Prolonging Small Feeding Volumes Early in Life Decreases the Incidence of Necrotizing Enterocolitis in Very Low Birth Weight Infants

Berseth, Carol Lynn; Bisquera, Jennifer A; Paje, Virna U

doi:10.1542/peds.111.3.529

Cited by 302 publications

(185 citation statements)

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“…The primary outcome was the hospital stay duration; and the secondary outcomes were as follows: growth evaluated through weight, head circumference, length, growth rate and Rohrer's ponderal index; age at which partial enteral feeding and total enteral feeding were started; age at which partial oral feeding and total oral feeding were started; the occurrence of late onset sepsis (occurring at least 72 h after birth) evidenced by clinical manifestations and positive blood and/or cerebrospinal fluid cultures; 21 presence of necrotizing enterocolitis confirmed by clinical and radiological signs; 22 and presence of bronchopulmonary dysplasia characterized by oxygen dependence after 36 weeks of corrected GA. 23 Procedure During the entire hospitalization period, newborns received the same care, except for maternal massage; besides, mothers from both groups performed the skin-to-skin care.…”

Section: Variablesmentioning

confidence: 99%

Massage therapy reduces hospital stay and occurrence of late-onset sepsis in very preterm neonates

Mendes

Procianoy

2008

J Perinatol

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Objective: To study the effect of maternal massage therapy on hospital stay in very-low-birth-weight infants who were already submitted to skin-toskin care.Study Design: A randomized study was performed including infants of birth weight X750 and p1500 g and gestational age p32 weeks. The exclusion criteria were as follows: death before completing 48 h and presence of major malformations. Neonates were divided into intervention group (IG) (standard care plus maternal massage) and control group (CG). Anthropometric data were always verified by a person blind to the group to which the newborn belonged. Maternal massage was performed four times a day on the face and limbs. Passive exercises of upper and lower limbs were also done by the mothers.Result: A total of 104 newborns were included, 52 in each group. Both groups were similar in gestational age (IG: 29.7 ± 1.6; CG: 29.4 ± 1.6 weeks), birth weight (IG: 1186±194; CG: 1156±198 g), gender, number of small-for-gestational-age infants, SNAPPE-II, deaths, gains in weight, length and head circumference. Incidence of late-onset sepsis was significantly lower in the intervention group (IG: 10.8%, n ¼ 5; CG: 38.3%, n ¼ 18; P ¼ 0.005). IG was discharged from the hospital 7 days before CG (IG: 42, confidence interval (CI) 95%: 38 to 46; CG: 49, CI 95%: 42 to 56), and presented 1.85 hazard ratio (CI 95%: 1.09 to 3.13; P ¼ 0.023) for early discharge. Keywords: massage therapy; tactile stimulation; kinesthetic stimulation; very-low-birth-weight infants; neonatal sepsis Introduction Early interruption of gestation brings consequences that still cannot be fully avoided even in neonatal units with the most modern technological resources and best survival rates. There is a high probability of preterm infants going beyond the neonatal period before reaching a growth 1 and development 2 pattern similar to that of term newborns. In addition, the need for a long hospital stay period makes the presence of parents essential for assistance, once the parents' competence to understand and provide the premature infant's needs is consolidated as one of the main medical criteria for hospital discharge. 3 Studies involving the hospital stay period of preterm infants showed that relatively simple measures improve their prognoses, such as skin-to-skin contact reduces the painful sensation of term neonates 4 and promotes the development and parental relation of preterm infants; 5 the creation of a sleep-provoking environment increases the growth rate of very-low-birth-weight (VLBW) infants; 6 the application of tactile-kinesthetic stimulation contributes to both growth and development of preterm infants between 1000 and 2000 g, without adverse effects on physiological parameters; 7 instructions to first-child parents on how to bathe and massage favors parent-infant bonding; 8 and the participation of mothers through massage with moderate pressure improves growth and development rates of term infants. 9 Despite these evidences, in two systematic revisions, one regarding the tactile-kinesthetic s...

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Section: Variablesmentioning

confidence: 99%

Massage therapy reduces hospital stay and occurrence of late-onset sepsis in very preterm neonates

Mendes

Procianoy

2008

J Perinatol

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“…Necrotizing enterocolitis (NEC) 1 is the leading cause of death from gastrointestinal disease in neonates and is second to respiratory disease as the overall leading cause of morbidity and mortality in this population (1)(2)(3). Clinical manifestations of NEC include abdominal distention, feeding intolerance, and systemic sepsis, which result from the destruction of the intestinal barrier (4,5).…”

mentioning

confidence: 99%

Endotoxin Inhibits Intestinal Epithelial Restitution through Activation of Rho-GTPase and Increased Focal Adhesions

Çetin

Ford

Sysko

et al. 2004

Journal of Biological Chemistry

131

145

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Diseases of gut inflammation such as neonatal necrotizing enterocolitis (NEC) result after an injury to the mucosal lining of the intestine, leading to translocation of bacteria and endotoxin (lipopolysaccharide). Intestinal mucosal defects are repaired by the process of intestinal restitution, during which enterocytes migrate from healthy areas to sites of injury. In an animal model of NEC, we determined that intestinal restitution was significantly impaired compared with control animals. We therefore sought to determine the mechanisms governing enterocyte migration under basal conditions and after an endotoxin challenge. Here we show that the cytoskeletal reorganization and stress fiber formation required for migration in IEC-6 enterocytes requires RhoA. Enterocytes were found to express the endotoxin receptor Toll-like receptor 4, which served to bind and internalize lipopolysaccharide. Strikingly, endotoxin treatment significantly inhibited intestinal restitution, as measured by impaired IEC-6 cell migration across a scraped wound. Lipopolysaccharide was found to increase RhoA activity in a phosphatidylinositol 3-kinasedependent manner, leading to an increase in phosphorylation of focal adhesion kinase and an enhanced number of focal adhesions. Importantly, endotoxin caused a progressive, RhoA-dependent increase in cell matrix tension/contractility, which correlated with the observed impairment in enterocyte migration. We therefore conclude that endotoxin inhibits enterocyte migration through a RhoA-dependent increase in focal adhesions and enhanced cell adhesiveness, which may participate in the impaired restitution observed in experimental NEC.Necrotizing enterocolitis (NEC) 1 is the leading cause of death from gastrointestinal disease in neonates and is second to respiratory disease as the overall leading cause of morbidity and mortality in this population (1-3). Clinical manifestations of NEC include abdominal distention, feeding intolerance, and systemic sepsis, which result from the destruction of the intestinal barrier (4, 5). Mucosal breakdown may occur as a result of a perinatal insult, such as hypoxia, which allows bacteria and bacterial by-products to breach the normally impermeable mucosal barrier and initiate a local and systemic inflammatory response (4,6,7,9). This causes the release of proinflammatory cytokines, including tumor necrosis factor, platelet-activating factor, nitric oxide, and endotoxin, which lead to further epithelial injury (10 -13). Following mucosal damage, healing occurs initially through the process of epithelial restitution, in which healthy enterocytes adjacent to the sites of injury migrate toward the denuded mucosa to bridge the defect (14 -18). We hypothesize that the intestinal barrier defect in NEC does not result from epithelial injury alone but also from impaired restitution. This paper focuses specifically on the process of enterocyte migration, which is the sine qua non of epithelial restitution and mucosal healing.Although a variety of cytokines may be importan...

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“…40 One group was fed 20 ml/kg/day for the first 10 study days (minimal), while the other (advancing) was fed 20 ml/kg/day and was increased by 20 ml/kg/day up to 140 ml/kg/day. The study was closed early because seven infants who were assigned to advancing feeding volumes developed NEC, whereas only one infant fed minimal volumes did, or 10 versus 1.4%.…”

Section: Initiation and Advancement Of Enteral Feedingsmentioning

confidence: 99%

“…The study was closed early because seven infants who were assigned to advancing feeding volumes developed NEC, whereas only one infant fed minimal volumes did, or 10 versus 1.4%. 40 Does gut stimulation protect against or contribute to the development of NEC? Regardless, the study reinforces previous conclusions that gut stimulation protocols are beneficial to ELBW infants.…”

Section: Initiation and Advancement Of Enteral Feedingsmentioning

confidence: 99%

Pragmatic Approach to In-Hospital Nutrition in High-Risk Neonates

Adamkin

2005

J Perinatol

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Prolonging Small Feeding Volumes Early in Life Decreases the Incidence of Necrotizing Enterocolitis in Very Low Birth Weight Infants

Abstract: Given that advancing feeding volumes increase the risk of NEC without providing benefits for motor function or feeding tolerance, neonatologists should consider using minimal feeding volumes until future trials assess the safety of advancing feeding volumes.

Cited by 302 publications

References 24 publications

Massage therapy reduces hospital stay and occurrence of late-onset sepsis in very preterm neonates

Massage therapy reduces hospital stay and occurrence of late-onset sepsis in very preterm neonates

Endotoxin Inhibits Intestinal Epithelial Restitution through Activation of Rho-GTPase and Increased Focal Adhesions

Pragmatic Approach to In-Hospital Nutrition in High-Risk Neonates

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