Nutrient‐enriched formula versus standard formula for preter | Figure 1

%27%3e%3cg%20id=%27Group-14%27%20transform=%27translate(13.000000,%20103.176124)%27%3e%3cg%20id=%27Group-Copy-5%27%20transform=%27translate(0.000000,%20182.676124)%27%3e%3crect%20id=%27Rectangle-8%27%20fill=%27%23E2E0DE%27%20x=%270%27%20y=%270%27%20width=%2736%27%20height=%2736%27%20rx=%2718%27%3e%3c/rect%3e%3cpath%20d=%27M28,27.6503435%20C28,22.127496%2023.5228474,17.6503435%2018,17.6503435%20C12.4771525,17.6503435%208,22.127496%208,27.6503435%20M18,16.3472505%20C20.8165136,16.3472505%2023.099749,14.0640151%2023.099749,11.2475015%20C23.099749,8.43098783%2020.8165136,6.1477524%2018,6.1477524%20C15.1834863,6.1477524%2012.9002509,8.43098783%2012.9002509,11.2475015%20C12.9002509,14.0640151%2015.1834863,16.3472505%2018,16.3472505%20Z%27%20id=%27Combined-Shape%27%20fill=%27%23FFFFFF%27%20fill-rule=%27nonzero%27%3e%3c/path%3e%3c/g%3e%3c/g%3e%3c/g%3e%3c/g%3e%3c/svg%3e)

Deleted account

Some actions are only available when you log in.

Report case

Report this to our moderators

Nutrient‐enriched formula versus standard formula for preterm infants

You can view up to 4 cases without signing up Sign up for unlimited access

Cochrane Review; seven trials with 590 infants; comparing feeding with nutrient‐enriched formula to standard formula.

Background

Standard formula (designed for term infants) may not provide preterm infants with sufficient quantities of nutrients to support optimal growth and development. Nutrient‐enriched formula (with extra protein and energy from carbohydrates or fat and other nutrients) has about 20% higher nutrient content than standard formula.

Key results

Nutrient‐enriched versus standard formula for preterm infants does not reduce the time taken to regain birth weight but is associated with higher rates of weight gain and head growth (although not length gain) during neonatal unit stay after birth. Only limited data are available for growth and developmental outcomes assessed beyond infancy, and these do not show consistent effects. No evidence suggests other potential benefits or harms of nutrient‐enriched formulas, including effects on feeding or bowel problems.

Conclusions

Although available trial data show that nutrient‐enriched formulas increase growth rates of preterm infants during their initial hospital admission, they do not provide evidence of effects on longer‐term growth or development. Further randomised trials would be needed to resolve this uncertainty.

Read the full Cochrane Review here

Comment

Sign up to add a comment

More about this case

ResolvedVerified literature

Why you should join Figure 1

Sign up to explore now

Similar cases

\ \ Monitoring of stomach aspirates to diagnose feed intolerance and necrotising enterocolitis is a common practice for preterm infants on tube feeds. There is no consensus on whether to re‐feed or discard the stomach aspirates. Although re‐feeding the aspirates may replace partially digested milk and gastrointestinal secretions that are essential for gastrointestinal maturation, re‐feeding abnormal aspirates may result in vomiting, necrotising enterocolitis, or sepsis. We have looked for evidence from clinical trials that assessed whether re‐feeding stomach aspirates is beneficial or harmful in preterm infants.\ Study characteristics\ The thorough literature search is up‐to‐date as of Febraury 2018. We found only one small randomised controlled trial (with 72 preterm infant participants) that addressed this question.\ Key results\ We are uncertain as to whether re‐feeding stomach aspirates has an effect on important outcomes such as incidence of necrotising enterocolitis, mortality before discharge, time to regain birth weight, time to reach full enteral feeds, duration of parenteral nutrition and duration of hospital stay.\ Quality of evidence\ Available evidence is insufficient to support or refute re‐feeding of stomach aspirates in preterm infants. More trials are needed to examine whether re‐feeding the stomach aspirates is beneficial or harmful in preterm infants.](https://app.figure1.com/case-detail/148f2130-2ae9-4e85-9d34-30bbe4d5a258)

\ \ Review question\ In preterm or low birth weight infants receiving gavage tube feedings, does push tube feeding compared with gravity tube feeding result in increased adverse events (low oxygen saturation, low heart rate, time to full suck feeding).\ Background\ Infants born prematurely (before 37 weeks) may be unable to co‐ordinate sucking, swallowing, and breathing, and require gavage feeding. In gavage feeding, milk is delivered intermittently through a tube passed via the nose or the mouth into the stomach. Intermittent bolus milk feeds may be administered by using a syringe to gently push milk into the infant's stomach (push feed). Alternatively, milk can be poured into a syringe attached to the tube and allowed to drip in by gravity (gravity feed).\ Study characteristics\ The search is up‐to‐date as of July 2020. We included one study (31 infants) in this updated review.\ Key results\ Evidence is insufficient to show whether use of push compared with gravity gavage feeding results in more rapid establishment of full gavage feeds without increasing adverse events in preterm or low birth weight infants, or both, who require intermittent bolus gavage feeding.\ Certainty of evidence\ Evidence from randomised trials comparing push versus gravity intermittent gavage tube feeding in preterm or low birth weight infants (less than 2500 grams) is insufficient to inform practice.](https://app.figure1.com/case-detail/40a89a04-f6a0-4c75-af62-b80b979fd054)

\ \ Review objective: to determine the relative benefits and harms of treatment with drugs that suppress inflammation, called corticosteroids, given to babies born too early during the first week after birth to prevent lung injury, known as bronchopulmonary dysplasia (sometimes also called “chronic lung disease”).\ Background: bronchopulmonary dysplasia is a major problem for newborn babies in neonatal intensive care units. Persistent inflammation of the lungs is the most likely cause. Corticosteroid drugs have been used to prevent or treat bronchopulmonary dysplasia through their strong anti‐inflammatory effects, but they may produce major adverse effects.\ Study characteristics: we reviewed all clinical trials in preterm babies for whom corticosteroids had been given systemically, that is, either as an injection or as a medicine, during the first week after birth, and for whom data on the rate of bronchopulmonary dysplasia later in the newborn period were available. We included 32 studies (4395 infants). The search is up‐to‐date as of 25 September 2020.\ Key results: this review of trials revealed that the benefits of giving systemic corticosteroids to infants starting within six days after birth may not outweigh the known adverse effects. However, a particular corticosteroid called hydrocortisone shows promise in improving short‐term outcomes without adversely affecting long‐term neurodevelopment, although the data on long‐term outcomes are limited so far. Beneficial effects of systemic corticosteroids overall included shorter time on the ventilator and less bronchopulmonary dysplasia; adverse effects included higher blood pressure, bleeding from the stomach or bowel, perforation of the bowel, excessive glucose in the bloodstream, and increased risk of cerebral palsy at follow‐up, particularly in those treated with dexamethasone ‐ another type of corticosteroid. Early use of corticosteroids, especially dexamethasone, to treat or prevent bronchopulmonary dysplasia should be curtailed until additional research has been performed.\ Certainty of evidence: overall, the certainty of evidence supporting our conclusions is high.](https://app.figure1.com/case-detail/6f824652-50ac-44e9-87ea-7cb6998792f1)

\ \ Do omega‐3 long chain polyunsaturated fatty acids (LCPUFA) taken during pregnancy improve health outcomes for babies & their mothers?\ Cochrane Review; 70 trials (19,927 women); mostly comparing omega‐3 LCPUFA vs. placebo or with no omega-3.\ Key findings\ Incidence of preterm birth (before 37 weeks) & very preterm birth (before 34 weeks) was lower in women who received omega‐3 LCPUFA compared with no additional omega‐3. There were also fewer babies with low birthweight. However, omega‐3 LCPUFA probably increased the incidence of pregnancies continuing beyond 42 weeks, although there was no difference identified in induction of labour for post‐term pregnancies. The risk of the baby dying or being very sick & going to neonatal intensive care may be lower with omega‐3 LCPUFA compared with no omega‐3. No differences were found between groups for serious adverse events for mothers or in postnatal depression. Very few differences between the omega‐3 LCPUFA groups & no omega‐3 groups were observed in child development & growth.\ 11 reported they had received industry funding. When we omitted these trials from the main outcomes (e.g. preterm birth & very preterm birth) it made very little, or no difference, to the results.\ The quality of the evidence from the included studies ranged from high to very low; this affected the certainty of the findings for different outcomes.](https://app.figure1.com/case-detail/7bc60148-3d3f-4430-b4eb-a7b5b5a3ac92)

Trending now

\ \ A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis.\ He had a history of hypertension, long-term smoking, and a sedentary lifestyle.\ On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.](https://app.figure1.com/case-detail/ae0fe999-6875-4474-94f0-ad823dbb9b3a)

\ \ A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets.\ Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.](https://app.figure1.com/case-detail/c271070f-2bc7-4052-9895-635277e1a7d5)

\ \ A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.](https://app.figure1.com/case-detail/48f41642-b9db-4089-b120-a94ee52328de)

\ \ patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ekg that would warrant further work-up or is this just a pediatric ekg?](https://app.figure1.com/case-detail/2af390e1-ace8-40ed-ba1c-98fb2d72f4c5)