This study evaluated the effectiveness of probiotics in reducing necrotizing enterocolitis (NEC) in very low birth weight (VLBW) infants. 367 VLBW infants were randomly assigned to receive breast milk with the probiotics Lactobacillus acidophilus and Bifidobacterium infantis or breast milk alone. The probiotic group had a significantly lower incidence of NEC and death compared to the control group. No adverse effects from the probiotics were observed. The probiotics were effective in reducing the incidence and severity of NEC in VLBW infants when administered with breast milk.
1) The study examined the effect of probiotics in preventing necrotizing enterocolitis (NEC) in preterm neonates compared to a control group.
2) 115 preterm infants weighing 750-1500g or less than 32 weeks gestation received probiotics or did not (control). The probiotic group had significantly lower incidence of NEC and fewer cases of elevated C-reactive protein.
3) However, there were no significant differences between the groups in duration of oxygen therapy, total parenteral nutrition, time to full feeding, or length of hospital stay. The study results suggest probiotics have a protective effect against NEC in preterm infants.
Exclusive Breastfeeding Reduces Acute Respiratory Infection And DiarrheaBiblioteca Virtual
This study examined the relationship between breastfeeding practices and infant mortality in Dhaka, Bangladesh. The researchers followed over 1600 infants from birth to 12 months. They found that exclusive breastfeeding declined from 53% at 1 month to 5% at 6 months. Partial or no breastfeeding was associated with a 2-3 times higher risk of infant death from all causes, acute respiratory infection (ARI), and diarrhea compared to exclusive breastfeeding. The study suggests that exclusive breastfeeding in early infancy reduces infant mortality, particularly from ARI and diarrhea.
1) This randomized controlled trial tested the probiotic Bifidobacterium breve BBG-001 in very preterm infants to see if it could reduce rates of necrotising enterocolitis, late-onset sepsis, and death.
2) 1315 very preterm infants from 24 hospitals in the UK were randomly assigned to receive either the probiotic or placebo daily until 36 weeks.
3) Rates of the primary outcomes (necrotising enterocolitis, sepsis, death) did not differ significantly between the probiotic and placebo groups, providing no evidence that this probiotic benefits this population of very preterm infants.
This randomized controlled trial tested the efficacy of the probiotic Lactobacillus reuteri in treating infantile colic in breastfed infants aged 2-16 weeks. It found that L. reuteri significantly reduced average daily crying time and increased the number of responders compared to placebo. Mechanisms may involve improving gut microbiota balance by reducing Escherichia coli and increasing Lactobacillus levels. The probiotic was well-tolerated with no significant differences in adverse events between groups. This study provides evidence that L. reuteri is an effective and safe treatment for infantile colic.
1. The study found that exclusive breastfeeding provided strong protection against infant death in Ghana, India, and Peru, where infant mortality from infectious disease is high. However, the risks of death or hospitalization for infants who were predominantly breastfed were not significantly different than for those who were exclusively breastfed.
2. Some experts were concerned that this finding could undermine promotion of exclusive breastfeeding, as the benefits of exclusive breastfeeding over predominant breastfeeding may be greatest in the first months of life when the study's sample sizes were smaller.
3. It was also noted that the study only looked at infants older than 6-10 weeks, so the findings may not apply to younger infants, for whom the differences between
Infant Feeding And Feeding Transitions During The First Year Of LifeBiblioteca Virtual
This document summarizes infant feeding patterns during the first year of life based on data from the Infant Feeding Practices Study II. Key findings include:
1) While 83% of infants were breastfed in the hospital, 42% of these infants also received formula supplementation. By 3 months, 61% of infants received formula.
2) Solid foods were introduced earlier than recommended, with 40% of infants consuming cereal and 17% consuming fruits/vegetables by 4 months of age.
3) Early introduction of solids was associated with discontinuing breastfeeding earlier and consuming more fatty/sugary foods by 12 months.
This study analyzed data from over 15,000 infants in the UK Millennium Cohort Study to examine the relationship between breastfeeding and hospitalization for diarrhea and respiratory infections in the first 8 months of life. The results showed that exclusive breastfeeding, compared to no breastfeeding, was associated with a lower risk of hospitalization for both diarrhea and respiratory infections after adjusting for various confounding factors. Partial breastfeeding also showed a protective effect, but it was weaker than exclusive breastfeeding. The protective effects of breastfeeding decreased after breastfeeding cessation. The study suggests that increased rates of exclusive and prolonged breastfeeding could significantly reduce hospitalizations in the UK.
1) The study examined the effect of probiotics in preventing necrotizing enterocolitis (NEC) in preterm neonates compared to a control group.
2) 115 preterm infants weighing 750-1500g or less than 32 weeks gestation received probiotics or did not (control). The probiotic group had significantly lower incidence of NEC and fewer cases of elevated C-reactive protein.
3) However, there were no significant differences between the groups in duration of oxygen therapy, total parenteral nutrition, time to full feeding, or length of hospital stay. The study results suggest probiotics have a protective effect against NEC in preterm infants.
Exclusive Breastfeeding Reduces Acute Respiratory Infection And DiarrheaBiblioteca Virtual
This study examined the relationship between breastfeeding practices and infant mortality in Dhaka, Bangladesh. The researchers followed over 1600 infants from birth to 12 months. They found that exclusive breastfeeding declined from 53% at 1 month to 5% at 6 months. Partial or no breastfeeding was associated with a 2-3 times higher risk of infant death from all causes, acute respiratory infection (ARI), and diarrhea compared to exclusive breastfeeding. The study suggests that exclusive breastfeeding in early infancy reduces infant mortality, particularly from ARI and diarrhea.
1) This randomized controlled trial tested the probiotic Bifidobacterium breve BBG-001 in very preterm infants to see if it could reduce rates of necrotising enterocolitis, late-onset sepsis, and death.
2) 1315 very preterm infants from 24 hospitals in the UK were randomly assigned to receive either the probiotic or placebo daily until 36 weeks.
3) Rates of the primary outcomes (necrotising enterocolitis, sepsis, death) did not differ significantly between the probiotic and placebo groups, providing no evidence that this probiotic benefits this population of very preterm infants.
This randomized controlled trial tested the efficacy of the probiotic Lactobacillus reuteri in treating infantile colic in breastfed infants aged 2-16 weeks. It found that L. reuteri significantly reduced average daily crying time and increased the number of responders compared to placebo. Mechanisms may involve improving gut microbiota balance by reducing Escherichia coli and increasing Lactobacillus levels. The probiotic was well-tolerated with no significant differences in adverse events between groups. This study provides evidence that L. reuteri is an effective and safe treatment for infantile colic.
1. The study found that exclusive breastfeeding provided strong protection against infant death in Ghana, India, and Peru, where infant mortality from infectious disease is high. However, the risks of death or hospitalization for infants who were predominantly breastfed were not significantly different than for those who were exclusively breastfed.
2. Some experts were concerned that this finding could undermine promotion of exclusive breastfeeding, as the benefits of exclusive breastfeeding over predominant breastfeeding may be greatest in the first months of life when the study's sample sizes were smaller.
3. It was also noted that the study only looked at infants older than 6-10 weeks, so the findings may not apply to younger infants, for whom the differences between
Infant Feeding And Feeding Transitions During The First Year Of LifeBiblioteca Virtual
This document summarizes infant feeding patterns during the first year of life based on data from the Infant Feeding Practices Study II. Key findings include:
1) While 83% of infants were breastfed in the hospital, 42% of these infants also received formula supplementation. By 3 months, 61% of infants received formula.
2) Solid foods were introduced earlier than recommended, with 40% of infants consuming cereal and 17% consuming fruits/vegetables by 4 months of age.
3) Early introduction of solids was associated with discontinuing breastfeeding earlier and consuming more fatty/sugary foods by 12 months.
This study analyzed data from over 15,000 infants in the UK Millennium Cohort Study to examine the relationship between breastfeeding and hospitalization for diarrhea and respiratory infections in the first 8 months of life. The results showed that exclusive breastfeeding, compared to no breastfeeding, was associated with a lower risk of hospitalization for both diarrhea and respiratory infections after adjusting for various confounding factors. Partial breastfeeding also showed a protective effect, but it was weaker than exclusive breastfeeding. The protective effects of breastfeeding decreased after breastfeeding cessation. The study suggests that increased rates of exclusive and prolonged breastfeeding could significantly reduce hospitalizations in the UK.
Phenobarbital uses in a Maternal-fetal infections : A case reportAxlerJEANPAUL
Maternal-fetal infections (MFIs) are important causes of morbi-mortality in neonatal units. According to the French Society of Neonatology in the 2017 version of its recommendations the care should be provided by a complete physical examination; and probabilistic antibiotic therapy with beta-lactam antibiotics and aminoglycosides, but never Phenobarbital.During our pediatric internship at the State University Hospital of Haiti (HUEH), we have noticed Phenobarbital is administered to newborns suspected with MFIs; we aim to draw attention to the indications of Phenobarbital in newborns through this case report and review literature study realize at the neonatal unit of the pediatric department of the State University Hospital of Haiti.
Comparison of prolonged low volume milk and routine volume milk onamir mohammad Armanian
This study compared outcomes for very low birth weight neonates who were fed using either a prolonged low volume milk strategy (20 mL/kg/day for 7 days before increasing) or a routine advancing volume strategy (increasing volumes by 20 mL/kg/day). The study found that the incidence of necrotizing enterocolitis was significantly lower in infants fed with the prolonged low volume strategy compared to those fed with advancing volumes. However, infants fed with advancing volumes reached full enteral feeding volumes sooner. Overall hospital stay times and weight gain at 30 days were similar between the two groups. The study suggests prolonged low volume feeding may help reduce NEC risk in very low birth weight neonates.
Role of l. reuteri in colic & easy digestion comfortable and healthy babykuntalbiswas56
Lactobacillus reuteri is a probiotic strain that provides several benefits for infant health and digestion. It reduces crying time in colicky infants by modulating the gut microbiota and decreasing levels of gas-forming bacteria like E.coli. It also reduces inflammation in the gut by immunomodulation, promoting the development of regulatory T cells. Furthermore, L. reuteri promotes development of the enteric nervous system, improving gut motility and decreasing visceral pain. Clinical studies show L. reuteri is more effective at reducing infant crying time compared to the antacid simethicone.
This document summarizes research on using a "BCG prime - DNA boost" vaccination strategy for tuberculosis. Key points:
- Mice vaccinated with BCG followed by a boost with DNA encoding the M. tuberculosis antigen α-crystallin had significantly reduced lung and spleen bacterial loads compared to BCG alone after airborne infection.
- The boosted mice also had less severe lung, liver and spleen pathology and granulomas.
- Protection lasted for at least 16 weeks and was associated with an increased proportion of the cytokines IL-12 and decreased IL-10 in the lungs.
- The results suggest boosting BCG with α-crystallin DNA enhances and prolongs protection against tuberculosis
Aydin arici current opinion in obstetrics & gynecology june 2010. 22-lippinco...Imad Zoukar
This document summarizes a study on whether repeated ovarian stimulation cycles negatively impact ovarian reserve. It discusses several previous studies on the topic. The key findings are:
1) For patients undergoing up to three repeated in vitro fertilization (IVF) cycles, studies show no significant decline in ovarian response or number of oocytes retrieved between cycles after controlling for age.
2) Studies also found no detrimental effect on ovarian function for egg donors undergoing up to three repetitive ovarian stimulation cycles for IVF.
3) For patients undergoing more than three cycles, the results are equivocal as age becomes a more important factor, with pregnancy and live birth rates declining with additional cycles.
Magnesium Prevents the Cerebral Palsy Precursor in Premature InfantsRoss Finesmith M.D.
To determine if magnesium sulfate has an effect on the development of cystic
periventricular leukomalacia in preterm infants, this retrospective case control study
was conducted. There were 23,382 infants born at three teaching hospitals in the metropolitan New York area from January 1992 to December 1994. Four hundred ninety-two infants met our entrance criteria. Criteria included a birth weight less than 750 g, survival to at least 7 days of life and at least one cranial ultrasound after 7 days of life.
Infants exposed to magnesium sulfate in utero were less likely to develop periventricular
leukomalacia. Two of 18 (11%) infants with periventricular leukomalacia were
exposed to magnesium sulfate in-utero compared to 14 of 36 controls (39%) (p =
0.035) (OR = 0.196, 95% Cl = 0.039-0.988). Pre-eclampsia as an independent factor
was not associated with a reduced risk (p = 0.251) (OR = 0.294, 95% Cl =
0.033-2.65). Preterm infants exposed to antenatal magnesium sulfate were found to
have a reduced risk of developing cystic periventricular leukomalacia.
This document discusses coccidioidomycosis (Valley fever) during pregnancy. It notes that the infection is more severe when acquired during pregnancy, especially in the third trimester, and that the use of azole antifungals during pregnancy can be teratogenic. It reviews literature on cases of coccidioidomycosis in pregnancy and the effect of sex hormones on fungal growth. It also discusses the risk of birth defects from azole exposure during pregnancy, specifically the Antley-Bixler syndrome. The document provides recommendations for managing coccidioidomycosis in pregnant women based on their infection status and trimester.
Two Month Old Infant Tetralogy of Fallot Post ECMO- NICU_ CurranCara Curran
This case report describes a two-month-old infant named Evan Foster who was born prematurely at 32 weeks gestation and diagnosed with Tetralogy of Fallot and a diaphragmatic hernia. After birth, Evan underwent repair of the hernia and was placed on ECMO for seven days. He is currently in the NICU awaiting repair of the Tetralogy of Fallot. The physical therapist performed assessments of Evan and found that he had cramped movements consistent with a preterm infant and was hypotonic and scoring below average for motor skills compared to other infants at his adjusted age. The case report provides context on Evan's condition and the role of physical therapy in optimizing outcomes for infants in the N
This study evaluated the impact of standard- and high-dose GnRH antagonists compared to a GnRH agonist on endometrial development in women undergoing controlled ovarian stimulation for oocyte donation. Thirty-one women were treated with either a standard dose of ganirelix, a high dose of ganirelix, or buserelin. Endometrial biopsies on days 2 and 7 after HCG administration found that development was similar in the standard- and high-dose ganirelix groups and comparable to natural cycles, but development was arrested in the buserelin group. Gene expression patterns after ganirelix more closely matched natural cycles than after buserelin. The study concluded that
This document discusses infantile colic, including definitions, pathophysiology, clinical features, diagnosis, and treatment options. Infantile colic is characterized by paroxysms of crying or fussing in an otherwise healthy infant under 4 months of age for at least 3 hours per day and for at least 1 week. The cause is unknown but may involve factors like immature gastrointestinal tract, cow's milk protein intolerance, or altered gut flora. Treatment focuses on parental counseling and reassurance, with some evidence that probiotic supplementation may help in severe cases.
The document describes efforts to reduce unnecessary antibiotic usage in a neonatal intensive care unit (NICU) at a tertiary healthcare center. A retrospective review found antibiotic recommendations could be decreased from 92% to 34% by using an early onset sepsis risk calculator. Implementation of a 36-hour antibiotic stop policy, use of the sepsis risk calculator, and antimicrobial stewardship rounds helped decrease the median antibiotic days per patient from 5 to 4 days while the overall antibiotic utilization rate slightly increased. Compliance with the 36-hour stop policy improved following its implementation. Further efforts using the calculator and antimicrobial stewardship are aimed at minimizing unnecessary antibiotic exposure in the NICU.
Breastfeeding And The Risk Of Postneonatal Death In The United StatesBiblioteca Virtual
This study examined the association between breastfeeding and postneonatal mortality in the United States using data from the 1988 National Maternal and Infant Health Survey. The study found that children who were ever breastfed had a 21% lower risk of postneonatal death compared to children who were never breastfed. Longer durations of breastfeeding were associated with even lower risk. The protective effect of breastfeeding was seen across different causes of postneonatal death, including infections, injuries, and sudden infant death syndrome.
Do Baby Friendly Hospitals Influence Breastfeeding Duration On ABiblioteca Virtual
This study examined the influence of Baby-Friendly Hospital Initiative (BFHI) compliance on breastfeeding rates and duration in Switzerland. The authors conducted a national survey in 2003 of over 2800 mothers who had given birth in the previous 9 months. They collected data on breastfeeding practices and the hospital of delivery. They found that infants born in hospitals with high BFHI compliance had significantly longer durations of exclusive, full, and any breastfeeding compared to other hospitals, even after controlling for other factors. This supports the hypothesis that increased BFHI implementation in Switzerland has contributed to improved national breastfeeding outcomes since 1994. However, the authors note mothers choosing BFHI hospitals may also breastfeed longer regardless of the hospital practices.
Compared With Cot Sleeping In The Home Setting Differences In Infant And Pare...Biblioteca Virtual
This study observed differences in infant and parent behaviors during bed sharing compared to cot sleeping in the home. 40 bed-sharing infant-parent pairs were matched with 40 cot-sleeping pairs and their overnight behaviors were video recorded. The study found that while total sleep time was similar, bed-sharing infants slept in the side position more and cot-sleeping infants slept supine more. Bed-sharing infants experienced more parental touching, looking, and breastfeeding but also more head covering. Whether increased head covering and side sleeping during bed-sharing increases SIDS risk requires further research.
Lo status materno di vitamina d influisce sulla crescita delle ossa nella pri...Merqurio
This prospective study followed 87 children from birth to 14 months to examine the impact of maternal vitamin D status during pregnancy on the children's bone growth. The children were divided into two groups based on their mother's vitamin D status during pregnancy. While postnatal vitamin D supplementation improved status in both groups, it only partly eliminated differences in bone variables induced during fetal development. Children in the lower prenatal vitamin D group had lower bone mineral content at birth but greater gains, resulting in similar levels at 14 months. Those in the higher prenatal group had a larger bone area at birth, and this difference persisted. Maternal vitamin D status during pregnancy thus influenced long-term bone development in offspring.
This study examined the effects of bisphenol A (BPA) exposure on mammary cancer risk in mice. The researchers found that prenatal exposure to low and high doses of BPA led to earlier vaginal opening in female mouse offspring, indicating precocious puberty. While no differences in mammary gland development were observed, both BPA exposure groups had a statistically significant increase in susceptibility to mammary tumors induced by DMBA compared to controls. The study also found that BPA treatment promoted the growth of established MCF-7 human breast cancer tumors transplanted into mice, an effect that was reversed by tamoxifen treatment. The results suggest that BPA exposure may increase mammary cancer risk through at least two mechanisms: altering fetal mammary
Oral presentation given at the jENS conference Nov 3, 2017, in Venice/Italy.
The presentation is a short summary of a project on maternal overweight and obesity and how that relates to offspring risk of cerebral palsy.
The study was published in in JAMA in 2017, where it is available as open access on https://jamanetwork.com/journals/jama/fullarticle/2608220
Delayed Breastfeeding Initiation Increases Risk Of Neonatal MortalityBiblioteca Virtual
This document summarizes a study that investigated the relationship between the timing of breastfeeding initiation and neonatal mortality in Ghana. The study found that initiating breastfeeding within the first day of life reduced the risk of neonatal death, with even earlier initiation (within the first hour) further reducing risk. Delaying breastfeeding initiation beyond 1 day increased the risk of neonatal death. The study suggests that promoting early breastfeeding initiation could significantly reduce neonatal mortality rates in sub-Saharan Africa.
The document repeatedly provides the URL www.myschoolchildren.com and states that other question papers can be downloaded for free from this website. The URL and statement are repeated over 30 times throughout the document.
Social Relationship Monitoring for Public Sector Jeffrey Corcoran
This document discusses Oracle's social cloud solutions for government organizations. It begins with an overview of social relationship management and why it is important for public sector organizations. It then outlines Oracle's social solutions, including social relationship management, and provides examples of how these solutions have been used by organizations like a transport network and General Motors to improve citizen engagement, customer service, and reputation management. The document emphasizes that Oracle's social solutions are integrated with its other technology offerings and can help government agencies enhance citizen experiences through social listening, engagement, and analytics.
This document summarizes the services of a full-service representative firm that aims to provide problem-free sourcing and support. The firm offers 24/7 support and local proximity. It has over 35 years of industry experience and sources from various product lines including metal castings, powdered metal, rubber, and plastics. It also offers off-shore sourcing from Asia with lower prices, bi-lingual staff, and quality inspection. The firm handles various manufacturing processes including die casting, stamping, forging, and plastic injection molding to serve customers' needs.
Phenobarbital uses in a Maternal-fetal infections : A case reportAxlerJEANPAUL
Maternal-fetal infections (MFIs) are important causes of morbi-mortality in neonatal units. According to the French Society of Neonatology in the 2017 version of its recommendations the care should be provided by a complete physical examination; and probabilistic antibiotic therapy with beta-lactam antibiotics and aminoglycosides, but never Phenobarbital.During our pediatric internship at the State University Hospital of Haiti (HUEH), we have noticed Phenobarbital is administered to newborns suspected with MFIs; we aim to draw attention to the indications of Phenobarbital in newborns through this case report and review literature study realize at the neonatal unit of the pediatric department of the State University Hospital of Haiti.
Comparison of prolonged low volume milk and routine volume milk onamir mohammad Armanian
This study compared outcomes for very low birth weight neonates who were fed using either a prolonged low volume milk strategy (20 mL/kg/day for 7 days before increasing) or a routine advancing volume strategy (increasing volumes by 20 mL/kg/day). The study found that the incidence of necrotizing enterocolitis was significantly lower in infants fed with the prolonged low volume strategy compared to those fed with advancing volumes. However, infants fed with advancing volumes reached full enteral feeding volumes sooner. Overall hospital stay times and weight gain at 30 days were similar between the two groups. The study suggests prolonged low volume feeding may help reduce NEC risk in very low birth weight neonates.
Role of l. reuteri in colic & easy digestion comfortable and healthy babykuntalbiswas56
Lactobacillus reuteri is a probiotic strain that provides several benefits for infant health and digestion. It reduces crying time in colicky infants by modulating the gut microbiota and decreasing levels of gas-forming bacteria like E.coli. It also reduces inflammation in the gut by immunomodulation, promoting the development of regulatory T cells. Furthermore, L. reuteri promotes development of the enteric nervous system, improving gut motility and decreasing visceral pain. Clinical studies show L. reuteri is more effective at reducing infant crying time compared to the antacid simethicone.
This document summarizes research on using a "BCG prime - DNA boost" vaccination strategy for tuberculosis. Key points:
- Mice vaccinated with BCG followed by a boost with DNA encoding the M. tuberculosis antigen α-crystallin had significantly reduced lung and spleen bacterial loads compared to BCG alone after airborne infection.
- The boosted mice also had less severe lung, liver and spleen pathology and granulomas.
- Protection lasted for at least 16 weeks and was associated with an increased proportion of the cytokines IL-12 and decreased IL-10 in the lungs.
- The results suggest boosting BCG with α-crystallin DNA enhances and prolongs protection against tuberculosis
Aydin arici current opinion in obstetrics & gynecology june 2010. 22-lippinco...Imad Zoukar
This document summarizes a study on whether repeated ovarian stimulation cycles negatively impact ovarian reserve. It discusses several previous studies on the topic. The key findings are:
1) For patients undergoing up to three repeated in vitro fertilization (IVF) cycles, studies show no significant decline in ovarian response or number of oocytes retrieved between cycles after controlling for age.
2) Studies also found no detrimental effect on ovarian function for egg donors undergoing up to three repetitive ovarian stimulation cycles for IVF.
3) For patients undergoing more than three cycles, the results are equivocal as age becomes a more important factor, with pregnancy and live birth rates declining with additional cycles.
Magnesium Prevents the Cerebral Palsy Precursor in Premature InfantsRoss Finesmith M.D.
To determine if magnesium sulfate has an effect on the development of cystic
periventricular leukomalacia in preterm infants, this retrospective case control study
was conducted. There were 23,382 infants born at three teaching hospitals in the metropolitan New York area from January 1992 to December 1994. Four hundred ninety-two infants met our entrance criteria. Criteria included a birth weight less than 750 g, survival to at least 7 days of life and at least one cranial ultrasound after 7 days of life.
Infants exposed to magnesium sulfate in utero were less likely to develop periventricular
leukomalacia. Two of 18 (11%) infants with periventricular leukomalacia were
exposed to magnesium sulfate in-utero compared to 14 of 36 controls (39%) (p =
0.035) (OR = 0.196, 95% Cl = 0.039-0.988). Pre-eclampsia as an independent factor
was not associated with a reduced risk (p = 0.251) (OR = 0.294, 95% Cl =
0.033-2.65). Preterm infants exposed to antenatal magnesium sulfate were found to
have a reduced risk of developing cystic periventricular leukomalacia.
This document discusses coccidioidomycosis (Valley fever) during pregnancy. It notes that the infection is more severe when acquired during pregnancy, especially in the third trimester, and that the use of azole antifungals during pregnancy can be teratogenic. It reviews literature on cases of coccidioidomycosis in pregnancy and the effect of sex hormones on fungal growth. It also discusses the risk of birth defects from azole exposure during pregnancy, specifically the Antley-Bixler syndrome. The document provides recommendations for managing coccidioidomycosis in pregnant women based on their infection status and trimester.
Two Month Old Infant Tetralogy of Fallot Post ECMO- NICU_ CurranCara Curran
This case report describes a two-month-old infant named Evan Foster who was born prematurely at 32 weeks gestation and diagnosed with Tetralogy of Fallot and a diaphragmatic hernia. After birth, Evan underwent repair of the hernia and was placed on ECMO for seven days. He is currently in the NICU awaiting repair of the Tetralogy of Fallot. The physical therapist performed assessments of Evan and found that he had cramped movements consistent with a preterm infant and was hypotonic and scoring below average for motor skills compared to other infants at his adjusted age. The case report provides context on Evan's condition and the role of physical therapy in optimizing outcomes for infants in the N
This study evaluated the impact of standard- and high-dose GnRH antagonists compared to a GnRH agonist on endometrial development in women undergoing controlled ovarian stimulation for oocyte donation. Thirty-one women were treated with either a standard dose of ganirelix, a high dose of ganirelix, or buserelin. Endometrial biopsies on days 2 and 7 after HCG administration found that development was similar in the standard- and high-dose ganirelix groups and comparable to natural cycles, but development was arrested in the buserelin group. Gene expression patterns after ganirelix more closely matched natural cycles than after buserelin. The study concluded that
This document discusses infantile colic, including definitions, pathophysiology, clinical features, diagnosis, and treatment options. Infantile colic is characterized by paroxysms of crying or fussing in an otherwise healthy infant under 4 months of age for at least 3 hours per day and for at least 1 week. The cause is unknown but may involve factors like immature gastrointestinal tract, cow's milk protein intolerance, or altered gut flora. Treatment focuses on parental counseling and reassurance, with some evidence that probiotic supplementation may help in severe cases.
The document describes efforts to reduce unnecessary antibiotic usage in a neonatal intensive care unit (NICU) at a tertiary healthcare center. A retrospective review found antibiotic recommendations could be decreased from 92% to 34% by using an early onset sepsis risk calculator. Implementation of a 36-hour antibiotic stop policy, use of the sepsis risk calculator, and antimicrobial stewardship rounds helped decrease the median antibiotic days per patient from 5 to 4 days while the overall antibiotic utilization rate slightly increased. Compliance with the 36-hour stop policy improved following its implementation. Further efforts using the calculator and antimicrobial stewardship are aimed at minimizing unnecessary antibiotic exposure in the NICU.
Breastfeeding And The Risk Of Postneonatal Death In The United StatesBiblioteca Virtual
This study examined the association between breastfeeding and postneonatal mortality in the United States using data from the 1988 National Maternal and Infant Health Survey. The study found that children who were ever breastfed had a 21% lower risk of postneonatal death compared to children who were never breastfed. Longer durations of breastfeeding were associated with even lower risk. The protective effect of breastfeeding was seen across different causes of postneonatal death, including infections, injuries, and sudden infant death syndrome.
Do Baby Friendly Hospitals Influence Breastfeeding Duration On ABiblioteca Virtual
This study examined the influence of Baby-Friendly Hospital Initiative (BFHI) compliance on breastfeeding rates and duration in Switzerland. The authors conducted a national survey in 2003 of over 2800 mothers who had given birth in the previous 9 months. They collected data on breastfeeding practices and the hospital of delivery. They found that infants born in hospitals with high BFHI compliance had significantly longer durations of exclusive, full, and any breastfeeding compared to other hospitals, even after controlling for other factors. This supports the hypothesis that increased BFHI implementation in Switzerland has contributed to improved national breastfeeding outcomes since 1994. However, the authors note mothers choosing BFHI hospitals may also breastfeed longer regardless of the hospital practices.
Compared With Cot Sleeping In The Home Setting Differences In Infant And Pare...Biblioteca Virtual
This study observed differences in infant and parent behaviors during bed sharing compared to cot sleeping in the home. 40 bed-sharing infant-parent pairs were matched with 40 cot-sleeping pairs and their overnight behaviors were video recorded. The study found that while total sleep time was similar, bed-sharing infants slept in the side position more and cot-sleeping infants slept supine more. Bed-sharing infants experienced more parental touching, looking, and breastfeeding but also more head covering. Whether increased head covering and side sleeping during bed-sharing increases SIDS risk requires further research.
Lo status materno di vitamina d influisce sulla crescita delle ossa nella pri...Merqurio
This prospective study followed 87 children from birth to 14 months to examine the impact of maternal vitamin D status during pregnancy on the children's bone growth. The children were divided into two groups based on their mother's vitamin D status during pregnancy. While postnatal vitamin D supplementation improved status in both groups, it only partly eliminated differences in bone variables induced during fetal development. Children in the lower prenatal vitamin D group had lower bone mineral content at birth but greater gains, resulting in similar levels at 14 months. Those in the higher prenatal group had a larger bone area at birth, and this difference persisted. Maternal vitamin D status during pregnancy thus influenced long-term bone development in offspring.
This study examined the effects of bisphenol A (BPA) exposure on mammary cancer risk in mice. The researchers found that prenatal exposure to low and high doses of BPA led to earlier vaginal opening in female mouse offspring, indicating precocious puberty. While no differences in mammary gland development were observed, both BPA exposure groups had a statistically significant increase in susceptibility to mammary tumors induced by DMBA compared to controls. The study also found that BPA treatment promoted the growth of established MCF-7 human breast cancer tumors transplanted into mice, an effect that was reversed by tamoxifen treatment. The results suggest that BPA exposure may increase mammary cancer risk through at least two mechanisms: altering fetal mammary
Oral presentation given at the jENS conference Nov 3, 2017, in Venice/Italy.
The presentation is a short summary of a project on maternal overweight and obesity and how that relates to offspring risk of cerebral palsy.
The study was published in in JAMA in 2017, where it is available as open access on https://jamanetwork.com/journals/jama/fullarticle/2608220
Delayed Breastfeeding Initiation Increases Risk Of Neonatal MortalityBiblioteca Virtual
This document summarizes a study that investigated the relationship between the timing of breastfeeding initiation and neonatal mortality in Ghana. The study found that initiating breastfeeding within the first day of life reduced the risk of neonatal death, with even earlier initiation (within the first hour) further reducing risk. Delaying breastfeeding initiation beyond 1 day increased the risk of neonatal death. The study suggests that promoting early breastfeeding initiation could significantly reduce neonatal mortality rates in sub-Saharan Africa.
The document repeatedly provides the URL www.myschoolchildren.com and states that other question papers can be downloaded for free from this website. The URL and statement are repeated over 30 times throughout the document.
Social Relationship Monitoring for Public Sector Jeffrey Corcoran
This document discusses Oracle's social cloud solutions for government organizations. It begins with an overview of social relationship management and why it is important for public sector organizations. It then outlines Oracle's social solutions, including social relationship management, and provides examples of how these solutions have been used by organizations like a transport network and General Motors to improve citizen engagement, customer service, and reputation management. The document emphasizes that Oracle's social solutions are integrated with its other technology offerings and can help government agencies enhance citizen experiences through social listening, engagement, and analytics.
This document summarizes the services of a full-service representative firm that aims to provide problem-free sourcing and support. The firm offers 24/7 support and local proximity. It has over 35 years of industry experience and sources from various product lines including metal castings, powdered metal, rubber, and plastics. It also offers off-shore sourcing from Asia with lower prices, bi-lingual staff, and quality inspection. The firm handles various manufacturing processes including die casting, stamping, forging, and plastic injection molding to serve customers' needs.
This document discusses how digital disruption is changing customer expectations and behaviors. It highlights the need for companies to deliver personalized, cross-channel customer experiences in order to thrive in today's environment. The Oracle Customer Experience Cloud is presented as a solution that connects every customer engagement across the buy-own cycles through applications for marketing, sales, commerce, service, and social. It provides standardized, integrated processes and industry-specific solutions to help companies improve the customer experience.
The document describes several children's toys made from various materials like wood, plastic, cloth, and metal. Most of the toys are round, circular, or oval in shape and are operated using basic hand tools like files, drills, disc sanders, and saws. The toys move in ways like rocking, spinning, rolling, or having movable parts and are constructed through techniques such as gluing, screwing, nailing, cutting, and engraving.
This document discusses using mail merge in Microsoft Word. It provides steps to perform a mail merge, including selecting the mail merge wizard, inserting a data source and merge fields, and printing the output. Mail merge allows creating personalized documents quickly from a main document and customer list, but should be used carefully to avoid issues like junk mail, environmental waste, or lack of sensitivity.
This document discusses copyright restrictions for the journal Pediatrics. It states that the copyright of Pediatrics belongs to the American Academy of Pediatrics. It also notes that content from Pediatrics may not be copied, emailed to multiple sites, or posted to a listserv without express written permission from the copyright holder. However, individual users are allowed to print, download, or email articles for their own use.
The document announces a Southeast Asian regional conference in September 2010 to celebrate ET Browne's 10th birthday. The conference will bring together representatives from countries in Southeast Asia to mark the anniversary and share experiences from the past decade.
This document summarizes evidence and guidelines around the evaluation and management of possible early-onset neonatal sepsis. It finds that restricting unnecessary evaluation and antibiotics is important. Clinical monitoring can identify red flags and is often sufficient for well-appearing late preterm and term infants, especially with serial exams over 12 hours. While tests have limited predictive value, stopping antibiotics by 36 hours for reassuring infants is recommended. Several adjuvant therapies like exchange transfusions, immunoglobulins, and colony stimulating factors show promise but require more research before routine use.
This document discusses necrotizing enterocolitis (NEC) in preterm infants. It notes that NEC is an enigma due to inconsistent definitions and the lumping together of different diseases under the term NEC. There is no clear consensus on what constitutes "classic NEC". The document explores potential causes of NEC like dysbiosis of the gut microbiome from overuse of antibiotics and lack of enteral feeding in preterm infants. It summarizes evidence that common neonatal practices may disrupt the developing microbiome and increase the risk of NEC. While some studies found probiotics reduced NEC rates, the largest and most recent trial found no effect, demonstrating more research is still needed to understand and prevent N
This document discusses the use of probiotics in the neonatal intensive care unit (NICU) to help prevent diseases like necrotizing enterocolitis (NEC). It provides background on the development of the infant gut microbiome and how probiotics may benefit preterm infants by competing with pathogens, producing antimicrobial substances, and modulating the immune system. Several studies cited found probiotic supplementation significantly reduced the risk of NEC and mortality in very low birth weight infants. Meta-analyses support the routine use of probiotics in the NICU.
This study compared the probiotic Lactobacillus reuteri to simethicone in treating infantile colic in 83 breastfed infants. It found that L. reuteri significantly reduced crying time within one week, with median crying times of 159 minutes per day for the probiotic group versus 177 minutes for simethicone on day 7. By day 28, the median crying time was 51 minutes for the probiotic group versus 145 minutes for simethicone. The probiotic was also found to be well-tolerated with no reported adverse effects.
This document discusses enteral nutrition in preterm neonates. It notes that providing adequate nutrition to preterm infants is challenging due to immaturity of bowel function and inability to suck and swallow. While parenteral nutrition can provide nutrients, lack of enteral intake can impair gut development and function. The document reviews evidence from several Cochrane reviews on different approaches to enteral feeding in preterm infants, finding insufficient evidence to recommend one approach over others and calling for additional large randomized controlled trials to evaluate effects on important outcomes.
Randomized, Controlled Trial Of A Prenatal And Postnatal Lactation ConsultantBiblioteca Virtual
This randomized controlled trial evaluated the effectiveness of a prenatal and postnatal lactation consultant intervention on the duration and intensity of breastfeeding up to 12 months. Over 300 low-income women receiving prenatal care at two community health centers were randomly assigned to an intervention or control group. The intervention group received individualized support from lactation consultants including prenatal meetings, a postpartum hospital visit, and home visits/phone calls. The trial found the intervention group was more likely to breastfeed through 20 weeks and had higher breastfeeding intensity scores at 13 and 52 weeks compared to the control group. US-born women in the control group had the lowest breastfeeding intensity. The study concluded the "best-practices" lactation
This document discusses intestinal flora in newborns and the use of probiotics to treat dysbiosis. It presents results from a study of 68 newborns divided into two groups: one treated with Subtil and the other with Eubioflor. Positive results were seen in 64% of Subtil patients by day 4 and 78% by day 10-30, while the Eubioflor group saw 82% improvement by day 4 and 89% by day 10-30. The study suggests Eubioflor may be more effective than Subtil at organizing intestinal flora and treating dysbiosis in newborns.
This research article describes a study of 127 premature infants diagnosed with necrotizing enterocolitis (NEC) who were treated with either medical or surgical interventions. 88 infants were treated medically, with 54 responding well and 34 requiring laparoscopy. 39 infants underwent emergency surgery. Overall, medical treatment had a 61.4% success rate and lower mortality and morbidity compared to surgical treatment. For infants not responding to medical care, bedside laparoscopy provided diagnostic and therapeutic benefits and reduced the need for emergency surgery in some cases. The study aims to outline treatment approaches and outcomes for NEC to improve management of this serious condition in preterm infants.
Ranitidine is associated with infections, necrotizing enterocolitisCMCH,Vellore
This study found that ranitidine use in very low birth weight newborns was associated with higher rates of infections, necrotizing enterocolitis (NEC), and mortality. Newborns treated with ranitidine had over 5 times higher risk of infections like sepsis and pneumonia compared to those not treated. Rates of NEC and mortality were also significantly higher in newborns receiving ranitidine. The study cautions against the use of ranitidine in preterm newborns due to these risks of severe infectious diseases and fatal outcomes.
Ranitidine is associated with infections, necrotizing enterocolitisCMCH,Vellore
This study found that the use of ranitidine in very low birth weight newborns was associated with higher rates of infections, necrotizing enterocolitis (NEC), longer hospital stays, and higher mortality. The study prospectively examined 274 newborns, 91 of which received ranitidine treatment. Newborns treated with ranitidine had over 5 times higher risk of infections like sepsis and pneumonia. They also had a higher risk of NEC and mortality. The results suggest ranitidine should be used cautiously in preterm infants due to these risks.
Probiotics may play a role in inflammatory bowel disease (IBD). In ulcerative colitis, probiotics like VSL#3 have been shown to induce remission in mild-to-moderate disease, maintain remission, and treat pouchitis. Certain probiotic strains are more effective than others. In Crohn's disease, VSL#3 and S. boulardii have demonstrated benefits like maintaining remission and improving intestinal permeability when used as an adjunct to standard therapies. Well-designed studies provide evidence for the therapeutic potential of specific probiotic strains in both ulcerative colitis and Crohn's disease.
This study examined levels of the protein inter-alpha inhibitor protein (IaIp) in infants with necrotizing enterocolitis (NEC), spontaneous intestinal perforation (SIP), and controls. The study found:
1) Mean IaIp levels were significantly lower in infants with NEC compared to infants with SIP and controls.
2) IaIp levels distinguished NEC from SIP with high accuracy, while C-reactive protein levels did not differ between groups.
3) IaIp levels may be a superior biomarker to C-reactive protein for the early detection of NEC.
This document provides an overview of necrotizing enterocolitis (NEC), including its definition, risk factors, pathophysiology, clinical presentation, diagnosis, and management. NEC is a leading cause of mortality and morbidity in very low birth weight neonates. Key points include that prematurity is the greatest risk factor, enteral feeding can increase risk but is also necessary for treatment, and abnormal gut microbiota and immature intestinal barriers may allow pathogenic bacteria to translocate and cause inflammation. Diagnosis involves imaging and lab tests. Treatment involves bowel rest, antibiotics, and potentially surgery for severe cases.
Group B Streptococcus (GBS) is a bacteria that can cause neonatal infections. Studies show the rate of early onset GBS in newborns has declined with the introduction of antibiotic prophylaxis during labor for women with risk factors. Risk factors include premature rupture of membranes, fever, previous GBS-infected baby. Guidelines recommend antibiotics for women in labor with risk factors to prevent transmission of GBS to the newborn around birth.
Food allergy has been long recognized and well documented. Other adverse reactions to foods first referred to as “toxic idiopathies” by John Freeman, co inventor of immunotherapy, at the early part of the 1900s can be mediated by and have their impact on the nervous and endocrine systems. It can also be mediated by pharmacologic mechanisms and can also affect any part of the body. There’s a great clinical need to accurately identify triggers of adverse reactivity as they have now been linked with even the most serious of modern maladies and diseases. In fact, inflammation is the hallmark of metabolic syndrome. Given the multitude of pathogenic mechanisms underlying adverse reactions to foods and other environmental exposures it is necessary that a utilizable and cost effective technology be understood so that its application be utilized under the appropriate circumstances.
KEY LEARNING POINTS
• The natural ability of certain foods to initiate an inflammatory response and induce metabolic disruptions and counterbalancing mechanisms to prevent that
• How foods can trigger “danger signals” for the immune system
Pharmacologic vs. immunologic reactions to foods
• Is there a common final pathway of all these mechanisms that can reliably indicate triggers of clinical pathology?
• Cellular testing vs. serologic testing: The advantages of cellular testing
This document discusses the use of probiotics to reduce necrotizing enterocolitis (NEC) in preterm infants. It summarizes several meta-analyses and randomized controlled trials that found probiotic supplementation significantly reduced the risk of NEC and mortality in preterm, low birth weight infants. Specifically, probiotics were found to reduce the risk of NEC by 45-49% and lower mortality rates by 23-29% compared to controls. Probiotics also reduced the incidence of late-onset sepsis by 12-19%. Common probiotic strains used included Lactobacillus and Bifidobacterium species. The document concludes that probiotics show promise in preventing NEC and improving outcomes in preterm infants
Protective Gut And Nutritional StratigiesPerwin Waly
Early and aggressive nutrition is recommended for preterm infants to support growth and development. This includes starting total parenteral nutrition within the first hours and minimal enteral feeding beginning on the first day using human milk when possible. Human milk provides important immune and nutritional benefits and is preferred over formula when available due to its protection against infection and promotion of development.
This document discusses Gastro Esophageal Reflux Disease (GERD) in infants. It provides definitions of key terms like GER and GERD. It reviews the epidemiology and natural history of GER in infants, noting that the prevalence of daily regurgitation peaks between 1-6 months of age in around 70% of infants. It discusses the anatomy and physiology involved in GER and reviews approaches to diagnosing GERD in infants, including history, physical exam, upper GI imaging, endoscopy, and pH monitoring. Non-pharmacological and pharmacological treatment options are also covered.
This document discusses Gastro Esophageal Reflux Disease (GERD) in infants. It provides definitions of key terms like GER and GERD. It reviews the epidemiology and natural history of GER in infants, noting that the prevalence of daily regurgitation peaks between 1-6 months of age in around 70% of infants. It also discusses the evaluation and diagnosis of GERD in infants, noting that diagnostic tests like upper GI radiography are not recommended, while tests like pH probes can help assess acid reflux. The document provides an overview of treatment options for GER including non-pharmacological and medication approaches.
Similar to Oral probiotics reduce the incidence and severity of necrotizing (20)
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
2. approved by our institutional review board. VLBW infants (birth Sample-Size Calculation and Statistics
weight Ͻ1500 g) who started to fed enterally and survived beyond Our historical data showed that the combined incidence of NEC
the seventh day after birth were eligible for the trial. They were or death was ϳ23%. Setting the ␣ error Ͻ .05 and  error Ͻ .2
randomized into the study or control groups by a random-number (2-tailed) and an absolute reduction of the incidence of NEC or
table sequence after informed parental consents were obtained. death by 50%, the total number needed to verify our hypothesis
The allocations were contained in opaque, sequentially numbered, was 338 (169 per arm of the study).
sealed envelopes. The study group was fed with Infloran (L aci- The 2 test was used to analyze the categorical data, along with
dophilus [minimum of 1 004 356, obtained from the American Type Fisher’s exact test when applicable. The Student’s t test was used
Culture Collection in 1973] and B infantis [minimum of 1 015 697, for continuous data. A logistic regression model was used to
obtained from the American Type Culture Collection in 1973]; analyze the treatment effects on the primary and secondary out-
Swiss Serum and Vaccine Institute, Berne, Switzerland): 125 come variables (death, NEC, and sepsis).
mg/kg per dose twice daily with breast milk until discharged. The
control group was fed with breast milk without the addition of RESULTS
probiotics. Infloran was stored in a refrigerator at a temperature
between 4°C and 8°C and mixed with breast milk before feeding.
There were 417 VLBW infants admitted to our
Breast milk was either from the infant’s own mother or from a NICU during the 4.5-year study period. Of these
breast milk bank. Infloran was added to the breast milk by per- infants, 50 expired (n ϭ 42) or had NEC before 7 days
sonnel on the breast milk team who were not involved in the care after birth (n ϭ 6) or the family members declined
of the infant and followed orders from the sealed envelope. Thus, consent for study (n ϭ 2). A total of 367 infants were
the only personnel who knew of the infants’ group assignments enrolled in the trial: 180 in the study arm and 187 in
were the investigators and those on the breast milk team who
were not involved in the care of the study infants.
the control arm. Fifty-six infants in the study group
Feeding was started when the infant had stable vital signs, and 61 infants in the control group were fed with
active bowel sound without abdominal distension, no bile or banked breast milk. The maternal clinical and in-
blood from the nasogastric tube, and no indwelling umbilical fant’s demographic and clinical characteristics did
artery or umbilical venous catheter for at least 24 hours. A strict not differ between the 2 groups (Table 1). The in-
feeding protocol was followed for all study infants. Depending on fants’ clinical characteristics also did not differ be-
the birth weight and gestational age of the infant, a certain amount
of breast milk was initiated after the infant tolerated 1 trial of tween the 2 groups (Table 2). None of the infants
distilled water. The amount of feeding was advanced slowly if with asphyxia had NEC.
tolerated, with no more than a 20 mL/kg per day increment per Table 3 shows the outcomes of the study by logis-
day. Feeding was stopped if there was any sign of feeding intol- tic regression analysis. The incidence of death or
erance (defined as the presence of gastric aspirate in the amount NEC was significantly lower in the probiotics group
that was more than half of the previous feeding, twice, with
when compared with the control group (9 of 180 [5%]
abdominal distension). Infants who weighed Ͻ1000 g received
total parenteral nutrition until half of the calories were supplied vs 24 of 187 [12.8%], respectively; P ϭ .009). The
by the oral route. The same attending physician was in charge of incidence of NEC was also lower in the probiotics
the care of the infants during their hospital stay. The residents when compared with the control group (2 of 180
who rotated through the NICU provided care following the es- [1.1%] vs 10 of 187 [5.3%], respectively; P ϭ .04).
tablished protocols of the unit. There were no modifications in There were 6 cases of severe NEC (Bell stage 3) in the
management protocols, clinical practices, equipment, and infra-
structure (such as nursing personnel) in the unit during the study
control group and none in the probiotics group (P ϭ
period. .03 by bivariate analysis). The incidence of culture-
NEC is categorized by modified Bell’s classification.12 The di- proven sepsis was significantly lower in the study
agnosis and classification of NEC was made by 2 independent group (P ϭ .03). None of the positive blood cultures
senior attending neonatologists who did not know the group grew Lactobacillus or Bifidobacterium species. The in-
assignment of the infant. If they disagreed on the classification, a cidence of NEC or sepsis was lower in the probiotic
third attending neonatologist was asked to arbitrate. Demographic
and clinical variables that are potential risk factors for NEC were
group (24 of 180 [13.3%] vs 46 of 187 [24.6%], respec-
prospectively abstracted from the medical records using the fol- tively; P Ͻ .03). The incidence of death, NEC, or
lowing definitions. A mother receiving 2 doses of betamethasone
or dexamethasone given Ն24 hours before delivery was consid- TABLE 1. Maternal Clinical and Infant’s Demographic and
ered to have been on prenatal steroids. Infants with birth weight Clinical Characteristics
Ͼ2 SDs below the mean for gestational age were considered small
Characteristics Study Group Control Group
for gestational age. Prolonged rupture of amniotic membrane was
(N ϭ 180) (N ϭ 187)
defined as rupture of the amniotic membrane Ͼ18 hours before
delivery. Chorioamnionitis was defined as maternal fever, foul- Prolonged rupture of amniotic 53 (29.4) 43 (23.0)
smelling amniotic fluid, and left shift of the white blood cell membrane, n (%)
differential count and was confirmed by the obstetrician. As- Preeclampsia, n (%) 26 (14.4) 24 (12.8)
phyxia was defined by the following criteria: (1) an umbilical or Prenatal steroid, n (%) 121 (67.2) 114 (61.0)
scalp blood pH Յ 7.0, (2) an Apgar score of Յ3 at 5 minutes, (3) Cesarean section, n (%) 104 (57.8) 100 (53.5)
neurologic manifestation including hypotonia seizure or hypoxic- Mutipregnancy, n (%) 34 (18.9) 33 (17.6)
ischemia encephalopathy, and (4) multiple organs failure. Surfac- Chorioamnionitis, n (%) 9 (5.0) 10 (5.3)
tant was used for respiratory distress syndrome within 2 hours Male, n (%) 84 (46.7) 100 (53.5)
after birth in cases of ventilated infants needing oxygen supple- Small for gestational age, n (%) 42 (23.3) 41 (22.8)
mentation with a fractional inspired oxygen of Ն0.40 and showing Gestation, wk 28.5 Ϯ 2.5* 28.2 Ϯ 2.5*
radiologic changes typical of respiratory distress syndrome. Indo- Birth weight, g 1104 Ϯ 242* 1071 Ϯ 243*
methacin was indicated in infants with patent ductus arteriosus Apgar (5 min)
showing left-to-right shunt by echocardiography. Sepsis was di- Ͻ3 41 44
agnosed for infants with clinical signs of sepsis occurring after 4–6 41 49
Ͼ7 98 94
randomization and was proven by positive blood culture. This
Asphyxia, n (%) 4 (2.2) 6 (3.2)
event was not limited to being associated with death or NEC.
pH 7.29 Ϯ 1* 7.29 Ϯ 11*
Primary outcome was the incidence of death or NEC (Ն stage 2).
Death was included as a primary outcome because it is a compet- None of the differences are statistically significant (P Ͼ .05).
ing variable of NEC. * Values are mean Ϯ SD.
2 PROBIOTICS IN NECROTIZING ENTEROCOLITIS
3. TABLE 2. Clinical Variables in Study Infants ture gut.15 The fact that NEC does not occur in utero
Variables Study Group Control Group despite stress and fetal ingestion of 150 mL/kg per
(N ϭ 180) (N ϭ 187) day of amniotic fluid that contains proteins, carbo-
Age at enrollment,* d 7.7 Ϯ 2.0 7.9 Ϯ 2.9
hydrates, fat, immunoglobulin, and electrolytes sug-
Nothing per ora,† d 4.3 Ϯ 3.5 4.4 Ϯ 4.2 gests that bacterial colonization is an important fac-
Total parenteral nutrition,‡ d 14.7 Ϯ 5.7 13.9 Ϯ 5.0 tor in the pathogenesis of this disease.16,17 An animal
Feeding amount at 14 d§ 79.7 Ϯ 47.2 86.0 Ϯ 49.3 model for NEC also demonstrated the need for bac-
Feeding amount at 21 d* 108.6 Ϯ 51.3 114.1 Ϯ 49.1 terial colonization in the development of NEC.18,19
Feeding amount at 28 d* 120.0 Ϯ 42.4 121.1 Ϯ 45.4
Use of surfactant, n (%) 100 (55.6) 94 (50.2) Intestinal microbiologic flora are an important fac-
Umbilical artery catheter,* d 0.7 Ϯ 1.3 0.7 Ϯ 1.4 tor in the host defense mechanism against bacterial
Umbilical venous catheter,* d 0.8 Ϯ 1.4 0.8 Ϯ 1.5 infections. Lawrence et al20 demonstrated that gut
Intermittent mandatory 9.6 Ϯ 17.7 12.0 Ϯ 21.0 colonization with limited numbers and species of
ventilation,* d
Pneumothorax, n (%) 4 (2.2) 3 (1.6)
bacteria is delayed in a sterile environment. They
O2,* d 33.9 Ϯ 31.7 34.0 Ϯ 34.6 speculated that lack of an aseptic environment in the
Use of dopamine, n (%) 110 (61.1) 100 (53.5) NICU resulted in intestinal colonization with absorp-
Dopamine,* d 3.5 Ϯ 5.5 3.7 Ϯ 6.1 tion of intact bacterial toxin, which may damage the
Indomethacin, n (%) 122 (67.8) 117 (62.6) immature ileum, resulting in the development of
Age onset of NEC* 19.5 Ϯ13.4 16.4 Ϯ 11.7
Intraventricular hemorrhage, 9 (5.0) 14 (7.5) NEC. Hoy et al21 and Millar et al22 observed both a
grades 3–4, n (%) quantitative and qualitative change in the fecal flora
NICU,* d 46.7 Ϯ 27.1 46.5 Ϯ 26.1 before the onset of NEC. They observed a decline in
* Values are mean Ϯ SD. None of the differences are statistically the variety of species and shift to a predominance of
significant (P Ͼ .05). Enterobacteriaceae before the onset of NEC. Gewolb
† Days from birth to initiation of enteral feeding, mean Ϯ SD. et al23 reported that Bifidobacterium and Lactobacillus
‡ Duration of parenteral nutrition, mean Ϯ SD. are found in the stool of Ͻ5% of extremely low birth
§ mL/kg per day, mean Ϯ SD.
weight infants within the first month of life. These
TABLE 3. Outcome Variables After Oral Probiotics (Logistic data suggest that low colonization of Bifidobacterium
Regression Analysis) and Lactobacillus in VLBW infants may serve as a
Variables Study Control P predisposing factor in microbial infection.
Group Group Values Potential mechanisms by which probiotics may
(N ϭ 180) (N ϭ 187) protect high-risk infants from developing NEC in-
Death 7 (3.9) 20 (10.7) .009 clude an increased barrier to translocation of bacteria
Death or NEC 9 (5) 24 (12.8) .009 and bacterial products across mucosa,24,25 competi-
NEC grade 2 or 3 2 (1.1) 10 (5.3) .04 tive exclusion of potential pathogens,26 modification
Sepsis (culture proven) 22 (12.2) 36 (19.3) .03
NEC or sepsis 24 (13.3) 46 (24.6) .03 of host response to microbial products,27,28 and en-
Death or NEC or sepsis 31 (17.2) 60 (32.1) .009 hancing enteral nutrition29 that inhibits the growth of
pathogens30,31 such as Klebsiella pneumoniae,32 Esche-
richia coli,33 and Candida albicans.34
sepsis was significantly lower in the probiotic group There is evidence from experimental data that sup-
(31of 180 [17.2%] vs 60 of 187 [32.1%], respectively; P ports the theory of microbial invasion as a contrib-
Ͻ .009). uting cause of NEC. This observation suggests that
altering microbial flora by enteral feeding of probi-
DISCUSSION otics may be beneficial. However, there is a paucity
Our study shows that Infloran reduces the inci- of clinical trials to confirm this hypothesis.9–11
dence and severity of NEC in VLBW infants. We also Infloran has been used as probiotics to reduce the
found that the study group had a lower incidence of incidence of NEC by Hoyos.10 In that study, one
NEC and sepsis. According to our data, the number fourth of a tablet of Infloran was given to all infants
needed to treat to prevent 1 case of NEC is 27, and admitted to the NICU. The results showed a signifi-
the number needed to treat to prevent 1 death due to cant reduction in the incidence of NEC and NEC
NEC is 31. associated death in the Infloran-treated infants when
Although many variables are associated with de- compared with historical controls. The study conclu-
velopment of NEC, only prematurity13 and low birth sion supported the notion of a randomized control
weight14 have been consistently identified in case- trial to verify the efficacy of this strategy.
controlled studies. Other factors that were associated In a recent multicenter double-blind study, 585
with an increased risk of NEC were vaginal delivery, infants of Ͻ33 weeks’ gestational age or birth weight
need for mechanical ventilator support, exposure to Ͻ1500 g who survived Ͼ2 weeks were randomized
both glucocorticoids and indomethacin during the to receive either placebo or Lactobacillus rhamnosus
first week of life, absence of an umbilical arterial GG once a day from the start of feeds to the time of
catheter, and low Apgar score at 5 minutes.14 Be- discharge.9 Outcome measures included the inci-
cause the current study was designed as a random- dence of urinary tract infection, bacterial sepsis, and
ized, controlled trial, these risk factors were distrib- NEC. There were no significant differences between
uted randomly and showed no difference between the probiotics and placebo groups in regards to any
the 2 study groups. of the 3 outcome variables. However, the event rate
A major component of the proposed pathogenesis was low in the control group for the 2 variables
of NEC is the interaction of bacteria with the prema- (NEC: 1.4%; sepsis: 3.4%), which needed a much
ARTICLES 3
4. larger sample size to verify their hypothesis. There rium infantis to neonates in an intensive care unit. Int J Infect Dis.
1999;3:197–202
are other differences between that trial and ours. We 11. Millar M, Wilks M, Costeloe K. Probiotics for preterm infants? Arch Dis
used Infloran, a live probiotic cultured from the stool Child Fetal Neonatal Ed. 2003;88:F354 –F358
of neonates and containing L acidophilus and B infan- 12. Walsh MC, Kliegman RM, Fanaroff AA. Necrotizing enterocolitis: a
tis. Another difference is the age of study infants at practitioner’s perspective. Pediatr Rev. 1988;9:219 –226
enrollment: 1 week in our study and Ͼ2 weeks in 13. Lee JS, Polin RA. Treatment and prevention of necrotizing enterocolitis.
Semin Neonatol. 2003;8:449 – 459
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Our study showed that the study group has a Necrotizing enterocolitis among neonates in the United States. J Perina-
lower incidence of NEC and sepsis. The mechanism tol. 2003;23:278 –285
for the efficacy of probiotics in reducing the inci- 15. Dai D, Walker WA. Role of bacterial colonization in neonatal necrotiz-
ing enterocolitis and its prevention. Zhonghua Min Guo Xiao Er Ke Yi Xue
dence of sepsis in VLBW infants is probably similar Hui Za Zhi. 1998;39:357–366
to NEC35,36 and possibly a result of increased colo- 16. Kligman RM, Fanaroff AA. Necrotizing enterocolitis. N Engl J med.
nization of desirable microflora such as Streptococcus 1984;310:1093–1103
salivarius.37 17. La Gamma EF, Browne Le. Feeding practices for infants weighing less
Although Wagner et al38 suggested that safety is- than 1500 g at birth and the pathogenesis of necrotizing enterocolitis.
Clin Perinatol. 1994;21:271–306
sues of probiotics treatment need to be addressed in 18. Kosloske AM. A unifying hypothesis for pathogenesis and prevention
immunodeficient hosts such as neonates, we did not of necrotizing enterocolitis. J Pediatr. 1990;117(1 pt 2):S68 –S74
observe complications (such as Lactobacillus or Bi- 19. Musemeche CA, Kosloske AM, Bartow SA, Umland ET. Comparative
fidobacterium sepsis) due to Infloran. However, our effects of ischemia, bacteria, and substrate on the pathogenesis of intes-
tinal necrosis. J Pediatr Surg. 1986;21:536 –538
trial was not powered to evaluate safety in regards to 20. Lawrence G, Bates J, Gaul A. Pathogenesis of neonatal necrotizing
the possible risk for Lactobacillus or Bifidobacterium enterocolitis. Lancet. 1982;1:137–139
sepsis. 21. Hoy C, Millar MR, MacKay P, Godwin PG, Langdale V, Levene MI.
We observed 6 infants with NEC before entry to Quantitative changes in faecal microflora preceding necrotizing entero-
the study and enteral feeding, 5 of whom were colitis in premature neonates. Arch Dis Child. 1990;65:1057–1059
22. Millar MR, MacKay P, Levene M, Langdale V, Martin C. Enterobacte-
Ͻ1000 g. Probiotics alone could not eliminate the riaceae and necrotizing enterocolitis. Arch Dis Child. 1992;67:53–56
NEC, which further confirmed the theory that NEC 23. Gewolb IH, Schwalbe RS, Taciak VL, Harrison TS, Panigrahi P. Stool
is a multifactorial disease, of which intestinal coloni- microflora in extremely low birthweight infants. Arch Dis Child Fetal
zation with unfavorable organisms is one. Neonatal Ed. 1999;80:F167–F173
24. Orrhage K, Nord CE. Factors controlling the bacterial colonization of
the intestine in breast-fed infants. Acta Paediatr. 1999;80:S47–S57
CONCLUSIONS
25. Mattar AF, Drongowski RA, Coran AG, Harmon CM. Effect of probi-
Oral Infloran administration in VLBW infants re- otics on bacterial translocation in vitro. Pediatr Surg Int. 2001;17:265–268
duces the incidence and severity of NEC, and Inflo- 26. Reid G, Howard J, Siang Gan B. Can bacterial interference prevent
ran as probiotics is protective of NEC in VLBW in- infection? Trends Microbiol. 2001;9:424 – 428
27. Duffy LC. Interactions mediating bacterial translocation in the imma-
fants. ture intestine. J Nutr. 2000;130(2S Suppl):432S– 436S
28. Schiffrin EJ, Brassart D, Servin AL, Rochat F, Donnet-Hughes A. Im-
ACKNOWLEDGMENTS mune modulation of blood leukocytes in humans by lactic acid bacteria:
This study was supported by the Research Department of criteria for strain selection. Am J Clin Nutr. 1997;66:515S–520S
China Medical University Hospital (grant DMR90140). 29. Kitajima H, Sumida Y, Tanaka R, Yuki N, Takayama H, Fujimura M.
We appreciate Associate Professor Li Tsai-Chung for help with Early administration of Bifidobacterium breve to preterm infants: random-
statistics. ised controlled trial. Arch Dis Child Fetal Neonatal Ed. 1997;76:F101–F107
30. Coconnier MH, Bernet MF, Chauviere G, Servin AL. Adhering heat-
killed human Lactobacillus acidophilus, strain LB, inhibits the process of
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4 PROBIOTICS IN NECROTIZING ENTEROCOLITIS