Randomized Controlled Trial of Oropharyngeal Colostrum Administration in Very-low-birth-weight Preterm Infants. Oropharyngeal Colostrum Administration in Very Low Birth Weight Infants: A Randomized Controlled Trial* Oropharyngeal Administration of Colostrum Increases Salivary Secretory IgA Levels in Very Low‐Birth‐Weight Infants Continuous feeding promotes gastrointestinal tolerance and growth in very low birth weight infants. Role of Oropharyngeal Administration of Colostrum in Very-Low-Birth-Weight Infants for Reducing Necrotizing Enterocolitis: A Randomized Controlled Trial. Oral probiotics: Lactobacillus sporogenes for prevention of necrotizing enterocolitis in very low-birth weight infants: a randomized, controlled trial Oropharyngeal Administration of Mother's Milk Prior to Gavage Feeding in Preterm Infants: A Pilot Randomized Control Trial. Feeding of very-low-birth-weight infants with special formula--continued use beyond 2000 g and effects on growth to 1 year. Effects of human milk fortification on morbidity factors in very low birth weight infants. Does Visceral Osteopathic Treatment Accelerate Meconium Passage in Very Low Birth Weight Infants?- A Prospective Randomized Controlled Trial Bovine lactoferrin supplementation for prevention of necrotizing enterocolitis in very-low-birth-weight neonates: a randomized clinical trial. Bovine lactoferrin supplementation for prevention of late-onset sepsis in very low-birth-weight neonates: a randomized trial. The initial maternal cost of providing 100 mL of human milk for very low birth weight infants in the neonatal intensive care unit. Does the Enteral Feeding Advancement Affect Short-term Outcomes in Very Low Birth Weight Infants? Oropharyngeal Colostrum Administration in Extremely Premature Infants: An RCT A Randomized Trial of Nasopharyngeal-Synchronized Intermittent Mandatory Ventilation Versus Nasopharyngeal Continuous Positive Airway Pressure in Very Low Birth Weight Infants After Extubation Factors influencing body composition of premature infants at term-adjusted age. Early human milk feeding is associated with a lower risk of necrotizing enterocolitis in very low birth weight infants Cost Savings of Human Milk as a Strategy to Reduce the Incidence of Necrotizing Enterocolitis in Very Low Birth Weight Infants Do oral probiotics affect growth and neurodevelopmental outcomes in very low-birth-weight preterm infants? Hydrolyzed protein accelerates feeding advancement in very low birth weight infants. [Effects of probiotics on feeding intolerance in low birth weight premature infants]. Glutamine-enriched enteral nutrition in very low birth weight infants. Design of a double-blind randomised controlled trial [ISRCTN73254583]
OBJECTIVE The purpose of this study was to evaluate the effects of oropharyngeal colostrum administration in the incidence of late-onset clinical and proven sepsis and in concentrations of immunoglobulin A ( IgA ) in very-low-birth-weight ( VLBW ) infants . METHODS We conducted a double-blinded , r and omized , placebo-controlled trial and assigned 113 VLBW infants to receive 0.2 mL of maternal colostrum or sterile water ( placebo ) via oropharyngeal route every 2 hours for 48 hours , beginning in the first 48 to 72 hours of life . Neonates of both groups were fed breast milk from the first 3 days of life until a volume of at least 100 mL · kg · day . IgA was measured in serum and urine before and after treatment . Clinical data during hospitalization were collected . RESULTS We found no statistically significant differences between colostrum and placebo groups in the incidence of late-onset clinical sepsis ( odds ratio 0.7602 ; CI 95 % 0.3 - 1.6 ) and proven sepsis ( odds ratio 0.7028 ; CI 95 % 0.3 - 1.6 ) . The measurement of IgA was similar in serum before ( P value 0.87 ) and after treatment ( P value 0.26 day 4 and 0.77 day 18 ) . No differences were also observed in IgA in urine before ( P value 0.8 ) and after treatment ( P value 0.73 day 4 and 0.52 ) . CONCLUSIONS This study could not confirm the hypothesis that oropharyngeal administration of maternal colostrum to VLBW could reduce the incidence of late-onset sepsis and increase the levels of IgA. We believe that this finding can be justified by the practice of feeding VLBW infants exclusively with breast milk in the first days of life and reinforces the prior knowledge of the importance of early nutrition , especially , with human milk . It also suggests that oropharyngeal administration of colostrum should be reserved for neonates who can not be fed in first few days of life Objectives : Studies have confirmed the safety of oropharyngeal administration of colostrum in very low birth weight infants . However , the effect of oropharyngeal administration of colostrum on immune system is inconclusive . This study aims to evaluate the effect of oropharyngeal administration of colostrum on secretory immunoglobulin A and lactoferrin in very low birth weight infants . Design : R and omized controlled trial . Setting : Forty-bedded neonatal ICU in a university children ’s hospital in the People ’s Republic of China . Patients : Very low birth weight infants were allocated to the study group ( n = 32 ) and control group ( n = 32 ) . Intervention : The intervention was oropharyngeal administration of 0.2 mL of their mother ’s colostrum every 4 hours for 7 days . The control group received saline solution . Measurements and Main Results : Secretory immunoglobulin A and lactoferrin in urine and saliva were measured within 24 hours of life ( baseline ) and at 7 and 21 days . Primary outcomes were changes of secretory immunoglobulin A and lactoferrin in urine and saliva between baseline and at 7 and 21 days . Infant ’s clinical data were also collected during hospitalization . Change from baseline in lactoferrin in saliva at 7 days ( 5.18 ± 7.07 vs –1.74 ± 4.67 µg/mL ; p < 0.001 ) and 21 days ( 5.31 ± 9.74 vs –1.17 ± 10.38 µg/mL ; p = 0.02 ) shows statistic difference . No differences were found of lactoferrin in urine and also no differences of secretory immunoglobulin A in urine and saliva . There were also no differences between days to full enteral feeding , occurrence rate of clinical sepsis , proven sepsis , and necrotizing enterocolitis . Conclusions : Oropharyngeal administration of colostrum can increases the level of lactoferrin in saliva in very low birth weight infants . No effect could be documented of secretory immunoglobulin A and lactoferrin in urine . Larger trials are needed to better describe the benefit of oropharyngeal administration of colostrum , if any , in very low birth weight infants Aim Oropharyngeal administration of colostrum ( OAC ) has been proposed to provide mother 's early milk to very low‐birth‐weight ( VLBW ) infants in the first few days of life . The aim of this study was to test the hypothesis that OAC would increase salivary secretory IgA ( SsIgA ) . Patients and Methods Overall , 30 VLBW infants r and omized to receive OAC or sterile water  had salivary sampling for SsIgA on the day of life ( DOL ) 2 , 7 , and 14 . The incidence of late‐onset sepsis ( LOS ) and necrotizing enterocolitis ( NEC ) was determined prospect ively . Within and between‐group comparisons were made by paired and independent sample s t ‐tests . Results Baseline characteristics were similar between groups . SsIgA was higher in OAC versus the control group ( p < 0.05 ) on DOL 7 , but not subsequently on DOL 14 . There was no difference in LOS or NEC . Conclusion OAC  increased SsIgA at DOL 7 . A large , multicenter trial is needed to determine if OAC  decreases LOS or NEC in VLBW infants OBJECTIVE To compare the effects of continuous versus intermittent feeding on gastrointestinal tolerance and growth in very low birth weight ( VLBW ) infants . STUDY DESIGN In a r and omized , controlled trial conducted at 3 neonatal units , 70 premature infants with a gestational age 24 to 29 weeks and birth weight < 1200 g were assigned to 1 of 3 feeding methods : continuous nasogastric feeding , intermittent nasogastric feeding , or intermittent orogastric feeding . Feeding was initiated within 30 hours of birth . Daily enteral and parenteral volumes , caloric and protein intakes , growth , enteral intolerance , and clinical complications were recorded . Cox regression analysis was used to determine primary outcome , the time to achieve full enteral feeding . RESULTS The continuously fed infants achieved full enteral feeding significantly faster than the intermittently fed infants ( hazard ratio [ HR ] = 1.86 ; 95 % confidence interval [ CI ] = 1.07 to 3.22 ) . In stratified analysis according to birth weight , the improvement was even more pronounced in the smallest infants , those with birth weight < or = 850 g ( adjusted HR = 4.13 ; 95 % CI = 1.48 to 11.53 ) . Growth rate was significantly faster in the continuously fed infants ( P = .002 ) . CONCLUSION In VLBW infants , continuous feeding seems to be better than intermittent feeding with regard to gastrointestinal tolerance and growth AIM To study the role of oropharyngeal administration of colostrum ( OAC ) in very-low-birth-weight infants for reducing necrotizing enterocolitis ( NEC ) . STUDY DESIGN In this r and omized controlled trial , 117 infants were enrolled , 59 were r and omized to OAC group and 58 to routine care group . Infants with birth weight ≤ 1,250 g and /or gestational age ≤ 30 weeks were enrolled . Infants in OAC group received maternal colostrum ( 0.2 mL ) , 0.1 mL on either side , after 24 hours of postnatal life and were given every 2 hour for the next 72 hours irrespective of the enteral feeding status of the neonate . The primary outcome of the study was the incidence of NEC ( stage 2 or 3 ) . RESULTS Baseline characteristics were comparable between the two groups . There was no significant reduction in the incidence of NEC  in OAC group ( 0 [ 0 % ] vs. 3 [ 7.1 % ] ; p = 0.11 ) . There was significant reduction of 7 days of hospital stay  in OAC group ( 34.2 ± 5.7 vs. 41.5 ± 6.7 days ; p = 0.04).The incidence of early-onset sepsis , late-onset sepsis , blood culture positive sepsis , and ventilator-associated pneumonia were comparable between the two groups . CONCLUSION OAC  is safe and reduces the duration of hospital stay Background / Objective : The identification of probiotic species involved in gut homeostasis and their potential therapeutic benefits have led to an interest in their use for preventing necrotizing enterocolitis ( NEC ) . Although bifidobacterium and lactobacilli sp. have been used to reduce the incidence of NEC in clinical trials . Lactobacillus sporogenes has not been used in the prevention of NEC in very low-birth weight infants yet . The objective of this study was to evaluate the efficacy of orally administered L sporogenes in reducing the incidence and severity of NEC in very low-birth weight ( VLBW ) infants . Subjects/ Methods : A prospect i ve , blinded , r and omized controlled trial was conducted in preterm infants with a gestational age of <33 weeks or birth weight of < 1500 g. VLBW infants who survived to start enteral feeding were r and omized into two groups The infants in the study group were given L. sporogenes with a dose of 350 000 000 c.f.u . added to breast milk or formula , once a day , starting with the first feed until discharged . The infants in the control group were fed without L. sporogenes supplementation . The primary outcome measurement was death or NEC ( Bell 's stage ⩾2 ) . Results : A total of 221 infants were studied : 110 in the study group and 111 in the control group . There was no significant difference in the incidence of death or NEC between the groups . Feeding intolerance was significantly lower in the probiotics group than in the control group ( 44.5 % ( n : 49 ) vs 63.1 % ( n : 70 ) , respectively ; P=0.006 ) . Conclusions : L. sporogenes supplementation at the dose of 350 000 000 c.f.u/day is not effective in reducing the incidence of death or NEC in VLBW infants , however , it could improve the feeding tolerance BACKGROUND Oropharyngeal administration of mother 's colostrum in early days has an immunoprotective effect in preterm infants . OBJECTIVES Our aim was to study the effect of oropharyngeal administration of mother 's milk ( OPAMM ) on decreasing the incidence of nosocomial sepsis . METHODS In a pilot prospect i ve r and omized study on preterm ( < 32 weeks gestation and 1500 g weight ) infants , we compared OPAMM practice ( applying 0.2 mL of mother 's colostrum or milk prior to gavage feeding until full oral feeding is reached ) with regular gavage feeding . The primary outcome was incidence of culture-proven nosocomial sepsis . Secondary outcomes included bacterial colonization of the gastrointestinal tract , feeding intolerance , time to reach full feeding , incidence of necrotizing enterocolitis , ventilator-associated pneumonia , duration of respiratory support , incidence of bronchopulmonary dysplasia ( BPD ) , length of hospital stay , and neonatal mortality . RESULTS The outcomes of 200 neonates ( 100 in each group ) were analyzed . OPAMM practice did not significantly reduce the incidence of culture proven nosocomial sepsis ( 8 % vs 13 % , P = 0.35 ) . Infants in the OPAMM group had a significantly lower growth of Klebsiella species in the oropharyngeal pouch , borderline lower incidence of ventilator-associated pneumonia , shorter duration of oxygen therapy , less episodes of feeding intolerance , reached full feeding earlier , and had a shorter length of hospital stay .  OPAMM practice did not affect the incidence of necrotizing enterocolitis , BPD , or neonatal mortality . CONCLUSION OPAMM prior to gavage feeding does not reduce the incidence of nosocomial sepsis but had beneficial effects on early achievement of feeding , and early hospital discharge in preterm very low-birth-weight infants Ten very-low-birth-weight ( VLBW ) infants fed a premature formula up to a weight of 2 000 g were r and omized either to continue on the premature formula for a further 8 weeks or to change to a st and ard infant formula .  Four infants in each group completed the 8-week study period , while growth and biochemical data were available on the other 2 infants for half the study period . No significant differences were seen at the end of the study . Infants on the premature formula showed a trend towards more rapid growth during the 8-week period , but this was no longer evident at a corrected age of 3 months . All infants were followed up to a corrected age of 1 year , during which time growth curves were similar to those previously described for VLBW infants . No long-term tendency towards obesity was evident in these infants , who had gained weight up to 2 000 g at a rate equivalent to the intra-uterine rate BACKGROUND The use of human milk as a sole source of nutrients for preterm infants has been the subject of debate in recent years . We studied the morbidity factors associated with hospitalization of very low birth weight ( VLBW ) infants fed human milk with and without fortification . PATIENTS AND METHODS One hundred VLBW infants were r and omly assigned to two groups with stratification for gestation and weight . The  control group ( n-50 ; mean birth weight 1239+/-186 g and mean gestation 29.3+/-2.1 wks ) was fed human milk only , and in the fortifier group ( n=50 ; mean birth weight 1245+/-191 g and mean gestation 29.5+/-2.1 wks ) , human milk was enriched with a fortifier after the babies reached a volume of 140 mL/kg/day by the enteral route . Weight was measured twice weekly , biochemical indices of nutritional and bone status and serum electrolytes were obtained weekly , and clinical evidence for sepsis , necrotizing enterocolitis and feeding intolerance was assessed regularly until infants were discharged . RESULTS Hospital stay was less than 45 days in the majority ( 94 % ) of the babies in the fortifier group , whereas the majority ( 66 % ) of the babies in the control group stayed for more than 45 days ( P<0.01 ) . Low serum phosphorus and raised alkaline phosphate levels were seen more frequently in the control group without fortification ( p<0.01 ) , as weel as hyponatremia ( P<0.01 ) , late metabolic acidosis of prematurity ( P<0.01 ) and culture-proven sepsis ( p<0.05 ) . There was no significant difference in the occurrence of necrotizing enterocolitis between the two groups ( P>0.05 ) . CONCLUSION Human milk fortification has beneficial effects on the growth of VLBW infants and decreases hospital stay and morbidity associated with prematurity and very low birth weight , with economic and psychological benefits for the parents Background To determine whether the complementary approach of visceral manipulative osteopathic treatment accelerates complete meconium excretion and improves feeding tolerance in very low birth weight infants . Methods This study was a prospect i ve , r and omized , controlled trial in premature infants with a birth weight < 1500 g and a gestational age < 32 weeks who received a visceral osteopathic treatment 3 times during their first week of life or no treatment .  Results Passage of the last meconium occurred after a median of 7.5 days ( 95 % confidence interval : 6–9 days , n = 21 ) in the intervention group and after 6 days ( 95 % confidence interval : 5 - 9 days , n = 20 , ) in the control group ( p = 0.11 ) . However , osteopathic treatment was associated with a 8 day longer time to full enteral feedings ( p = 0.02 ) , and a 34 day longer hospital stay ( Median = 66 vs. 100 days i.e. ; p=0.14 ) . Osteopathic treatment was tolerated well and no adverse events were observed . Conclusions Visceral osteopathic treatment of the abdomen did not accelerate meconium excretion in VLBW ( very low birth weight)-infants . However infants in the osteopathic group had a longer time to full enteral feedings and a longer hospital stay , which could represent adverse effects . Based on our trial results , we can not recommend visceral osteopathic techniques in VLBW-infants . Trial registration Clinical trials.gov : IMPORTANCE NEC is a common and severe complication in premature neonates , particularly those with very-low-birth-weight ( VLBW , < 1500 g at birth ) .  Probiotics including lactobacillus rhamnosus GG ( LGG ) proved effective in preventing NEC in preterm infants in several RCTs . OBJECTIVE Lactoferrin , a mammalian milk glycoprotein involved in innate immune host defences , can reduce the incidence of NEC in animal models , and its action is enhanced by LGG . We tried to assess whether bovine lactoferrin ( BLF ) , alone or with the probiotic LGG , has a similar effect in human infants , something that has not yet been studied . DESIGN An international , multicenter , r and omized , double-blind , placebo-controlled trial conducted from October 1st , 2007 through July 31st , 2010 . SETTING Thirteen Italian and New Zeal and tertiary neonatal intensive care units . PARTICIPANTS 743 VLBW neonates were assessed until discharge for development of NEC . INTERVENTION Infants were r and omly assigned to receive orally either BLF ( 100 mg/day ) alone ( group LF ; n = 247 ) or with LGG ( at 6 × 10(9 ) CFU/day ; group BLF + LGG ; n = 238 ) , or placebo ( Control group ; n = 258 ) from birth until day 30 of life ( 45 for neonates < 1000 g at birth ) . MAIN OUTCOME MEASURES ≥ stage 2 NEC ; death- and /or-≥ stage 2 NEC prior to discharge . RESULTS Demographics , clinical and management characteristics of the 3 groups were similar , including type of feeding and maternal milk intakes . NEC incidence was significantly lower in groups BLF and BLF + LGG [ 5/247 ( 2.0 % ) ] and 0/238 ( 0 % ) , respectively ] than in controls [ 14/258 ( 5.4 % ) ] ( RR = 0.37 ; 95 % CI : 0.136 - 1.005 ; p = 0.055 for BLF vs. control ; RR = 0.00 ; p < 0.001 for BLF + LGG vs. control ) . The incidence of death- and /or-NEC was significantly lower in both treatment groups ( 4.0 % and 3.8 % in BLF and BLF + LGG vs. 10.1 % in control ; RR = 0.39 ; 95 % CI : 0.19 - 0.80 ; p = 0.008 . RR = 0.37 ; 95 % CI : 0.18 - 0.77 ; p = 0.006 , respectively ) . No adverse effects or intolerances to treatment occurred . CONCLUSIONS AND RELEVANCE Compared with placebo , BLF supplementation alone or in combination with LGG reduced the incidence of ≥ stage 2 NEC and of death- and /or ≥ stage 2 NEC in VLBW neonates . BLF might be a promising strategy to prevent NEC in NICU setting s. Further data on larger sample sizes are warranted before BLF can be widespreadly used in clinical setting s. TRIAL REGISTRATION IS RCT N53107700-http://www.controlled-_trials.com/IS RCT N53107700 CONTEXT Sepsis is a common and severe complication in premature neonates , particularly those with very low birth weight ( VLBW ) ( < 1500 g ) . Whether lactoferrin , a mammalian milk glycoprotein involved in innate immune host defenses , can reduce the incidence of sepsis is unknown . In animal models , the probiotic Lactobacillus rhamnosus GG ( LGG ) enhances the activity of lactoferrin but has not been studied in human infants . OBJECTIVE To establish whether bovine lactoferrin ( BLF ) , alone or in combination with LGG , reduces the incidence of late-onset sepsis in VLBW neonates . DESIGN , SETTING , AND PATIENTS Prospect i ve , multicenter , double-blind , placebo-controlled , r and omized trial conducted in 11 Italian tertiary neonatal intensive care units . Patients were 472 VLBW infants enrolled from October 1 , 2007 , through July 31 , 2008 , and assessed until discharge for development of sepsis . INTERVENTION Infants were r and omly assigned to receive orally administered BLF ( 100 mg/d ) alone ( n = 153 ) , BLF plus LGG ( 6 x 10(9 ) colony-forming units/d ) ( n = 151 ) , or placebo ( n = 168 ) from birth until day 30 of life ( day 45 for neonates < 1000 g at birth ) . MAIN OUTCOME MEASURE First episode of late-onset sepsis , ie , sepsis occurring more than 72 hours after birth with isolation of any pathogen from blood or from peritoneal or cerebrospinal fluid . RESULTS Demographic , clinical , and management characteristics of the 3 groups were similar , including type of feeding and intake of maternal milk . Incidence of late-onset sepsis was significantly lower in the BLF and BLF plus LGG groups ( 9/153 [ 5.9 % ] and 7/151 [ 4.6 % ] , respectively ) than in the control group receiving placebo ( 29/168 [ 17.3 % ] ) ( risk ratio , 0.34 ; 95 % confidence interval , 0.17 - 0.70 ; P = .002 for BLF vs control and risk ratio , 0.27 ; 95 % confidence interval , 0.12 - 0.60 ; P < .001 for BLF plus LGG vs control ) . The decrease occurred for both bacterial and fungal sepsis . No adverse effects or intolerances to treatment occurred . CONCLUSION Compared with placebo , BLF supplementation alone or in combination with LGG reduced the incidence of a first episode of late-onset sepsis in VLBW neonates . TRIAL REGISTRATION is rct n.org Identifier : IS RCT N53107700 OBJECTIVES Human milk ( HM ) feeding is associated with lower incidence and severity of costly prematurity-specific morbidities compared to formula feeding in very low birth weight ( VLBW ; < 1,500 g ) infants . However , the costs of providing HM are not routinely reimbursed by payers and can be a significant barrier for mothers . This study determined the initial maternal cost of providing 100 mL of HM for VLBW infants during the early neonatal intensive care unit ( NICU ) stay . METHODS This secondary analysis examined data from 111 mothers who provided HM for their VLBW infants during the early NICU stay . These data were collected during a multisite , r and omized clinical trial where milk output and time spent pumping were recorded for every pumping session ( n = 13,273 ) . The cost analysis examined the cost of the breast pump rental , pump kit  , and  maternal opportunity cost  ( an estimate of the cost of maternal time ) . RESULTS Mean daily milk output and time spent pumping were 558.2 mL ( SD = 320.7 ; range = 0 - 2,024 ) and 98.7 minutes ( SD = 38.6 ; range = 0 - 295 ) , respectively . The mean cost of providing 100 mL of HM  varied from $ 2.60 to $ 6.18 when maternal opportunity cost was included and from $ 0.95 to $ 1.55 when it was excluded . The cost per 100 mL of HM  declined with every additional day of pumping and was most sensitive to the costs of the breast pump rental and pump kit . CONCLUSIONS These findings indicate that HM is reasonably inexpensive to provide and that the maternal cost of providing milk is mitigated by increasing milk output over the early NICU stay Background and Objectives : Controversy exists regarding the optimal enteral feeding regimen of very low birth weight infants ( VLBW ) . Rapid advancement of enteral feeding has been associated with an increased rate of necrotizing enterocolitis . In contrast , delaying enteral feeding may have unfavorable effects on nutrition , growth , and neurodevelopment . The aim is to compare the short-term outcomes of VLBW infants in tertiary care centers according to their enteral feeding advancement . Patients and Methods : We prospect ively studied the influence of center-specific enteral feeding advancement in 1430 VLBW infants recruited from 13 tertiary neonatal intensive care units in Germany on short-term outcome parameters . The centers were post hoc stratified to “ rapid advancement to full enteral feeds ” ( median duration of advancement to full enteral feeds ≤12.5 days ; 6 centers ) , that is , rapid advancement ( RA ) , or “ slow advancement to full enteral feeds ” ( median duration of advancement to full enteral feeds > 12.5 days ; 7 centers ) , that is , slow advancement ( SA ) . Results : VLBW infants born in centers with SA ( n = 713 ) had a significantly higher rate of sepsis compared with VLBW infants born in centers with RA ( n = 717 ) , which was particularly evident for late-onset sepsis ( 14.0 % vs 20.4 % ; P = 0.002 ) . Furthermore , more central venous lines ( 48.6 % vs 31.1 % , P < 0.001 ) and antibiotics ( 92.4 % vs 77.7 % , P < 0.001 ) were used in centers with SA . Conclusions : Center differences in enteral feeding advancement occur and may have a significant impact on short-term outcomes such as nosocomial sepsis . Large , multicenter , prospect i ve trials are required to further eluci date the optimal feeding strategy for VLBW infants OBJECTIVE : To determine the immunologic effects of oropharyngeal colostrum administration in extremely premature infants . METHODS : We conducted a double-blind , r and omized , placebo-controlled trial involving 48 preterm infants born before 28 weeks ’ gestation . Subjects received 0.2 mL of their mother ’s colostrum or sterile water via oropharyngeal route every 3 hours for 3 days beginning at 48 to 96 hours of life . To measure concentrations of secretory immunoglobulin A , lactoferrin , and several immune substances , urine and saliva were obtained during the first 24 hours of life and at 8 and 15 days . Clinical data during hospitalization were collected . RESULTS : Urinary levels of secretory immunoglobulin A at 1 week ( 71.4 vs 26.5 ng/g creatinine , P = .04 ) and 2 weeks ( 233.8 vs 48.3 ng/g creatinine , P = .006 ) , and lactoferrin at 1 week ( 3.5 vs 0.9 μg/g creatinine , P = .01 ) were significantly higher in colostrum group . Urine interleukin-1β level was significantly lower in colostrum group at 2 weeks ( 55.3 vs 91.8 μg/g creatinine , P = .01 ) . Salivary transforming growth factor-β1 ( 39.2 vs 69.7 μg/mL , P = .03 ) and interleukin-8 ( 1.2 vs 4.9 ng/mL , P = .04 ) were significantly lower at 2 weeks in colostrum group . A significant reduction in the incidence of clinical sepsis was noted in colostrum group ( 50 % vs 92 % , P = .003 ) . CONCLUSIONS : This study suggests that oropharyngeal administration of colostrum may decrease clinical sepsis , inhibit secretion of pro-inflammatory cytokines , and increase levels of circulating immune-protective factors in extremely premature infants . Larger studies to confirm these findings are warranted OBJECTIVE : To prospect ively compare the incidence of respiratory failure in premature infants r and omized to receive either nasopharyngeal continuous positive airway pressure ( NPCPAP ) or nasopharyngeal-synchronized intermittent m and atory ventilation ( NP-SIMV )  in the immediate postextubation period . STUDY DESIGN : This is a prospect i ve study of very low birth weight ( VLBW ) infants r and omized at the time of extubation to receive either NPCPAP or NP-SIMV in a university-based level III neonatal intensive care unit . Statistical analysis were performed with the Mann-Whitney U test for continuous and ordinal variables , and with the χ-squared test or Fisher ’s exact test for categorical variables . RESULTS : A total of 41 VLBW infants were studied ; 19 were in the NPCPAP group , and 22 were in the NP-SIMV group . Respiratory failure after extubation in the NP-SIMV group was significantly lower than in the NPCPAP group ( 5 % vs 37 % , respectively ) ( p = 0.016 ) . No statistically significant differences between groups with regard to demographics , severity of initial illness and associated complications , time to extubation , ventilatory management before extubation , weight , age , or nutritional status at the time of extubation were noted . CONCLUSION : NP-SIMV applied to VLBW infants upon extubation is more effective in preventing respiratory failure than NPCPAP We investigated the influence of body size at birth , feeding of mother 's milk versus formula , or st and ard-term formula versus energy- or nutrient-enriched formula on the growth and whole body bone mineral content ( BMC ) , lean and fat mass ( using dual-energy X-ray absorptiometry ) of low-birth-weight ( LBW ) infants to term-adjusted age . LBW infants who were appropriate for gestational age were lighter and shorter than term-born infants ( n = 46 ) but had a higher percent fat mass ( 19 - 28 % vs. 15 + /- 7 % ) . For LBW infants fed st and ard formula or mother 's milk after hospital discharge , the mean BMC expressed either as a function of weight ( 17 + /- 2 , 19 + /- 2 vs. 20 + /- 2 g/kg ) or length ( 1.1 + /- 0.2 , 1.1 + /- 0.2 vs. 1.5 + /- 0.2 g/cm ) was more than 1 SD below term infant values . However , infants fed a nutrient-enriched formula from hospital discharge had BMC within 1 SD below term infants . Infants who were born small , compared to appropriate for gestational age , compared to infants of similar birth weight had lower percent body fat ( 16 + /- 6 vs. 19 + /- 5 ) and lower BMC ( 47 + /- 3 vs. 62 + /- 5 g ) at term age . Both size at birth and diet influence patterns of growth and body composition in early life in very-low-birth-weight ( VLBW ) infants . The long-term significance of these variable growth patterns in VLBW infants in early life requires further investigation Background : Necrotizing enterocolitis ( NEC ) is a frequent cause of mortality and morbidity in very low birth weight ( VLBW ) infants .  Human milk ( HM ) feeding has been associated with lower risk of NEC . However , mothers of VLBW infants often experience insufficient milk production , result ing in mixed feedings of HM and formula . Moreover , medical complications often limit the volume of feeding they can be given . Objective : To determine if high proportions of ( 50 % or greater ) HM enteral feeding within the first 14 days of life are protective against NEC . Method : This was a prospect i ve cohort study of VLBW infants who were grouped according to the HM proportion of enteral feeding in the first 14 days : < 50 % ( low human milk , LHM , n=46 ) and ⩾50 % ( high human milk , HHM , n=156 ) . The outcome of interest was development of NEC ( Bell stage 2 or 3 ) . Logistic regression was used to estimate odds ratios ( OR ) and 95 % confidence intervals ( CI ) and to assess potential confounding due to perinatal risk factors . Result : Two hundred and two infants were studied . Confirmed NEC occurred in 5/46 ( 10.6 % ) of the LHM group , as compared with 5/156 ( 3.2 % ) of the HHM . Gestational age was the only perinatal factor associated with risk of NEC . After adjustment for gestational age , HHM was associated with a lower risk of NEC ( ( OR=0.17 , 95 % CI : 0.04 to 0.68 ) , P=0.01 ) . Conclusion : Enteral feeding containing at least 50 % HM in the first 14 days of life was associated with a sixfold decrease in the odds of NEC Background : Necrotizing enterocolitis ( NEC ) is a costly morbidity in very low birth weight ( VLBW ; < 1,500 g birth weight ) infants that increases hospital length of stay and requires expensive treatments . Objectives : To evaluate the cost of NEC as a function of dose and exposure period of human milk ( HM ) feedings received by VLBW infants during the neonatal intensive care unit ( NICU ) hospitalization and determine the drivers of differences in NICU hospitalization costs for infants with and without NEC . Methods : This study included 291 VLBW infants enrolled in an NIH-funded prospect i ve observational cohort study between February 2008 and July 2012 . We examined the incidence of NEC , NICU hospitalization cost , and cost of individual re sources used during the NICU hospitalization . Results : Twenty-nine ( 10.0 % ) infants developed NEC . The average total NICU hospitalization cost ( in 2012 USD ) was USD 180,163 for infants with NEC and USD 134,494 for infants without NEC ( p = 0.024 ) . NEC was associated with a marginal increase in costs of USD 43,818 , after controlling for demographic characteristics , risk of NEC , and average daily dose of HM during days 1 - 14 ( p < 0.001 ) . Each additional ml/kg/day of HM during days 1 - 14 decreased non-NEC-related NICU costs by USD 534 ( p < 0.001 ) . Conclusions : Avoidance of formula and use of exclusive HM feedings during the first 14 days of life is an effective strategy to reduce the risk of NEC and result ing NICU costs in VLBW infants . Hospitals investing in initiatives to feed exclusive HM during the first 14 days of life could substantially reduce NEC-related NICU hospitalization costs OBJECTIVE To evaluate the growth and neurodevelopment outcomes of very low-birth-weight ( VLBW ) preterm infants supplemented with oral probiotics for the prevention of necrotizing enterocolitis ( NEC ) . STUDY DESIGN This prospect i ve follow-up study was conducted in a cohort of VLBW preterm infants enrolled in a r and omized controlled clinical trial to evaluate the efficacy of oral probiotics for the prevention of NEC . Growth outcomes included weight , length , and head circumference . Cognitive and neuromotor development were assessed by using the Bayley Scales of Infant Development II . Sensory and neurological performance was evaluated by st and ard techniques . The primary outcome was neurodevelopmental impairment at 18 to 22 months ' corrected age . RESULTS A total of 221 infants completed the trial protocol . Of the 208 infants eligible for follow-up , 174 infants ( 86 in the probiotics group and 88 in the control group ) were evaluated . There was no significant difference in growth and neurodevelopmental outcomes between the two groups . CONCLUSION Oral probiotic administered to VLBW infants to reduce the incidence and severity of NEC started with the first feed did not affect growth , neuromotor , neurosensory , and cognitive outcomes at 18 to 22 months ' corrected age BACKGROUND Feeding intolerance is common in very low birth weight ( VLBW ; < 1500 g ) infants .  Hydrolyzed protein preterm infant formula ( HPF ) has been shown to accelerate the gastrointestinal transit of formula . The aim of this study was to investigate whether HPF improves early feeding tolerance compared with st and ard preterm infant formula ( SPF ) . We hypothesized that HPF would accelerate early enteral feeding advancement . METHODS Primary outcome was the time from initiation of milk feeds until full feeds ( 150 mL/kg birth weight/d ) were achieved in infants who received < 10 % human milk ( HM ) to exclude HM as a confounder . Because the availability of HM was not predictable at the time of enrollment , all eligible VLBW infants ( n = 129 ) were r and omly assigned in a r and omized , controlled trial to receive HPF or SPF if HM was not available . Infants who received > 10 % HM ( n = 42 ) were excluded . Milk bolus feeding every 2 to 3 hours was started at the discretion of the attending physician and advanced by 16 mL/kg/d . Prepr and ial gastric residuals were tolerated up to 5 mL/kg ; otherwise , feedings were reduced or withheld . Data are shown as median ( 5th and 95th percentile ) . RESULTS Forty-six and 41 ( HPF vs SPF ) infants received < 10 % HM . There was no significant difference with regard to birth weight , gestational age , and onset of milk feeds ( day 3 [ 1 - 8 ] vs 4 [ 2 - 6 ] ) . The time from initiation of milk feeds to full feeds was significantly shorter with HPF feeding ( 10 [ 9 - 27 ] vs 12 [ 9 - 28 ] days ) . CONCLUSION HPF improved the feeding tolerance and enabled a more rapid establishment of full enteral feeding in VLBW infants compared with SPF OBJECTIVE To study the efficacy and safety of probiotics for the prevention of feeding intolerance in low birth weight ( LBW ) premature infants . METHODS Sixty eligible LBW premature infants were r and omly divided into probiotics and conventional treatment groups ( n=30 each ) . Both groups received treatment of the primary disease . Additionally , the probiotics treatment group was administered with probiotics ( 0.25 g , twice daily ) . The incidence of feeding intolerance , the time to regain birth weight and to reach full enteral nutrition and the length of hospitalization were compared between the two groups . The occurrence of adverse reactions was recorded . RESULTS The incidence of feeding intolerance in the probiotics treatment group was lower than that in the conventional treatment group ( 4 % vs 14 % ; P<0.01 ) . The time to regain birth weight ( 6.8±1.2 days vs 7.7±1.6 days ; P<0.05 ) and the time to reach full enteral nutrition ( 8.0±1.4 days vs 9.0±2.0 days ; P<0.05 ) in the probiotics treatment group were shorter than those in the conventional treatment group . No adverse reactions were observed in the probiotics treatment group . CONCLUSIONS Probiotics can reduce the incidence of feeding intolerance in LBW premature infants , can promote weight gain and shorten the time to reach full enteral nutrition . The application of probiotics appears to be safe in LBW premature infants Background Enteral feeding of very low birth weight ( VLBW ) infants is a challenge , since metabolic dem and s are high and administration of enteral nutrition is limited by immaturity of the gastrointestinal tract . The amino acid glutamine plays an important role in maintaining functional integrity of the gut . In addition , glutamine is utilised at a high rate by cells of the immune system . In critically ill patients , glutamine is considered a conditionally essential amino acid . VLBW infants may be especially susceptible to glutamine depletion as nutritional supply of glutamine is limited in the first weeks after birth . Glutamine depletion has negative effects on functional integrity of the gut and leads to immunosuppression . This double-blind r and omised controlled trial is design ed to investigate the effect of glutamine-enriched enteral nutrition on feeding tolerance , infectious morbidity and short-term outcome in VLBW infants . Furthermore , an attempt is made to eluci date the role of glutamine in postnatal adaptation of the gut and modulation of the immune response . Methods VLBW infants ( gestational age < 32 weeks and /or birth weight < 1500 g ) are r and omly allocated to receive enteral glutamine supplementation ( 0.3 g/kg/day ) or isonitrogenous placebo supplementation between day 3 and 30 of life . Primary outcome is time to full enteral feeding ( defined as a feeding volume ≥ 120 mL/kg/day ) . Furthermore , incidence of serious infections and short-term outcome are evaluated . The effect of glutamine on postnatal adaptation of the gut is investigated by measuring intestinal permeability and determining faecal microflora . The role of glutamine in modulation of the immune response is investigated by determining plasma Th1/Th2 cytokine concentrations following in vitro whole blood stimulation
OC could significantly reduce the occurrence of VAP , and consequently , its routine use should be considered for VLBWs to prevent infectious diseases .
OC  significantly reduces the occurrence of VAP and NEC in VLBW infants  .
OC may reduce the incidence of VAP and NEC by increasing IgA levels .
Early OC therapy for mechanical ventilation of low-weight infants may prevent the occurrence of VAP .
OC significantly reduces the occurrence of VAP and NEC in VLBW infants .
OC may reduce the incidence of VAP and NEC by increasing IgA levels .
Early OC therapy for mechanical ventilation of low-weight infants may prevent the occurrence of VAP
Oropharyngeal colostrum ( OC ) is a novel feeding strategy to prevent complications of prematurity .
A meta- analysis was conducted to investigate whether very low birth weight infants ( VLBWs ) can benefit from OC .