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#worldprematurityday

11/9/2016

17 November 2016 is World Prematurity Day with you and designed to raise awareness for the smallest heroes among us.

EFCNI provides a full range of (graphic) materials free of charge to help supporters from all around the world to promote their ideas and activities. Amongst other, EFCNI has developed high resolution logos, poster templates, Facebook and Twitter covers in about 40 languages. Further materials such as a toolkit, knitting instructions for socks, and a cutting pattern for the famous socks line are available in English. The material will be used globally and shows the unity and well as the impact of all those committed to preterm infants, their families and the professional teams surrounding them.

Please feel free to download and use the graphic materials for your activities around World Prematurity Day – but please also note the guidelines for the use of the material: www.efcni.org/worldprematurityday.

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Breast feeding and outcome at 7 years age

9/26/2016

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Photo credit: http://neurosciencenews.com/breastfeeding-neurocognition-neurodevelopment-4759/

We all know breast feeding is best for both term and preterm infants. It reduces the chances of NEC and improves a range of other outcomes, most importantly the brain. This new study provides interesting information from a group of preterm infants in Australia (Victorian birth cohort) and looked at the number of days, in the first month of life, when they received more than 50% of their intake as breast milk. They then looked at the child's IQ outcomes (including maths, reading, reasoning skills etc.) at age 7 years and found a consistent association. Importantly the analysis is adjusted for other factors - we know that social class, and neonatal illness (NEC, BPD etc.) will affect your IQ outcomes, so they adjust for this (in effect try to 'cancel out' that bias) in the analyses. Of course, in any observational study there is a risk of residual confounding, but this appears to be yet more information supporting the longer term benefits of breast milk exposure in just the first 4 weeks of life.

http://www.jpeds.com/article/S0022-3476(16)30411-5/fulltext

Breast Milk Feeding, Brain Development, and Neurocognitive Outcomes: A 7-Year Longitudinal Study in Infants Born at Less Than 30 Weeks' Gestation. Belfort, Mandy B. et al. The Journal of Pediatrics , Volume 177 , 133 - 139.e1

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Father's day - a story from a new father on having a baby with HIE

6/29/2016

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A friend pointed this out to me (thanks Alison!). This is a really good short cartoon video of a father's experience following the birth of a baby with HIE. Credit: Telegraph newspaper http://s.telegraph.co.uk/graphics/projects/fathers-days/index.html

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World breastfeeding week

8/5/2015

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http://www.worldbreastfeedingweek.org/pcresults.shtml

WORLD BREASTFEEDING WEEK (Coordinated by WABA)1-7 August 2015
This World Breastfeeding Week, WABA calls for concerted global action to support women to combine breastfeeding and work. Whether a woman is working in the formal, non-formal or home setting, it is necessary that she is empowered in claiming her and her baby’s right to breastfeed.

The idea that we are supposed to promote breast feeding for at least 6 months, but then not provide proper maternity leave has always seemed a bit bonkers and unfair. Still, many women in more resource poor settings do this all the time. There are some great photos on the website (copyright WABA)

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Breastfeeding - if it reduced the risk of childhood leukemia would more people support it?

6/5/2015

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It’s pretty old news that breast feeding is associated with numerous health benefits, in fact it’s increasingly difficult to find any important outcome that isn’t made better by breast feeding. Whether its brain growth, avoiding hip fractures or dying from cardiovascular disease, let alone all the benefits for preterm infants in reducing NEC, mothers own breast milk is always good for you. However, the effects on childhood cancer have always been uncertain.

In this recent study, Amitay et al. (JAMA Pediatr 2015: 169(6) ) conducted a meta-analysis of published studies. This means they carefully searched every published study that examined the association between breast feeding and leukaemia (which represents 30% of all childhood cancer) and analysed them to find the overall (average) result. They found 18 separate studies: these showed that compared with no breast feeding or shorter breast feeding, breast feeding for 6 months or more was associated with a 19% lower risk of leukaemia. This is a large study – in total 10292 leukaemia cases and 17517 control cases were examined. That’s quite a lot and far more than you could ever study in a single country. In a further analysis in just 15 studies they showed that ever breast fed, compared with never breast fed, was associated with a 11% reduction.

Observational studies, and meta-analyses (like this), can never prove direct causation and there are methodological flaws in every study. No study gives you the perfect correct answer. But the size of this reduction for such a serious condition is important - maybe prospective mothers need to know. http://archpedi.jamanetwork.com/journal.aspx

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Antibiotics - are they making our children fat?

6/5/2015

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You are what you eat.
And swallow.

It will come as no surprise that taking antibiotics alters the gut flora of infants, however a recent study confirms the findings of several other studies in suggesting that antibiotics may have more profound longer term effects on infants, and probably children (and then adults). One way of thinking about this, is to appreciate that in farming, antibiotics were widely used as growth promoting agents.

In this current study by Saari et al (Pediatrics 2015 135:617-626) they followed up a large group (6114 boys and 5984 girls) and looked at their growth and obesity (BMI) over the first 2 years, and examined these changes in relation to antibiotic exposure before 6 months of age. BMI is not a very accurate measure of the amount of fat you have: think of a body builder – they have lots of muscles and almost no fat, but still have a high BMI. But BMI is the only thing you can really measure when you follow up thousands of children (you can't do expensive MRI scans on them all). The study found that children who had received antibiotics were heavier (more so in boys, than girls) and this was particularly strong for certain types of antibiotics (macrolides). The authors suggest that antibiotic exposure may play a role in the growing [sic] epidemic of obesity . Of course, a study like this doesn’t prove that antibiotics cause obesity, just that there is an association. Maybe families who have obese children have a different approach to use of antibiotics i.e. maybe they attend GPs more often? Either way, it emphasises that we should be cautious of the unnecessary use of antibiotics, and especially in infancy. http://pediatrics.aappublications.org/content/135/4/617.abstract

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Evidenced based neonatology - exclusive human milk based diets?

6/2/2015

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Nutrition for extremely preterm infants is critical to growth and development. In this review we discuss a randomized controlled trial that examined the short-term outcomes of feeding these infants on an exclusively bovine or exclusively human milk diet. The study found that an exclusive fortified human milk diet resulted in improved short-term outcomes, including a reduction in NEC and days on PN. However, this intervention is expensive and needs testing in other situations. Read the full review here https://ebneo.org/2015/06/randomized-trial-of-exclusive-human-milk-versus-preterm-formula-diets-in-extremely-premature-infants/

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Kangaroo care - International Awareness Day

5/16/2015

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OK, so International Kangaroo awareness day was yesterday, but even though I'm a day late, this really deserves highlighting. Out of all the interventions studies in neonates, this is one with overwhelming evidence of benefit on just about any outcome you chose to examine - both for the mother and the baby, and obviously breast feeding success. If you want to make nutrition better for babies, you need to promote breast-feeding and KMC is without doubt one of the cheapest and most-effective things to do.

How does it work? I've appended 5 key papers over the last few years that have added to our knowledge, and also emphasize the importance of this intervention in more resource-poor settings.

Lawn, J.E., Mwansa-Kambafwile, J., Horta, B.L., Barros, F.C., Cousens, S. Kangaroo mother care' to prevent neonatal deaths due to preterm birth complications (2010) International Journal of Epidemiology, 39 (SUPPL. 1), pp. i144-i154.
Barros, F.C., Bhutta, Z.A., Batra, M., Hansen, T.N., Victora, C.G., Rubens, C.E. Global report on preterm birth and stillbirth (3 of 7): Evidence for effectiveness of interventions (2010) BMC Pregnancy and Childbirth, 10 (SUPPL. 1), art. no. S3,
Feldman, R., Eidelman, A.I. Skin-to-skin contact (Kangaroo Care) accelerates autonomic and neurobehavioural maturation in preterm infants (2003) Developmental Medicine and Child Neurology, 45 (4), pp. 274-281.
Furman, L., Minich, N., Hack, M. Correlates of lactation in mothers of very low birth weight infants (2002) Pediatrics, 109 (4)
Charpak, N., Ruiz-Peláez, J.G., Figueroa De C, Z., Charpak, Y. Kangaroo mother versus traditional care for newborn infants ≤2000 grams: A randomized, controlled trial (1997) Pediatrics, 100 (4), pp. 682-688.

Thanks for the photo Louiza!

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Re-feeding gastric residuals in extremely preterm infants - we still don't know the answer

5/12/2015

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The question of when to re-feed gastric residuals (and when to stop feeds on the basis of a large residual) occurs on a daily basis in most large NICUs. The evidence base for the practice is limited but has been reviewed in a recent post from EBNEO Mikael Norman (Professor of Neonatal Medicine at the Karolinska Institute & University Hospital, Sweden) reviewing this recent article in Archives Disease and Childhood (Salas AA, Cuna A, Bhat R, Mcgwin G, Carlo WA, Ambalavanan N. A randomised trial of re-feeding gastric residuals in preterm infants. Arch Dis Child Fetal Neonatal Ed. 2015;100(3):F224-8. PMID 25552280).

You can read the full review here https://ebneo.org/category/reviews/

In summary (and apologies for any paraphrasing) Prof Norman says.... there is no evidence from clinical trials to support either approach (not/re-feeding), especially in the high-risk (for both NEC and undernutrition) group of extremely preterm infants.

Salas et al is to be congratulated .........but for the primary question “Does re-feeding of gastric residual volumes reduce the time needed to achieve full enteral feeding in preterm infants?”, the authors conclude that the answer is no. However, although intention to treat analysis was intended, the primary efficacy end point was only possible to assess in 59 infants, as the estimated sample size (n=72) was not reached. Therefore, there are two possibilities: Either the study may have been under-powered ....... or, the results rightly disprove the hypothesis for an effect size of 2 days difference or more to achieve full feeds.

In addition .... numbers were too small to draw any firm conclusions about safety. Information on the volumes of gastric residuals in the two treatment arms was also lacking...... Finally, donor milk was not offered, possibly contributing to quite high rates reported of intestinal perforation, surgical necrotizing enterocolitis, or death. [Although on this point I'd need to say that the data on whether donor human milk is definitely better when used to supplement mother's own milk is also based on scant evidence]

Norman agrees with the conclusion that re-feeding gastric residual volumes in extremely preterm infants does not seem to reduce time to achieve full enteral feeding, and is likely to be safeBut as always ....further evidence is needed

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Last two weeks of neonatalresearch.net activity

4/29/2015

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If anyone is actually 'out there' then you can probably see I haven't done this before, but there's a few from here and there. Welcome!

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