Are breast milk adipokines affected by maternal dietary factors?

Background: Maternal diet and gestational age of infant may affect the composition of breast milk. The aim of this study was to evaluate the relationship between breast milk adiponectin and leptin levels of mothers delivering preterm and term infants and maternal diet. Methods: Sixty-five mothers (31 preterm, 34 term) were included in the study. General information about parents and infants and food consumption of mothers were determined through a questionnaire. Milk samples were taken from mothers during the period between the 15th and 30th day after birth (mature milk). For the evaluation of maternal diet, the nutrient adequacy ratio (NAR) and mean adequacy ratio (MAR) were used. Results: According to MAR, 71.0% of preterm mothers' and 79.4% of term mothers' dietary adequacy was categorized as "good", and none of the mothers fell into the "insufficient" category (p > 0.05). The median (interquartile range [IQR]) level of adipokines was found to be higher in preterm than in term mothers (24.6 [14.3] ng/mL; 22.9 [9.7] ng/mL for adiponectin and 2.0 [2.5] ng/mL; 0.0 [2.3] ng/mL for leptin, respectively) (p > 0.05). A negative correlation was found between the leptin level and intake of unsaturated fatty acids, protein NAR and meat, poultry and fish consumption in preterm mothers (p < 0.05). A positive correlation was found between leptin concentration and MAR, protein, calcium, potassium NAR and consumption of dairy products in term mothers (p < 0.05). In the regression model, gestational age and MAR are important predictors of leptin. Conclusions: These results show that maternal diet is related to the leptin content in breast milk

Turkish Neonatal Society guideline on enteral feeding of the preterm infant

WOS: 000484450300011PubMed ID: 31236024Early initiation of enteral feeding with the own mother's milk and prevention of postnatal growth failure is the target of nutrition in preterm infants. Together with total parenteral nutrition, mouth care and minimal enteral nutrition is started with colostrum in the very early hours of life in small preterm infants. Expressed mother's milk is given via a gastric tube and gradually increased in accordance with the gestational age/birth weight and the risk factors. For infants born heavier than 1000 grams, the aim is to reach total enteral feeding at the end of first week, and at the end of the second week for infants weighing less than 1000 grams. Supporting mothers in milk expression and kangaroo mother care, promoting non-nutritive feeding, appropriate fortification of mother' milk, and initiating and advancing breastfeeding as soon as the infant is ready are all crucial. Donor mother milk, and as a second choice, preterm formula is advised if the mother's milk is not available. Individualized post-discharge nutrition decisions can be taken in accordance with the actual growth at the time of discharge. The goal is optimal neuro developmental achievement together with the prevention of long-term metabolic problems. Late preterm infants, which constitute the majority of preterm infants, also need close nutritional attention and follow-up

Severe Apnea in a Premature Infant after Accidental Vancomycin Overdose Responsive to Treatment with Exchange Transfusion

Background: Mostly seen toxicities following vancomycin are ototoxicity and nephrotoxicity. We here report a very low birth weight preterm neonate who developed severe episodes of apnea after accidental iatrogenic vancomycin overdose, responsive to treatment with double volume exchange transfusion. Case report: A preterm neonate weighing 1380 grams received two doses of 10-fold of the normal dose of vancomycin per kg in this age group. She developed sudden onset of frequent and severe episodes of apnea, which required noninvasive ventilation. Using fluorescence polarization immunoassay, serum vancomycin level was found to be 84 μg/mL 10 hours after the last dose. The patient underwent exchange transfusion. Apnea episodes terminated 12 hours after exchange transfusion. The blood level of vancomycin decreased from 84 μg/mL before exchange to 67 μg/mL immediately post-exchange and eventually to less than 1 μg/mL in 36th hour after exchange. Discussion: Target peak concentration of vancomycin in neonates is between 20 and 40 μg/mL and trough concentration ranges from 5 to 10 μg/mL. Peak serum concentration of our patient can be back extrapolated to be about 336 μg/mL which was higher than the target level. This high plasma levels of vancomycin might be the cause of apnea in our patient as evidenced in similar reports. Conclusion: Apnea is a potential sign of vancomycin overdose in neonates and infants treated with this antibiotic. Exchange transfusion is a potential effective treatment to rapidly resolve this unwanted complication

Our experience in two cases of type IV laryngotracheoesophageal cleft (LTEC) with a diagnosis of antenatal esophageal atresia.

Laryngotracheoesophageal clefts (LTECs) are rare congenital defects that are often accompanied by additional anomalies. The major issues in the treatment of these patients are intraoperative exposure insufficiency, technical difficulty of the operation, and anesthesia problems originating from the respiratory tract. Problems originating from mechanical ventilation and respiratory tract, eating disorders and relapse of fistula are among the problems encountered following surgery. Most of the time, concomitant additional anomalies also worsen the clinical picture. It was our aim with these case reports to report our experience in two cases with Type IV LTEC ranging from the inoperable type IV LTEC due to additional anomalies mounted up to severe respiratory distress to the carina that we operated on with a single stage anterior cervicothoracic approach on its fifth day on life

Nasal HFOV with Binasal Cannula Appears Effective and Feasible in ELBW Newborns.

Non-invasive ventilation has been used increasingly in recent years to reduce the duration of endotracheal ventilation and its complications, especially bronchopulmonary dysplasia. Nasal continuous positive airway pressure and nasal intermittent positive pressure ventilation are the most common non-invasive modalities, and nasal high-frequency oscillatory ventilation (n-HFOV) is relatively new but it seems effective and feasible. We present three premature cases who were ventilated with n-HFOV with Neotech RAM Cannula as interphase. In two cases, we used n-HFOV with good results to prevent extubation failure, and in one case, we used it to avoid intubation with success. n-HFOV may be useful both in early times of respiratory failure and also to facilitate extubation particularly in patients with prolonged intubation

Different presentations of cow's milk protein allergy during neonatal period

Cow's milk protein allergy (CMPA) is the most common cause of allergy occurring in the first year of life due to infant formula or breast-milk of mothers who are drinking cow's milk or eating cow's milk products. Most children with allergic colitis are symptomatic in the first months, usually by 4 weeks. There are rare cases whom were sensitized prenatally and demonstrated symptoms in the first week, even in the first 2 days of life. The most common clinical sign of CMPA is bloody stool in a well-appearing infant. Gross bloody stool or fecal occult blood are also the common signs of necrotizing enterocolitis (NEC), especially in preterm infants with systemic instability. The treatment options are totally different so the clinician has to be very careful evaluating the patient. We report 5 preterm cases of CMPA, two of whom were siblings. Two of them presented with massive bloody stools and 3 of them presented with abdominal distension and fecal occult blood all of which were initially considered as NEC. Literature review of 20 cases with similar history is summarized as well