Category: Gastrointestinal

Donor breast milk vs formula – a randomized trial

In a double-blind multicenter trial very-low birth weight infants with inadequate supply of their mother’s own milk were randomly assigned to receive either donor breast milk with bovine fortifier or formula (for 90 days or until discharge). There were no…

Do transfusions cause NEC? Or is it the anemia?

A prospective multicenter cohort study of 600 VLBW infants studied the effect of RBC transfusions and anemia on the development of necrotizing enterocolitis and mortality. In a multivariable analysis, the rate of NEC was associated with severe anemia, but not…

Upper GI contrast for malrotation

A retrospective review of 166 neonates with bilious vomiting who underwent an upper gastrointestinal contrast study showed that only 14 (9%) had malrotation (confirmed at laparotomy). Of infants referred in the first three days of life, less than 1% had…

Routine glycerine suppositories in preterm infants

A single-center randomized trial evaluated the effect of daily (from day 2 – 14) glycerin suppositories in infants with a birth weight of 1000 – 1500 grams compared to similar infants receiving no intervention. Each arm had 25 infants. The time…

Changes in intestinal microbiome prior to onset of NEC

A case control study evaluated the patterns of the intestinal microbiome prior to the development of NEC in 12 infants and compared these with the patterns in 26 control infants without NEC. Fecal samples were collected from all these infants…

Gastric residuals in preterm infants

A randomized trial in preterm infants compared outcomes in infants 24 – 32 weeks gestation in whom gastric residuals were routinely checked prior to every feed versus those in whom residuals were not checked. An algorithm guided all other aspects…

Infusion of TPN into the liver from malpositioned umbilical venous catheters

A case series from a single center describes five neonates who had parenteral nutrition inadvertently infused into the liver from malpositioned umbilical venous catheters. Presenting features were abdominal distension, hemodynamic instability and anemia. Diagnosis was confirmed by ultrasound which showed…

Spontaneous intestinal perforation, prophylactic indomethacin and early feeds

An observational study of nearly 16,000 extremely-low-birth-weight infants analyzed the rates of spontaneous intestinal perforation in extremely-low-birth-weight infants, some of whom were exposed to prophylactic indomethacin or early feedings, or both. In those treated with prophylactic indomethacin, the risk of SIP…

Do term infants with bilious vomiting require urgent referral?

A retrospective analysis of 163 term infants who had bilious emesis in the first week of life found that 14% had a surgical condition that required immediate management. Overall, approximately half of these infants had a surgical condition. Abnormal abdominal…

Infant stool color cards to screen for biliary atresia

Late diagnosis of biliary atresia, which presents with jaundice and acholic stools, can lead to liver failure and liver transplantation. The use of an infant stool color card that can be used by the parents to detect acholic stools at…

Benign transient non-organic ileus of neonates

Benign transient non-organic ileus of neonates (BTNIN) is a condition that mimics Hirschsprung disease clinically and radiographically, but is not associated with aganglionic bowel. Surgery is not required and only conservative treatment is required. A retrospective review of 19 neonates…

Probiotics in very preterm infants

A randomized trial in babies less than 32 weeks gestation and less than 1500 grams compared the use of probiotics to placebo. Over 1000 babies were studied. Overall breast milk usage rate was high (>95%) in both arms. Babies in…

Exclusive human milk diet versus cows milk formula and fortifier

A multicenter randomized trial in extremely preterm infants compared a feeding regimen based exclusively on human milk (donor breast milk with fortifier derived from human milk) to one using preterm formula and fortifier derived from cows milk. Infants were eligible…

Witholding feeds during a blood transfusion in preterm infants

A review of five observational studies and one systematic review (of observational studies) found that withholding enteral feeds during a PRBC transfusion may reduce the risk of transfusion-associated NEC. None of the studies were randomized trials, all were unblinded, and the…

Outcome of fetal echogenic bowel

A retrospective review from a single center was performed of all fetal ultrasounds that showed a fetal echogenic bowel. If the finding was an isolated one (around 40% of cases) then the outcome was uneventful. If it was associated with…

Does PRBC transfusion increase the risk of NEC?

A systematic review with a meta-analysis of eleven observational studies evaluated whether PRBC transfusions were associated with an increased risk of NEC in the 48 hours following the transfusion. Most of these studies had a low or moderate risk of…