Oropharyngeal Administration of Colostrum Increases Salivary Secretory IgA Levels in Very Low‐Birth‐Weight Infants Randomized Controlled Trial of Oropharyngeal Colostrum Administration in Very-low-birth-weight Preterm Infants. Role of Oropharyngeal Administration of Colostrum in Very-Low-Birth-Weight Infants for Reducing Necrotizing Enterocolitis: A Randomized Controlled Trial. Oropharyngeal Administration of Mother's Milk Prior to Gavage Feeding in Preterm Infants: A Pilot Randomized Control Trial. Oropharyngeal Colostrum Administration in Extremely Premature Infants: An RCT Oropharyngeal Colostrum Administration in Very Low Birth Weight Infants: A Randomized Controlled Trial* Randomised controlled trial of an aggressive nutritional regimen in sick very low birthweight infants First intention high-frequency oscillatory and conventional mechanical ventilation in premature infants without antenatal glucocorticoid prophylaxis* Early nutritional intervention in oropharyngeal cancer patients undergoing radiotherapy Preventing Excessive Weight Gain During Pregnancy Through Dietary and Lifestyle Counseling: A Randomized Controlled Trial Guiding mothers' management of health problems of very low birth-weight infants. Oropharyngeal and nasopharyngeal suctioning of meconium-stained neonates before delivery of their shoulders: multicentre, randomised controlled trial Oral colostrum priming shortens hospitalization without changing the immune-microbial milieu Early neonatal outcomes of volume guaranteed ventilation in preterm infants with respiratory distress syndrome The Provo multicenter early high-frequency oscillatory ventilation trial: improved pulmonary and clinical outcome in respiratory distress syndrome. Necrotizing enterocolitis - classification and two initial steps towards prevention. Continuous feeding promotes gastrointestinal tolerance and growth 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 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 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 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 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 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 AIMS To improve energy intake in sick very low birthweight ( VLBW ) infants ; to decrease growth problems , lessen pulmonary morbidity , shorten hospital stay , and avoid possible feeding related morbidity . Morbidity in VLBW infants thought to be associated with parenteral and enteral feeding includes bronchopulmonary dysplasia , necrotising enterocolitis , septicaemia , cholestasis and osteopenia of prematurity . METHODS A prospect i ve r and omised controlled trial ( RCT ) comparing two types of nutritional intervention was performed involving 125 sick VLBW infants in the setting of a regional neonatal intensive care unit . Babies were r and omly allocated to either an aggressive nutritional regimen ( group A ) or a control group ( group B ) . Babies in group B received a conservative nutritional regimen while group A received a package of more aggressive parenteral and enteral nutrition . Statistical analysis was done using Student’st test , the Mann-Whitney U test , the χ2 test and logistic regression . RESULTS There was an excess of sicker babies in group A , as measured by initial disease severity ( P < 0.01 ) , but mean total energy intakes were significantly higher ( P < 0.001 ) in group A at days 3 to 42 while receiving total or partial parenteral nutrition . Survival and the incidences of bronchopulmonary dysplasia , septicaemia , cholestasis , osteopenia and necrotising enterocolitis were similar in both groups . Growth in early life and at discharge from hospital was significantly better in babies in group A. There were no decreases in pulmonary morbidity or hospital stay . CONCLUSION Nutritional intake in sick VLBW infants can be improved without increasing the risk of adverse clinical or metabolic sequelae . Improved nutritional intake result ed in better growth , both in the early neonatal period and at hospital discharge , but did not decrease pulmonary morbidity or shorten hospital stay Objective : Data comparing the effectiveness of high-frequency oscillatory ventilation and of conventional mechanical ventilation in the treatment of respiratory distress syndrome of very low birth weight infants are , to date , still matter of debate . We investigated the effects of first intention high-frequency oscillatory ventilation or conventional mechanical ventilation support on selected primary and secondary outcomes in very low birth weight infants complicated by respiratory distress syndrome in which antenatal glucocorticoid prophylaxis was not performed . Design : Multicenter r and omized control trial . Setting : Three tertiary centers of neonatal intensive care units from December 2004 to December 2007 . Population : Eighty-eight very low birth weight infants complicated by respiratory distress syndrome , without antenatal glucocorticoids , supported by first intention high-frequency oscillatory ventilation ( n = 44 ) or conventional mechanical ventilation ( n = 44 ) . Interventions : All newborns were monitored by st and ard monitoring procedure , including routine laboratory variables , neurologic patterns , and ultrasound imaging . Primary outcomes were : the length of ventilatory support , the need of reintubation , and the length of nasal continuous positive airway pressure support in the postextubation period . Secondary outcomes were : the length of stay in neonatal intensive care unit and in hospital , death before discharge , adverse short- and long-term pulmonary and neonatal outcomes , and the need for a second dose of surfactant and of postnatal glucocorticoid treatment .  Results : High-frequency oscillatory ventilation infants showed a significant lower duration ( p < .001 for all ) of ventilator dependency , lower need of reintubation and of duration of nasal continuous positive airway pressure support in the postextubation period . Among secondary outcomes in the high-frequency oscillatory ventilation infants , the need of a second dose of surfactant administration , and the length of stay in the neonatal intensive care unit and in hospital were significantly lower ( p < .05 for all ) . Conclusions : We found that high-frequency oscillatory ventilation in very low birth weight infants without antenatal glucocorticoid prophylaxis reduced the need of ventilatory support , surfactant therapy , and reintubation , and shortened neonatal intensive care unit and hospital stay , thus reducing unit and hospital costs . These data would support the usefulness of first intention high-frequency oscillatory ventilation strategy in managing in a selected population , such as very low birth weight newborns complicated by severe respiratory distress syndrome not antenatally treated with glucocorticoids Nutritional interventions are not routine in patients undergoing oropharyngeal radiotherapy . The aim of the present study was to assess the effects of early nutritional intervention . Forty-five out patients undergoing radiotherapy for oropharyngeal cancer were prospect ively managed by nutritionists  ( intervention group ) . In this group , a percutaneous endoscopic gastrostomy ( PEG ) was inserted before radiotherapy in any patient in whom at least one of the following applied : weight loss > 10 % ; BMI < 20 kg/m2 ; age > 70 years . Data were compared with those recorded in an historical control group of 45 paired patients . A PEG was inserted in 33 ( 74 % ) of the 45 patients in the intervention group , as against 5 ( 11 % ) of the 45 in the control group ( P<0.001 ) . The mean weight loss and the frequency of hospital admission for dehydration were lower in the intervention group than in the control group ( P<0.01 ) . In conclusion , early nutritional intervention , including PEG insertion , is feasible and efficient in preventing dehydration in oropharyngeal cancer patients undergoing radiotherapy .  It may improve quality of life by decreasing the frequency of hospital admissions OBJECTIVE : To estimate whether an organized , consistent program of dietary and lifestyle counseling prevents excessive weight gain  in pregnancy . METHODS : This r and omized controlled trial assigned women to receive either an organized , consistent program of intensive dietary and lifestyle counseling or routine prenatal care . The primary study outcome was the proportion of patients whose gestational weight gain was within the Institute of Medicine ( IOM ) guidelines . Secondary outcomes included mode of delivery , rate of operative vaginal delivery , neonatal weight , and the incidence of preeclampsia , gestational diabetes mellitus ( GDM ) , vaginal/perineal lacerations , and shoulder dystocia . RESULTS : A total of 100 women were r and omized to the study ( lifestyle counseling 57 , routine prenatal care 43 ) . Baseline demographic characteristics were similar between the study groups . The lifestyle counseling group gained significantly less weight than did the routine prenatal care group ( 28.7±12.5 lb compared with 35.6±15.5 lb , P=.01 ) . The routine prenatal care group had significantly more cesarean deliveries due to “ failure to progress ” ( routine prenatal care 58.3 % compared with lifestyle counseling 25.0 % , P=.02 ) . Across groups , patients who were not adherent to the IOM guidelines had significantly heavier neonates ( adherent 3,203.2±427.2 g compared with not adherent 3,517.4±572.4 g , P<.01 ) . Nulliparous women  gained significantly more weight than did parous women ( 36.5±14.5 lb compared with 27.7±12.7 lb , P<.01 ) . The most predictive factor of IOM adherence was having a normal prepregnancy body mass index . No statistically significant differences were noted between the groups in adherence to IOM guidelines , rate of cesarean delivery , preeclampsia , GDM , operative vaginal delivery , or vaginal lacerations . CONCLUSION : An organized , consistent program of dietary and lifestyle counseling did reduce weight gain in pregnancy . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . clinical trials.gov , NCT00792480 LEVEL OF EVIDENCE : OBJECTIVE Explore the feasibility , usefulness , and outcomes of a pilot program to support mothers in developing competencies for managing health problems of their very low birth-weight ( VLBW ) infants in partnership with the primary care clinician ( PCC ) . DESIGN In a r and omized study , mothers who received guided participation ( GP ) and printed guidelines for managing VLBW infant health problems were compared with mothers who received only the guidelines and st and ard care ( GL group ) . SAMPLE All mothers ( GP = 20 ; GL = 11 ) were at least 18 years old and English speaking . Infants were all VLBW ( < or = 1,500 g ) . INTERVENTION GP began during the infant 's neonatal intensive care unit stay and continued with public health nurses ( PHNs ) and a family service clinician through the infant 's first 4 postterm months . MEASUREMENTS Intervention feasibility and usefulness were assessed with maternal and clinician feedback . Outcomes included maternal and clinician appraisal of mothers ' use of clinical re sources and mothers ' perceptions of primary -care quality and the family-PCC relationship . RESULTS Intervention feasibility and usefulness were supported . GP and GL groups did not differ significantly on outcomes . CONCLUSIONS Findings indicate a longer intervention period , GP organized by infant problem episodes , and enhancement of the PHN role in the context of interdisciplinary and interagency collaboration BACKGROUND Meconium aspiration syndrome ( MAS ) is a life-threatening respiratory disorder in infants born through meconium-stained amniotic fluid ( MSAF ) . Although anecdotal data concerning the efficacy of intrapartum oropharyngeal and nasopharyngeal suctioning of MSAF are conflicting , the procedure is widely used . We aim ed to assess the effectiveness of intrapartum suctioning for the prevention of MAS . METHODS We design ed a r and omised controlled trial in 11 hospitals in Argentina and one in the USA . 2514 patients with MSAF of any consistency , gestational age at least 37 weeks , and cephalic presentation were r and omly assigned to suctioning of the oropharynx and nasopharynx ( including the hypopharynx ) before delivery of the shoulders ( n=1263 ) , or no suctioning before delivery ( n=1251 ) . Postnatal delivery-room management followed Neonatal Resuscitation Program guidelines . The primary outcome was incidence of MAS . Clinicians diagnosing the syndrome and design ating other study outcomes were masked to group assignment . An informed consent waiver was used . Analysis was by intention to treat . FINDINGS 18 infants in the suction group and 15 in the no suction group did not meet entry criteria after r and om assignment . 87 in the suction group were not suctioned , and 26 in the no suction group were suctioned . No significant difference between treatment groups was seen in the incidence of MAS ( 52 [ 4 % ] suction vs 47 [ 4 % ] no suction ; relative risk 0.9 , 95 % CI 0.6 - 1.3 ) , need for mechanical ventilation for MAS ( 24 [ 2 % ] vs 18 [ 1 % ] ; 0.8 , 0.4 - 1.4 ) , mortality ( 9 [ 1 % ] vs 4 [ 0.3 % ] ; 0.4 , 0.1 - 1.5 ) , or in the duration of ventilation , oxygen treatment , and hospital care . INTERPRETATION Routine intrapartum oropharyngeal and nasopharyngeal suctioning of term-gestation infants born through MSAF does not prevent MAS . Consideration should be given to revision of present recommendations Objective : Oral colostrum priming ( OCP ) after birth in preterm infants is associated with improved weight gain and modification of the oral immunomicrobial environment . We hypothesized that OCP would modify salivary immune peptides and the oral microbiota in preterm infants . Study design : We conducted a prospect i ve , r and omized clinical trial to determine the effects of OCP on salivary immune peptide representation in preterm infants ( < 32 weeks completed gestation at birth ) .  Saliva sample s were collected before and after OCP . Salivary immune peptide representation was determined via mass spectroscopy . Oral microbiota representation was determined via sequencing of the 16S rRNA gene . Results : Neonates who received OCP ( n=48 ) had a 16-day reduction in the median length of hospitalization as compared with infants who did not receive OCP ( n=51 ) . No differences in salivary immune peptide sequence representation before OCP between groups were found . Longitudinal changes in peptides were detected ( lysozyme C , immunoglobulin A , lactoferrin ) but were limited to a single peptide difference ( α-defensin 1 ) between primed and unprimed infants after OCP . We found no difference in microbial diversity between treatment groups at any time point , but diversity decreased significantly over time in both groups . OCP treatment marginally modified oral taxa with a decline in abundance of Streptococci in the OCP group at 30 days of life . Conclusions : OCP had neither an effect on the salivary peptides we examined nor on overall oral bacterial diversity and composition . Infants who received OCP had a reduced length of hospitalization and warrants further investigation Background : Volume guaranteed ( VG ) synchronized intermittent m and atory ventilation ( SIMV ) is a novel mode of SIMV that provides automatic adjustment of the peak inspiratory pressure for ensuring a minimum set tidal volume and there are limited data about the effects of VG ventilation on short term neonatal outcomes in preterm infants with respiratory distress syndrome ( RDS ) . Objective : The main objective of this study was to evaluate the effect of VG ventilation on duration of ventilation and total supplemental oxygen . We also aim ed to compare the early neonatal outcomes of VG ventilation versus conventional SIMV on short-term outcomes in preterm babies with RDS who were given surfactant . Methods : In this r and omized controlled study , preterm infants who were admitted with RDS and given surfactant were divided into 2 groups : group 1 included infants ventilated on conventional SIMV ( n = 30 ) and group 2 included infants ventilated on VG ventilation ( n = 42 ) . Neonatal morbidities such as air leak , bronchopulmonary dysplasia ( BPD ) , intraventricular hemorrhage ( IVH ) , retinopathy of prematurity ( ROP ) , necrotizing enterocolitis ( NEC ) and duration of mechanical ventilation and total oxygen supplementation were all recorded . Results : There were no significant differences between two groups in terms of demographic features . Infants ventilated with VG mode had significantly shorter duration of ventilation and need of total supplemental oxygen . The incidences of oxygen related short term complications including BPD , ROP , and IVH were also significantly lower in these infants compared with those ventilated with conventional SIMV . No significant differences were found between two groups with respect to NEC and air leak . Conclusion : In conclusion , VG ventilation in combination with surfactant treatment significantly reduced both duration of mechanical ventilation and early neonatal oxygen related morbidities including BPD , ROP and IVH in preterm infants with RDS . This data favors the use of VG ventilation in respiratory support of premature infants OBJECTIVE To compare the hospital course and clinical outcome of preterm infants with respiratory distress syndrome treated with surfactant and managed with high-frequency oscillatory ventilation ( HFOV ) or conventional mechanical ventilation ( CV ) as their primary mode of ventilator support . DESIGN A prospect i ve r and omized clinical trial . SETTING Three community-based level III neonatal intensive care units . SUBJECTS A total of 125 neonates who were 35 weeks or less estimated gestation requiring intubation and assisted ventilation for respiratory distress syndrome with arterial to alveolar oxygen ratio less than .50 . INTERVENTIONS Patients were r and omized to continue CV ( 61 patients ) or be changed to HFOV ( 64 patients ) after exogenous surfactant administration ( 100 mg/kg ) . HFOV was used in a strategy to promote lung recruitment and maintain lung volume . Protocol respiratory care guidelines were followed ; otherwise routine care was provided by each neonatal intensive care unit . MEASUREMENTS AND MAIN RESULTS No differences were noted in demographic features between the two study groups . The study population birth weight was 1.51 + /- .47 kg ( mean + /- SD ) , gestational age was 30.9 + /- 2.5 weeks , and study entry age was 2 to 3 hours . Patients r and omized to HFOV demonstrated the following significant findings compared with CV-treated patients : vasopressor support was less intensive ; surfactant redosing was not as frequent ; oxygenation improved more rapidly and remained higher during the first 7 days ; fewer infants required prolonged supplemental oxygen or ventilator support ; treatment failure was reduced ; more patients survived without chronic lung disease at 30 days ; need for continuous supplemental oxygen at discharge was less ; frequency of necrotizing enterocolitis illness was lower ; there were fewer abnormal hearing tests ; and hospital costs were decreased . No differences were seen between the two study groups in the frequency or severity of patent ductus arteriosus , air leak , retinopathy of prematurity , or intraventricular hemorrhage . Length of hospital stay and survival to discharge were similar for HFOV- and CV-treated infants . CONCLUSIONS When used early with a lung recruitment strategy , HFOV after surfactant replacement result ed in clinical outcomes consistent with a reduction in both acute and chronic lung injury . Benefit was evident for preterm infants both less than or equal to 1 kg and more than 1 kg . In addition , early HFOV treatment may have had a more global effect on patient health throughout the hospitalization , result ing in reduced morbidity and decreased health care cost The premature infant suffers from immaturity of all organ systems , one of them being the gastrointestinal tract . When the infant is born , the immature gastrointestinal tract is exposed to milk and simultaneously colonized by high densities of bacteria . The combination of milk , microbiota and an immature gut , leaves the infant vulnerable to developing the dreaded intestinal emergency necrotizing enterocolitis ( NEC ) . NEC is often very aggressive and no cure exists , which means that prevention is an utmost important topic to research ers , physicians , parents - and infants . Despite immense research during the last decades , no specific test to determine if an infant suffers from NEC exists . Most neonatal units use Bell 's staging criteria , which are based on clinical and radiographic findings , as a diagnostic tool ; however the diagnosis given according to Bell 's stages has not been vali date d. In study I , we aim ed to determine the validity of the NEC diagnosis given at discharge . An expert panel consisting of a neonatologist , a paediatric surgeon and a paediatric radiologist served as the golden st and ard . We found that the diagnosis given at discharge had a poor validity which significantly affected the reported incidence of NEC in the neonatal department at Rigshospitalet , Denmark . The validity of the NEC diagnosis was worse than the validity of most other paediatric diagnoses that had been investigated . In studies II and III , we aim ed to explore possible means of NEC prevention . The role of nutrition in NEC development is well established with mother 's milk as the best option to avoid NEC in the preterm infant . Maternal milk is , however , most often not available in sufficient amounts during the first days of life , and preterm infant formula or human donor milk is used in its absence . Studies in preterm piglets showed that bovine colostrum equally to human donor milk protected against NEC compared to infant formula . Furthermore , bovine colostrum was superior to human donor milk in stimulating gut immunity and digestive functions . Hence , in study II we aim ed to design a pilot study of bovine colostrum used as a supplement to maternal milk in the first days of life and to determine if the study was feasible . In the paper , we present the protocol and the results of the first two phases of the Precolos study in which 12 infants were included and received pasteurized , spray-dried and reconstituted bovine colostrum during the first days of life as the first infants in the world . We found that the infants tolerated bovine colostrum without clinical adverse effects , but we also observed a transient hypertyrosinemia on day seven of life in five infants . The results were evaluated by a safety management board which encouraged us to continue the pilot study with the last phase , which was a r and omized controlled trial of 20 + 20 infants comparing supplementation with bovine colostrum to supplementation with st and ard nutrition . The r and omized trial has just finished recruitment . At last , we wanted to shed light on a possible microbiological angle of NEC prevention . Dysbiosis and bacterial translocation are believed to play a crucial role in the development of NEC as intestinal pneumatosis , which occurs when bacteria produce gas inside the intestinal wall , is a pathognomonic radiographic finding . In a quality improvement study from the US published in 2014 , NEC incidence was significantly reduced after the implementation of several quality improvement interventions . St and ardized weekly exchange of nasogastric feeding tubes was suggested as one of the potential NEC-reducing interventions . In the neonatal unit at Rigshospitalet , Denmark , preterm infants are fed 8 - 12 times daily through a resident nasogastric feeding tube which is exposed to body temperature , contains milk residuals from the last meal and is h and led by both parents and personnel . Since bacterial pollution of milk given through the nasogastric feeding tube might be NEC-inducing , we aim ed in study III to determine the bacterial load given to the infants when feeding them through a tube . We collected 92 used nasogastric feeding tubes and flushed them with one ml saline each to imitate a meal given through them . Eighty-nine percent of the tubes contaminated the meals with more than 1000 colony-forming units of bacteria and fifty-five percent contaminated the meals with the possible pathogens Enterobacteriaceae or Staphylococcus aureus . The concentration of bacteria in the saline flushed through the tubes was as high as 109 colony-forming units per ml ; however , neither the risk of contamination nor the concentration of bacteria in the flush was associated with the duration of use . Implementation of st and ardized weekly exchange of feeding tubes would therefore not prevent the contamination of meals . In conclusion , the studies included in this thesis serve as a base for future studies investigating the prevention of NEC . We found a poor validity of the NEC diagnosis given at discharge . This should be kept in mind when conducting epidemiological studies of NEC and especially when conducting interventional trials with NEC as an outcome . If the findings of the r and omized part of the Precolos study indicate a positive effect of bovine colostrum and do not give rise to concerns regarding feasibility , safety or tolerability , a large-scale r and omized controlled study with NEC as the primary outcome will be planned . Based on the high concentrations of bacteria found in the nasogastric feeding tubes , a r and omized controlled trial investigating whether the frequency of feeding tube exchange affects the early colonization has been commenced in the neonatal department at Rigshospitalet . Hopefully , the results of these studies will bring us closer to preventing NEC in the future 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
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 .