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  1. Article ; Online: Fluid and Parenteral Nutrition Practices in Extreme Preterm Neonates Among Neonatology Practitioners in India: A Web-based Survey.

    Chinnappan, Arunambika / Sahoo, Tanushree / Mohanty, Pankaj / Som, Tapas / Devi, Usha

    Indian pediatrics

    2022  Volume 61, Issue 2, Page(s) 171–174

    Abstract: An online survey pertinent to fluid and parenteral nutrition practices in extreme preterm neonates was undertaken with responses from 123 neonatology practitioners across India. The initial fluid rate of 80 mL/kg/day was preferred by 67% neonatologists ... ...

    Abstract An online survey pertinent to fluid and parenteral nutrition practices in extreme preterm neonates was undertaken with responses from 123 neonatology practitioners across India. The initial fluid rate of 80 mL/kg/day was preferred by 67% neonatologists for 750-1000 g neonates. Half of them increased the fluid rates when weight loss per day was >2%. Practices vary widely across settings and guideline tailor made to clinical conditions is needed.
    MeSH term(s) Infant, Newborn ; Humans ; Neonatology ; Parenteral Nutrition ; Surveys and Questionnaires ; India ; Internet
    Language English
    Publishing date 2022-12-21
    Publishing country India
    Document type Journal Article
    ZDB-ID 402594-5
    ISSN 0974-7559 ; 0019-6061
    ISSN (online) 0974-7559
    ISSN 0019-6061
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Additional Insights Into the Use of Preterm Formula Among Neonates-Reply.

    Sharma, Akash / Chinnappan, Arunambika / Sankar, M Jeeva

    JAMA pediatrics

    2021  Volume 175, Issue 12, Page(s) 1287

    MeSH term(s) Humans ; Infant Formula ; Infant, Newborn ; Infant, Premature
    Language English
    Publishing date 2021-08-30
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 2701223-2
    ISSN 2168-6211 ; 2168-6203
    ISSN (online) 2168-6211
    ISSN 2168-6203
    DOI 10.1001/jamapediatrics.2021.3140
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Fortification of Breast Milk With Preterm Formula Powder vs Human Milk Fortifier in Preterm Neonates: A Randomized Noninferiority Trial.

    Chinnappan, Arunambika / Sharma, Akash / Agarwal, Ramesh / Thukral, Anu / Deorari, Ashok / Sankar, M Jeeva

    JAMA pediatrics

    2021  Volume 175, Issue 8, Page(s) 790–796

    Abstract: Importance: Fortification of expressed breast milk (EBM) using commercially available human milk fortifiers (HMF) increases short-term weight and length in preterm very low-birth-weight (VLBW) neonates. However, the high cost and increased risk of feed ... ...

    Abstract Importance: Fortification of expressed breast milk (EBM) using commercially available human milk fortifiers (HMF) increases short-term weight and length in preterm very low-birth-weight (VLBW) neonates. However, the high cost and increased risk of feed intolerance limit their widespread use. Preterm formula powder fortification (PTF) might be a better alternative in resource-limited settings.
    Objective: To demonstrate that fortification of EBM by preterm formula powder is noninferior to fortification by HMF, in terms of short-term weight gain, in VLBW neonates.
    Design, setting, and participants: Open-label, noninferiority, randomized trial conducted from December 2017 to June 2019 at a level 3 neonatal unit in India. The trial enrolled preterm (born at or before 34 weeks of gestation) VLBW neonates receiving at least 100 mL/kg/d of feeds and consuming 75% of milk or more as EBM.
    Interventions: Neonates were randomly assigned to receive fortification by either PTF or HMF. Calcium, phosphorus, iron, vitamin D, and multivitamins were supplemented in PTF and only vitamin D in the HMF group to meet the recommended dietary allowances.
    Main outcomes and measures: The primary outcome was the weight gain until discharge from the hospital or 40 weeks' postmenstrual age, whichever was earlier; the prespecified noninferiority margin was 2 g/kg/d. Secondary outcomes included morbidities such as necrotizing enterocolitis, feed intolerance, and extrauterine growth restriction (<10th percentile on the Fenton chart at 40 weeks' postmenstrual age).
    Results: Of the 123 neonates enrolled, 60 and 63 were randomized to the PTF and HMF groups, respectively. The mean gestation (30.5 vs 29.9 weeks) and birth weight (1161 vs 1119 g) were comparable between the groups. There was no difference in the mean (SD) weight gain between the PTF and HMF groups (15.7 [3.9] vs 16.3 [4.0] g/kg/d; mean difference, -0.5 g/kg/d; 95% CI, -1.9 to 0.7). The lower bound of 95% CI did not cross the noninferiority margin. The incidence of feed intolerance was lower in the PTF group (1.4 vs 6.8 per 1000 patient-days; incidence rate ratio 0.19; 95% CI, 0.04 to 0.95), and fewer neonates required withholding of fortification for 24 hours or more (5% vs 22%; risk ratio, 0.22; 95% CI, 0.07 to 0.75). The incidence of necrotizing enterocolitis stage II or more (0 vs 5%) and extrauterine growth restriction (73% vs 81%) was comparable between the groups.
    Conclusions and relevance: Fortification with preterm formula powder is not inferior to fortification with human milk fortifiers in preterm neonates. Given the possible reduction in feed intolerance and lower costs, preterm formula might be a better option for fortification, especially in resource-restricted settings.
    Trial registration: Clinical Trial Registry, India Identifier: CTRI/2017/11/010593.
    MeSH term(s) Female ; Food, Fortified ; Humans ; Infant Formula ; Infant, Newborn/growth & development ; Infant, Premature/growth & development ; Male ; Milk, Human/chemistry ; Weight Gain
    Language English
    Publishing date 2021-05-10
    Publishing country United States
    Document type Equivalence Trial ; Journal Article
    ZDB-ID 2701223-2
    ISSN 2168-6211 ; 2168-6203
    ISSN (online) 2168-6211
    ISSN 2168-6203
    DOI 10.1001/jamapediatrics.2021.0678
    Database MEDical Literature Analysis and Retrieval System OnLINE

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