No abstract

BACKGROUND: Consensus on the defi nition and management of hypotension in preterm neonates is lacking.(1-3) Owing to this, there are wide variations in the reported incidence of hypotension in premature infants, especially in the fi rst week from birth.(1,3,4) Inotropes can often cause vasoconstriction, which may alter brain perfusion especially in the absence of established cerebral autoregulation.(5) The use of these drugs is associated with multiple short and long term morbidities.(2,6-12) Studies that targeted blood pressure alone as the criteria for use of inotropes did not show improvement in mortality and morbidity. (12,13) We evaluated the effect of quality improvement (QI) bundle on rate of inotrope use and associated morbidities. METHODS: Inborn preterm neonates born at <29weeks gestational age (GA) and admitted to level III NICU were

No abstract

Background Approximately 43-65% of very low birth weight (VLBW) infants develop extra-uterine growth restriction (EUGR). EUGR is associated with a significant increase in the risk of neurodevelopmental impairment. Inadequate early postnatal nutrition results in excessive weight loss that cannot be explained by the physiologic contraction of body water alone. EUGR and postnatal growth failure are usually associated with negative early energy and nitrogen balance in the first week of life. Growth trajectories after initial weight loss have similar slopes regardless of gestational age, which indicates that the early excessive weight loss is a lead cause for EUGR. Objectives To study whether an early and higher parenteral lipid intake in the first week after birth would decrease the percentage of weight loss and subsequently the incidence of EUGR. Design/Methods This was a randomized, open-label, control trial of appropriate-for-gestational age VLBW infants admitted to our level III NICU. Lipid intake in the control group started at 0.5-1 g/kg/day and was increased daily by 0.5-1 g/kg/day until 3 g/kg/day was reached. The intervention group was started on 2 g/kg/day then increased to 3 g/kg/day the following day. Triglyceride levels were measured the day after the start and after each increase in lipid intake. Results Among the 176 infants assessed for eligibility, eighty-three were included in the trial. There were no significant differences between the control and the intervention group in mean gestational age (27.3 ± 2.4 vs. 27.1 ± 2.3 weeks respectively) or birth weight (1011 ± 250 vs. 1019 ± 271 g respectively). Infants in the intervention group were started on lipid earlier (13.8±7.8 vs. 17.5±7.8 h; p=0.03) and had higher cumulative lipid intake in the first 7 days of age (13.5±4.2 vs. 10.9±3.5 g/kg; p=0.004) that led to a protein to energy ratio; closer to the recommended values. Total fluid intake was similar between the two groups. Infants in the intervention group had a lower percentage of weight loss (10.4±3.6 vs. 12.7±4.6; p=0.02). The mean triglyceride level was higher in the intervention group (1.91± 0.79 vs. 1.49±0.54 mmol/L; p= 0.01), however, hypertriglyceridemia was similar between the two groups at 2 and 3 g/kg/day of lipid intake. Enteral energy and protein intake calculated weekly between the time of parenteral nutrition discontinuation and 36 weeks corrected gestational age (CGA) were similar between the 2 groups. EUGR at 36 weeks CGA was significantly lower in the intervention group (38.6% vs. 67.6%; p=0.01). Conclusion In VLBW infants, the provision of an early and higher dose of parenteral lipid in the first week of life results in less weight loss and lower incidence of EUGR.

Objectives: We aimed to assess the relationship between feeding intolerance or necrotizing enterocolitis (NEC), and neonatal blood eosinophilc counts >700 cells/mm3 (eosinophilia) in the first 28 days of life.Methods: In this prospective observational cohort study, the highest and the average absolute eosinophil counts were recorded for each infant. Date of onset at first enteral feed, type of milk, time taken to reach full oral feeding, and incidence of feeding intolerance were also noted.Results: A total of 486 infants admitted to the neonatal intensive care unit with 1171 complete blood cell count samples drawn were observed. Eosinophilia (count >700/mm 3 ) was noted in 106 infants (22%). When compared to infants without eosinophilia (n = 380) infants with eosinophilia had significantly younger gestational age. Fourteen percent of infants with eosinophilia compared with 6% of the controls developed feeding intolerance (OR 2.86, 95% CL 1.40-5.68). Moreover, infants with eosinophilia were less likely to achieve full feeds in one week (OR 0.48, 95% CL 0.30-0.76) or two weeks (OR 0.37, 95% CL 0.21-0.65) as compared to their controls respectively. However, after gestational age adjustment only exclusive formula feeding was found to have a significant association with eosinophilia (OR 1.76, 95% CL 1.07-2.89). Of other secondary factors evaluated only antenatal antibiotics (OR 2.29,) and total parenteral nutrition (TPN) (OR 2.99, 95% CL 1.32-6.77) continued to maintain statistical significance after gestational age adjustment.Conclusions: Eosinophilia is more likely in infants who are premature, receiving TPN, exclusively formula-fed, and whose mothers received antenatal antibiotics. Eosinophilia does not independently correlate with either feeding intolerance or NEC.