Öz
Objective: To determine the association between feeding intolerance and late onset sepsis (LOS) in very low birth weight (VLBW) infants.
Material and Methods: In this retrospective study inborn infants with a gestational age less than 32 weeks or birth weight less then 1500 grams were enrolled. Demographic and neonatal characteristics of infants who had culture proven LOS were compared with the control infants, matched for birth weight and gestational age.
Results: A total of 408 infants (LOS n=136, non LOS n=272) were analyzed. The mean (SD) gestational age and birth weight of the whole cohort were 27.8 weeks (±1.6) and 1016.92 grams (±200.39) Exclusively breast feeding was lower and feeding intolerance was more frequent in LOS group (p=0.028, p<0.001; respectively). Time to regain birth weight, time to reach full enteral feeding, nothing per oral day, duration of the requirement of total parenteral nutrition were longer in LOS group compared to non LOS group (p=0.048, p<0.001, p<0.001, p<0.001; respectively). Weight gain per day, weight gain at first and fourth week of life were significantly lower in infants with LOS (p=0.000, p=0.045 and p=0.046; respectively). Logistic regression analysis revealed that respiratory distress syndrome (OR=1.76, 95% CI 1.12-2.76;P=0.013), feeding intolerance (OR=3.84 95% CI 2.36-6.24; p<0.001) or exclusively breast feeding (OR=0.60, 95% CI 0.39-0.94;p=0.025) were independently associated with the development of LOS.
Conclusion: Feeding intolerance impairs the immunologic and barrier functions of the gut and facilitates the onset of sepsis.
Anahtar Kelimeler
Kaynakça
- Reference 1.Dong Y., Speer CP. Late-onset sepsis:recent developments. Arch Dis Child Fetal Neonatal Ed 2014;0:F1-F7.
- Reference 2.Deitch EA, Xu D, Naruhn MB, Deitch DC, Lu Q, Marino AA.Elemental diet and IV-TPN-inducedbacterial translocation is associated with loss of intestinal mucosal barrier function against bacteria.Ann Surg. 1995 Mar;221(3):299-307
- Reference 3.Cortez J, Makker K, Kraemer DF, Neu J, Sharma R, Hudak ML Maternal milk feedings reduce sepsis, necrotizing enterocolitis and improve outcomes of premature infants.J Perinatol. 2018 Jan;38(1):71-74.
- Reference 4.El Manouni El Hassani S, Berkhout DJC, Niemarkt HJ et al. Risk Factors for Late-OnsetSepsis in Preterm Infants: A MulticenterCase-Control Study.Neonatology. 2019;116(1):42-51
- Reference 5.Barone G, Maggio L, Saracino A, Perri A, Romagnoli C, Zecca E.How to feed small for gestational age newborns.Ital J Pediatr. 2013 May 10;39:28
- Reference 6.Senterre T.Practice of enteral nutrition in very low birth weight and extremely low birth weight infants.World Rev Nutr Diet. 2014;110:201-14
- Reference 7.Lucchini R, Bizzarri B, Giampietro S, De Curtis M. Feeding intolerance in preterm infants. How to understand the warning signs. J Matern Fetal Neonatal Med. 2011 Oct;24 Suppl 1:72-4.
- Reference 8.Gane B, Bhat BV, Adhisivam B et al. Risk factors and outcome in neonatalnecrotising enterocolitis. Indian J Pediatr. 2014 May;81(5):425-8
- Reference 9.American Academy of Pediatrics Committee on Nutrition. Nutritional needs of low birth weight infants. Pediatrics 1982;76:976-86.
- Reference 10.Escalante MJ, Ceriani-Cernadas JM, D'Apremont I et al. NEOCOSUR Neonatal NetworkLate Onset Sepsis in Very Low Birth Weight Infants in the South American NEOCOSUR Network. Pediatr Infect Dis J. 2018 Oct;37(10):1022-1027
- Reference 11.Ehrenkranz RA, Younes N, Lemons JA et al. Longitudinal growth of hospitalized very low birth weight infants. Pediatrics. 1999 Aug;104(2 Pt 1):280
- Reference 12. Frank L, Sosenko IRS. Undernutrition as a major contributing factor in the pathogenesis of bronchopulmonary dysplasia. Am Rev Respir Dis. 1988;138:725–729
Öz
Amaç: Çok düşük doğum ağırlıklı (ÇDDA) bebeklerdeki beslenme intoleransının geç neonatal sepsis (GNS) ile ilişkisinin değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntemler: Bu retrospektif çalışmaya doğum ağırlığı ≤1500 gram veya gestasyon haftası ≤32 hafta olan infantlar dahil edildi. Kültür ile kanıtlanmış GNS tanısıyla izlenen bebeklerin demografik ve klinik özellikleri, doğum ağırlığı ve gestasyon haftası benzer olan kontrol grubu ile karşılaştırıldı.
Bulgular: Toplam 408 infant (GNS olan n=136, GNS olmayan=272) değerlendirildi. Çalışmaya dahil edilen hastaların ortalama (SD) gestasyon haftası ve doğum ağırlığı 27.8 hafta (±1.6) ve 1016.92 gram (±200.39) idi. GNS olan bebeklerde sadece anne sütü ile beslenme oranı daha düşük, beslenme intoleransı daha fazlaydı (sırasıyla p=0.028, p<0.001). GNS olan bebeklerde doğum ağırlığına ulaşma süresi, tam enteral beslenmeye geçiş zamanı, hiç beslenmediği gün sayısı, total parenteral nutrisyon ihtiyacı olan gün sayısı GNS olmayan grup ile karşılaştırıldığında anlamlı olarak daha yüksekti. (sırasıyla p=0.048, p<0.001, p<0.001, p<0.001). Günlük kilo alımının, 1.ve 4. haftadaki kilo alımının GNS olan grupta anlamlı olarak daha düşük olduğu bulundu (sırasıyla p=0.000, p=0.045 ve p=0.046).). Lojistik regresyon analizinde respiratuar distres sendromu (OR=1.76, 95% CI 1.12-2.76;P=0.013), beslenme intoleransı (OR=3.84 95% CI 2.36-6.24; p<0.001) ve sadece anne sütü ile beslenmenin (OR=0.60, 95% CI 0.39-0.94;p=0.025) GNS gelişimi ile bağımsız olarak ilişkili olduğu gösterildi.
Sonuç: Beslenme intoleransı bağırsağın immunolojik ve bariyer fonksiyonlarını bozarak sepsis gelişimini kolaylaştırır.
Anahtar Kelimeler
Kaynakça
- Reference 1.Dong Y., Speer CP. Late-onset sepsis:recent developments. Arch Dis Child Fetal Neonatal Ed 2014;0:F1-F7.
- Reference 2.Deitch EA, Xu D, Naruhn MB, Deitch DC, Lu Q, Marino AA.Elemental diet and IV-TPN-inducedbacterial translocation is associated with loss of intestinal mucosal barrier function against bacteria.Ann Surg. 1995 Mar;221(3):299-307
- Reference 3.Cortez J, Makker K, Kraemer DF, Neu J, Sharma R, Hudak ML Maternal milk feedings reduce sepsis, necrotizing enterocolitis and improve outcomes of premature infants.J Perinatol. 2018 Jan;38(1):71-74.
- Reference 4.El Manouni El Hassani S, Berkhout DJC, Niemarkt HJ et al. Risk Factors for Late-OnsetSepsis in Preterm Infants: A MulticenterCase-Control Study.Neonatology. 2019;116(1):42-51
- Reference 5.Barone G, Maggio L, Saracino A, Perri A, Romagnoli C, Zecca E.How to feed small for gestational age newborns.Ital J Pediatr. 2013 May 10;39:28
- Reference 6.Senterre T.Practice of enteral nutrition in very low birth weight and extremely low birth weight infants.World Rev Nutr Diet. 2014;110:201-14
- Reference 7.Lucchini R, Bizzarri B, Giampietro S, De Curtis M. Feeding intolerance in preterm infants. How to understand the warning signs. J Matern Fetal Neonatal Med. 2011 Oct;24 Suppl 1:72-4.
- Reference 8.Gane B, Bhat BV, Adhisivam B et al. Risk factors and outcome in neonatalnecrotising enterocolitis. Indian J Pediatr. 2014 May;81(5):425-8
- Reference 9.American Academy of Pediatrics Committee on Nutrition. Nutritional needs of low birth weight infants. Pediatrics 1982;76:976-86.
- Reference 10.Escalante MJ, Ceriani-Cernadas JM, D'Apremont I et al. NEOCOSUR Neonatal NetworkLate Onset Sepsis in Very Low Birth Weight Infants in the South American NEOCOSUR Network. Pediatr Infect Dis J. 2018 Oct;37(10):1022-1027
- Reference 11.Ehrenkranz RA, Younes N, Lemons JA et al. Longitudinal growth of hospitalized very low birth weight infants. Pediatrics. 1999 Aug;104(2 Pt 1):280
- Reference 12. Frank L, Sosenko IRS. Undernutrition as a major contributing factor in the pathogenesis of bronchopulmonary dysplasia. Am Rev Respir Dis. 1988;138:725–729
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Çocuk Sağlığı ve Hastalıkları |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Nisan 2021 |
| Gönderilme Tarihi | 29 Mayıs 2020 |
| Kabul Tarihi | 18 Ocak 2021 |
| Yayımlandığı Sayı | Yıl 2021 Cilt: 18 Sayı: 1 |
