The Value of Human Milk Compared with Other Feeds for Premature Infants

Vm, Crosse; Em, Hickmans; Be, Howarth; Aubrey, J

doi:10.1136/adc.29.145.178

Cited by 24 publications

(3 citation statements)

References 10 publications

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“…The need and pressure to publish research in the peer review medical literature has created a immense amount of results that, in some instances, have not been validated by follow up studies [1,2]. Usually, the preliminary data of new discoveries in neonatal care, that promised great improvements in the survival and/or decrease morbidities and better quality of life, are done with great intentions and expectations and many times encompass the passion and lifelong commitment of the investigator to prove his/her theory [2,3]. Follow up studies to confirm the results of these preliminary findings often fail to show the claim or show serious side effects and complications [3][4][5][6][7].…”

Section: Editorialmentioning

confidence: 99%

Untitled

2015

JPNC

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A four year old boy presented with complaints of pain, redness and swelling in the region of the right parotid gland since 12 days. The pain and swelling was sudden in onset and gradually increasing causing difficulty in opening the mouth. There was associated low grade intermittent fever. The pain increased on eating. He was initially treated with a course of anti-biotics and anti-inflammatory medication, but the symptoms did not resolve.On examination, locally there was induration and tenderness in the region of the right parotid gland. Bimanual palpation revealed a palpable stone in the distal part of the right parotid duct. No discharge was seen from the parotid duct opening. Oral hygiene was good.The child was evaluated with an ultrasound scan which showed a 2-3mm hyperechogenic focus in the right parotid duct with proximal duct dilatation and increased echogenic reflectivity of the parotid gland. The finding was confirmed by a CT scan which showed a 3mm calculus just proximal to the ductal opening and a 4mm calcific focus in the parotid gland.The child's serum amylase (47 IU/ l), serum calcium (9.4mg/ dl) and routine blood tests were within normal limits.The child was taken up for surgery to remove the calculus. Few pus flakes were seen at the opening of the right parotid duct, but the culture showed no growth. The duct opening was stenotic and it was cannulated with a 24 French venflon after which the stone was found to have slipped proximally. The duct was then laid open over the venflon and flushed with saline. The calculus was flushed out by this method. The widened ductal opening was sutured to the surrounding mucosa with 6/0 absorbable suture.The child had an uneventful recovery with subsidence of the pain and swelling of the parotid gland. Case 2A three and a half year old boy presented with a parotid fistula on the external aspect of the left cheek, which intermittently discharged milky to clear fluid. This discharge was associated with bouts of pain and swelling. This pain and swelling was present since 3 weeks. It was managed conservatively without any resolution.On examination, a small opening of the fistula was seen on the external aspect of the left cheek 3cm above the angle of the mandible in front of the ear. There was puckering and redness of the surrounding skin. Clear discharge was seen from the fistula on squeezing the gland or the duct. On bimanual palpation a calculus was felt in the left parotid duct. Cervical lymph nodes were palpable and non-tender. Oral hygiene was poor with caries of the adjacent premolar tooth.An ultrasound scan showed a dilated left parotid duct with thick walls communicating with the discharging sinus on the skin. A 3mm calculus was noted in the distal end of the duct. These findings were confirmed by a CT scan.The child was taken up for surgery where in the left parotid AbstractSialolithiasis is mostly seen in adults and seldom develops in children. Calculi in dilated ducts can slip proximally during induction of general anaesthesia due to the supine position...

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Section: Editorialmentioning

confidence: 99%

Untitled

2015

JPNC

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“…Gaisford and Schofield in 1950 believed in a 3to 4-day period of starvation (Gaisford and Schofield, 1950). Crosse, writing in 1954, even believed that the survival of premature infants had been greatly improved by giving nothing by mouth for several days after birth and suggested starving the infants from 12 hours to 4 days after birth (Crosse et al, 1954).…”

Section: The Era Of Delayed Feedingmentioning

confidence: 99%

The first feed of low birthweight infants. Changing attitudes in the twentieth century.

Davies¹

1978

Archives of Disease in Childhood

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“…Usually, the preliminary data of new discoveries in neonatal care, that promised great improvements in the survival and/or decrease morbidities and better quality of life, are done with great intentions and expectations and many times encompass the passion and lifelong commitment of the investigator to prove his/her theory [2,3]. Follow up studies to confirm the results of these preliminary findings often fail to show the claim or show serious side effects and complications [3][4][5][6][7].The problem is that the medical community, when these positive results are published, tends to accept them as the new standard of care. These new advances are incorporated in…”

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confidence: 99%

Has the Time Come to Evaluate Studies Results before their Adoption as Standards of Care in the Neonatal Units?

Godoy¹

2015

JPNC

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Editorialhospitals and unit protocols and are offered to sick newborns without the benefit of statistically valid methods and medical due diligence [7]. Reports that have not been done with appropriate prospective randomization, blind allocation and stratification of selected target population, and with an adequate power and Beta error scrutiny, should be interpreted with caution [8]. All of these claims should be done ethically, and contain medical and statistic methods that study the possible complications and side effects of such procedures, before adopted as "golden standards".A recent example is the use of iNO in premature infants [9]. The preliminary results published by Dr. R. Ballard found in her population that iNO improved pulmonary outcomes. After that report, several studies (meta analysis) failed to confirm Dr. Ballard findings [10,11]. Even further, a recent propensity score modeling study by the National Institute of Health (NIH),in their generic database (GDB) that included data from 4979 of infants >22 and < 29 weeks gestation, found that the exposure to iNO in this population was associated with more severe outcomes [11]. I suggest to proceed with caution before the neonatal care community adopts these new findings as facts. We should read these reports for what they are, preliminary data that should be verified by follow up studies that are conducted in an ethical, medically sound and statistically well-designed manner [7].Many manuscripts end their conclusions with the reminder that their findings are limited to a small number or particular population and the need for further multicenter trials, to prove or disprove them. We should develop a group of investigators around the globe that take that challenge and in a systematic, well thought multi-center, prospective, randomized, blind method and study these preliminary results. The challenge is deep and extensive, but a well-organized and committed group could answer these important questions. EditorialThe need and pressure to publish research in the peer review medical literature has created a immense amount of results that, in some instances, have not been validated by follow up studies [1,2]. Usually, the preliminary data of new discoveries in neonatal care, that promised great improvements in the survival and/or decrease morbidities and better quality of life, are done with great intentions and expectations and many times encompass the passion and lifelong commitment of the investigator to prove his/her theory [2,3]. Follow up studies to confirm the results of these preliminary findings often fail to show the claim or show serious side effects and complications [3][4][5][6][7].The problem is that the medical community, when these positive results are published, tends to accept them as the new standard of care. These new advances are incorporated in

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The Value of Human Milk Compared with Other Feeds for Premature Infants

Cited by 24 publications

References 10 publications

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The first feed of low birthweight infants. Changing attitudes in the twentieth century.

Has the Time Come to Evaluate Studies Results before their Adoption as Standards of Care in the Neonatal Units?

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