SCAMP:standardised, concentrated, additional macronutrients, parenteral nutrition in very preterm infants: a phase IV randomised, controlled exploratory study of macronutrient intake, growth and other aspects of neonatal care

<p>Abstract</p> <p>Background</p> <p>Infants born <29 weeks gestation are at high risk of neurocognitive disability. Early postnatal growth failure, particularly head growth, is an important and potentially reversible risk factor for impaired neurodevelopmental outcome. Inadequate nutrition is a major factor in this postnatal growth failure, optimal protein and calorie (macronutrient) intakes are rarely achieved, especially in the first week. Infants <29 weeks are dependent on parenteral nutrition for the bulk of their nutrient needs for the first 2-3 weeks of life to allow gut adaptation to milk digestion. The prescription, formulation and administration of neonatal parenteral nutrition is critical to achieving optimal protein and calorie intake but has received little scientific evaluation. Current neonatal parenteral nutrition regimens often rely on individualised prescription to manage the labile, unpredictable biochemical and metabolic control characteristic of the early neonatal period. Individualised prescription frequently fails to translate into optimal macronutrient delivery. We have previously shown that a standardised, concentrated neonatal parenteral nutrition regimen can optimise macronutrient intake.</p> <p>Methods</p> <p>We propose a single centre, randomised controlled exploratory trial of two standardised, concentrated neonatal parenteral nutrition regimens comparing a standard macronutrient content (maximum protein 2.8 g/kg/day; lipid 2.8 g/kg/day, dextrose 10%) with a higher macronutrient content (maximum protein 3.8 g/kg/day; lipid 3.8 g/kg/day, dextrose 12%) over the first 28 days of life. 150 infants 24-28 completed weeks gestation and birthweight <1200 g will be recruited. The primary outcome will be head growth velocity in the first 28 days of life. Secondary outcomes will include a) auxological data between birth and 36 weeks corrected gestational age b) actual macronutrient intake in first 28 days c) biomarkers of biochemical and metabolic tolerance d) infection biomarkers and other intravascular line complications e) incidence of major complications of prematurity including mortality f) neurodevelopmental outcome at 2 years corrected gestational age</p> <p>Trial registration</p> <p>Current controlled trials: <a href="http://www.controlled-trials.com/ISRCTN76597892">ISRCTN76597892</a>; EudraCT Number: 2008-008899-14</p

Benefit of antenatal glucocorticoids according to the cause of very premature birth

In this observational study performed in a large cohort of very preterm singletons, respiratory outcome was found to be strongly dependent on the cause of premature delivery. Although less apparent in infants born to mothers with chorioamnionitis, exposure to antenatal glucocorticoids remained significantly associated with a decrease in the incidence of respiratory distress syndrome after adjustment for the main cause of premature birth

Improving neonatal unit admission temperatures in preterm babies: exothermic mattresses, polythene bags or a traditional approach?

OBJECTIVE To investigate whether exothermic sodium acetate mattresses were associated with an improvement in the thermal care of babies <30 weeks gestation between birth and admission to a neonatal unit. STUDY DESIGN Analysis of a three case series of babies: the first with traditional thermal care of drying and wrapping in a towel, the second with wrapping in food standard polythene bags and the third with wrapping in polythene bags and nursing on an activated exothermic mattress. The main outcome measure was the temperature on admission to the neonatal unit. RESULT There were no significant differences between the groups for gestation and birth weight. Hypothermia was less frequent in the 'bag and mattress' group compared with the 'bag only' and traditional care groups (26 vs 69 vs 84%, respectively) even though the median time to admission was longest in the 'bag and mattress' group (23 min). The proportions of babies admitted with temperatures in the target range of 36.5 to 37.5 degrees C were 46, 27 and 16%, respectively. Multiple regression analysis showed that use of the mattress raised admission temperatures by 1.04 degrees C. The median temperature of babies in the 'bag and mattress' group was higher compared with the other groups (36.9 vs 36.0 vs 35.8 degrees C), but significantly more were hyperthermic (28 vs 4 and 0.4%, respectively). CONCLUSION Use of exothermic mattresses for babies <30 weeks gestation was associated with a significantly greater proportion of babies being admitted to the neonatal unit with a temperature in the euthermic range, but there was also an increased risk of hyperthermia