Tanis, Rinske Cornelia (2012) De invloed van moedermelk op het ontwikkelen van ernstige infecties en mortaliteit bij Very Low Birth Weight (VLBW) neonaten. thesis, Medicine.
Full text available on request.Abstract
Background: Infants who are born with birth weight below 1500 gram (very low birth weight (VLBW) infants)) have an increased risk of several complications like late onset sepsis (LOS) and necrotizing enterocolitis (NEC). Own mother’s milk (OMM) seems to protect against NEC. Several studies showed OMM also protects against LOS, however meta-analysis did not confirm this. It is not clear if this health benefit is caused by the protective characteristics of OMM or is due to the avoidance of formula feeding. For many VLBW infants no OMM is available during the first days of life and they are being fed by preterm formula (PF). We hypothesize that a higher intake of OMM (as a percentage of the total enteral feeding) during the first 10 days of life is associated with a larger event free survival of LOS, NEC, neonatal meningitis (NM) and death during the first 30 days of life. Methods: In this retrospective cohort study infants newly admitted within 24 hours after birth and for at least 72 hours on the neonatal intensive care unit (NICU) of Vrije Universiteit medical centre (VUmc) with birth weight below 1500 grams were analysed. The inclusion period was from January 2009 to October 2011. In this group we examined the type and amount of feeding (OMM versus PF) during the first 10 days of life, and the combined appearance of LOS, NEC, NM and/or death during the first 30 days of life. Data were analysed according to 3 models of OMM intake with Cox regression analysis: OMM intake during day 1 to 5, OMM intake during day 6 to 10 and OMM intake during day 1 to 10. And corrected for the confounders sex, birth weight, maternal factors, presence of central venous lines, invasive ventilation, use of antibiotics and antimycotics. Results: Of 252 VLBW infants admitted during include period, 164 were included. Of 30 infants the medical file was missing and therefore intake could not be evaluated. 58 infants were excluded because of early onset sepsis, discharge or death within 72 hours or major congenital malformations. Intake of OMM from day 6 to day 10 is associated with a higher event free survival during the first 30 days of life if more than 50% of the nutrition is OMM (Hazard ratio (HR) group >50% OMM intake: HR 2,19 {95% CI 1.18 – 4.08}; p = 0.01: calculated in relation to 0% OMM). Intake of OMM calculated during the first 10 days of life is associated with a higher event free outcome when some OMM has been given (HR group 0.01%-50% OMM intake; HR 2.35 {95% CI 1.14 – 4.84}; p = 0.02) (HR group >50% MM intake: HR 1.91 {95% CI 1.24 – 2.94}; p = 0.003: both calculated in relation to 0% OMM). Conclusions: Intake of OMM is associated with a higher event free survival (LOS, NEC, NM, death) during the first 30 days of life, if more than 50% of the nutrition is OMM. This effect appears to be the strongest during day 6 to day 10, although intake of OMM during day 1 to day 5 seems to strengthen this effect. Due to inadequate availability of OMM during the first days of life a lot of VLBW infants could not benefit this protective effect. A solution for this problem could be found in supplying donor milk when OMM is not available.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Bos, Prof. A.F. UMCG |
| Supervisor name: | Corpeleijn, Drs. W.E. VUmc |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:46 |
| Last Modified: | 25 Jun 2020 10:46 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/754 |
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