Management of Enteral Feeding and Application of Probiotics in Very Low Birth Weight Infants – A National Survey in German NICUs

Abstract

Background The advantage of breast milk feeding, and supplementation of probiotics is well known and proven. However, the lack of reliable amounts of colostrum and/or transient breast milk during the first few postnatal days might inhibit timely enteral nutrition.

Methods The aim of this nationwide survey in German Level-1 neonatal intensive care units (NICUs) was to collect data regarding the management of feeding in the first days of life in very low birth weight infants (VLBWIs, birth weight<1500 g). In addition, we analyzed differences in the use of probiotics. An online survey was sent to all 163 Level-1 NICUs in Germany.

Results 110/163 (67.5%) hospitals participated in our study. One-fifth of all participants used exclusively breast milk. The reported incidence of necrotizing enterocolitis (NEC) was lower in NICUs that exclusively used breast milk in VLBWIs (p=0.08). Two-thirds start enteral feeding independent of gestational age during the first 12 hours postnatally with either breast milk or formula. 80% of all participants checked gastric residuals routinely. The use of probiotics differs widely concerning duration and interruption during antibiotic therapy.

Conclusion The exclusive use of breast milk is associated with a lower incidence of NEC. The result of our survey emphasizes the paramount importance of nutrition with mother`s milk. In case of insufficient availability of mother`s milk, the use of human donor milk still appears to be superior to formula feeding. The implementation of human donor milk banks should therefore be promoted.

Zusammenfassung

Einleitung Im Leben von Frühgeboren (Geburtsgewicht<1500 g) spielen die ersten Lebenstage eine entscheidende Rolle für einen unkomplizierten Verlauf und eine gute Entwicklungsprognose. Insbesondere in den ersten postnatalen Tagen mangelt es jedoch an mütterlichem Kolostrum oder Muttermilch, was einem frühen enteralen Nahrungsaufbau entgegensteht. Aus diesem Grund ist die Verwendung von Formula-Nahrung immer noch weit verbreitet.

Methodik Um das Vorgehen beim Nahrungsaufbau sowie die Applikation von Probiotika zu analysieren, wurde im Sommer 2020 an alle 163 Level-1 Zentren in Deutschland ein online-Umfragebogen versandt.

Ergebnisse Insgesamt nahmen 110 (67,5%) Zentren an der Umfrage teil. 1/5 gaben an, ausschließlich Muttermilch zu verwenden. Die Inzidenz der Nekrotisierenden Enterokolitis (NEC) war bei diesen Zentren geringer (p=0.08). 2/3 erklärten, unabhängig vom Gestationsalter innerhalb der ersten 12 Stunden die enterale Ernährung entweder mit Muttermilch (inkl. Spendermilch) oder Formulanahrung zu beginnen. 80% aller Zentren prüft routinemäßig Magenreste vor der nächsten Mahlzeit. Die Applikation von Probiotika hinsichtlich Dauer oder der Fortführung während einer antibiotischen Therapie variierte erheblich.

Zusammenfassung Die ausschließliche Verwendung von Frauenmilch geht mit einer geringeren NEC-Inzidenz einher. Die Ergebnisse dieser Umfrage unterstreichen damit die Bedeutung von Muttermilchernährung. Im Falle von fehlender mütterlicher Milch erscheint die Verwendung von Ammenmilch der Ernährung mit Formulanahrung überlegen. Der Aufbau von Muttermilchbanken sollte unterstützt werden.

Key words

preterm infants - enteral feeding - probiotics

Schlüsselwörter

Nahrungsaufbau - Frühgeburtlichkeit - Probiotika Gabe

Publikationsverlauf

Eingereicht: 03. Mai 2022

Angenommen nach Revision: 23. August 2022

Artikel online veröffentlicht:
10. Oktober 2022

• References

• 1 Jochum F, Moltu SJ, Senterre T. et al. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: fluid and electrolytes. Clin Nutr 2018; 37: 2344-2353
• 2 Vohr BR, Poindexter BB, Dusick AM. et. al. Persistent beneficial effects of breast milk ingested in the neonatal intensive care unit on outcomes of extremely low birth weight infants at 30 months of age. Pediatrics 2007; 120: 953-959
• 3 Manzoni P, Stolfi I, Pedicino R. et al. Human milk feeding prevents retinopathy of prematurity (ROP) in preterm VLBW neonates. Early Hum Dev 2013; 89: S64-S68
• 4 Villamor-Martínez E, Pierro M, Cavallaro G. et al. Donor human milk protects against bronchopulmonary dysplasia: a systematic review and meta-analysis. Nutrients 2018; 10: 238
• 5 Furman L, Taylor G, Minich N. et al. The effect of maternal milk on neonatal morbidity of very low-birth-weight infants. Arch Pediatr Adolesc Med 2003; 157: 66-71
• 6 Corpeleijn W, Kouwenhoven SMP, Paap MC. et al. Intake of own mother’s milk during the first days of life is associated with decreased morbidity and mortality in very low birth weight infants during the first 60 days of life. Neonatology 2012; 102: 276-281
• 7 Morgan J, Bombell S, McGuire W. Early trophic feeding versus enteral fasting for very preterm or very low birth weight infants. Cochrane Database Syst Rev 2013; CD000504
• 8 AlFaleh K, Anabrees J. Probiotics for prevention of necrotizing enterocolitis in preterm infants. Cochrane Database Syst Rev 2014; 4: CD005496
• 9 Gargasz A. Neonatal and pediatric parenteral nutrition. AACN Advanced Critical Care 2012; 23: 451-464
• 10 Satrom K, Gourley G. Cholestasis in preterm infants. Clin Perinatol 2016; 43: 355-373
• 11 Andreas NJ, Kampmann B, Mehring Le-Doare K. Human breast milk: a review on its composition and bioactivity. Early Human Dev 2015; 91: 629-635
• 12 Witkowska-Zimny M, Kaminska-El-Hassan E. Cells of human breast milk. Cell Mol Biol Lett 2017; 22: 11
• 13 Triantis V, Bode L, Neeren van JRJ. Immunological effects of human milk oligosaccharides. Front Pediatr 2018; 6: 190
• 14 Nasuf AWA, Ojha S, Dorling J. Oropharyngeal colostrum in preventing mortality and morbidity in preterm infants. Cochrane Database Syst Rev 2018; 9: CD011921
• 15 Tao J, Mao J, Yang J. et al. Effects of oropharyngeal administration of colostrum on the incidence of necrotizing enterocolitis, late-onset sepsis, and death in preterm infants: a meta-analysis of RCTs. Eur J Clin Nutr 2020; 74: 1122-1131
• 16 Dorling J, Abbott J, Berrington J. et al. Controlled trial of two incremental milk-feeding rates in preterm infants. N Engl J Med 2019; 10: 1434-1443
• 17 de Pipaón Marcos MS, Montes Bueno MT, SanJosé B. et al. Acquisition of full enteral feeds may depend on stooling pattern in very premature infants. J Perinat Med 2012; 40: 427-431
• 18 Miller J, Tonkin E, Damarell RA. et al. A systematic review and meta-analysis of human milk feeding and morbidity in very low birth weight infants. Nutrients 2018; 10: 31-35
• 19 Quigley M, Embleton ND, McGuire W. Formula versus maternal breast milk for feeding preterm or low birth weight infants. Cochrane Database of Systematic Reviews 2018; 6: CD002971
• 20 Elser HE. Positioning after feedings: what is the evidence to reduce feeing intolerances?. Adv Neonatal Care 2012; 12: 172-175
• 21 Mihatsch WA, von Schoenaich P, Fahnenstich H. et al. The significance of gastric residuals in the early enteral feeding advancement of extremely low birth weight infants. Pediatrics 2002; 109: 457-459
• 22 Li YF, Lin HC, Torrazza RM. et al. Gastric residual evaluation in preterm neonates: a useful monitoring technique or a hindrance?. Pediatr Neonatol 2014; 55: 335-340
• 23 Riskin A, Cohen K, Kugelman A. et al. The impact of routine evaluation of gastric residual volumes on the time to achieve full enteral feeding in preterm infants. J Pediatr 2017; 189: 128-134
• 24 Salas AA, Cuna A, Bhat R. et al. A randomised trial of re-feeding gastric residual in preterm infants. Arch Dis Child Fetal Neonatal Ed 2015; 100: F224-F228
• 25 Boix-Amorós A, Collado MC, Mira A. Relationship between milk microbiota, bacterial load, macronutrients, and human cells during lactation. Front Microbiol 2016; 7: 492
• 26 Thomas DW, Greer FR, Bhatia JJS. et al. Clinical report – Probiotics and prebiotics in pediatrics. Pediatrics 2010; 126: 1217-1231
• 27 Costeloe K, Hardy P, Juszczak E. et al. Bifidobacterium breve BBG-001 in very preterm infants: a randomised controlled phase 3 trial. Lancet 2016; 387: 649-660
• 28 Sharif S, Oddie SJ, Heath PT. et al. Probiotics to prevent necrotising enterocolitis in very preterm or very low birth weight infants. Cochrane Database of Syst Rev 2021; 2021
• 29 Alcon-Giner C, Dalby MJ. et al. Microbiota supplementation with bifidobacterium and lactobacillus modifies the preterm infant gut microbiota and metabolome: an observational study. Cell Rep Med 2020; 1: 100077
• 30 Genzel-Boroviczény O, Jenke A, Mihatsch W. et al S2k-Leitlinie: Nekrotisierende Enterokolitis. AWMF Online. 2017