Objective: The purpose of this study was to evaluate the effects of oropharyngeal colostrum administration in the incidence of late-onset clinical and proven sepsis and in concentrations of immunoglobulin A (IgA) in very-low-birth-weight (VLBW) infants. Methods: We conducted a double-blinded, randomized, placebo-controlled trial and assigned 113 VLBW infants to receive 0.2 mL of maternal colostrum or sterile water (placebo) via oropharyngeal route every 2 hours for 48 hours, beginning in the first 48 to 72 hours of life. Neonates of both groups were fed breast milk from the first 3 days of life until a volume of at least 100 mL · kg−1 · day−1. IgA was measured in serum and urine before and after treatment. Clinical data during hospitalization were collected. Results: We found no statistically significant differences between colostrum and placebo groups in the incidence of late-onset clinical sepsis (odds ratio 0.7602; CI 95% 0.3–1.6) and proven sepsis (odds ratio 0.7028; CI 95% 0.3–1.6). The measurement of IgA was similar in serum before (P value 0.87) and after treatment (P value 0.26 day 4 and 0.77 day 18). No differences were also observed in IgA in urine before (P value 0.8) and after treatment (P value 0.73 day 4 and 0.52). Conclusions: This study could not confirm the hypothesis that oropharyngeal administration of maternal colostrum to VLBW could reduce the incidence of late-onset sepsis and increase the levels of IgA. We believe that this finding can be justified by the practice of feeding VLBW infants exclusively with breast milk in the first days of life and reinforces the prior knowledge of the importance of early nutrition, especially, with human milk. It also suggests that oropharyngeal administration of colostrum should be reserved for neonates who cannot be fed in first few days of life.

This prospective cohort study aimed to assess the association of admission hypothermia (AH) with death and/or major neonatal morbidities among very low birth weight (VLBW) preterm infants based on the relative performance of 20 centers of the Brazilian Network of Neonatal Research. This is a retrospective analysis of prospectively collected data using the database registry of the Brazilian Network on Neonatal Research. Center performance was defined by the relative mortality rate using conditional inference trees. A total of 4356 inborn singleton VLBW preterm infants born between January 2013 and December 2016 without malformations were included in this study. The centers were divided into two groups: G1 (with lower mortality rate) and G2 (with higher mortality rate). Crude and adjusted relative risks (RR) and 95% confidence intervals (95%CI) were estimated by simple and multiple log-binomial regression models. An AH rate of 53.7% (19.8-93.3%) was significantly associated with early neonatal death in G1 (adjusted RR 1.41, 95% CI 1.09-1.84) and G2 (adjusted RR 1.29, 95%CI 1.01-1.65) and with in-hospital death in G1 (adjusted RR 1.29, 95%CI 1.07-1.58). AH was significantly associated with a lower frequency of necrotizing enterocolitis (adjusted RR 0.58, 95%CI 38-0.88) in G2.Conclusion: AH significantly associated with early neonatal death regardless of the hospital performance. In G2, an unexpected protective association between AH and necrotizing enterocolitis was found, whereas the other morbidities assessed were not significantly associated with AH. What is Known:• Admission hypothermia is associated with early neonatal death.• The association of admission hypothermia with major neonatal morbidities has not been fully established. What is New:• Admission hypothermia was significantly associated with early neonatal and in-hospital death in centers with the lowest relative mortality rates.• Admission hypothermia was not associated with major neonatal morbidities and with in-hospital death but was found to be a protective factor against necrotizing colitis in centers with the highest relative mortality rates.

The purpose of this study was to evaluate the impact of implementing a care bundle for preventing peri-intraventricular hemorrhage (PIVH) in preterm newborns. A longitudinal, quantitative, quasi-experimental study was conducted with preterm newborns from a neonatal unit. The study was divided into 2 stages: the first consisted of a retrospective cohort of newborns (control group) not exposed to the bundle, and the second consisted of 5 practical steps of implementing a care bundle for preventing PIVH in eligible newborns. The results show that a significant reduction in PIVH occurred, from 34.8% before the intervention to 26.3% after application of the bundle. Also, after implementation of the bundle, there was a reduction in the severe forms of PIVH in the newborns who presented with hemorrhage compared with the control group. The study shows how the use of a low-cost and easy operationalization tool can contribute to the health of preterm newborns. It was found that the bundle is directly related to the decrease in the incidence of PIVH. The results may contribute to the improvement in care quality, thus promoting safe care for premature newborns.

Objectives: To evaluate the prevalence of congenital heart disease and their outcomes in a Brazilian cohort of very low birth weight preterm infants. Design: Post hoc analysis of data from the Brazilian Neonatal Network database, complemented by retrospective data from medical charts and a cross-sectional survey. Setting: Twenty public tertiary-care university hospitals. Patients: A total of 13,955 newborns weighing from 401 to 1,499 g and between 22 and 36 weeks of gestational age, born from 2010 to 2017. Interventions: None. Measurements and Main Results: The prevalence of congenital heart disease was 2.45% (95% CI, 2.20–2.72%). In a multivariate regression analysis, risk factors associated with congenital heart disease were maternal diabetes (relative risk, 1.55; 95% CI, 1.11–2.20) and maternal age above 35 years (relative risk, 2.09; 95% CI, 1.73–2.51), whereas the protection factors were maternal hypertension (relative risk, 0.54; 95% CI, 0.43–0.69), congenital infection (relative risk, 0.45; 95% CI, 0.21–0.94), and multiple gestation (relative risk, 0.73; 95% CI, 0.55–0.97). The pooled standardized mortality ratio in patients with congenital heart disease was 2.48 (95% CI, 2.22–2.80), which was significantly higher than in patients without congenital heart disease (2.08; 95% CI, 2.03–2.13). However, in multiple log-binomial regression analyses, only the presence of major congenital anomaly, gestational age (< 29 wk; relative risk, 2.32; 95% CI, 2.13–2.52), and Score for Neonatal Acute Physiology and Perinatal Extension II (> 20; relative risk, 3.76; 95% CI, 3.41–4.14) were independently associated with death, whereas the effect of congenital heart disease was spotted only when a conditional inference tree approach was used. Conclusions: The overall prevalence of congenital heart disease in this cohort of very low birth weight infants was higher and with higher mortality than in the general population of live births. The occurrence of a major congenital anomaly, gestational age (< 29 wk), and Score for Neonatal Acute Physiology and Perinatal Extension II (> 20) were significantly and independently associated with death, whereas the association of congenital heart disease and death was only evident when a major congenital anomaly was present.