mônica Camargo; Martinez, Francisco Eulógio; Neto, Morun Bernardino; Abdallah, Vânia Olivetti Steffen

doi:10.1097/mpg.0000000000002356

Cited by 25 publications

(48 citation statements)

References 19 publications

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“…Six studies [17,18,22,23,33,34] had a low ROB in random sequence generation, with one study [35] reported a high risk and two [36,37] reported an unclear risk. Allocation concealment was of high risk in one study [35] and of unclear risk in three studies [17,18,37]. The risk of blinding of participants and personnel was high in four studies [18,33,35,36] and unclear in one study [37].…”

Section: Rob Of Rctmentioning

confidence: 99%

“…After eliminating the studies of Zhang et al [23], Glass et al [18], and Romano-Keeler et al [35] for the all-cause mortality rate, six studies [17,22,33,34,36,37], with a total sample of 505 preterm infants were included to measure the mortality rate (Fig. 3c).…”

Section: Effect On the All-cause Mortality Ratementioning

confidence: 99%

“…4a). In another three [17,34,35] studies, the item "time to reach to full enteral feeding" was reported in the form of median and interquartile range, considering the small sample size, data transformation was not performed, and one [36] study did not report this outcome. The pooled results showed statistical significance between the OAC group and the control group (p = 0.02, MD = −3.60, 95% CI = −6.55-0.64).…”

Section: Time To Reach Full Enteral Feedingmentioning

confidence: 99%

“…Duration of hospital stay was reported in five studies [17,22,33,34,37], while two studies [17,34] were excluded; thus, three studies [22,33,37], with a sample of 332 preterm infants, were included (Fig. 4b).…”

Section: Duration Of Hospital Staymentioning

confidence: 99%

“…Oropharyngeal administration of colostrum (OAC) is a simple feeding method for preterm neonates first suggested by Rodriguez and in the following experiment, its safety and feasibility have been tested [15,16]. A small amount of colostrum, usually 0.2 ml, is perfused into a syringe (in vast majority studies) or soaked onto a cotton swab (in very few studies) and the infant's mouth is equally smeared with colostrum from the left buccal mucosal tissue to the right buccal mucosal tissue [17,18]. Colostrum is rich in various immunological substances, and therefore, OAC should be able to activate the oral and intestinal immunity, protecting the preterm infants against serious inflammatory diseases, such as NEC and LOS [19][20][21].…”

Section: Introductionmentioning

confidence: 99%

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Effects of oropharyngeal administration of colostrum on the incidence of necrotizing enterocolitis, late-onset sepsis, and death in preterm infants: a meta-analysis of RCTs

et al. 2020

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Necrotizing enterocolitis (NEC) and late-onset sepsis (LOS) are two major contributors to death among preterm infants. Oropharyngeal administration of colostrum (OAC) has been proved as an easy, safe, and economically viable technique to help preterm neonates to build up their immunity. In this review, we assessed the effects of OAC on preterm infants. Several mainstream databases were searched including PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and a website of clinical trials. Randomized controlled trials (RCTs) comparing OAC vs. placebo or no intervention in preterm infants (gestation age <34 weeks or birth weight <1500 g) were eligible. Overall, nine RCTs (n = 689) were included in the review. Meta-analysis showed no statistical significance in terms of the incidence of NEC (RR = 0.59, 95% CI = 0.33-1.06, p = 0.08), LOS (RR = 0.78, 95% CI = 0.60-1.03, p = 0.08) and mortality rate (RR = 0.63, 95% CI = 0.38-1.05, p = 0.07). No significant difference was found in the subgroup analysis, apart from the group of the undeveloped region in NEC and mortality. In addition, time was significantly reduced in terms of achieving full enteral feeding (MD = −3.60, 95% CI = −6.55-0.64, p = 0.02) and hospital stay (MD = −10.38, 95% CI = −18.47-2.29, p = 0.01). The results show that OAC does not reduce the incidences of NEC, LOS, and death in preterm infants, but there is a trend toward a positive effect. It is therefore recommended as routine care for preterm infants in the NICU.

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Section: Rob Of Rctmentioning

confidence: 99%

Section: Effect On the All-cause Mortality Ratementioning

confidence: 99%

Section: Time To Reach Full Enteral Feedingmentioning

confidence: 99%

Section: Duration Of Hospital Staymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effects of oropharyngeal administration of colostrum on the incidence of necrotizing enterocolitis, late-onset sepsis, and death in preterm infants: a meta-analysis of RCTs

et al. 2020

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Effects on Growth of Smell and Taste of Milk During Tube Feeding of Preterm Infants

et al. 2021

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IMPORTANCE Smell and taste of food increase food anticipation, activate gut motility, and stimulate digestion and metabolism. Despite poor growth of many preterm infants in neonatal intensive care units, the smell and taste of milk with tube feeding are not generally considered a regular component of care.OBJECTIVE To determine the effect of smell and taste of milk with tube feeding on weight z scores at discharge from the hospital. DESIGN, SETTING, AND PARTICIPANTSA randomized, controlled, nonblinded, superiority trial was conducted at 2 perinatal centers between May 9, 2017, and February 1, 2020. Eligible infants (n = 659) were born at less than 29 weeks' postmenstrual age (PMA) and/or with a birth weight of less than 1250 g. INTERVENTIONSInfants were randomly assigned to receive either the smell and taste of milk with each tube feeding or routine care without the provision of smell and taste of milk. MAIN OUTCOMES AND MEASURESThe primary outcome was weight z score at discharge from any hospital. Secondary outcomes included anthropometric measures at predefined time points, time to full enteral feeds, and other health outcomes associated with prematurity. RESULTSOf the 658 infants, a total of 396 infants were randomized; some parents had not been approached for consent (n = 144) or declined participation (n = 117), and 1 infant with consent was not randomized. Of the 396 infants, 196 were assigned to the treatment group (51% male; mean [SD] PMA at birth, 27.5 [2.2] weeks) and 200 were assigned to the control group (52% male; mean [SD] PMA at birth, 27.6 (2.3) weeks). Mean weight z scores at discharge were −0.87 (95% CI, −1.02 to −0.72) for the treatment group and −0.97 (95% CI, −1.11 to −0.83) for the control group (P = .40). The mean difference in z scores between the treatment and control groups at 36 weeks' PMA was 0.21 (95% CI, 0.01 to 0.4; P = .04) for head circumference and 0.26 (95% CI, 0.05 to 0.51; P = .04) for length. There were no clinically notable differences between the study groups for any other anthropometric, feeding, or health outcomes. CONCLUSIONS AND RELEVANCEIn this randomized clinical trial, regular smell and taste of milk included with tube feeding did not improve weight at discharge in preterm infants. Secondary outcomes suggest exposure to smell and taste may improve head circumference and length at 36 weeks' PMA, but not at discharge. Regular exposure to the smell and taste of milk is a simple and inexpensive intervention with potential benefits and no apparent adverse effects.

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Effect of oropharyngeal colostrum therapy on neonatal sepsis in preterm neonates: A systematic review and meta‐analysis

Anne,

Kumar,

Kumar

et al. 2023

J. pediatr. gastroenterol. nutr.

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Various studies have shown that oropharyngeal colostrum application (OPCA) is beneficial to preterm neonates. We performed a systematic review and meta‐analysis to assess whether OPCA reduces the incidence of culture‐proven neonatal sepsis in preterm neonates. Randomized controlled trials comparing OPCA with placebo or standard care in preterm neonates were included. Medline, Embase, Web of Science, Cumulated Index to Nursing and Allied Health Literature, Scopus, and CENTRAL were searched for studies published up to June 15, 2023. We used the Cochrane Risk of Bias tool, version 2, for risk of bias assessment, the random‐effects model (RevMan 5.4) for meta‐analysis, and Gradepro software for assessing the certainty of evidence. Twenty‐one studies involving 2393 participants were included in this meta‐analysis. Four studies had a low risk of bias, whereas seven had a high risk. Oropharyngeal colostrum significantly reduced the incidence of culture‐proven sepsis (18 studies, 1990 neonates, risk ratio [RR]: 0.78, 95% confidence interval [95% CI]: 0.65, 0.94), mortality (18 studies, 2117 neonates, RR: 0.73, 95% CI: 0.59, 0.90), necrotizing enterocolitis (NEC) (17 studies, 1692 neonates, RR: 0.59, 95% CI: 0.43, 0.82), feeding intolerance episodes (four studies, 445 neonates, RR: 0.59, 95% CI: 0.38, 0.92), and the time to full enteral feeding (19 studies, 2142 neonates, mean difference: −2 to 21 days, 95% CI: −3.44, −0.99 days). There was no reduction in intraventricular hemorrhage, retinopathy of prematurity, bronchopulmonary dysplasia, ventilator‐associated pneumonia, neurodevelopmental abnormalities, hospital stay duration, time to full oral feeding, weight at discharge, pneumonia, and duration of antibiotic therapy. The certainty of the evidence was high for the outcomes of culture‐positive sepsis and mortality, moderate for NEC, low for time to full enteral feeding, and very low for feeding intolerance. OPCA reduces culture‐positive sepsis and mortality (high certainty), NEC (moderate certainty), and time to full enteral feeding (low certainty) in preterm neonates. However, scarcity of data from extremely premature infants limits the generalizability of these results to this population.

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Randomized Controlled Trial of Oropharyngeal Colostrum Administration in Very‐low‐birth‐weight Preterm Infants

Cited by 25 publications

References 19 publications

Effects of oropharyngeal administration of colostrum on the incidence of necrotizing enterocolitis, late-onset sepsis, and death in preterm infants: a meta-analysis of RCTs

Effects of oropharyngeal administration of colostrum on the incidence of necrotizing enterocolitis, late-onset sepsis, and death in preterm infants: a meta-analysis of RCTs

Effects on Growth of Smell and Taste of Milk During Tube Feeding of Preterm Infants

Effect of oropharyngeal colostrum therapy on neonatal sepsis in preterm neonates: A systematic review and meta‐analysis

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