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Despite improvements in nutritional management, preterm infants continue to face high rates of postnatal growth restriction. Because variability in breast milk composition may result in protein and energy deficits, targeted fortification has been advocated. We conducted an interventional study to compare body composition and growth outcomes of very low birth weight infants fed targeted protein-fortified human milk (HM) with those fed standard fortified HM. If mother&rsquo, s own milk was not available, donor milk was used. Weekly analysis of HM with mid-infrared spectroscopy was conducted and additional protein was added to the fortified HM to ensure a protein intake of 4 g/kg/day. Weekly anthropometric measurements were done. Prior to discharge or at 37 weeks, corrected age skinfold thickness (SFT) measurements as well as body composition measurement using air displacement plethysmography were done. Among 36 preterm infants enrolled, those in the targeted group (n = 17) received more protein and had a larger flank SFT at study end than those in the standard group (n = 19). A pilot post-hoc analysis of subjects having at least 30 intervention days showed a 3% higher fat-free mass in the targeted group. Use of a targeted fortification strategy resulted in a higher protein intake and fat-free mass among those receiving longer intervention.

Gastroschisis is a severe congenital anomaly associated with a significant morbidity and mortality. There are limited temporal trend data on incidence, mortality, length of stay, and hospital cost of gastroschisis. Our aim was to study these temporal trends using the National Inpatient Sample (NIS). We identified all neonatal admissions with a diagnosis of gastroschisis within the NIS from 2010 through 2014. We limited admission age to ≤ 28 days and excluded all those transferred to other hospitals. We estimated gastroschisis incidence, mortality, length of hospital stay, and cost of hospitalization. For continuous variables, trends were analyzed using survey regression. Cochrane–Armitage trend test was used to analyze trends for categorical variables. P

To investigate strategies used for the management of respiratory distress syndrome (RDS) and bronchopulmonary dysplasia (BPD) in extremely low birth weight (ELBW) infants.A survey of neonatal specialists working in US academic institutions with fellowship training programs.Eighty percent (72/89) of the identified academic institutions had at least one physician who responded to the survey. Among respondents, 85% (171/201) agreed or strongly agreed to use continuous positive airway pressure (CPAP) initially for the management of RDS, and the majority agreed or strongly agreed to use a fraction of inspired oxygen (FiO2) ≥0.4 and a mean airway pressure (MAP) ≥10 cm H2O as a criteria for surfactant therapy; and 73% (146/200) sometimes or always used caffeine to prevent BPD. Only 25% (50/202) sometimes or almost always used steroids to prevent or treat BPD. Identified indications to use steroids were 3 or more extubation failures or inability to extubate beyond 8 weeks of age.Variability in treatment strategies of ELBW is common among neonatal specialists. However, the majority of the respondents agreed or strongly agreed to use early CPAP for the management of RDS, consider a FiO2 ≥0.4 and a MAP ≥10 cm H2O as criteria for surfactant therapy, and sometimes or almost always used caffeine to prevent BPD. Steroids continue to have a role in the management of BPD in infants who are difficult to extubate.

To determine trends in neonatal extracorporeal membrane oxygenation (ECMO) utilization from 2002–2011. Using the Nationwide inpatient sample (NIS), we conducted a population-based retrospective cohort study to identify ECMO utilization among neonates. Incidence of ECMO utilization, length of stay (LOS), cost and mortality were estimated. In all, 33,367,146 neonates were identified of which 7603 (18 per 100,000 live births) underwent ECMO. Neonatal ECMO increased from 12 to 23 runs per 100,000 live births. Mortality was 48.4%, decreasing from 47.5 to 41.9% between 2002 and 2011. On multivariate analysis, mortality was significantly higher for infectious indications (OR 4.1; CI 1.1–16.0), E-CPR (OR 3.8; CI 1.4–10.7) and cardiac indications (OR 2.0; CI 1.5–2.8). On hierarchical regression, LOS increased by 1.6 days each year (p = 0.02) and cost of hospitalization increased by $14,033 each year (p

A 33 year old mother female diagnosed with twin gestation, received adequate prenatal care and all prenatal screens were negative. She took synthroid and prenatal vitamins, denied smoking, drinking alcohol, or using illicit drugs Spontaneous preterm premature rupture of membranes for Twin A at 19 weeks, admitted to the hospital at 24 weeks. Received dexamethasone, ampicillin, and erythromycin; for the preterm premature rupture of membranes. Twin A's umbilical cord prolapsed at 24 2/7 weeks; emergency cesarean section was performed to deliver both babies. Twin A, expired shortly after birth secondary to respiratory distress. Twin B developed multiple clinical problems in the NICU, many of which required intervention. Twin B's parents were very supportive and understanding and were constantly involved in the child's care during NICU stay. The mother and father participated in the discharge planning education course and roomed-in with their baby for 2 days. Twin B lost very little weight initially and regained birth weight by the 7-8th day of life and remained above the 10th percentile for weight on the growth curve. Twin B was discharged from the NICU on day 109 at post conception age 39 weeks, weighed 2834 grams (10th percentile for corrected age), measured 49 cm length (50th percentile for corrected age), fronto-occipital circumference 34 cm (50th percentile for corrected age). The patient's care was transferred to the primary care pediatrician. As for our patient, he was dismissed from the NICU 9 years ago and was followed by the high-risk clinic associated with Texas Tech Pediatrics in Amarillo for 2 years after NICU dismissal. He continues to gain weight and is progressing well. His ophthalmologist follows his visual status as he has to wear glasses for visual acuity. His broncho pulmonary dysplasia has resolved. He continues to follow up with his primary care pediatrician.