The experience of breastfeeding infants affected by congenital diaphragmatic hernia or esophageal atresia

Salvatori, Guglielmo; Foligno, Silvia; Massoud, Michela; Piersigilli, Fiammetta; Bagolan, Pietro; Dotta, Andrea

doi:10.1186/s13052-018-0509-6

Cited by 8 publications

(4 citation statements)

References 32 publications

(32 reference statements)

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“…Zozaya et al reported on time to reach 120 mL/kg/d; a median of 19 days postoperatively and 10 days after initiation of enteral feeds, Salvatori et al reported on time to reach 150 mL/kg/d; a median of 31.49 days from birth was noted and Jani et al reported age at full enteral feeding (not defined) as a median of 23 days. [18][19][20] From these reporting centers, we note two main differences to our approach: we initiated enteral nutrition before surgical repair and resumed enteral nutrition immediately in the postoperative period. Our results, with equal or shorter time to full enteral nutrition, support the feasibility of our current practice.…”

Section: Discussionmentioning

confidence: 99%

Early Pre- and Postoperative Enteral Nutrition and Growth in Infants with Symptomatic Congenital Diaphragmatic Hernia

et al. 2023

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Objectives Nutritional support during the neonatal and postoperative period in congenital diaphragmatic hernia (CDH) is challenging and controversial. We aimed to report on early enteral nutritional support in symptomatic CDH patients during the pre- and postoperative period, including feasibility, associated factors with established full enteral nutrition, and weight at birth, discharge, and 18 months. Methods We retrospectively collected data on nutrition: type and volume of enteral nutrition and parental support. Enteral feeding was introduced preoperatively from day 1 after birth, increased step-wised (breastmilk preferred), and resumed after CDH repair on the first postoperative day. Baseline data were available from our CDH database. Results From 2011 to 2020, we identified 45 CDH infants. Twenty-two were girls (51.1%), 35 left sided (77.8%), and 40 underwent CDH repair (88.9%). Median (interquartile range) length of stay in the pediatric intensive care unit was 14.6 days (6.0–26.5), and 1-year mortality was 17.8%.Postoperatively, 120 and 160 mL/kg/d of enteral nutrition was achieved after a median of 6.5 (3.6–12.6) and 10.6 (7.6–21.7) days, respectively. In total, 31 (68.9%) needed supplemental parenteral nutrition in a median period of 8 days (5–18), and of those 11 had parenteral nutrition initiated before CDH repair. No complications to enteral feeding were reported. Conclusion Early enteral nutrition in CDH infants is feasible and may have the potential to reduce the need for parental nutrition and reduce time to full enteral nutrition in the postoperative period.

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Section: Discussionmentioning

confidence: 99%

Early Pre- and Postoperative Enteral Nutrition and Growth in Infants with Symptomatic Congenital Diaphragmatic Hernia

et al. 2023

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“…The breastfeeding rate in high-risk newborns should be increased by specific steps, sustaining mothers during NICU hospitalization and after discharge [ 37 ]. HMBs could play a key role in promoting maternal breastfeeding, health, and growth of these fragile infants and cost savings in NICUs [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

How much does a liter of donor human milk cost? Cost analysis of operating a human milk bank in Italy

et al. 2022

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Background To date, 40 Human Milk Banks (HMB) have been established in Italy; however, recent cost analysis data for operating an HMB in Italy are not available in the literature. Methods This study was a cross-sectional study performed at “Bambino Gesù” Children’s Hospital in Rome, Italy in 2019. We assessed the one-year operational costs and, the per liter unit costs at our HMB. Results During the 2019 year we collected 771 l of human milk supplied by 128 donors. The total cost was € 178,287.00 and the average cost was € 231.00 per liter. € 188,716.00 would have been spent had the maximum capacity for 904 l been reached. We found a significant difference (€ 231.00 vs € 209.00 per liter, p = 0.016) comparing the cost for collected liters in the year 2019 and the cost for the maximum capacity of the bank for that year of activity. Analyzing each cost item that determines the charge of donor human milk (DHM), the highest costs are the salaries of medical and paramedical staff, and then the costs related to transporting. If the HMB works at maximum capacity and manages a greater number of liters of milk, this can represent an important saving. Conversely, the price of consumables is modest (i.e., the price of a single-use kit for breast pumps was € 0.22 per unit). Conclusion The costs for a liter of DHM are quite high, but they must be related to the benefits, especially for preterm infants. Comparing the cost for collected liters in 2019 and the costs for the 2019 maximum capacity of the HMB, we calculated how much fixed costs of collection and distribution of DHM can be reduced, by increasing the volume of milk collected. To the best of our knowledge, this is the first complete cost analysis for an Italian Milk Bank. A thorough analysis could help to abate fixed costs and reduce the cost of a liter of DHM. The centralization of DHM can allow savings, rather than creating small HMBs scattered throughout the territory that would operate with lower milk volumes.

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“…When EA and LGEA are combined, 42.4% of the infants were breastfed at discharge compared with the results of Salvatori et al, who report 24.0% of their infants to be breastfed at discharge. 19 The percentage of infants who were breastfed at discharge was lower among the infants with LGEA. This may be due to their age at the time of final discharge.…”

Section: Breastfeedingmentioning

confidence: 92%

“…It has previously been reported that 42.2% of infants with gastroschises 18 and 24.0% of infants with EA and LGEA 19 were breastfed at discharge. However, growth status at discharge and at 1 year of age was not reported.…”

Section: Introductionmentioning

confidence: 99%

Feeding Practice, Nutrition, and Growth in Infants with Abdominal Wall Defects and Esophageal Atresia: A Retrospective Case–Control Study

et al. 2022

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Introduction Infants born with abdominal wall defects and esophageal atresia (EA) are at risk of impaired growth. Little is known about the optimal nutritional strategy and its impact on growth for these infants. This study aims to explore nutrition, focusing on breastfeeding, and the presumed impact on infant growth during the first year of life. Materials and Methods We performed a registry study. The participants comprised infants born with gastroschisis, omphalocele, or EA from 2009 to 2020. Breastfed healthy infants from the Odense Child Cohort served as the control group. Descriptive statistics were applied when presenting data on nutrition. Growth data were converted to weight z-scores at birth and at discharge, and estimated weight z-scores at 6 and 12 months were calculated. Univariate regression analysis was applied. Results The study included 168 infants in the study group and 403 infants in the control group. Exclusive breastfeeding rates at discharge were as follows: 55.7% (gastroschisis), 58.3% (omphalocele), 50.9% (EA), and 7.7% (long-gap EA). For the study group our data demonstrate no difference in growth at 1 year of age when comparing mother's milk to formula feeding. During the first year of life, infants in the study group showed slower growth compared with the control group. At 12 months of age, all infants had a mean weight z-score above –2. Conclusion Breastfeeding in infants with abdominal wall defects and EA can be established without compromising growth. Mother's milk can be recommended for infants with abdominal wall defects and EA.

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The experience of breastfeeding infants affected by congenital diaphragmatic hernia or esophageal atresia

Cited by 8 publications

References 32 publications

Early Pre- and Postoperative Enteral Nutrition and Growth in Infants with Symptomatic Congenital Diaphragmatic Hernia

Early Pre- and Postoperative Enteral Nutrition and Growth in Infants with Symptomatic Congenital Diaphragmatic Hernia

How much does a liter of donor human milk cost? Cost analysis of operating a human milk bank in Italy

Feeding Practice, Nutrition, and Growth in Infants with Abdominal Wall Defects and Esophageal Atresia: A Retrospective Case–Control Study

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