Phototherapy: a new risk factor for necrotizing enterocolitis in very low birth weight preterm infants? a retrospective case-control study.

OBJECTIVE: To investigate the association between phototherapy (PT) and the development of necrotizing enterocolitis (NEC) in very low birth weight (VLBW) infants. STUDY DESIGN: A retrospective case-control study was conducted on VLBW infants with or without NEC (stage IIA or greater) born at ≤35 weeks' gestation in a tertiary hospital over 7 years. Sample size calculation, trend test, as well as univariate and multiple logistic regression analyses were employed. RESULTS: A total of 824 VLBW infants were reviewed, with 74 cases and 122 controls finally enrolled. The odds of NEC increased with the duration and number of PT sessions. Exposure to >120 h and >4 instances of PT were significantly associated with NEC in multivariate analysis. CONCLUSION: This is the first study suggesting a potential association between PT and development of NEC in VLBW infants. This association needs further exploration.

[Prospective and controlled study on effect of fortified human milk feeding on infants with extremely and very low birth weight during hospital stay].

OBJECTIVE: To explore the effect of fortified human milk feeding on growth and complications of infants with extremely and very low birth weight (ELBW/VLBW) during hospital stay by a prospective, random and controlled study. METHODS: In the study, 122 ELBW/VLBW infants were enrolled and divided into two groups. The infants fed with human breast milk, combined with human milk fortification (HMF) during hospital stay were named HMF group (n=62), and those fed exclusively with premature formula were named premature formula feeding group (PF group, n=60). The data of the infants'growth (the velocity of increase on the weight, length, head circumference and upper arm circumference), the time of rebounding to birth weight, the time of needing intravenous nutrition, the time of hospitalizing, the proportion of extrauterine growth retardation (EUGR) during hospital stay, the level of hemoglobin, bone metabolism and incidence of complications were compared between the two groups. RESULTS: Among the 122 infants included, (1) the length increment in HMF group was higher than PF group [(0.89 ± 0.23) cm/week vs. (0.79 ± 0.34) cm/week, P=0.04]; there were no significant differences in the weight gain, head circumference increment and upper arm circumference increment (P>0.05); (2) the age of rebounding to birth weight [(10.13 ± 4.03) d vs. (8.03 ± 3.28) d, P=0.002] and the duration of intravenous nutrition [(16.77 ± 6.63) d vs. (14.23 ± 4.15) d, P=0.01] in HMF group were longer than that in PF group, there were no significant differences between the two groups in the hospital stay and age achieved feeding; (3) there were no significant differences between the two groups in the incidence rate of EUGR during hospital stay (P>0.05); (4) the level of calcium at birth in HMF group was lower than that in PF group [(2.19 ± 0.22) mmol/L vs.( 2.32 ± 0.27) mmol/L, P=0.005], and the level of alkaline phosphatase (AKP) in HMF group at discharge was higher than in PF group [(363.98 ± 122.49) mmol/L vs. (299.73 ± 117.39) mmol/L, P=0.004]; (5) the incidence of the feeding intolerance (6.5% vs. 18.3%, P=0.04) and sepsis (4.8% vs. 16.7%, P=0.03) in HMF group were less than in PF group, there were no significant differences between the two groups on the morbidity of necrotizing enterocditis, retinopathy of prematurity (ROP), and bronchopulmonary dysplasia (BPD) (P>0.05). CONCLUSION: HMF for premature infants may ensure the same growth pattern as those fed by premature formula, promote the calcium absorption, decrease the incidence of sepsis and feeding intolerance, and does not increase the incidence of necrotizing enterocolitis.