Earlier initiation of enteral nutrition is associated with lower risk of late-onset bacteremia only in most mature very low birth weight infants

Abstract

Objective: To examine the temporal relationship between early enteral nutrition (EN) and coagulase-negative staphylococcal (CoNS)-related lateonset bacteremia (LOB) in very low birth weight (VLBW) neonates.Study Design: Multivariate analyses performed on a large retrospective cohort of neonates admitted to a tertiary care neonatal unit.Results: Due to the predominance and particular timing of CoNS, LOB occurred mostly during a critical period peaking at 9 days of age. This period also corresponded to a gestational maturation-dependent breakpoint in time to achieve full EN, associated with significant reduction in incidence of bacteremia (adjusted OR 0.15; 95%CI [0.10-0.20]; P<0.05). In subgroup analyses, more 'mature' (i.e. X28 and <32 weeks) preterm neonates reached full EN before this critical period and consequently, earlier EN in this group was associated with a shorter duration of PN and reduced incidence of CoNS bacteremia. In contrast, most 'immature' preterm neonates (i.e. <28 weeks) generally received PN beyond this critical period and therefore, did not appear to benefit from earlier initiation of EN. Even though EN was usually initiated earlier when formula milk was used as a complement to breast-milk, this practice was not associated with a reduction in the incidence of CoNS in any preterm gestational groups tested. Conclusion:A reduction in incidence of bacteremia was observed only in more mature VLBW neonates who achieved full EN before the secondweek of life critical period for CoNS, These results provide important endpoints for future trials evaluating changes in nutritional interventions potentially effective in reducing neonatal LOB.

Attenuated innate immune defenses in very premature neonates during the neonatal period

“…The risk of infections in these patients is greatest during the neonatal/early childhood period, underlining the importance of these receptors for immune protection during infancy (18,19). As shown from previous epidemiological studies, the incidence of sepsis sharply increases in these infants shortly after birth, peaking during the first week of postnatal age, then slowly declining thereafter (20,21). Although additional reasons may underlie the increased vulnerability of these infants to sepsis, including a high need for invasive life-saving interventions early on, and the prompt microbial colonization of their skin and mucosal membranes after birth, our data mirror this period of vulnerability.…”

Early inflammation in the absence of overt infection in preterm neonates exposed to intensive care

“…This increase in cytokine levels within the early SIP, in most cases, could not be attributed to infectious events (for illustration, see bottom panel, figure 1). Indeed, sepsis, NEC and intestinal perforation are uncommon during this period [17,19]. In our series, only 2 infants developed culture-proven sepsis during the first 72 hours of extra-uterine life while none of the infants developed NEC or intestinal perforation.…”

Prolonged Mechanical Ventilation: Challenges to Nurses and Outcome in Extremely Preterm Babies

“…2 Enteral feeding is ideal for optimum growth and development and prevention of infection in a preterm infant. 20 Practitioners vary in their process of initiating and advancing the feedings in preterm infants. Early initiation of trophic feeding is beneficial to all infants, particularly extremely preterm infants.…”

“…Practitioners must adjust the micronutrients daily; prolonged use of total parental nutrition can lead to complications such as cholestasis, infections, and longer hospitalizations. 2,20 Intravenous access adds to the risk for infection in extremely premature infants. Prolonged intubation necessitates tube feedings for extended periods.…”

“…Early initiation of trophic feeding is beneficial to all infants, particularly extremely preterm infants. 20 The volume of feeding may be advanced carefully and as tolerated on the basis of institution-specific protocols. Stable hemodynamic status and existing pathological changes and anomalies may determine the process used.…”