Background: Colostrum contains various bioactive compounds that have various roles and potentials in preventing the occurrence of necrotizing enterocolitis (NEC). EGF and IGF-1 are growth factors found in breast milk colostrum in the form of polypeptides that play a role in regulating and stimulating cell proliferation and differentiation processes. The purpose of this study was to determine the relationship between EGF and IGF-1 levels in breast milk colostrum with the occurrence of NEC in neonates. Methods: This analytical observational study was conducted at Saiful Anwar Hospital Malang during June-August 2019 on mothers and neonates who were breastfed. Maternal colostrum was collected at 72 hours postpartum, while NEC incidence in infants was determined prospectively. EGF and IGF-1 levels in colostrum were examined using the ELISA method. The data were processed by SPSS 21 program and analyzed using Spearman’s test and logistic regression. Results: 24 mother and baby pair samples were included in the study. The mean level of EGF in maternal colostrum was 466±304 ng/ml, and the mean level of IGF-1 was 1.99±0.96 ng/ml with no significant difference in levels based on gestational age. There is a strong negative correlation between the levels of EGF (r = -0.630; p=0.001) and IGF-1 (r = -0.646; p=0.001) on the occurrence of NEC. With the regression test, there was no significant effect between the levels of IGF-1 (p=0.995) and EGF (p=0.997) on NEC occurrence. Conclusion: EGF and IGF-1 levels have a significant relationship to the occurrence of NEC. The higher levels of EGF and IGF-1 contained in breast milk colostrum reduced the incidence of necrotizing enterocolitis in neonates.

Background High incidence of late-onset sepsis (LOS) in preterm infants contributes to neonatal morbidity. Therapeutic outcomes of LOS have deteriorated as a result of increased antibiotic resistance problems, mainly from ESBL isolates. Controlling risk factors is important in reducing morbidity and mortality as well as providing guidance for antibiotic selection. Objectives To determine the risk factors of LOS due to ESBL-producing bacteria in preterm infants. Methods This is a retrospective study. The inclusion criteria was neonates diagnosed with late-onset neonatal sepsis by clinical signs and a positive blood culture. The blood culture result and characteristics patients as secondary data were extracted from medical records within the hospital facilities and the institutional database of the Neonatology Department of Universitas Brawijaya (January 2019 to March 2021). Statistical analysis was done to compare characteristics of the patients in the ESBL positive group to those in the ESBL negative group to assess the potential risk factors. Results Among 124 preterm infants with LOS, 62 of them were ESBL-positive case subjects and the other 62 were non-ESBL-producing control subjects. Gram-negative bacteria were the most common pathogens identified, with 96% (n=59) of them being the ESBL-producing strain, predominated by Klebsiella pneumoniae (n=56). Factors significantly correlated with the occurrence of LOS-ESBL included prior history of invasive procedures (OR 3.13; 95%CI 1.45 to 6.73; P=0.00), central access insertion (OR 9.54; 95%CI 3.7 to 24.2; P=0.00), and parenteral nutrition (OR 6.03; 95%CI 2.77 to 13.16; P=0.00). Central access insertion had the strongest influence (Exp(B) 6.98; P= 0.00). Conclusion Prior invasive procedures, central access insertion, and parenteral nutrition had significant correlations with the occurrence of LOS-ESBL in preterm infants. Central access insertion is a predictive factor for LOS-ESBL.