الفهرس 
NECROTIZING ENTEROCOLITIS (NEC) & FEEDING INTOLERANCE (FI)Only 14 pages are availabe for public view
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Abstract
SUMMARY
W
e hypothesis that Breast Fed (BF) preterm neonates exhibit higher level of serum TGF-β2 and lower incidence of Feeding Intolerance (FI) compared to premature formula feed preterm neonates.
We conducted a prospective, observational study in the period from May 2018 to October 2018 for 80 preterm neonates ≤ 36 wks at El-Demerdash Maternity Hospital NICU.
It aimed to assess the occurrence of FI and NEC in preterm neonates and its relation to serum TGF-β2 in BF versus premature formula fed neonates.
Eighty preterm neonates were enrolled. Inclusion criteria were GA ≤ 36 weeks. Exclusion criteria were the presence of any contraindication to feeding (e.g. GIT surgical condition), inborn error of metabolism, chromosomal abnormalities or congenital malformation. They allocated equally in 2 groups (BF group and premature formula fed group).
BF group included 40 preterm neonates among which 50% were female. Mean for birth weight was 1.72 kg, mean for GA was 32.8 wks, 70% were delivered via CS.
As for the premature formula group, among the 40 neonates included, 52.5% were female, 47.5% was born to CS. Mean for birth weight was 2kg while mean for GA was 34 weeks.
All study subjects received their usual care and medications according to the treating physicians, protocols of management. Additionally, trophic feeding was started (10-20 ml/kg/day) with daily increment of (10-20 ml/kg/day) if feeds were tolerated.
Study subjects were followed up daily till they were discharged or died. Daily measurement of weight, feeding protocol of all subjects was recorded, type of milk, daily increment of feeding, frequency of feeding intolerance, and stoppage of feeding for any stage of NEC (staging and diagnosis were done according to Bell’s criteria), Frequency of septic episodes, respiratory support needed. Serum TGF-β2 level was measured (when baby was fed 75 ml/kg/day).
Overall incidence of NEC was 2 out of total 80 neonates (2.5%), all were in premature formula group and no NEC occurred in BF group. Lower GA and birth weight were a risk factors. FI was found in 29 out of total 80 (36.25%), 9 of them (22.5%) were in BF group, and 20(50%) were in premature formula group.
Overall mortality in the whole study was 22.5%. No significant difference was found between the 2 groups. But it worth to notice that the mortality rate in premature formula group is 7.5% (3 out of 40) is less than BF 15% (6 out of 40). However, the only 2 NEC infants in the study died.
TGF-β2 serum level was significantly lower in PTF group than BF group. There was a negative correlation between TGF-β2 and FI, the only 2 infants with NEC in this study have a very low level of TGF-β but of no significant value.
TGF-β2 was not significantly related to gender, maternal illness, mortality or type of delivery between the 2 groups. There was a highly significant correlation between the TGF-β2 serum level with birth weight, gestational age and CRP. On the other hand, there was significant negative correlation between NEC and gestational age. Also there was negative correlation between feeding intolerance and birth Wt.
Finally, the study support the hypothesis that BF preterm neonates exhibit higher level of serum TGF-β2 and lower incidence of FI compared to premature formula fed preterm neonates.