Practical experience in the application of clinical guidelines «Enteral feeding of preterm infants»


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Abstract

Appropriate nutrition is essential for the health and optimal growth of preterm infants. Aim. To investigate the effectiveness of the application of clinical guidelines "Enteral feeding of preterm infants" in infants below 32 weeks' gestation. Material and methods. The study comprised 114 extremely preterm infants born before (2013-2014, group 1, n=53) and after (2014-2015, group 2, n=61) introduction of the clinical guidelines. Comparative analysis included breastfeeding frequency, the time of initiation of enteral feeding and achieving enteral feeds up to a volume of 150ml/kg/d, the incidence of necrotizing enterocolitis (NEC), gastrointestinal dysfunction, gastric bleeding, the use of breast milk fortifier, and the dynamics of infant postnatal physical growth. A comparative assessment also included the length of hospital stay, postconceptional age (PCA) and body weight at the time of hospital discharge. Results. After the introduction of clinical guidelines, 47 (77%) children received maternal colostrum on the first day of life. Breastfeeding was initiated significantly earlier: within 1 (1-5) day after birth in group 2 compared with 9 (2-28) days in group 1. Most infants received enteral feeding on the first day of life, though the infants in group 2 were administered it significantly earlier [7.5 hours (3.5-51) vs. 12 (6-144)]. A significant part of the extremely preterm infants was fed with breast milk. Sixteen (30%) infants in group 1 and almost twice fewer children in group 2 [10 (16%)] were on artificial feeding. In group 2, full enteral feeding was achieved significantly earlier than in group 1 [12 days (6-48) vs. 18.5 (13-47)], while the incidence of NEC in group 2 decreased 1.7-fold (14.8% vs. 24.5%). By 36 weeks’ PCA, the infants in group 2 had significantly higher body weight than babies in group 1 [2220g (1420-2818) vs. 2050g (950-3190)]. Conclusion. The clinical implementation of the guidelines "Enteral feeding of preterm infants" has resulted in significantly higher feeding efficiency in extremely preterm babies.

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About the authors

Marina Viktorovna Narogan

National Medical Research Center of Obstetrics, Gynecology, and Perinatology named after Academician V.I. Kulakov, Ministry of Health of Russia; I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia

Email: m_narogan@oparina4.ru
Dr.Med.Sci., Leading Researcher at the Department of Pathology of Newborn and Premature Children; Professor of Neonatology

Irina Ivanovna Ryumina

V.I. Kulakov NMRC for OG&P of Minzdrav of Russia

Email: i_ryumina@oparina4.ru
Dr.Med.Sci., Head of the Department of Pathology of Newborn and Premature Children

Marina Vyacheslavovna Kukhartseva

National Medical Research Center of Obstetrics, Gynecology, and Perinatology named after Academician V.I. Kulakov, Ministry of Health of Russia; I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia

Email: m_kukhartseva@oparina4.ru ; kolibry90@list.ru
Neonatologist at the Department of Pathology of Newborn and Premature Children; Ph.D. Student at the Department of Neonatology

Elena Vladimirovna Grosheva

V.I. Kulakov NMRC for OG&P of Minzdrav of Russia

Email: e_grosheva@oparina4.ru
Ph.D., Deputy Head of the Department of Pathology of Newborn and Premature Children № 2 on clinical work

Oleg Vadimovich Ionov

National Medical Research Center of Obstetrics, Gynecology, and Perinatology named after Academician V.I. Kulakov, Ministry of Health of Russia; I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia

Email: o_ionov@oparina4.ru
Ph.D., Head of the Department of Neonatal Intensive Care; Associate Professor at the Department of Neonatology

Vasilisa Mikhailovna Talvirskaya

National Medical Research Center of Obstetrics, Gynecology, and Perinatology named after Academician V.I. Kulakov, Ministry of Health of Russia; I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia

Email: dr.vasilisa@gmail.com
Neonatologist at the Department of Newborn Children; Ph.D. Student at the Department of Neonatology

Valentina Vladimirovna Lazareva

I.M. Sechenov First MSMU of Minzdrav of Russia (Sechenov University)

Email: l_tifl@mail.ru
Ph.D. Student at the Department of Neonatology

Viktor Vasil'evich Zubkov

V.I. Kulakov NMRC for OG&P of Minzdrav of Russia

Email: v_zubkov@oparina4.ru
Dr.Med.Sci., Professor, Head of the Department of Neonatology and Pediatrics

Dmitrii Nikolaevich Degtyarev

National Medical Research Center of Obstetrics, Gynecology, and Perinatology named after Academician V.I. Kulakov, Ministry of Health of Russia; I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia

Email: d_degtiarev@oparina4.ru
Dr.Med.Sci., Professor, Deputy Director for Science; Head of the Department of Neonatology

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