[Show abstract][Hide abstract] ABSTRACT: To assess the influence of an infusion of clonidine 1 μg/kg/hr on fentanyl and midazolam requirement in ventilated newborns and infants.
Prospective, double-blind, randomized controlled multicenter trial. Controlled trials.com/ISRCTN77772144.
Twenty-eight level 3 German PICUs/neonatal ICUs.
Ventilated newborns and infants: stratum I (1-28 d), stratum II, (29-120 d), and stratum III (121 d to 2 yr).
Patients received clonidine 1 μg/kg/hr or placebo on day 4 after intubation. Fentanyl and midazolam were adjusted to achieve a defined level of analgesia and sedation according to Hartwig score.
Two hundred nineteen infants were randomized; 212 received study medication, 69.7% were ventilated in the postoperative care and 30.3% for other reasons. Primary endpoint: consumption of fentanyl and midazolam in the 72 hours following the onset of study medication (main observation period) in the overall study population. The confirmatory analysis of the overall population showed no difference in the consumption of fentanyl and midazolam. Explorative age-stratified analysis demonstrated that in stratum I (n = 112) the clonidine group had a significantly lower consumption of fentanyl (clonidine: 2.1 ± 1.8 μg/kg/hr, placebo: 3.2 ± 3.1 μg/kg/hr; p = 0.032) and midazolam (clonidine: 113.0 ± 100.1 μg/kg/hr, placebo: 180.2 ± 204.0 μg/kg/hr; p = 0.030). Strata II (n = 43) and III (n = 46) showed no statistical difference. Sedation and withdrawal-scores were significantly lower in the clonidine group of stratum I (p < 0.001). Frequency of severe adverse events did not differ between groups.
Clonidine 1 μg/kg/hr in ventilated newborns reduced fentanyl and midazolam demand with deeper levels of analgesia and sedation without substantial side effects. This was not demonstrated in older infants, possibly due to lower clonidine serum levels.
Pediatric Critical Care Medicine 04/2014; · 2.35 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Nicotine and alcohol consumption have been associated with premature delivery and adverse neonatal outcome. We wanted to analyze the influence of self-reported nicotine and alcohol consumption on outcome of VLBW infants.In an ongoing multicenter study 2 475 parents of former very low birth weight (VLBW) infants born between January 2009 and December 2011 answered questionnaires about maternal smoking habits and alcohol consumption during pregnancy. 2 463 (99.5%) completed questions on alcohol consumption and 2 462 (99.5%) on smoking habits. These infants were stratified to reported maternal smoking and alcohol consumption during pregnancy. We compared the reasons for premature delivery, neonatal outcome and parental reports on bronchitis during the first year of life, as well as growth and development at age 2 years to pregnancy exposure.In nicotine exposed infants intrauterine growth restriction (31 vs. 21%, p<0.01), a birth weight below the 10th percentile (26 vs. 17%, p<0.01) and placenta abruption (9.2 vs. 5.8%, p<0.05) was seen more often. Premature rupture of membranes (24 vs. 30%, p<0.05) or HELLP syndrome (6 vs. 11%, p<0.01) was less frequent. A birth weight below the 3rd percentile was seen more frequently in mothers with reported alcohol consumption (13 vs. 6%, p<0.05). We noted an increased rate of BPD and ROP if mothers reported smoking during pregnancy (p<0.05). Growth parameters and scores on Bayley Sscales of infant development at age 2 years did not differ.Smoking during pregnancy results in a high rate of growth restricted VLBW infants. Prenatal exposition to nicotine seems to increase postnatal complications such as BPD und ROP.
Zeitschrift für Geburtshilfe und Neonatologie 12/2013; 217(6):215-219. · 0.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective:The study investigated the ability of near-infrared spectroscopy (NIRS) to detect subgroups of preterm infants who benefit most from red blood cell (RBC) transfusion in regard to cerebral/renal tissue oxygenation (i) and the number of general oxygen desaturation below 80% (SaO(2) <80%) (ii).Study Design:Cerebral regional (crSO(2)) and peripheral regional (prSO(2)) NIRS parameters were recorded before, during, immediately after and 24 h after transfusion in 76 infants. Simultaneously, SaO(2) <80% were recorded by pulse oximetry. To answer the basic question of the study, all preterm infants were divided into two subgroups according to their pretransfusion crSO(2) values (<55% and 55%). This cutoff was determined by a k-means clustering analysis.Result:crSO(2) and prSO(2) increased significantly in the whole study population. A stronger increase (P<0.0005) of both was found in the subgroup with pretransfusion crSO(2) values <55%. Regarding the whole population, a significant decrease (P<0.05) of episodes with SaO(2) <80% was observed. The subgroup with crSO(2) baselines <55% had significant (P<0.05) more episodes with SaO(2) <80% before transfusion. During and after transfusion, the frequency of episodes with SaO(2) <80% decreased more in this group compared with the group with crSO(2) baselines 55%.Conclusion:NIRS measurement is a simple, non-invasive method to monitor regional tissue oxygenation and the efficacy of RBC transfusion. Infants with low initial NIRS values benefited most from blood transfusions regarding SaO(2) <80%, which may be important for their general outcome.Journal of Perinatology advance online publication, 30 August 2012; doi:10.1038/jp.2012.108.
Journal of perinatology: official journal of the California Perinatal Association 08/2012; · 1.59 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The accurately timed extubation of ventilated ELBW preterm infants is still a problem. With different data systems the attempt has been made to more accurately predict the successful extubation of these infants. However, there do not yet exist any satisfying solutions.
We retrospectively analysed 66 ELBW preterm infants who were endotracheal intubated and ventilated within 24 h postnatal. Basic data, clinical and ventilation data immediately before planned extubation and in several intervals during the following 24 h, as well as outcome variables at discharge were interpreted.
51 patients were successfully extubated (EE-group), 15 (22.7%) failed extubation (reintubation within 48 h after extubation, EV-group). Immediately before extubation in the EE-group there was found a significantly higher inspiratory oxygen concentration (FiO2) in comparison to the EV-group (0.25 vs. 0.3; p=0.01). After the extubation attempt the inspiratory oxygen concentration stayed lower in the EE-group, whereas in the EV-group it rose remarkably (2 h after ext.: 0.26 vs. 0.4; p<0.001). Neither of the basic data showed any significant difference. The outcome analysis indicated a longer intensive care in the EV-group and a trend towards increased BPD and ROP.
The study shows that for ELBW preterm infants the inspiratory oxygen concentration is especially important to predict a successful extubation. According to our data, the inspiratory oxygen demand before and immediately after extubation establishes the essential difference between successfully extubated and reintubated infants.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: The criteria for erythrocyte transfusion in stable premature infants are currently controversial. Haemodynamic measurements are not common in transfusion practice. The purpose of this study was to determine whether haemodynamic measurements could be helpful as objective criterion for transfusion decisions. We, therefore, evaluated clinical and haemodynamic changes in stable, anaemic, premature infants before and after transfusion using our current blood transfusion protocol based on a haematocrit threshold (<24%) and the neonatologist's discretion. MATERIAL AND METHODS: Stable premature infants with a haematocrit level ≤30% were prospectively enrolled into the study. Cerebral, intestinal and renal blood flow velocities, cardiac function parameters and vital signs were measured up to three times following every routine haematocrit analysis. Moreover, transfused infants were evaluated three more times: directly before transfusion, and 24 hours and 72 hours after transfusion. RESULTS: Thirty-six infants were enrolled and 23 of them were transfused. Subgroup analysis of transfused infants showed a significant decrease in cerebral blood flow velocities, cardiac output and heart rate. These changes persisted after transfusion. In the entire cohort, the degree of anaemia correlated with the increase of cerebral blood flow velocities, heart rate and cardiac output. DISCUSSION: Cerebral blood velocities in the anterior cerebral artery might represent an objective Doppler sonographic criterion indicating the need for transfusion. The measurement of these velocities is non-invasive and quick and easy to perform. However, a randomised, controlled trial is necessary before a formal recommendation can be made.
[Show abstract][Hide abstract] ABSTRACT: To characterize glucose tolerance and adipokine serum levels in a cohort of women shortly after delivery.
A study population of healthy pregnant women (n = 65) was invited to undergo a standardized oral glucose tolerance test within 24 h after delivery at the University Hospital of Leipzig. As controls, 30 nonpregnant healthy, lean women were studied. Glucose, insulin, proinsulin, c-peptide, leptin, adiponectin, and soluble leptin receptor levels were compared in cases and controls by using the Mann-Whitney U two-sample statistics and correlation according to Spearman.
As compared to normal glucose tolerant (NGT) women postpartum, fasting c-peptide levels were significantly higher (NGT mothers = 0.23 nmol/L, controls: 0.49 nmol/L, p < 0.001), whereas proinsulin serum levels were significantly lower in nonpregnant controls (NGT mothers = 1.37 pmol/L, controls = 1.00 pmol/L, p = 0.05). Considering fasting adiponectin values, postpartum adiponectin was significantly decreased compared with controls (NGT mothers = 6.9 μg/L, controls = 8.9 μg/L, p = 0.05). Fasting serum levels of leptin (NGT mothers = 17 ng/mL, controls = 10.6 ng/mL, p < 0.009) and soluble leptin receptor (NGT mothers = 34.4 ng/mL, controls = 17.7 ng/mL, p < 0.001) were increased postpartum.
We found significantly lower adiponectin and higher leptin sera levels in women postpartum as compared to nonpregnant women. In addition, adipokine serum levels shortly after delivery were related to parameters of adiposity and glucose tolerance. We hypothesize that women in the post-delivery period exhibit biochemical features resembling metabolic syndrome, impaired glucose tolerance, and derangement of the adipokine system.
Hypertension in Pregnancy 03/2012; 31(2):228-39. · 0.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Abstract
Background: Infants with extremely low birth weight uniformly
develop anemia of prematurity and frequently require
red blood cell transfusions (RBCTs). Although RBCT is
widely practiced, the indications remain controversial in the
absence of conclusive data on the long-term effects of RBCT.
Objectives: To summarize the current equipoise and to
outline the study protocol of the ‘Effects of Transfusion
Thresholds on Neurocognitive Outcome of extremely low
birth-weight infants (ETTNO)’ study. Methods: Review of
the literature and design of a large pragmatic randomized
controlled trial of restrictive versus liberal RBCT guidelines
enrolling 920 infants with birth weights of 400–999 g with
long-term neurodevelopmental follow-up. Results and
Conclusions: The results of ETTNO will provide definite data
about the efficacy and safety of restrictive versus liberal
RBCT guidelines in very preterm infants.
[Show abstract][Hide abstract] ABSTRACT: We evaluated blood culture-proven sepsis episodes occurring in microclusters in very-low-birth-weight infants born in the German Neonatal Network (GNN) during 2009-2010.
Thirty-seven centers participated in GNN; 23 centers enrolled ≥50 VLBW infants in the study period. Data quality was approved by on-site monitoring. Microclusters of sepsis were defined as occurrence of at least two blood-culture proven sepsis events in different patients of one center within 3 months with the same bacterial species. For microcluster analysis, we selected sepsis episodes with typically cross-transmitted bacteria of high clinical significance including gram-negative rods and Enterococcus spp.
In our cohort, 12/2110 (0.6%) infants were documented with an early-onset sepsis and 235 late-onset sepsis episodes (≥72 h of age) occurred in 203/2110 (9.6%) VLBW infants. In 182/235 (77.4%) late-onset sepsis episodes gram-positive bacteria were documented, while coagulase negative staphylococci were found to be the most predominant pathogens (48.5%, 95%CI: 42.01-55.01). Candida spp. and gram-negative bacilli caused 10/235 (4.3%, 95%CI: 1.68% -6.83%) and 43/235 (18.5%) late-onset sepsis episodes, respectively. Eleven microclusters of blood-culture proven sepsis were detected in 7 hospitals involving a total 26 infants. 16/26 cluster patients suffered from Klebsiella spp. sepsis. The median time interval between the first patient's Klebsiella spp. sepsis and cluster cases was 14.1 days (interquartile range: 1-27 days). First patients in the cluster, their linked cases and sporadic sepsis events did not show significant differences in short term outcome parameters.
Microclusters of infection are an important phenomenon for late-onset sepsis. Most gram-negative cluster infections occur within 30 days after the first patient was diagnosed and Klebsiella spp. play a major role. It is essential to monitor epidemic microclusters of sepsis in surveillance networks to adapt clinical practice, inform policy and further improve quality of care.
PLoS ONE 01/2012; 7(6):e38304. · 3.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: ATP-binding cassette member A 3 (ABCA3) plays a critical role for the transport of surfactant phospholipids into the lamellar bodies of type II alveolar epithelial cells. Term infants carrying the E292V missense mutation of the gene encoding ABCA3 are likely to develop respiratory distress syndrome, and the mutation has also been linked to interstitial lung disease in paediatric patients. The aim of this study was to investigate the association of the E292V genotype with pulmonary morbidity in a large cohort of very-low-birth-weight (VLBW) infants.
We performed a genetic association study with a prospective, population-based multi-centre cohort of 3177 VLBW infants born in 16 German study centres between 2003 and 2009 (German Neonatal Network). The ABCA3 genotype was determined by restriction fragment length polymorphism-PCR in genomic DNA samples derived from buccal swabs.
In a large cohort of 3177 VLBW infants, 11 individuals were found to be heterozygote for the E292V mutation (0.34%). After stratification according to ABCA3 genotype, no differences were noted for clinical characteristics, necessary treatments and neonatal pulmonary outcomes.
Within the size limits of our study cohort, the ABCA3 missense mutation E292V had no remarkable effect on pulmonary outcome in VLBW infants. Present results do not rule out the possibility that E292V phenotype is associated with minor difference in the morbidity.
[Show abstract][Hide abstract] ABSTRACT: The adipokine leptin has been detected in human breast milk, but its effect on postnatal growth and development remains largely unclear. We hypothesized that leptin could affect infant's body weight gain during early lactation in the first 6 mo of life. Therefore, we evaluated leptin levels in maternal serum and breast milk of 23 healthy, lactating mothers and their neonates in a prospective, longitudinal study. Leptin concentration was quantified by a commercially available human leptin RIA. Our results showed that leptin levels in breast milk were 22-fold lower than in maternal serum, but both parameters were positively correlated to each other (r = 0.431, p = 0.001) and to maternal BMI (serum: r = 0.512, p < 0.001; milk: r = 0.298, p < 0.001) over 6 mo of lactation. A negative association was found between breast milk leptin levels during the first week after delivery and the infant weight gain from the end of the first to the sixth month (r = -0.681, p = 0.007). This suggests that milk-borne leptin provides a link between maternal body composition and infant growth and development and plays a critical role in regulating appetite and food intake during early infancy.
Pediatric Research 08/2011; 70(6):633-7. · 2.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To determine whether the tumor necrosis factor-α -308 G/A polymorphism is associated with blood culture-proven sepsis in two large cohorts of very-low-birth-weight infants.
Genetic association studies.
Prospective, population-based, multicentered cohort of 1944 very-low-birth-weight infants born in 14 German study centers between 2003 and 2008 and 976 mothers, and a second prospective cohort of 926 very-low-birth-weight infants born in 2009 (German Neonatal Network).
In cohort I, 344 of 1944 (18.2%) very-low-birth-weight infants had at least one episode of blood culture-proven sepsis develop. The sepsis incidence stratified to genotype was 19.3% for G/G, 15.8% for G/A, 10.0% for A/A genotype (Cochrane-Armitage trend test: G/G vs. G/A: odds ratio, 1.32; 95% confidence interval, 1.03-1.71; G/G vs. A/A: odds ratio, 1.74; 95% confidence interval, 1.06-2.91; p = .03). There was a trend for association of tumor necrosis factor-α -308 A/G genotype with late-onset sepsis episodes (incidence: 17.2% for G/G, 12.5% for G/A, 10.0% for A/A genotype; Cochrane-Armitage trend test: G/G vs. G/A: odds ratio, 1.43; 95% confidence interval, 1.09-1.9; G/G vs. A/A: odds ratio, 2.05; 95% confidence interval, 1.19-3.56; p = .009). However, after adjustment for multiple testing, no significant associations were found. Furthermore, the genotype of the investigated 976 mothers had no impact on sepsis risk for their very-low-birth-weight infants. We additionally studied a second prospective cohort of 926 very-low-birth-weight infants and found no associations with sepsis risk.
No association was found between the tumor necrosis factor-α -308 G/A polymorphism blood culture-proven sepsis in two large cohorts of very-low-birth-weight infants. A recent meta-analysis demonstrated that the tumor necrosis factor-α -308 A allele is associated with higher sepsis risk in adult cohorts. Thus, potential differences between adults and infants need to be incorporated in future study designs evaluating risk profiles for sepsis.
Critical care medicine 05/2011; 39(5):1190-5. · 6.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Rapid enteral feeding volume advancement in preterm infants can reduce the use of intravenous fluids. This practice may decrease the hazards of intravenous infusion solutions and potentially the morbidity rate. Several cohort trials demand the standardised nutritional regimen to reduce the complications and the time to reach full enteral feeds.
to determine whether using a standardized nutritional regimen the rapid enteral feeding advancement in preterm infants is practicable without increasing the incidence of feeding complications.
A prospective, randomized, controlled trial was performed in 99 preterm infants, birth weight ≤1,750 g. Group ST (standardized nutritional regimen) received breast human milk according to a standardized nutritional regimen. Group IN (individual nutritional regimen) received breast human milk or semi-elemental nutrition (Pregomin(®) Milupa) depending on enteral problems of the infant. The feeding volume advancement in the IN-Group was decided individually. The main outcome measure was time to reach full enteral feedings.
Infants in the ST-Group achieved full enteral feedings after 14.93±9.95 (median 12) d, infants in the IN-Group after 16.23±10.86 (median 14) d. The difference between the groups was significant only in small for gestational age (SGA) infants: ST-Group 10.20±4.78 (median 8.5) vs. IN-Group 16.73±8.57 (Median 15) days (p=0.045). The weight gain was similar in both groups. Infants in ST-Group achieved full enteral feedings having 116% of birth weight, infants in IN-Group 122% of birth weight. This difference was not significant (p=0.195). The incidence of NEC (necrotizing enterocolitis, 4%) and other complications were low in both groups. The diagnosis "feeding complications" was described in IN-Group in 14 vs. 7 infants in ST-Group.
SGA-infants profit from the enteral feeding advancement by using a standardized nutritional regimen. These infants achieved full enteral feedings sooner then the SGA-infants, who did not feed by using a standardized nutritional regimen. A standardized nutritional regimen can be realized in clinical routine and is by strict clinical observation practicable without increasing the incidence of feeding complications.
[Show abstract][Hide abstract] ABSTRACT: Hypogammaglobulinemia or agammaglobulinemia are major features of specific syndromes, including X-linked agammaglobulinemia and common variable immunodeficiency. However, the combination of hypogammaglobulinemia with specific dysmorphic features is less common, with only a few reported cases. One such report was a sporadic case of humoral immunodeficiency, facial dysmorphism, and limb anomalies in a young girl, later referred to as Hoffman syndrome. We report on a 7-year-old girl with almost complete loss of B cells, facial dysmorphism, and malformation of the limbs and genitalia, whose mother shows similar dysmorphic features with an attenuated version of the B-cell deficiency. We believe that all three cases described above represent the same condition. The features of the three affected individuals with Hoffman syndrome are reviewed. Further investigations in this recently recognized B-cell immunodeficiency syndrome are warranted.
American Journal of Medical Genetics Part A 01/2011; 155A(1):149-53. · 2.30 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Herbal medicine (phytotherapy) is increasingly used by the German population. But its use for children has been rarely analysed. This study determined prevalence, motivations and indications for the use of herbal medicine use. It also investigated parent-related variables associated with its use.
An anonymized questionnaire was filled in by parents of children and adolescents who attended the general pediatric out-patient department of two German university children's hospitals and the practice of two general pediatricians.
413 of 600 parents (68.8%) completed the questionnaire. Mean age of the children was 6.7 +/- 4.7 years. 353 (85.5%) were given one or more herbal products, chamomile (85.5%), fennel (81.3%), eucalyptus (43.9%). Bronchipret 43.1%) (thyme and primrose [tablets] or thyme with ivy [syrup] and Prospan (43.1%) (a syrup of ivy leaf extract) were the most commonly used, in the treatment of cough. Parents who give phytotherapeuticals to their children were significantly more often women, living in a large city, of good education and financially better off (p< 0.05).
Herbal medicine is widely used in Germany during childhood and adolescence. To achieve high therapeutic safety it is important to ask parents explicitly about such use.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Recently in a report of a single center a method has been described to apply surfactant via a thin endotracheal catheter to very low birth weight infants spontaneously breathing with nasal continuous positive airway pressure. We now analyzed available multicenter data. PATIENTS AND METHODS: In a multicenter study investigating genetic risk factors, clinical and outcome data and data of antenatal and postnatal treatment of infants with a birth weight below 1,500 g were prospectively recorded. The measures of infants treated with the new method of surfactant application were compared to those of infants who received standard care. The analysis was restricted to infants with a gestational age below 31 weeks (n=1,541). RESULTS: 319 infants were treated with the new method and 1,222 with standard care. The need for mechanical ventilation during the first 72 h (29% vs. 53%, p<0.001), the rate of bronchopulmonary dysplasia defined as oxygen at 36 weeks of postmenstrual age (10.9 % vs. 17.5%, p=0.004) and the rate of death or bronchopulmonary dysplasia were significantly lower in the treatment group than in the standard care group. Surfactant, theophyllin, caffeine and doxapram were significantly more often and analgetics, catecholamines and dexamethasone were significantly less frequently used in the treatment group. CONCLUSIONS: A new method of surfactant application was associated with a lower prevalence of mechanical ventilation and better pulmonary outcome. A prospective controlled trial is required to determine whether this approach is superior to standard care.
[Show abstract][Hide abstract] ABSTRACT: The insertion/deletion polymorphism of the angiotensin-converting enzyme (ACE-ins/del) and the angiotensin II type 1 receptor 1166A/C polymorphism (ATR1166A/C) were reported to be associated with several unfavorable outcome parameters in preterm infants like bronchopulmonary dysplasia, persistent ductus arteriosus and impaired insulin sensitivity. Objective: To confirm the above-mentioned associations in a large cohort of very-low-birthweight (VLBW) infants.
Clinical data of VLBW infants were prospectively recorded. The ACE-ins/del polymorphism and the ATR1166A/C polymorphism were determined by polymerase chain reaction in 1,209 and 1,168 infants, respectively.
There was no significant association between ACE-ins/del or ATR1166A/C genotype and outcome parameters (death, intraventricular hemorrhage, sepsis, bronchopulmonary dysplasia, ventilation, supplemental oxygen at discharge, postnatal treatment with insulin, surgery for intestinal perforation/necrotizing enterocolitis/retinopathy of prematurity/persistent ductus arteriosus.
Both known functional polymorphisms of the renin-angiotensin system do not seem to be associated with the outcome of VLBW infants.
[Show abstract][Hide abstract] ABSTRACT: Controversy exists regarding the optimal enteral feeding regimen of very low birth weight infants (VLBW). Rapid advancement of enteral feeding has been associated with an increased rate of necrotizing enterocolitis. In contrast, delaying enteral feeding may have unfavorable effects on nutrition, growth, and neurodevelopment. The aim is to compare the short-term outcomes of VLBW infants in tertiary care centers according to their enteral feeding advancement.
We prospectively studied the influence of center-specific enteral feeding advancement in 1430 VLBW infants recruited from 13 tertiary neonatal intensive care units in Germany on short-term outcome parameters. The centers were post hoc stratified to "rapid advancement to full enteral feeds" (median duration of advancement to full enteral feeds < or =12.5 days; 6 centers), that is, rapid advancement (RA), or "slow advancement to full enteral feeds" (median duration of advancement to full enteral feeds >12.5 days; 7 centers), that is, slow advancement (SA).
VLBW infants born in centers with SA (n = 713) had a significantly higher rate of sepsis compared with VLBW infants born in centers with RA (n = 717), which was particularly evident for late-onset sepsis (14.0% vs 20.4%; P = 0.002). Furthermore, more central venous lines (48.6% vs 31.1%, P < 0.001) and antibiotics (92.4% vs 77.7%, P < 0.001) were used in centers with SA.
Center differences in enteral feeding advancement occur and may have a significant impact on short-term outcomes such as nosocomial sepsis. Large, multicenter, prospective trials are required to further elucidate the optimal feeding strategy for VLBW infants.
Journal of pediatric gastroenterology and nutrition 05/2009; 48(4):464-70. · 2.18 Impact Factor