Nutritional Management of Moderate- and Late-Preterm Infants Commenced on Intravenous Fluids Pending Mother's Own Milk: Cohort Analysis From the DIAMOND Trial
BackgroundExclusive breastmilk is the desired enteral nutrition for babies born moderate- and late-preterm between 32+0 and 36+6 weeks' gestation; however, this goal is often difficult to achieve.MethodsA prospective cohort of babies 32+0 −35+6 weeks' gestation enrolled in the DIAMOND tria...
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Frontiers Media S.A.
2022-03-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2022.817331/full |
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| author | Tanith Alexander Tanith Alexander Michael Meyer Jane E. Harding Jane M. Alsweiler Jane M. Alsweiler Yannan Jiang Clare Wall Mariana Muelbert Frank H. Bloomfield The DIAMOND Study Group |
| author_facet | Tanith Alexander Tanith Alexander Michael Meyer Jane E. Harding Jane M. Alsweiler Jane M. Alsweiler Yannan Jiang Clare Wall Mariana Muelbert Frank H. Bloomfield The DIAMOND Study Group |
| author_sort | Tanith Alexander |
| collection | DOAJ |
| description | BackgroundExclusive breastmilk is the desired enteral nutrition for babies born moderate- and late-preterm between 32+0 and 36+6 weeks' gestation; however, this goal is often difficult to achieve.MethodsA prospective cohort of babies 32+0 −35+6 weeks' gestation enrolled in the DIAMOND trial were randomized to a condition specifying that babies should receive mother's own milk (MOM) as the only enteral feed. Factors associated with the successful transition to MOM, defined as MOM being the sole enteral feeding at the time of the first cessation of intravenous (IV) fluids, were investigated by logistic regression. Time to commencement of a milk other than MOM was analyzed by Kaplan–Meier survival curves.ResultsA total of 151 eligible babies (60% boys) were included, 93 (63%) of whom successfully transitioned from IV fluids onto MOM only. Alternative sources of milk, mostly formula, were used to transition from IV fluids onto enteral feeds more often in multiples and Māori, and was commenced earlier in Māori than other ethnicities (p = 0.007) and in late-preterm compared with moderate-preterm babies (p=0.01). Receiving exclusively breastmilk at discharge was more likely for babies who successfully transitioned from IV fluids onto MOM only [OR (95% confidence intervals) 4.9 (2.3–10.6)] and who received only MOM in the first week after birth [4.8 (2.2–10.4)], both p < 0.0001. Receiving breastmilk exclusively at discharge was less likely for Māori than Caucasian babies [0.2 (0.1–0.6), p < 0.0006]. There was no difference in the use of alternative sources of milk in babies who received parenteral nutrition or dextrose or between small-for-gestational-age and appropriate-for-gestational-age babies.ConclusionsDespite an intention to provide only MOM, significant numbers of moderate- and late-preterm babies received formula to transition from IV fluids, and this differed by ethnicity. The drivers underlying these decisions require further investigation. These data highlight an urgent need for quality initiatives to support and encourage mothers of moderate- and late-preterm babies in their lactation. |
| first_indexed | 2024-12-18T10:03:58Z |
| format | Article |
| id | doaj.art-1f5b86281419421a97fdc85443bec903 |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-12-18T10:03:58Z |
| publishDate | 2022-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-1f5b86281419421a97fdc85443bec9032022-12-21T21:11:35ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602022-03-011010.3389/fped.2022.817331817331Nutritional Management of Moderate- and Late-Preterm Infants Commenced on Intravenous Fluids Pending Mother's Own Milk: Cohort Analysis From the DIAMOND TrialTanith Alexander0Tanith Alexander1Michael Meyer2Jane E. Harding3Jane M. Alsweiler4Jane M. Alsweiler5Yannan Jiang6Clare Wall7Mariana Muelbert8Frank H. Bloomfield9The DIAMOND Study GroupLiggins Institute, University of Auckland, Auckland, New ZealandNeonatal Unit, Kidz First, Middlemore Hospital, Counties Mankau Health, Auckland, New ZealandNeonatal Unit, Kidz First, Middlemore Hospital, Counties Mankau Health, Auckland, New ZealandLiggins Institute, University of Auckland, Auckland, New ZealandNewborn Services, Auckland City Hospital, Auckland, New ZealandThe Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New ZealandDepartment of Statistics, Faculty of Science, University of Auckland, Auckland, New ZealandDepartment of Nutrition, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New ZealandLiggins Institute, University of Auckland, Auckland, New ZealandLiggins Institute, University of Auckland, Auckland, New ZealandBackgroundExclusive breastmilk is the desired enteral nutrition for babies born moderate- and late-preterm between 32+0 and 36+6 weeks' gestation; however, this goal is often difficult to achieve.MethodsA prospective cohort of babies 32+0 −35+6 weeks' gestation enrolled in the DIAMOND trial were randomized to a condition specifying that babies should receive mother's own milk (MOM) as the only enteral feed. Factors associated with the successful transition to MOM, defined as MOM being the sole enteral feeding at the time of the first cessation of intravenous (IV) fluids, were investigated by logistic regression. Time to commencement of a milk other than MOM was analyzed by Kaplan–Meier survival curves.ResultsA total of 151 eligible babies (60% boys) were included, 93 (63%) of whom successfully transitioned from IV fluids onto MOM only. Alternative sources of milk, mostly formula, were used to transition from IV fluids onto enteral feeds more often in multiples and Māori, and was commenced earlier in Māori than other ethnicities (p = 0.007) and in late-preterm compared with moderate-preterm babies (p=0.01). Receiving exclusively breastmilk at discharge was more likely for babies who successfully transitioned from IV fluids onto MOM only [OR (95% confidence intervals) 4.9 (2.3–10.6)] and who received only MOM in the first week after birth [4.8 (2.2–10.4)], both p < 0.0001. Receiving breastmilk exclusively at discharge was less likely for Māori than Caucasian babies [0.2 (0.1–0.6), p < 0.0006]. There was no difference in the use of alternative sources of milk in babies who received parenteral nutrition or dextrose or between small-for-gestational-age and appropriate-for-gestational-age babies.ConclusionsDespite an intention to provide only MOM, significant numbers of moderate- and late-preterm babies received formula to transition from IV fluids, and this differed by ethnicity. The drivers underlying these decisions require further investigation. These data highlight an urgent need for quality initiatives to support and encourage mothers of moderate- and late-preterm babies in their lactation.https://www.frontiersin.org/articles/10.3389/fped.2022.817331/fullmoderate pretermlate pretermnutritionbreastmilkintravenous fluidMāori |
| spellingShingle | Tanith Alexander Tanith Alexander Michael Meyer Jane E. Harding Jane M. Alsweiler Jane M. Alsweiler Yannan Jiang Clare Wall Mariana Muelbert Frank H. Bloomfield The DIAMOND Study Group Nutritional Management of Moderate- and Late-Preterm Infants Commenced on Intravenous Fluids Pending Mother's Own Milk: Cohort Analysis From the DIAMOND Trial Frontiers in Pediatrics moderate preterm late preterm nutrition breastmilk intravenous fluid Māori |
| title | Nutritional Management of Moderate- and Late-Preterm Infants Commenced on Intravenous Fluids Pending Mother's Own Milk: Cohort Analysis From the DIAMOND Trial |
| title_full | Nutritional Management of Moderate- and Late-Preterm Infants Commenced on Intravenous Fluids Pending Mother's Own Milk: Cohort Analysis From the DIAMOND Trial |
| title_fullStr | Nutritional Management of Moderate- and Late-Preterm Infants Commenced on Intravenous Fluids Pending Mother's Own Milk: Cohort Analysis From the DIAMOND Trial |
| title_full_unstemmed | Nutritional Management of Moderate- and Late-Preterm Infants Commenced on Intravenous Fluids Pending Mother's Own Milk: Cohort Analysis From the DIAMOND Trial |
| title_short | Nutritional Management of Moderate- and Late-Preterm Infants Commenced on Intravenous Fluids Pending Mother's Own Milk: Cohort Analysis From the DIAMOND Trial |
| title_sort | nutritional management of moderate and late preterm infants commenced on intravenous fluids pending mother s own milk cohort analysis from the diamond trial |
| topic | moderate preterm late preterm nutrition breastmilk intravenous fluid Māori |
| url | https://www.frontiersin.org/articles/10.3389/fped.2022.817331/full |
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