Progression of Enteral Feeding Volumes in Extremely Low Birth Weight Infants in the "Connection Trial".

Autor:	Neu J; Department of Pediatrics, University of Florida Health Shands Children's Hospital, Gainesville, Florida., Ashley P; Department of Pediatrics, Duke University, Durham, North Carolina., Chowdhary V; Department of Pediatrics, Arkansas Children's Hospital, Little Rock, Arkansas., Lampland A; Department of Neonatology, Children's Minnesota St. Paul Clinic, Saint Paul, Minnesota., Porcelli P; Department of Pediatrics, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina., Rothstein R; Department of Pediatrics, Baystate Children's Hospital, Springfield, Massachusetts., Slancheva B; Department of Neonatology, Medical University of Sofia, Sofia, Bulgaria., Kronström A; Infant Bacterial Therapeutics Inc., Stockholm, Sweden., Rastad J; Infant Bacterial Therapeutics Inc., Stockholm, Sweden., Strömberg S; Infant Bacterial Therapeutics Inc., Stockholm, Sweden., Thuresson M; Infant Bacterial Therapeutics Inc., Stockholm, Sweden.
Jazyk:	angličtina
Zdroj:	American journal of perinatology [Am J Perinatol] 2024 May; Vol. 41 (S 01), pp. e2717-e2726. Date of Electronic Publication: 2023 Sep 08.
DOI:	10.1055/s-0043-1774314
Abstrakt:	Objective: Investigate daily feeding volumes and their association with clinical variables in the early postnatal care of premature infants of the "Connection Trial." Study Design: A total of 641 infants of 510 to 1,000-g birth weight (BW, mean: 847 g) and mean 27 weeks' gestational age at birth (GA) were analyzed for total daily enteral (TDE) feeding volumes of 10, 20, 40, 80, and 120 mL/kg/d and their association with 24 clinical variables. Uni- and multivariable Cox regression models were used to calculate hazard ratios (HR) with 95% confidence intervals as a measure of the chance of reaching each of the TDE volumes. Results: Daily feeding volumes were highly variable and the median advancement from 10 to 120 mL/kg/d was 11 mL/kg/d. Univariable analyses showed the lowest chance (HR, 0.22-0.81) of reaching the TDE volumes for gastrointestinal (GI) serious adverse events (SAEs), GI perforation, GI obstruction, and necrotizing enterocolitis, as well as respiratory SAEs, persistent ductus arteriosus, and hypotension. Each GA week, 100-g BW, and point in 5-minute Apgar score at birth associated with 8 to 20% increased chance of reaching the TDE volumes. Multivariable analyses showed independent effects for BW, GA, Apgar score, GI SAEs, abdominal symptoms/signs, respiratory SAEs, days on antibiotics, and hypotension. Conclusion: This observational analysis demonstrates the variable and cautious progression of enteral feedings in contemporary extremely low BW infants and the extent to which clinical variables associate with this progression. Key Points: · Total feedings of 10 and 120 mL/kg/d were reached at median 4 and 14 day of age, respectively, and at a daily increase of 11 mL/kg.. · Each incremental GA week, 100-g BW, and point in 5-minute Apgar score associated with 8 to 20% increased chance of reaching enteral feedings of 10 to 120 mL/kg/d.. · Progression of enteral feeding associated with several clinical events and was slower than advocated in common feeding protocols.. Competing Interests: J.N. is the global coordinating investigator of the Connection Trial sponsored by Infant Bacterial Therapeutics. P.A., V.C., A.L., P.P., R.R., B.S. are principal investigators of the Connection Trial sponsored by Infant Bacterial Therapeutics Inc. M.T. is a consultant statistician employed by Infant Bacterial Therapeutics Inc. A.K., S.S., and J.R. are all employees of Infant Bacterial Therapeutics Inc. sponsoring the Connection Trail. (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)
Databáze:	MEDLINE
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