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Journal of Pediatric Gastroenterology... Feb 2023To review the current literature and develop consensus conclusions and recommendations on nutrient intakes and nutritional practice in preterm infants with birthweight... (Review)
Review
OBJECTIVES
To review the current literature and develop consensus conclusions and recommendations on nutrient intakes and nutritional practice in preterm infants with birthweight <1800 g.
METHODS
The European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee of Nutrition (CoN) led a process that included CoN members and invited experts. Invited experts with specific expertise were chosen to represent as broad a geographical spread as possible. A list of topics was developed, and individual leads were assigned to topics along with other members, who reviewed the current literature. A single face-to-face meeting was held in February 2020. Provisional conclusions and recommendations were developed between 2020 and 2021, and these were voted on electronically by all members of the working group between 2021 and 2022. Where >90% consensus was not achieved, online discussion meetings were held, along with further voting until agreement was reached.
RESULTS
In general, there is a lack of strong evidence for most nutrients and topics. The summary paper is supported by additional supplementary digital content that provide a fuller explanation of the literature and relevant physiology: introduction and overview; human milk reference data; intakes of water, protein, energy, lipid, carbohydrate, electrolytes, minerals, trace elements, water soluble vitamins, and fat soluble vitamins; feeding mode including mineral enteral feeding, feed advancement, management of gastric residuals, gastric tube placement and bolus or continuous feeding; growth; breastmilk buccal colostrum, donor human milk, and risks of cytomegalovirus infection; hydrolyzed protein and osmolality; supplemental bionutrients; and use of breastmilk fortifier.
CONCLUSIONS
We provide updated ESPGHAN CoN consensus-based conclusions and recommendations on nutrient intakes and nutritional management for preterm infants.
Topics: Child; Humans; Infant; Infant, Newborn; Enteral Nutrition; Gastroenterology; Infant, Premature; Milk, Human; Vitamins; Water
PubMed: 36705703
DOI: 10.1097/MPG.0000000000003642 -
Seminars in Fetal & Neonatal Medicine Oct 2020The current standard approach to manage circulatory insufficiency is inappropriately simple and clear: respond to low blood pressure to achieve higher values. However,... (Review)
Review
The current standard approach to manage circulatory insufficiency is inappropriately simple and clear: respond to low blood pressure to achieve higher values. However, the evidence for this is limited affecting all steps within the process: assessment, decision making, therapeutic options, and treatment effects. We have to overcome the 'one size fits all' approach and respect the dynamic physiologic transition from fetal to neonatal life in the context of complex underlying conditions. Caregivers need to individualize their approaches to individual circumstances. This paper will review various clinical scenarios, including managing transitional low blood pressure, to circulatory impairment involving different pathologies such as hypoxia-ischemia and sepsis. We will highlight the current evidence and set potential goals for future development in these areas. We hope to encourage caregivers to question the current standards and to support urgently needed research in this overlooked but crucial field of neonatal intensive care.
Topics: Hemodynamics; Humans; Hypotension; Infant, Newborn; Intensive Care, Neonatal; Neonatology; Shock, Septic
PubMed: 32473881
DOI: 10.1016/j.siny.2020.101121 -
Neonatology 2020Progress in our understanding of the pathophysiology, prevention and treatment of necrotizing enterocolitis (NEC) has been hampered for many reasons. Included among... (Review)
Review
Progress in our understanding of the pathophysiology, prevention and treatment of necrotizing enterocolitis (NEC) has been hampered for many reasons. Included among these is the fact that what we are calling "NEC" is likely to represent different disease processes, which need to be delineated before evaluating individual pathogenic mechanisms and attempting to develop predictive and diagnostic biomarkers. Treatment is also likely to be hampered because not all of the different entities called "NEC" will respond to the same regimen. In this review, some of these entities will be discussed in more detail, with suggestions for refining our approach toward improving methods for their diagnosis, prevention and treatment.
Topics: Enterocolitis, Necrotizing; Humans; Infant, Newborn; Infant, Newborn, Diseases
PubMed: 32155645
DOI: 10.1159/000506866 -
Archivos Argentinos de Pediatria Oct 2019The recognition of the existence of pain in infants hospitalized in the Neonatal Intensive Care Units makes it necessary to reach consensus on prevention, assessment and...
The recognition of the existence of pain in infants hospitalized in the Neonatal Intensive Care Units makes it necessary to reach consensus on prevention, assessment and treatment strategies. Acute pain produces adverse changes in the short term and chronic pain alters the response systems to stress and impacts on neurodevelopment. The objective of this pain management agreement is to unify criteria of attention of these patients in different situations that generate pain and stress that they face during their hospitalization. There are validated scales to assess pain and guide appropriate strategies for its approach that include measures of comprehensive or nonpharmacological care and pharmacological care that we will review.
Topics: Acute Pain; Chronic Pain; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Neonatology; Pain Management; Pain Measurement; Pain Perception
PubMed: 31833337
DOI: 10.5546/aap.2019.S180 -
Pediatric Research Mar 2020White matter injury (WMI) is the most frequent form of preterm brain injury. Cranial ultrasound (CUS) remains the preferred modality for initial and sequential... (Review)
Review
White matter injury (WMI) is the most frequent form of preterm brain injury. Cranial ultrasound (CUS) remains the preferred modality for initial and sequential neuroimaging in preterm infants, and is reliable for the diagnosis of cystic periventricular leukomalacia. Although magnetic resonance imaging is superior to CUS in detecting the diffuse and more subtle forms of WMI that prevail in very premature infants surviving nowadays, recent improvement in the quality of neonatal CUS imaging has broadened the spectrum of preterm white matter abnormalities that can be detected with this technique. We propose a structured CUS assessment of WMI of prematurity that seeks to account for both cystic and non-cystic changes, as well as signs of white matter loss and impaired brain growth and maturation, at or near term equivalent age. This novel assessment system aims to improve disease description in both routine clinical practice and clinical research. Whether this systematic assessment will improve prediction of outcome in preterm infants with WMI still needs to be evaluated in prospective studies.
Topics: Brain; Brain Injuries; Echoencephalography; Humans; Infant; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Leukomalacia, Periventricular; Magnetic Resonance Imaging; Neonatology; Predictive Value of Tests; White Matter
PubMed: 32218534
DOI: 10.1038/s41390-020-0781-1 -
Revue Medicale de Liege Feb 2020Late preterm infants are born between 34 weeks of amenorrhea and 36 weeks 6 days. Late preterms represent the largest proportion of premature infants (about 75 %). Late... (Review)
Review
Late preterm infants are born between 34 weeks of amenorrhea and 36 weeks 6 days. Late preterms represent the largest proportion of premature infants (about 75 %). Late prematurity is increasing in recent decades. While studies initially focused on mortality and morbidity related to very preterm birth, the late preterms have been the subject of increased attention over the past 15 years. Late preterm infants have an increased risk of respiratory complications, infections, feeding problems, hypothermia and hypoglycemia. Neonatal, infant and during adulthood mortalities are significantly higher in late preterm than in term infants. In addition, late preterm infants carry an increased risk of long-term morbidities, such as neurodevelopmental delay, cerebral palsy, chronic respiratory or metabolic diseases. This review highlights the evidence that late preterm infants are high risk newborns and require adapted follow-up.
Topics: Adult; Female; Gestational Age; Humans; Infant; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Morbidity; Pregnancy; Premature Birth
PubMed: 32030935
DOI: No ID Found -
Pediatric Research Mar 2020Germinal matrix-intraventricular haemorrhage (GMH-IVH), periventricular haemorrhagic infarction (PHI) and its complication, post-haemorrhagic ventricular dilatation... (Review)
Review
Germinal matrix-intraventricular haemorrhage (GMH-IVH), periventricular haemorrhagic infarction (PHI) and its complication, post-haemorrhagic ventricular dilatation (PHVD), are still common neonatal morbidities in preterm infants that are highly associated with adverse neurodevelopmental outcome. Typical cranial ultrasound (CUS) findings of GMH-IVH, PHI and PHVD, their anatomical substrates and underlying mechanisms are discussed in this paper. Furthermore, we propose a detailed descriptive classification of GMH-IVH and PHI that may improve quality of CUS reporting and prediction of outcome in infants suffering from GMH-IVH/PHI.
Topics: Brain; Cerebral Hemorrhage; Cerebral Ventricles; Dilatation; Echoencephalography; Humans; Incidence; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature; Infant, Premature, Diseases; Magnetic Resonance Imaging; Neonatology; Treatment Outcome; Ultrasonography, Doppler
PubMed: 32218535
DOI: 10.1038/s41390-020-0780-2 -
Neonatology 2021
PubMed: 34126616
DOI: 10.1159/000514923 -
Archives de Pediatrie : Organe Officiel... May 2022Nutritional vitamin D supplements are often used in general pediatrics. Here, the aim is to address vitamin D supplementation and calcium nutritional intakes in...
OBJECTIVES
Nutritional vitamin D supplements are often used in general pediatrics. Here, the aim is to address vitamin D supplementation and calcium nutritional intakes in newborns, infants, children, and adolescents to prevent vitamin D deficiency and rickets in general populations.
STUDY DESIGN
We formulated clinical questions relating to the following categories: the Patient (or Population) to whom the recommendation will apply; the Intervention being considered; the Comparison (which may be "no action," placebo, or an alternative intervention); and the Outcomes affected by the intervention (PICO). These PICO elements were arranged into the questions to be addressed in the literature searches. Each PICO question then formed the basis for a statement. The population covered consisted of children aged between 0 and 18 years and premature babies hospitalized in neonatology. Two groups were assembled: a core working group and a voting panel from different scientific pediatric committees from the French Society of Pediatrics and national scientific societies.
RESULTS
We present here 35 clinical practice points (CPPs) for the use of native vitamin D therapy (ergocalciferol, vitamin D and cholecalciferol, vitamin D) and calcium nutritional intakes in general pediatric populations.
CONCLUSION
This consensus document was developed to provide guidance to health care professionals on the use of nutritional vitamin D and dietary modalities to achieve the recommended calcium intakes in general pediatric populations. These CPPs will be revised periodically. Research recommendations to study key vitamin D outcome measures in children are also suggested.
Topics: Adolescent; Calcium; Calcium, Dietary; Child; Child, Preschool; Cholecalciferol; Consensus; Dietary Supplements; Humans; Infant; Infant, Newborn; Neonatology; Vitamin D; Vitamin D Deficiency; Vitamins
PubMed: 35305879
DOI: 10.1016/j.arcped.2022.02.008 -
World Journal of Surgery Aug 2020Enhanced Recovery After Surgery (ERAS) Society guidelines integrate evidence-based practices into multimodal care pathways that have improved outcomes in multiple adult...
BACKGROUND
Enhanced Recovery After Surgery (ERAS) Society guidelines integrate evidence-based practices into multimodal care pathways that have improved outcomes in multiple adult surgical specialties. There are currently no pediatric ERAS Society guidelines. We created an ERAS guideline designed to enhance quality of care in neonatal intestinal resection surgery.
METHODS
A multidisciplinary guideline generation group defined the scope, population, and guideline topics. Systematic reviews were supplemented by targeted searching and expert identification to identify 3514 publications that were screened to develop and support recommendations. Final recommendations were determined through consensus and were assessed for evidence quality and recommendation strength. Parental input was attained throughout the process.
RESULTS
Final recommendations ranged from communication strategies to antibiotic use. Topics with poor-quality and conflicting evidence were eliminated. Several recommendations were combined. The quality of supporting evidence was variable. Seventeen final recommendations are included in the proposed guideline.
DISCUSSION
We have developed a comprehensive, evidence-based ERAS guideline for neonates undergoing intestinal resection surgery. This guideline, and its creation process, provides a foundation for future ERAS guideline development and can ultimately lead to improved perioperative care across a variety of pediatric surgical specialties.
Topics: Anti-Infective Agents; Antibiotic Prophylaxis; Consensus; Digestive System Surgical Procedures; Enhanced Recovery After Surgery; Evidence-Based Medicine; Gastroenterology; Humans; Infant, Newborn; Interdisciplinary Communication; Neonatology; Perioperative Care; Postoperative Care; Practice Guidelines as Topic; Societies, Medical
PubMed: 32385680
DOI: 10.1007/s00268-020-05530-1