Systematic review: feeding practices for LBW

Transcript:Systematic review: feeding practices for LBW:
Systematic review: feeding practices for LBW infants in LMICs Abimbola Akindolire Background Survival of small and very small babies have improved over the last 20 years. A large majority of preterms at term gestational age are growth restricted The main consequence of this growth restriction is reduced brain growth leading to cognitive delays. To prevent this, adequate nutrition must be started as early as possible. New research into best feeding practices in order to how to achieve the same intrauterine growth rates Most available research/reviews are from the HICs and current guidelines are based on these information Literature search A literature search was conducted to see what evidence is available from LMICs to base current feeding practices on The questions we were asking at this time were What to feed How to feed When to start feeding How to advance Literature search- what to feed Reviews comparing formula milk to human milk Henderson et al in 2007 compared formula milk and maternal breast milk The outcomes of interest were the effects on growth & development and morbidity & mortality No randomized control trials were found Henderson et al in 2007 compared nutrient enriched formula milk and human breast milk post-discharge The outcome of interest were the effects on growth & development, bone mineralization, feed intolerance, BMI and blood pressure on follow up No randomized control trials were found Literature search- what to feed Review comparing formula milk to donor human milk Quigley 2014 9 studies -Europe 5, USA 3, Europe &USA 1; 5 studies term formula vs donor human milk and 4 studies preterm formula vs human donor milk 1070 babies- <1,800gm/32 weeks Outcomes of interest were effects on Growth & development. Incidence of adverse effects such as death, NEC, invasive infection and feed intolerance. Days to full feed. Quality of evidence was weak Main findings were increased short-term growth with formula but no effect on post-discharge growth or developmental outcomes. There was increased risk of NEC and feed intolerance in the formula fed population Literature search Reviews on breast milk fortification Many reviews in HICs Most show evidence of improvement in weight gain with fortification Literature search Reviews comparing different types of formula feeds Literature review- When to start feeds Morgan, 2013, Trophic feeds vs fasting Primary outcomes Feed intolerance: days to establish full enteral feeding independently of parenteral nutrition. Necrotising enterocolitis Secondary outcomes All-cause mortality prior to hospital