Displaying publications 61 - 80 of 93 in total

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  1. Ram, S.P., Zabidi Azhar M Hussin
    MyJurnal
    Two active interventions were carried out in order to encourage breast feeding of low birth weight (LBW) neonates who were admitted to the neonatal intensive care unit (NICU), Universiti Sains Malaysia. These were the establishment of (a) an effective transport system for conveying expressed breast milk (EBM) from the motherk home to the neonatal intensive care unit and (b) providing rooming-infacilities in the neonatal ward. The EBM was transported by a male health assistant, by the parents themselves or by the local bus company. A total of 473 babies were admitted from April 1994 to September 1995. Thirty-three babies weighed between 540-1000g and 440 were between 1001-2000g. A total of 226 (47.8%) babies were given mixed formula (less than 20% of daily needs) and EBM feeds (Group A) and 247 (52.2%) were given only formula feeds (Group B). A total of 79 babies died of which 5 were in Group A and 74 were in group B. (P value is 0.00). In Group A, 45 babies had clinical sepsis, 9 of whom were blood culture positive. Four of these babies died. In group B, out of 108 babies with clinical sepsis 36 were blood culture positive. 29 died because of the sepsis This study shows that by providing an effective transport system for breast milk expressed at home and the availability of roomingfacilities in the neonatal ward a significant number of LBW babies admitted to the NICU continue to receive their mothers' milk. The incidence of nosocomial sepsis and the over all mortality due to sepsis was significantly higher in those on full formulafeeding compared to those given mixed formula and expressed breast milk.
    Matched MeSH terms: Intensive Care Units, Neonatal
  2. Rohana, J., Latinah, M., Thambidorai, C.R., Kaur, B.
    MyJurnal
    A retrospective study was conducted to evaluate the magnitude, clinical course and risk factors of cholestasis in surviving very low birth weight (VLBW) infants who received parenteral nutrition at the neonatal intensive care unit (NICU) of Hospital Universiti Kebangsaan Malaysia. Cholestasis was defined as direct hyperbilirubinaemia of >34 mmol/L. Between 1St July 2000 to 31St March 2001, 58 VLBW infants received parenteral nutrition (PN). Forty seven infants survived to discharge. Complete data was obtained from 43 (90.1%) infants. Thirteen (30.2%) of these infants developed cholestasis. The cholestasis persisted beyond the age of 6 weeks in 8 infants and they underwent hepato imino diacetic acid (HIDA) scan. The HIDA scan was reported as normal in 2 infants and inconclusive in 6 infants. Operative cholangiography. (OTC) was then performed in these infants and were all normal. The cholestasis finally resolved in all infants. Analysis of risk factors revealed that duration of assisted ventilation and PN and the presence of patent ductus arteriosus (PDA) had significant correlation with the development of cholestasis. These factors together with lower mean gestational age increased the likelihood of persistent cholestasis beyond 6 weeks of life in these infants. In conclusion cholestasis is common in VLBW infants who received parenteral nutrition. Although the clinical course seems benign, in a significant proportion of these infants it may persist longer and put them at increased risk of requiring invasive investigations.
    Matched MeSH terms: Intensive Care Units, Neonatal
  3. Lim, N.L., Boo, N.Y., Nur Atiqah, N.A., Padma Soosai, A., Musa Mohd Nordin, M Sham. Kasim
    MyJurnal
    Severe jaundice (serum bilirubin level > 340 gmol/L) occurred in 81 infants admitted to the Neonatal Intensive Care Unit (NICU) of the Maternity Hospital Kuala Lumpur (MHKL) in 1993. Of these 46 (56.8%) underwent 53 exchange transfusions. In-patient case notes were available for study on 41 of them. Two infants had no cause identified while 12 were associated with prematurity, 13 ABO incompatibility, 8 G6PD deficiency, 6 sepsis 2 Rh isoimmunisation and 6 miscellaneous causes. In 14 infants it was felt that exchange transfusions might have been avoided if they were detected earlier and phototherapy instituted promptly. Twenty six (26) infants were deemed to have been given phototherapy at the appropriate time but jaundice increased to exchange transfusion levels, threshold values depending on the unit in charge. Use of higher intensity phototherapy might have been more effective in some of the cases. Available data showed similar outcomes in both groups.
    Matched MeSH terms: Intensive Care Units, Neonatal
  4. Rusnani Ab Latif
    MyJurnal
    Psychological well-being is relatively complex notions with a variety of components that may contribute to it. Individuals differ in their overall levels of psychological health and well-being. Mother with low birth weight (LBW) babies required hospitalization especially in the Neonatal Intensive Care Unit (NICU) more exposed to the experience of anxious symptoms. Therefore, it would become a stressful event that might cause psychological distress or even emotional crisis in mother's when their infants were LBW especially premature. Health promotion is very important to prevent this problem. Health promotion efforts aimed at improving infant health status must do so by improving women's health. Improving women's health before, during, and after pregnancy is the key to reduce the human and economic costs associated with infant mortality and morbidity. To improve both women's and infants' health, efforts should include an emphasis on preventive health care services, family-oriented work site options, changes in social norms, and individual behavior modification. Therefore, it is important for health care professionals in NICU to be able to assess the factors associated psychological well-being of mother's with LBWinfant.
    Matched MeSH terms: Intensive Care Units, Neonatal
  5. Boo NY, Ang EBK, Neoh SH, Ang EL, Chee SC
    Malays J Pathol, 2022 Dec;44(3):443-459.
    PMID: 36591712
    OBJECTIVES: To determine the incidence, causative pathogens, morbidities, mortality, and risk factors associated with blood culture-positive early-onset sepsis (EOS, ≤72 hours of age) in symptomatic neonates admitted to the neonatal intensive care units (NICUs) of a middle-income country.

    STUDY DESIGN: Retrospective cohort study using data submitted prospectively to the Malaysian National Neonatal Registry (MNNR).

    SETTING: 44 Malaysian NICUs.

    PARTICIPANTS: All neonates born in 2015- 2020.

    RESULTS: EOS was reported in 991 neonates. The annual incidence of EOS increased from 0.46 to 0.49/1000 livebirths over the six years. The most common pathogen was Streptococcus agalactiae or Group B haemolytic streptococcus (GBS) (n=388, 39.2%), followed by Escherichia coli (E. coli) (n=80, 8.1%), Klebsiella spp (n=73, 7.4%), coagulase negative staphylococcus (CONS) (n=73, 7.4%), Pseudomonas spp (n=44, 4.4%) and methicillin-sensitive Staphylococcus aureus (n=34, 3.4%). The incidence of EOS due to GBS increased from 0.17 to 0.22/1000 livebirths. Morbidities and mortality were higher in those with EOS than without EOS. Multiple logistic regression analysis showed that Indian ethnic group, chorioamnionitis, gestation≥37weeks, female, spontaneous vaginal delivery, instrumental delivery, and surfactant therapy were significantly associated with increased risk of EOS due to GBS. Four factors were significantly associated with increased risk of non-GBS EOS (outborns, birthweight lt;1000 g, vaginal delivery, and surfactant therapy). Early continuous positive airway pressure was associated with significantly lower risk of EOS.

    CONCLUSION: The incidence of EOS showed an increasing trend in Malaysian NICUs. GBS was the most common causative pathogen. Several modifiable risk factors associated with EOS have been identified.

    Matched MeSH terms: Intensive Care Units, Neonatal
  6. Boo NY, Nor Azlina AA, Rohana J
    Singapore Med J, 2008 Mar;49(3):204-8.
    PMID: 18363001
    This study was designed to determine the sensitivity and specificity of a semi-quantitative procalcitonin (PCT) test kit for the diagnosis of neonatal sepsis.
    Matched MeSH terms: Intensive Care Units, Neonatal
  7. Boo NY, Nordiah AJ, Alfizah H, Nor-Rohaini AH, Lim VK
    J Hosp Infect, 2001 Dec;49(4):274-81.
    PMID: 11740876
    The objective of this study was to compare the rates of bacterial contamination of expressed breast milk (EBM) obtained by manual expression and breast pumps in mothers of very low birthweight (VLBW) infants (<1501 g). This was a randomized, controlled study carried out on 28 mothers of such babies and 92 specimens of EBM were collected: 41 specimens from 13 mothers assigned to the manual group and 51 specimens from 15 mothers in the breast-pump group. EBM was cultured quantitatively by the Miles and Misra method. Breast milk expressed by breast pumps (86.3% or 44/51 specimens) had a significantly higher rate of bacterial contamination than milk expressed by the manual method (61.0% or 25/41 specimens) (P= 0.005). When breast milk was expressed in the hospital, there was no significant difference in contamination rates between the two methods. When breast milk was expressed at home, the rates of bacterial contamination by staphylococci (P= 0.003) and Gram-negative bacilli (P= 0.002) were significantly higher in the breast-pump group than the manual group. In conclusion, the rate of bacterial contamination of EBM of mothers of VLBW infants was high, especially when EBM was obtained by the breast pump or when expression was carried out at home.
    Matched MeSH terms: Intensive Care Units, Neonatal
  8. Lai NM, Foong SC, Foong WC, Tan K
    Cochrane Database Syst Rev, 2016 Apr 14;4(4):CD008313.
    PMID: 27075527 DOI: 10.1002/14651858.CD008313.pub3
    BACKGROUND: The increased birth rate of twins during recent decades and the improved prognosis of preterm infants have resulted in the need to explore measures that could optimize their growth and neurodevelopmental outcomes. It has been postulated that co-bedding simulates twins' intrauterine experiences in which co-regulatory behaviors between them are observed. These behaviors are proposed to benefit twins by reducing their stress, which may promote growth and development. However, in practice, uncertainty surrounds the benefit-risk profile of co-bedding.

    OBJECTIVES: We aimed to assess the effectiveness of co-bedding compared with separate (individual) care for stable preterm twins in the neonatal nursery in promoting growth and neurodevelopment and reducing short- and long-term morbidities, and to determine whether co-bedding is associated with significant adverse effects.As secondary objectives, we sought to evaluate effects of co-bedding via the following subgroup analyses: twin pairs with different weight ranges (very low birth weight [VLBW] < 1500 grams vs non-VLBW), twins with versus without significant growth discordance at birth, preterm versus borderline preterm twins, twins co-bedded in incubator versus cot at study entry, and twins randomized by twin pair versus neonatal unit.

    SEARCH METHODS: We used the standard search strategy of the Cochrane Neonatal Review Group (CNRG). We used keywords and medical subject headings (MeSH) to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 2), MEDLINE (via PubMed), EMBASE (hosted by EBSCOHOST), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and references cited in our short-listed articles, up to February 29, 2016.

    SELECTION CRITERIA: We included randomized controlled trials with randomization by twin pair and/or by neonatal unit. We excluded cross-over studies.

    DATA COLLECTION AND ANALYSIS: We extracted data using standard methods of the CNRG. Two review authors independently assessed the relevance and risk of bias of retrieved records. We contacted the authors of included studies to request important information missing from their published papers. We expressed our results using risk ratios (RRs) and mean differences (MDs) when appropriate, along with 95% confidence intervals (95% CIs). We adjusted the unit of analysis from individual infants to twin pairs by averaging measurements for each twin pair (continuous outcomes) or by counting outcomes as positive if developed by either twin (dichotomous outcomes).

    MAIN RESULTS: Six studies met the inclusion criteria; however, only five studies provided data for analysis. Four of the six included studies were small and had significant limitations in design. As each study reported outcomes differently, data for most outcomes were effectively contributed by a single study. Study authors reported no differences between co-bedded twins and twins receiving separate care in terms of rate of weight gain (MD 0.20 grams/kg/d, 95% CI -1.60 to 2.00; one study; 18 pairs of twins; evidence of low quality); apnea, bradycardia, and desaturation (A/B/D) episodes (RR 0.85, 95% CI 0.18 to 4.05; one study; 62 pairs of twins; evidence of low quality); episodes in co-regulated states (MD 0.96, 95% CI -3.44 to 5.36; one study; three pairs of twins; evidence of very low quality); suspected or proven infection (RR 0.84, 95% CI 0.30 to 2.31; three studies; 65 pairs of twins; evidence of very low quality); length of hospital stay (MD -4.90 days, 95% CI -35.23 to 25.43; one study; three pairs of twins; evidence of very low quality); and parental satisfaction measured on a scale of 0 to 55 (MD -0.38, 95% CI -4.49 to 3.73; one study; nine pairs of twins; evidence of moderate quality). Although co-bedded twins appeared to have lower pain scores 30 seconds after heel lance on a scale of 0 to 21 (MD -0.96, 95% CI -1.68 to -0.23; two studies; 117 pairs of twins; I(2) = 75%; evidence of low quality), they had higher pain scores 90 seconds after the procedure (MD 1.00, 95% CI 0.14 to 1.86; one study; 62 pairs of twins). Substantial heterogeneity in the outcome of infant pain response after heel prick at 30 seconds post procedure and conflicting results at 30 and 90 seconds post procedure precluded clear conclusions.

    AUTHORS' CONCLUSIONS: Evidence on the benefits and harms of co-bedding for stable preterm twins was insufficient to permit recommendations for practice. Future studies must be adequately powered to detect clinically important differences in growth and neurodevelopment. Researchers should assess harms such as infection, along with medication errors and caregiver satisfaction.

    Matched MeSH terms: Intensive Care Units, Neonatal
  9. See GB, Mesran I
    Indian J Otolaryngol Head Neck Surg, 2019 Oct;71(Suppl 1):45-48.
    PMID: 31741928 DOI: 10.1007/s12070-016-0992-2
    Subglottic cysts (SGCs) are a rare cause of airway obstruction in children. Medical advances, higher survival rates for preterm infants, and improved diagnostic equipment have increased the number of reported cases of SGCs over the last three decades, the majority occurring in infants who had been extremely premature neonates and had suffered from respiratory distress, therefore having been intubated and managed in neonatal ICUs. Symptoms of laryngeal cysts depend on the size and the location of the cyst and include a change in the tone of voice, dysphonia, hoarseness, dysphagia, stridor, and dyspnea. This condition is often misdiagnosed as laryngomalacia, asthma, croup, or other diseases, due to the fact that it manifests as recurring respiratory infections, stridor, and wheezing. Death can occur in severe cases that are not treated. When present, it may account for severe inspiratory stridor that compromise the airway. The accepted gold standard treatment is direct laryngoscopy with marsupialization of the cyst to prevent recurrence. Two cases of subglottic cyst in our centre are described here. Although all cases presented differently, but in both of our cases, which have previous history of intubation with prematurity were initially diagnosed as laryngomalacia and croup.
    Matched MeSH terms: Intensive Care Units, Neonatal
  10. Wan Hanifah W, Lee J, Quah B
    Malays J Med Sci, 2000 Jan;7(1):33-40.
    PMID: 22844213
    Nosocomial infection is a common problem in the Neonatal Intensive Care Unit (NICU) and a knowledge of the pattern of nosocomial infection will contribute greatly to the intensification of infection control measures and the development of antibiotic policies in the NICU. This study aims to compare the incidence and clinical characteristics of neonates with nosocomial infection in NICU of both Kuala Terengganu Hospital (HKT) and Universiti Sains Malaysia Hospital (HUSM). Neonates who had both clinical signs of sepsis and positive blood cultures, 48 hours after admission to NICU, from 1(st) January to 31(st) December 1998, in both hospitals were retrospectively studied. Among neonates admitted to NICU, 30 (5.4%) in HKT and 65 (3.6%) in HUSM had nosocomial infection (p = 0.07). The mean duration of hospitalisation was shorter (HUSM 37 days, HKT 49 days; p = 0.02), and the number of neonates with predisposing factors for infection is higher (HUSM 100%, HKT 73.3%; p < 0.001) in HUSM compared with HKT. There were no differences in gestation, mean age of onset of infection and mortality between both hospitals. The most common organism isolated from the blood in HKT was Klebsiella pneumoniae (33.3%), and in HUSM Klebsiella aerogenes (24.6%). Half of Klebsiella pneumoniae isolates were resistant to cephalosporins and aminoglycosides in HKT and a similar number of Klebsiella aerogenes isolates were resistant to piperacillin and aminoglycosides in HUSM. In conclusion nosocomial infection is a common problem in both hospitals. Except for more frequent predisposing factors for infection in HUSM, and a longer duration of hospital stay among neonates in HKT, the clinical characteristics of neonates with nosocomial infection in both hospitals were similar.
    Matched MeSH terms: Intensive Care Units, Neonatal
  11. Yap PS, Ahmad Kamar A, Chong CW, Yap IK, Thong KL, Choo YM, et al.
    Pathog Glob Health, 2016 Sep;110(6):238-246.
    PMID: 27650884
    The prevalence and antibiotic susceptibility of intestinal carriage of Gram-negative bacteria among preterm infants admitted to the neonatal intensive care unit (NICU) in a tertiary teaching hospital in Malaysia were determined. A total of 34 stool specimens were obtained from preterm infants upon admission and once weekly up to two weeks during hospitalization. The presumptive colonies of Escherichia coli and Klebsiella pneumoniae were selected for identification, antibiotic susceptibility testing, and subtyping by using pulsed-field gel electrophoresis (PFGE). Out of 76 Gram-negative isolates, highest resistance was detected for amoxicillin/clavulanate (30.8%, n = 16), ceftriaxone (42.3%, n = 22), ceftazidime (28.8%, n = 15), cefoxitin (28.8%, n = 15), aztreonam (36.5%, n = 19), and polymyxin B (23.1%, n = 12). Three colistin resistant K. pneumoniae have also been detected based on E-test analysis. Thirty-nine isolates of K. pneumoniae and 20 isolates of E. coli were resistant to more than three antimicrobial classes and were categorized as multidrug resistant (MDR). PFGE analysis revealed a higher diversity in pulsotypes for K. pneumoniae (18 pulsotypes) in comparison to E. coli (four pulsotypes). In addition, a total of fifteen pulsotypes was observed from 39 MDR K. pneumoniae. The risk factors for antibiotic resistance were assessed using random forest analysis. Gender was found to be the most important predictor for colistin resistant while length, OFC, and delivery mode were showing greater predictive power in the polymyxin B resistance. This study revealed worrying prevalence rates of intestinal carriage of multidrug-resistant K. pneumoniae and E. coli of hospitalized preterm infants in Malaysia, particularly high resistance to polymyxins.
    Matched MeSH terms: Intensive Care Units, Neonatal*
  12. Lopez O, Subramanian P, Rahmat N, Theam LC, Chinna K, Rosli R
    J Clin Nurs, 2015 Jan;24(1-2):183-91.
    PMID: 25060423 DOI: 10.1111/jocn.12657
    To determine the effectiveness of facilitated tucking in reducing pain when venepuncture is being performed on preterm infants.
    Matched MeSH terms: Intensive Care Units, Neonatal
  13. Lee JK
    J Paediatr Child Health, 2008 Jan;44(1-2):62-6.
    PMID: 17640280
    An outbreak of Burkholderia cepacia septicaemia occurred in our neonatal unit over a 9-week period in 2001, affecting 23 babies and two died. A second outbreak lasting 8 days occurred a year later, affecting five babies.
    Matched MeSH terms: Intensive Care Units, Neonatal
  14. Partridge JC, Martinez AM, Nishida H, Boo NY, Tan KW, Yeung CY, et al.
    Pediatrics, 2005 Aug;116(2):e263-71.
    PMID: 16061579
    To characterize parent perceptions and satisfaction with physician counseling and delivery-room resuscitation of very low birth weight infants in countries with neonatal intensive care capacity.
    Matched MeSH terms: Intensive Care Units, Neonatal
  15. Boo NY, Chee SC, Rohana J
    Acta Paediatr, 2002;91(6):674-9.
    PMID: 12162601
    A randomized controlled study was carried out on 96 preterm infants (< 37 wk) with birthweight less than 2000 g admitted to a neonatal intensive care unit. The aim was to compare the weight gain between preterm infants exposed to 12 h cyclical lighting (intensity of light: 78.4 +/- 24.7 lux, mean +/- SD) and those exposed to a continuously dim environment (5.9 +/- 1.9 lux). The exclusion criteria were infants with major congenital malformations or who needed continuous lighting for treatment procedure and care. From day 7 of life until discharge, 50 infants were randomized to receive 12 h cyclical lighting and 46 infants to a continuously dim environment. There was no significant difference in the mean birthweight (12 h lighting vs continuously dim: 1482 vs 1465 g, p = 0.8), mean gestational age (31.6 vs 31.4 wk, p = 0.6), median duration of hospital stay (28.5 vs 28.5 d, p = 0.8), mean age to regain birthweight (13.0 vs 12.9 d, p = 0.3), mean weight gained by day 14 (27.6 vs 36.2 g, p = 1.0), median weight gain per day (11.9 vs 12.2 g, p = 0.9) or median body weight on discharge (1800 vs 1800 g, p = 0.4) between the two groups of infants.

    CONCLUSION: Exposing preterm infants to either 12 h cyglical lighting or continuously dim environment did not have any significant effect on their weight gain during the neonatal period.

    Matched MeSH terms: Intensive Care Units, Neonatal
  16. Malik AS
    Med J Malaysia, 1994 Mar;49(1):12-6.
    PMID: 8057984
    In view of controversial reports about the role of prelabour rupture of foetal membranes (PROM) in neonatal morbidity and to study the association of PROM with infections and meconium aspiration syndrome (MAS), a prospective case control study was conducted in a level II nursery of Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan. Of the 111 neonates with PROM studied, 18 developed clinical problems (septicaemia and other specific problems such as pneumonia, omphalitis, skin infection and MAS) while 5/56 of the control group developed similar problems. The difference between the two groups was not significant (p < 0.30). There was no neonatal death. It is concluded that PROM is not associated with neonatal morbidity. Neonates with this problem alone do not need to be admitted to the neonatal nursery.
    Matched MeSH terms: Intensive Care Units, Neonatal
  17. Lee YQ, Ahmad Kamar A, Velayuthan RD, Chong CW, Teh CSJ
    Pediatr Neonatol, 2021 03;62(2):129-137.
    PMID: 33218933 DOI: 10.1016/j.pedneo.2020.10.002
    BACKGROUND: Gastrointestinal carriage of multidrug resistant (MDR) Gram-negative bacilli, especially Klebsiella pneumoniae and Escherichia coli, was highly associated with severe nosocomial infections. The main objectives of this study were to determine the clonal relatedness of intestinal carriage and transmission risk factors of MDR E. coli and K. pneumoniae amongst preterm infants admitted to the neonatal intensive care unit (NICU).

    METHODS: A prospective cohort study of preterm infants with gestational age 

    Matched MeSH terms: Intensive Care Units, Neonatal
  18. Oei JL, Saugstad OD, Lui K, Wright IM, Smyth JP, Craven P, et al.
    Pediatrics, 2017 01;139(1).
    PMID: 28034908 DOI: 10.1542/peds.2016-1452
    BACKGROUND AND OBJECTIVES: Lower concentrations of oxygen (O2) (≤30%) are recommended for preterm resuscitation to avoid oxidative injury and cerebral ischemia. Effects on long-term outcomes are uncertain. We aimed to determine the effects of using room air (RA) or 100% O2 on the combined risk of death and disability at 2 years in infants <32 weeks' gestation.

    METHODS: A randomized, unmasked study designed to determine major disability and death at 2 years in infants <32 weeks' gestation after delivery room resuscitation was initiated with either RA or 100% O2 and which were adjusted to target pulse oximetry of 65% to 95% at 5 minutes and 85% to 95% until NICU admission.

    RESULTS: Of 6291 eligible patients, 292 were recruited and 287 (mean gestation: 28.9 weeks) were included in the analysis (RA: n = 144; 100% O2: n = 143). Recruitment ceased in June 2014, per the recommendations of the Data and Safety Monitoring Committee owing to loss of equipoise for the use of 100% O2. In non-prespecified analyses, infants <28 weeks who received RA resuscitation had higher hospital mortality (RA: 10 of 46 [22%]; than those given 100% O2: 3 of 54 [6%]; risk ratio: 3.9 [95% confidence interval: 1.1-13.4]; P = .01). Respiratory failure was the most common cause of death (n = 13).

    CONCLUSIONS: Using RA to initiate resuscitation was associated with an increased risk of death in infants <28 weeks' gestation. This study was not a prespecified analysis, and it was underpowered to address this post hoc hypothesis reliably. Additional data are needed.

    Matched MeSH terms: Intensive Care Units, Neonatal
  19. Ibrahim NR, Kheng TH, Nasir A, Ramli N, Foo JLK, Syed Alwi SH, et al.
    Arch. Dis. Child. Fetal Neonatal Ed., 2017 May;102(3):F225-F229.
    PMID: 27671836 DOI: 10.1136/archdischild-2015-310246
    OBJECTIVE: To determine whether feeding with 2-hourly or 3-hourly feeding interval reduces the time to achieve full enteral feeding and to compare their outcome in very low birthweight preterm infants.

    DESIGN: Parallel-group randomised controlled trial with a 1:1 allocation ratio.

    SETTING: Two regional tertiary neonatal intensive care units.

    PATIENTS: 150 preterm infants less than 35 weeks gestation with birth weight between 1.0 and 1.5 kg were recruited.

    INTERVENTIONS: Infants were enrolled to either 2-hourly or 3-hourly interval feeding after randomisation. Blinding was not possible due to the nature of the intervention.

    MAIN OUTCOME MEASURES: The primary outcome was time to achieve full enteral feeding (≥100 mL/kg/day). Secondary outcomes include time to regain birth weight, episode of feeding intolerance, peak serum bilirubin levels, duration of phototherapy, episode of necrotising enterocolitis, nosocomial sepsis and gastro-oesophageal reflux.

    RESULTS: 72 infants were available for primary outcome analysis in each group as three were excluded due to death-three deaths in each group. The mean time to full enteral feeding was 11.3 days in the 3-hourly group and 10.2 days in the 2-hourly group (mean difference 1.1 days; 95% CI -0.4 to 2.5; p=0.14). The mean time to regain birth weight was shorter in 3-hourly group (12.9 vs 14.8 days, p=0.04). Other subgroup analyses did not reveal additional significant results. No difference in adverse events was found between the groups.

    CONCLUSION: 3-hourly feeding was comparable with 2-hourly feeding to achieve full enteral feeding without any evidence of increased adverse events.

    TRIAL REGISTRATION NUMBER: ACTRN12611000676910, pre-result.

    Matched MeSH terms: Intensive Care Units, Neonatal
  20. Boo NY, Soon CC, Lye MS
    J Trop Pediatr, 2000 Oct;46(5):272-7.
    PMID: 11077935 DOI: 10.1093/tropej/46.5.272
    An observational study was carried out in the Kuala Lumpur Maternity Hospital to determine the risk factors associated with feed intolerance in very low birthweight (VLBW, <1501 g) infants given intermittent 3-hourly enteral feeds within 72h after birth. Feed intolerance developed in 85 (64.4 per cent) of 132 infants. Logistic regression analysis showed that the only significant risk factor associated with feed intolerance was the age when the first feed was commenced. For each hour delay in the age of the infants when the first feed was given, the adjusted odds ratios of feed intolerance was 1.03 (95 per cent confidence intervals: 1.01-1.05; p = 0.01). Other factors (modes of delivery, Apgar score at 1 min, sex, ethnicity, history of resuscitation at birth, birthweight, gestation, multiple pregnancy, perinatal asphyxia, types of milk, hypothermia before first feed, hypotension before first feed, respiratory distress syndrome, patent ductus arteriosus, septicaemia, theophylline therapy, indomethacin therapy, ventilatory support, continuous positive airway pressure, umbilical catheterization, and surfactant therapy) were not significantly associated with feed intolerance. Our study suggests that to promote tolerance of enteral feeds in VLBW infants, intermittent orogastric feeds should be commenced as soon as possible during the first 72 h of life.
    Matched MeSH terms: Intensive Care Units, Neonatal
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