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Query: UMLS:C0036690 (sepsis)
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Extrauterine growth restriction in preterm infants secondary to suboptimal nutrition is a major problem in neonatal intensive care units. Evidence is emerging that early growth deficits have long-term adverse effects, including short stature and poor neurodevelopmental outcomes. The parenteral route of feeding is essential to maintain nutritional integrity before successful transition to the enteral route of feeding is achieved. Nevertheless, early initiation of enteral feeding in sub-nutritional trophic quantity is vital for promoting gut motility and bile secretion, inducing lactase activity, and reducing sepsis and cholestatic jaundice. Results emerging from over sixty randomized clinical trials are available for providing a template on which feeding protocols can be based. Preterm breast milk expressed from the infant's own mother is the milk of choice. Supplementation with a human milk fortifier is necessary to optimize nutritional intake. Preterm formulas are an appropriate substitute for preterm human milk when the latter is unavailable. There are over ten systematic reviews of randomized controlled trials published by the Cochrane Library that addressed feeding strategies, but most do not address long-term outcome measures of clinical importance. There is an urgent need for large-scale, long-term randomized controlled trials to help evaluate metabolic, growth, and neurodevelopmental responses of preterm infants to earlier and more aggressive nutritional management.
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PMID:Extrauterine growth restriction in preterm infants: importance of optimizing nutrition in neonatal intensive care units. 1615 65

Background: Changes in intestinal mucosal integrity and gut microbial balance occur in severe acute malnutrition (SAM), resulting in treatment failure and adverse clinical outcomes (gram-negative sepsis, diarrhoea and high case-fatality). Transient lactose intolerance, due to loss of intestinal brush border lactase, also complicates SAM, thus milk based feeds may not be optimal for nutritional rehabilitation. Since the gut epithelial barrier can be supported by short chain fatty acids, derived from microbiota fermentation by particular fermentable carbohydrates, we postulated that an energy-dense nutritional feed comprising of legume-based fermentable carbohydrates, incorporated with lactose-free versions of standard World Health Organization (WHO) F75/F100 nutritional feeds will enhance epithelial barrier function in malnourished children, reduce and promote resolution of diarrhoea and improve overall outcome. Methods: We will investigate in an open-label trial in 160 Ugandan children with SAM, defined by mid-upper arm circumference <11.5cm and/or presence of kwashiorkor. Children will be randomised to a lactose-free, chickpea-enriched feed containing 2 kcal/ml, provided in quantities to match usual energy provision (experimental) or WHO standard treatment F75 (0.75 kcal/ml) and F100 (1 kcal/ml) feeds on a 1:1 basis, conducted at Mbale Regional Referral Hospital nutritional rehabilitation unit. The primary outcomes are change in MUAC at day 90 and survival to day 90. Secondary outcomes include: i) moderate to good weight gain (>5 g/kg/day), ii) de novo development of diarrhoea (>3 loose stools/day), iii) time to diarrhoea resolution (if >3 loose stools/day), and iv) time to oedema resolution (if kwashiorkor) and change in intestinal biomarkers (faecal calprotectin). Discussion: We hypothesize that, if introduced early in the management of malnutrition, such lactose-free, fermentable carbohydrate-based feeds, could safely and cheaply improve global outcome by reducing lactose intolerance-related diarrhoea, improving mucosal integrity and enhancing immunity, and limiting the risk of systemic infection and associated broad-spectrum antibiotic resistance. Registration: ISRCTN 10309022.
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PMID:Modifying Intestinal Integrity and Micro Biome in Severe Malnutrition with Legume-Based Feeds (MIMBLE 2.0): protocol for a phase II refined feed and intervention trial. 3034 81