Impact of breast milk intake on body composition at term in very preterm babies: secondary analysis of the Nutritional Evaluation and Optimisation in Neonates randomised controlled trial

The objective of this study was to investigate the impact of breast milk (BM) intake on body composition at term in very preterm infants (<31 weeks gestation).  It used a preplanned secondary analysis of the Nutritional Evaluation and Optimisation in Neonates study, and the main outcome measure was on non-adipose tissue mass, ATM and ATM as a percentage of body weight at term.

Conclusions show the slower weight gain of preterm infants fed BM appears to be due to a deficit in non ATM and perhaps reflects lower protein intake. Whether this pattern persisting into childhood, is altered by BM fortification or later diet, or relates to functional outcomes and are important research questions.

You can read the abstract of this article here.

Li Y, Liu X, Modi N, et al

Impact of breast milk intake on body composition at term in very preterm babies: secondary analysis of the Nutritional Evaluation and Optimisation in Neonates randomised controlled trial

Archives of Disease in Childhood – Fetal and Neonatal Edition Published Online First: 14 July 2018. doi: 10.1136/archdischild-2017-314625

 

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Neonatal outcomes following a trial of labor after Caesarean delivery: a population-based study

Abstract

Purpose: To evaluate the neonatal effects of trial of labor after Caesarean (TOLAC) births. Methods: We conducted a retrospective population-based cohort study using the CDC’s Period Linked Birth/Infant Death Public Use File (2011–2013) on women with a live singleton pregnancy and prior Caesarean delivery. Multivariate logistic regression compared neonatal outcomes between women who underwent a TOLAC with women who did not. Secondary analysis compared outcomes of birth with uterine rupture to those without. Results: A total of 1,036,554 births met inclusion criteria, of which 17.5% underwent TOLAC. Women who had a TOLAC were more likely to deliver infants requiring neonatal intensive care unit (NICU) admission (odds ratios (OR) 1.12, 95%CI 1.09–1.16) and assisted ventilation (OR 1.07, 95%CI 1.03–1.12). Among women with TOLAC, 0.18% of births were in context of a uterine rupture and those neonates had an increased risk of NICU admissions (OR 5.95, 95%CI 4.56–7.76), assisted ventilation (OR 8.89, 95%CI 6.73–11.75), seizures (OR 91.66, 95%CI 42.23–198.93), and death (OR 16.28, 95%CI 5.09–52.08). Conclusions: Neonatal morbidity appears slightly increased among women with a TOLAC. However, morbidity and mortality are considerably increased in cases of uterine rupture. Appropriate selection and counseling of women for TOLAC should be undertaken as to minimize uterine rupture risk.

 

Obstetric risk factors for poor neonatal adaptation at birth

Abstract

Purpose: To identify obstetric risk factors of delivering a neonate with poor neonatal adaptation at birth.  Material and methods: Nested case–control study. Poor neonatal adaptation was defined for presence of at least: umbilical cord artery pH <7.10, base deficit ≥12 mmol/L, Apgar score at 1′ ≤5. Controls were selected from the same population and matched with cases. The association between clinical parameters and poor neonatal adaptation was analyzed by logistic regression. Results: One hundred and thirty three women (2.1% of all live births) with a neonate presenting a poor neonatal adaptation were matched with 133 subsequent controls. Significant contributions for the prediction of poor neonatal adaptation were provided by maternal age ≥35 years (p ≤ .001, odds ratio (OR) 3.9 [95%CI: 2.3–6.8]), nulliparity (p ≤ .001, OR 3.3 [95%CI: 1.8–6]), complications during pregnancy (p = .032, OR 2.2 [95%CI: 1.1–4.4]), gestational age at delivery <37 weeks (p = .008, OR 5.2 [95%CI: 1.5–17.8]) and cardiotocography category II or III (p ≤ .001, OR 36.3 [95%CI: 16.5–80.1]). The receiver operative characteristic curve was 0.91 [95%CI: 0.87–0.95], and detection rates 82.7% and 89.5% at 10% and 20% of false positive rates, respectively. Conclusions: Several obstetric risk factors before and during labor can identify a subgroup of newborns at higher risk of a poor neonatal adaptation at birth.

 

Short-term outcome of brainstem auditory function in term infants after discharge from the neonatal intensive care unit

 

Abstract

Objectives: To examine short-term outcome of brainstem auditory function in term infants after discharge from the neonatal intensive care unit (NICU). Methods: Brainstem auditory evoked response (BAER) was recorded and analysed at various click rates at 2–4 months of age in 43 term NICU graduates. The data were compared with those in age-matched normal controls. Results: The threshold of BAER in the NICU graduates was marginally elevated. The graduates also showed an increase in wave III latency at 91/s and wave V latency at all 21–91/s. The I–V interval was increased at 51 and 91/s, whereas the I–III and III–V intervals were slightly increased, with no significant differences from normal controls at any click rates. The amplitudes of waves I and V in the NICU graduates were moderately reduced at all click rates. Wave III amplitudes were reduced at 51 and 91/s. None of the slopes of BAER variables-rate functions in the NICU graduates differed significantly from normal controls. Conclusions: The BAER was moderately abnormal in the NICU graduates, suggesting that brainstem auditory function is moderately impaired at 2–4 months of age after discharge. There is a need to monitor postnatal auditory and neural development for NICU graduates.

Neonatal acute kidney injury: recording rate, course, and outcome: one center experience

Abstract

Background: Neonates, and particularly preterm newborns, are at increased risk for acute kidney injury (AKI) due to immature kidney function. While specific criteria have been defined for AKI in this particular population, this diagnosis is frequently overlooked, and consequently, is often not recorded in patients’ medical files. AKI-associated short- and long-term morbidity and mortality underline the importance of this diagnosis. Objective: To assess the recording rate of AKI in the neonatal intensive care unit (NICU), and to identify clinical features that may promote awareness to this condition. Study design: The database of one medical center was searched for serum creatinine values above 1 mg% among all the newborns (more than 48 hours old) who were hospitalized in the neonatal intensive care unit (NICU) during the years 2010–2015, and who underwent at least two blood tests during their hospitalization. The files of patients who met acute kidney injury (AKI) diagnostic criteria were searched for AKI diagnosis, maternal, fetal, and postnatal course and outcome. Results: Of 59 newborns who met AKI criteria, 51 (86%) were preterm and 8 term newborns. The respective mean gestational weeks at birth were: 28 ± 3 and 38.5 ± 1, and mean birth weights: 1002 ± 57 and 3157 ± 375 grams. Mortality rates were 14/51 (27%) versus 1/8 (12.5%). Of the 44 survivors, AKI was recorded in the medical files of 9/37 (24%) preterm versus 5/7 (71%) term-newborns. AKI associated with twin pregnancy in preterm neonates: 22 (43%) versus 1 (12.5%) in term-newborn. Unexpected high frequencies of maternal obstetrical problems and cesarean section delivery: 62.5 and 78%, respectively, along with persistently depressed 5-min Apgar 6.6 ± 3.5 were found in term newborns with AKI. Congenital anomalies of the urinary tract (CAKUT) were suspected prenatally on fetal ultrasound in 3 (6%) and 1 (12.5%) of the respective groups, a 10-fold higher rate than that observed in the general population. AKI recurred in 18 (35%) of the preterm and none of the term neonates. Mild AKI episodes (Stage 1–2) occurred in 30/37 (81%) by contrast to severe events (Stage 3) in 4/7 (57%) preterm and term survivors, respectively. Ventilation duration associated significantly with AKI recurrence, and sepsis with mortality: OR 1.25 (95%CI = 1.09–1.43) (p < .001) and OR = 4.65 (95%CI = 1.26–17.2) (p = .014), respectively. Conclusions: We demonstrated underreporting of AKI, particularly among preterm newborns, a population at high risk of developing recurrent episodes. Our data suggest different clinical profiles of AKI among preterm and term neonates: with later onset, milder but recurrent episodes in the former. Increased alertness for AKI diagnosis is needed for neonates with prolonged respiratory support, treated with diuretics and after sepsis. Newborns suspected of CAKUT (Congenital Anomalies of Kidneys and Urinary Tract) as per fetal ultrasound might need closer observation for AKI occurrence.

Obesity and maternal ICU admission

In this study Heather R. Masters, from the University of Cincinnati College of Medicine, led a team of researchers looking into the links between mothers’ obesity and their likelihood of being admitted to an intensive care unit (ICU) during their labour. The study included 999,437 births and the overall admission rate to an ICU was 1.1 per 1,000. For mothers with a BMI of 30-39.9 it was 1.24 per 1,000; for mothers with a BMI of 40-49.0 it was 1.8 per 1,000 and for those with a BMI of more than 50 it was 2.98 per 1,000.

You can read the abstract of this article here.

Overweight mothers and foetal acidosis

Foetal acidosis occurs when unborn babies’ blood becomes too acidic and typically occurs when a child is deprived of oxygen for an extended period of time during or after birth. In this study Stefan Johansson, from the Karolinska Institutet in Stockholm, looked into the links between overweight and obese mothers and foetal acidosis. 84,785 babies were involved in the study which found that the risks of foetal acidosis increased as mothers got heavier.

You can read the abstract of this article here.