Optimizing Nutritional Supply Reduces Postnatal Growth Restriction in VLBW Infants

peer reviewe

Advantages of Individualized Fortification of Human Milk for Preterm Infants

Despite the benefits of human milk fortification, nutrients of human milk are not sufficient to cover the greater needs of very low birth weight and to ensure a growth similar to that of premature infants fed with preterm formula. These differences could be related to the variation in the macronutrient composition of expressed breast milk with lower protein and energy content. Unfortunately there is unusually no information on macronutrients composition prior human milk fortification. With such data, it would be possible to individualize the fortification. In order to use adjustable fortification of human milk, we have assessed a rapid and simple method using full spectrum infrared laser technology (Milkoscan) to analyze human milk composition. We describe the variation in concentration of protein, lipid and energy in the human milk received in our neonatal unit. Then we evaluate the benefit of adjustable fortification of human milk compared with standard fortification. After standard fortification the variability of protein and lipid remains with a risk of protein deficiency or excess and a risk of energy deficiency. After adjustable human milk fortification based on human milk analysis using Milkoscan, we observe a more stable protein content and a lower amount of added fortifier decreasing the risk of hyperosmolarity. Furthermore, the energy content is higher following of the fat human milk adjusted content. Up to now, our preliminary results suggest that individualized fortification of human milk improves growth rate in preterm infants (21 g/kg/d) to a level close to formula fed infants

Rilpivirine in HIV-1-positive women initiating pregnancy: to switch or not to switch?

International audienceBackgroundSafety data about rilpivirine use during pregnancy remain scarce, and rilpivirine plasma concentrations are reduced during second/third trimesters, with a potential risk of viral breakthroughs. Thus, French guidelines recommend switching to rilpivirine-free combinations (RFCs) during pregnancy.ObjectivesTo describe the characteristics of women initiating pregnancy while on rilpivirine and to compare the outcomes for virologically suppressed subjects continuing rilpivirine until delivery versus switching to an RFC.MethodsIn the ANRS-EPF French Perinatal cohort, we included women on rilpivirine at conception in 2010–18. Pregnancy outcomes were compared between patients continuing versus interrupting rilpivirine. In women with documented viral suppression (<50 copies/mL) before 14 weeks of gestation (WG) while on rilpivirine, we compared the probability of viral rebound (≥50 copies/mL) during pregnancy between subjects continuing rilpivirine versus those switching to RFC.ResultsAmong 247 women included, 88.7% had viral suppression at the beginning of pregnancy. Overall, 184 women (74.5%) switched to an RFC (mostly PI/ritonavir-based regimens) at a median gestational age of 8.0 WG. Plasma HIV-1 RNA nearest delivery was <50 copies/mL in 95.6% of women. Among 69 women with documented viral suppression before 14 WG, the risk of viral rebound was higher when switching to RFCs than when continuing rilpivirine (20.0% versus 0.0%, P = 0.046). Delivery outcomes were similar between groups (overall birth defects, 3.8/100 live births; pregnancy losses, 2.0%; preterm deliveries, 10.6%). No HIV transmission occurred.ConclusionsIn virologically suppressed women initiating pregnancy, continuing rilpivirine was associated with better virological outcome than changing regimen. We did not observe a higher risk of adverse pregnancy outcomes