Player is loading...
Feeding in late and moderately preterm infants : risks and benefits in the short and long-term
Nicholas D. Embleton, United Kingdom
Tuesday, Jan. 21, 2020 · 4:22 p.m. · 28m 43s
Embed
Transcriptions
Note: this content has been automatically generated.
00:00:00
uh thanks very much thank you for staying until the end uh i'm
00:00:03
very surprised because i saw the swiss what was on time for everything so
00:00:08
this is a huge uh emotional
00:00:12
i i've only and just some complex i have had
00:00:17
a funding from a commercial organisations as well as them
00:00:21
the n. h. s. um i'm also says on the s.
00:00:24
can connect again we have for inclusion network is more complex
00:00:29
and and this is where i come from you cancel here in the north of england about three hundred miles long than
00:00:35
a population reach about three million we have three nick use thirty five thousand but it's across the region
00:00:41
and the new costs on the coup takes all the babies with complex
00:00:45
surgery any see in these things so that's my day to day work
00:00:50
and uh we have a website he anything new data research dot next if you have a smart phone
00:00:55
and uh you shine it this set you are correct this will give you all the slides from today
00:01:01
so you don't need to make any notes uh you can just go there and uh an access the slides
00:01:08
and and on the on the website as well um you can read a bit about ah
00:01:12
other research we've been involved in some big trials last year we finish the big black parents study
00:01:18
the big sift feeding study i'm done with doing work
00:01:22
with a proactive looking at human no come micro by him
00:01:26
so we got a lot of activity that um as i say if i go
00:01:29
around and i do talk to my slides rock bass there's about twenty five different talks
00:01:35
and you're welcome to go along and you can take all the slides and use them for free
00:01:41
and uh you can pretend they belong to you and everything out of my so that's fine
00:01:46
and okay so his the left to control the light tomato the pretend
00:01:50
babies by which i mean babies born between thirty two and thirty six weeks
00:01:55
and the many many more these papers in papers plum for a pizza and but only in a two unit most
00:02:01
stalwart is involved looking after the babies on the thirty
00:02:04
weeks all twenty eight weeks and we spend very little interest
00:02:09
in these big papers but likes more repeat i'm i'm gonna show you
00:02:13
is that they have where sound comes over their entire life of course
00:02:17
basic there says it was significant health care costs they have was caulking to pout comes
00:02:23
they have was behavioural problems in infancy have wis metabolic count
00:02:27
comes in our altered these are a very important uh griffith papers
00:02:33
undertaken messages that even in this population studies have shown
00:02:38
that breastfeeding has the potential to choose many these complications
00:02:44
yeah so i've been to nutrition for many years now and what i find
00:02:49
is that when you talk about nutrition people get very fixated on the nutrients
00:02:53
and didn't step back and see nutrition is a slightly more holistic concept
00:02:58
so what i think is hell freezes to recognise that all of these things uh what go to make up nutrition
00:03:04
of course it's the machinations somewhat convictions it's also an awareness of the functional components
00:03:09
that you won't get in french nutrition and you probably don't really getting for the milk
00:03:15
important interactions with the micro pine we probably interest in this
00:03:18
in our research program but then think about all the painful
00:03:22
the social aspects the aspects of breast feeding the technical aspects nasal gastric or gastric
00:03:28
bogus feeds this is all part of nutrition and it's new nato or just we need
00:03:32
to see this is the concept and not just get focused on at the nutrient bits
00:03:39
so you know all this you know that uh i like moderate
00:03:41
preterm between thirty two and thirty sweets six weeks free preterm extremely pretend
00:03:46
and the sort of the similar to pray low birth weight on low birth weight but of course
00:03:52
later model if we turn is a very different concept from being
00:03:55
low birth weight does a lot of overlap them not the same thing
00:04:00
and uh so we have to pray web low birth weight does not equal weights whatever you pretend
00:04:07
when you look at the global proponents of a permit
00:04:10
to deliver you'll see them lots of parts of africa
00:04:14
now some of between ten and fifteen we've never fifteen percent of babies supple and treat 'em
00:04:21
this results in a major bit on hell systems
00:04:24
is like to have lifelong consequences but these populations
00:04:29
and when you look at the perimeter that this is the last uh more million babies
00:04:33
less than twenty eight weeks these the baby is that we focus on the new late again
00:04:38
apollo then you will see lots more babies born at twenty eight to
00:04:41
thirty one but in this huge number of babies were born later moderately pretend
00:04:46
and i can tell you now you will struggle to find
00:04:49
a single randomised control trial of nutrition this group of papers
00:04:54
despite the fact that it represents the greatest bit in the health care system
00:05:00
so read about eight sensible pretend to select smoothly preterm in most countries
00:05:05
about six or seven percent of all your pets like small group return
00:05:10
obviously there are variations which reflects population resources maternal factors
00:05:16
and nato factors with you scan with you and you say that
00:05:20
are free but also data collection which is politically challenging in resourceful situations
00:05:27
actually that the needs of light to moderate preterm babies may be similar in terms of
00:05:33
risks of hype if fame you in high because i seem even pull grace
00:05:37
uh then needs but similar but again each member that's moved just station age is not the same as low birth weight
00:05:44
is not the same as i jot is not the same as like moderately preterm we need
00:05:48
to separate these populations out to understand what we're talking about um what interventions might be relevant
00:05:55
so if you is back in the u. k. they did a
00:05:57
big a population based cohort study looking at lights moderately preterm baby
00:06:03
and they were able to translate possible link to stay in interventions
00:06:08
um and they could work out the costs of transferring babe is the cost the marker
00:06:12
and the post i too costly to this using questionnaires looking at all the drug usage
00:06:17
what they show is that for molly pretend baby the average cost around about
00:06:21
twelve thousand pounds compared to any two thousand pounds for babies born to um
00:06:27
so late to moderate pretend babies cost the health service much much small babies born to him
00:06:35
and these the reasons why because when possible for longer you
00:06:38
know all these factors you know that i'm much more like get
00:06:42
oddly yes hypothermia hapless emailed the much more likely
00:06:46
we heard a great talk this morning about feeding difficulties
00:06:50
much more like to suffer weight loss simple groves infections due on this and this results in high rates of
00:06:56
possible rip missions was perjury problems an increased risk mortality
00:07:01
as we already understand these are very vulnerable group of papers
00:07:07
early on again we'll know that they had in which you
00:07:10
account to regulate you mechanisms that premier prototype try seem yeah
00:07:15
the maybe not as good it's which opens and supply didn't have good glycogen stores they have low fat stores
00:07:22
spend much more waste a north this is contributed to by the late feeding
00:07:27
low volumes of milk and perhaps by low use of
00:07:31
mothers know where it might be supplemented or place by former
00:07:35
so we understand why high pricey mate is important risk in these babies
00:07:40
and this is now from a large scope for conducted by lame boiling u. k. uh for you is gonna
00:07:46
what she did was look at the risks of moderate pretend these
00:07:49
of thirty two thirty three compact late preterm thirty four to thirty six
00:07:54
and compare them to turn babies more you can see is that much more likely to be admitted nick you
00:08:00
to have a much longer length of stay much more
00:08:03
likely to need whispered to support high rates of printed tradition
00:08:08
low rates of breast look at discharge any fifty percent compared to about seventy percent
00:08:13
a much lower rates of exclusive breastfeeding so only about one in
00:08:17
three these papers in the u. k. will go home exclusively breastfed
00:08:23
sophie difficult is much more common again it's easy to understand why they have conjures pretty problems
00:08:29
the metabolic glucose control or motor function is very interested in these
00:08:34
babies they haven't on cool would make this stuff can swallow as
00:08:37
we heard this morning and in the chip every style system much more likely to present us in terms of free flux of pa something
00:08:44
and it's interesting to know whether these breathing difficulties may assist the
00:08:49
on the neck you do we see the speeding problems in in one
00:08:53
so sam johnson and elaine put this co what together of about six hundred
00:08:58
fifty like a moderately preterm babies needed questionnaires ticket eating behaviours in four different domains
00:09:05
refusal to eat or waiter problems or hype cents between eating behaviours
00:09:10
and so used haven't reports but they also did a park
00:09:13
arches a questionnaire bit like uh bailey and unemotional assessment school
00:09:20
and what the show was like maury pretend babies a much more like to
00:09:24
have food refusal but it was about one point five all or most problems
00:09:29
the independent associations with into difficulties if they hadn't is gastric cheap one two weeks if they also
00:09:36
have behaviour problems all the lights social competence these
00:09:40
this sort of autistic tight features some these babies so
00:09:44
when they look at the data most the feeling difficult to seem
00:09:47
to be associated with neural developmental problems rocket than being born premature itself
00:09:55
so this cover current serve feeding problems with behaviour problems is very important
00:10:00
and the should alerts us the fact that eating difficulties knees impotence
00:10:03
maybe a marker to more important on the line you would problem
00:10:09
and having an n. g. g. bar for more than two weeks has
00:10:12
a very strong respect in this group uh previews does not associated like problems
00:10:18
okay enough to discharge these infants malden two times as likely to receive
00:10:23
treatments for re flux when it to dean campus on these things like really the speeding problems persist
00:10:30
and we know that in very preterm infants these pay this exhibit of phenotype which the
00:10:36
people to stick in many respects so that's well very well known in the parade preterm babies
00:10:42
and the not so many good studies we should a man but as we discussed this morning to the
00:10:46
daily is not a very good measure of paper it's not a very subtle my shirt call the function
00:10:53
and that social communication difficulties which are very important are actually quite difficult to assess
00:10:59
but there is this questionnaire couldn't modify checked us but also
00:11:03
the top list and chart which screens for papers with autistic features
00:11:09
so they gave us out two years of age too late small impede term
00:11:13
papers and then they forgot the telephone interview to validate that these results to true
00:11:19
and the background term population any about point five percent of the population have
00:11:24
autistic type each is this was about five times higher lights moderately pretend babies
00:11:30
and there's a trend that seem to be associated with old maternal age whole
00:11:34
mental health another but importantly not receiving breast look at this chart was another base
00:11:42
we also did the bailey will the park ave looked
00:11:44
your sensory outcomes as well they showed that compared with ten
00:11:48
babies about five times as likely to have in your
00:11:51
sensory impairment about two times as likely to have cognitive impairment
00:11:56
these children represents a significant base but set in our population
00:12:01
we tend not to follow babies optimal in thirty two weeks we just destroys these papers the family doctor
00:12:08
i mean they look at the correlates they found independent this factors for having code impairment
00:12:13
good being male socioeconomic status been nonwhite and if the mother happy times yeah
00:12:19
but most important again not receiving breast milk discharge wasn't independent list for these problems
00:12:27
again this data just compares all the papers to turn bay businesses compton pair
00:12:32
of what we see like what we pretend mad about six percent supported payment
00:12:36
compared twenty two percent to and read about seven percent happy new developmental disability compact twenty two percent
00:12:43
so much higher right sit in your sensory problems about mental problems in this population
00:12:50
so when you have added up it comes out to be so mad
00:12:52
about to know hi-fi two point five i. q. points perhaps the boys
00:12:58
interestingly yes seven times the base of girls would be quite interesting to
00:13:02
speculate biologically why the risk is so much higher for boys and girls
00:13:08
this association past look at discharge is very important and we know that
00:13:13
the speech is also appear in extremely low birth weight papers as well
00:13:19
so inadequate breast milk is associated with star come all the possible mechanisms
00:13:24
and to think about this again i think it helps get back to this model and think about what we mean by nutrition
00:13:30
and then we can start to understand perhaps nugent profiles and not receiving the
00:13:34
breast milk you since the fatty acids the proteins might be back up you
00:13:39
maybe aspects a psycho social functioning open thing that are affected
00:13:43
maybe sensory aspects of taste and smell his papers that the private so from the first born
00:13:49
of course would like to be functional aspects from not receiving breast no
00:13:53
not getting enough liked affair and not enough no part probably membrane lots
00:13:57
of these other compounds the maybe something to do with the mike voices
00:14:00
really multiple reasons why the speech is maybe related teachers in these papers
00:14:07
so why breastfeeding rates low well of course they get exposed to form a quite daily have interrupted skin
00:14:13
to skin the sensory experiences in terms of taste and
00:14:17
smell and all types that's to the to very different
00:14:21
the mothers are different then then more likely to be peace the more likely to have pregnancy complications
00:14:27
we know that some of them struggle to establish lactation and
00:14:31
maybe socioeconomic factors basis i didn't know high quality on c.
00:14:36
t.s despite this representing twelve million babies every in the world
00:14:40
and i'm very few qualitative studies that really helps on the standard
00:14:45
and what about the outcomes later on his a sick joke cobalt just like
00:14:50
pretend babies thirty four to thirty six weeks assessed that six years of age
00:14:54
still one twice as likely to have a low i. q. compact and babies
00:14:58
more like kevin pad performance functioning again high levels autistic features
00:15:04
these difficult to send it possessed a into into like to channel to
00:15:10
this is data from scotland a long time ago this here represents the spurs sense just showed
00:15:15
with special education on the c. c. children who need extra help in the school setting to function
00:15:21
along the side they are on the bottom here you see just station week uh
00:15:25
so that i'm only about two percent of the term population need special education needs
00:15:31
again not surprise he went about fifty percent of your papers but what twenty four weeks need special help in school
00:15:38
but i want you to notice that this is a continual line the reason to point which this risk decreases
00:15:45
and you can see again the lights more the pretend babies that fits in this summer
00:15:49
between about six and ten percent these babies alike you need extra help in the school setting
00:15:57
so let me repeat and they must have whispering type outcomes of the life course
00:16:03
like a breast feeding is an independent respect that but all observation or data is
00:16:08
confounded we don't like to accept it because we like to write us that is
00:16:13
but every observation study is confounded even if you
00:16:16
adjust the still like it to be residual confounding there
00:16:20
we don't know what the breast feeding is because uh some
00:16:22
biological effect uh whether back a breast feeding is the marker
00:16:26
to something different about them up though on some a market for smarter problem uh dishes experience
00:16:33
so his one way to think about uh the hapless affect me think about exposures
00:16:39
maybe these mothers exposed to different factors before they even conceive increase the
00:16:43
risks in the baby maybe maternal disease all different drugs a lifestyle factors
00:16:50
see these pages may be experiencing different in uterine
00:16:53
environment create clam zero percent when you can supply
00:16:57
and then the post they appeared is exactly know the baby the prototype
00:17:00
us enough but of course if you're not gonna get these babies french
00:17:03
nutrition they're not gonna get anywhere near the amount to be unless it's
00:17:07
the debating you try would get over the past few days and weeks
00:17:10
so lots of didn't exposures to think about and we can think about what mechanisms could be
00:17:15
but it's possible that even preconceptions arisen tops exposes the mom
00:17:20
but increase the risk of having a baby late somebody pretend that may also increase the risk the brain problem
00:17:27
and there are likely to be a whole host of
00:17:29
a genetic factors regulated by the i'm appalachian might be important
00:17:34
we know that when that wanna you instruct brain
00:17:37
development so thirty four weeks the brains only about sixty
00:17:41
percent the size the baby it uh of those last four weeks you don't mass amount to bring right
00:17:48
and and the maybe is the same nutritional factors but again thinking about nutrition the widest concept
00:17:54
not just new tunes but functional nutrients microbiology and
Conference Program
Welcome words
Matthias Roth-Kleiner, Lausanne
Jan. 21, 2020 · 10 a.m.
162 views
Welcome words
Andreas Malzacher, St. Gallen
Jan. 21, 2020 · 10:01 a.m.
Altered brain metabolism contributes to executive function deficits in children born very preterm
Barbara Schnider, Department of Pediatric Intensive Care and Neonatology, Kinderspital Zürich
Jan. 21, 2020 · 10:07 a.m.
1759 views
Early assessment of "shift of the SpO2 vs. PiO2 curve" predicts bronchopulmonary dysplasia in extremely preterm infants
Ben Stöcklin, UKBB
Jan. 21, 2020 · 10:18 a.m.
156 views
Music in preterm infants enhances maturation of neural pathways involved in Emotional Processing
Joana de Almeida
Jan. 21, 2020 · 10:27 a.m.
140 views
Parental self-efficacy and Quality of Life is reduced in parents of late-preterm children
Tanja Restin, USZ, Neonatal department
Jan. 21, 2020 · 10:50 a.m.
191 views
Perinatal palliative care services and needs of health care professionals working in Swiss perinatal centres - A nationwide survey
Manya J. Hendriks, Newborn Research Department of Neonatology, Perinatal Centre, USZ
Jan. 21, 2020 · 10:59 a.m.
205 views
Preterm oral feeding – beyond reflexes
Nicole Kaufmann, ICBCLC, Logopädie, Ostschweizer Kinderspital
Jan. 21, 2020 · 12:10 p.m.
298 views
Plasma mr-pro-atrial natriuretic peptide and ct-pro-endothelin-1 is associated with respiratory morbidity in very preterm infants
Roland P. Neumann, Department of Neonatology, University Children’s Hospital Basel UKBB
Jan. 21, 2020 · 1:52 p.m.
Physical activity programs for promoting bone mineralization and growth in preterm infants
Sirée Kaempfen, UKBB
Jan. 21, 2020 · 1:55 p.m.
Characterization of the acoustic environment in a neonatal intensive care unit
Mikael Martins Gaspar, Faculty of Mechanical and Process Engineering, ETH Zurich
Jan. 21, 2020 · 1:59 p.m.
Detection of molecular mechanisms in response to hypoxia and starvation in placental cells
Tanja Restin, USZ, Neonatal department
Jan. 21, 2020 · 2:08 p.m.
First report of a neonate girl with imperforate hymen and congenital urethrovaginal fistula
Sonja Fontana, Division of Pediatric and Adolescent Gynecology, University Children’s Hospital Zurich
Jan. 21, 2020 · 2:12 p.m.
248 views
Large congenital hemangioma causing significant cardiac and respiratory insufficiency
Andrea Peitler, Kinderspital Zürich
Jan. 21, 2020 · 2:15 p.m.
220 views
An unusual cause of hydrops fetalis
Cristina Felice Civitillo, CHUV, Lausanne University Hospital & HUG, Geneva University Hospital
Jan. 21, 2020 · 2:18 p.m.
136 views
Neonatal alloimmune thrombocytopenia and enterovirus meningitis - an unusual combination
Veronika Rings, Department of Neonatology, Spital Zollikerberg, Switzerland
Jan. 21, 2020 · 2:22 p.m.
193 views
Cardiorespiratory events post immunization in extremely preterm infants
Susanne Boettger, Neonatal Department, USZ
Jan. 21, 2020 · 2:25 p.m.
Early Onset Neonatal Sepsis in Africa: Alarming Results from a Systematic Review and Meta-analysis
Flavia Rosa Mangeret, Neonatology Unit, Geneva University Hospitals (HUG) & Institute of Global Health, Department of Medicine, University of Geneva
Jan. 21, 2020 · 2:29 p.m.
128 views
When an elephant hides another one
Varvara Dimopoulou Agri, Clinic of Neonatology, Department of Woman Mother and Child, University Hospital Center and University of Lausanne (CHUV)
Jan. 21, 2020 · 2:33 p.m.
206 views
How confident do neonatologists feel in predicting the long-term prognosis of the extremely preterm children born <28 gestational weeks when discharging from the NICU?
Ulla Jochumsen , Child Development Center, University Children`s Hospital Zurich
Jan. 21, 2020 · 2:36 p.m.
103 views
Prognostic value of placenta pathology in neonates with hypoxic ischemic encephalopathy (hie)
Laura D. Benz, Department of Pediatric and Neonatal Intensive Care, University Children’s Hospital Zurich
Jan. 21, 2020 · 2:40 p.m.
The milk gap: Contextualizing Human Milk Banking and Informal Milk Sharing Practices and Perceptions in Switzerland
Jacqueline Barin, CHUV
Jan. 21, 2020 · 2:45 p.m.
An unexpected and severe complication due to a presumed umbilical venous catheterisation
Markus Hahn, PICU/NICU
Jan. 21, 2020 · 2:47 p.m.
170 views
Severe refractory status epilepticus in a neonate
Claudia Beck, Pediatric and Neonatal Intensive Care Unit, Children’s Hospital of Eastern Switzerland
Jan. 21, 2020 · 2:51 p.m.
105 views
The Red Code: improving patient safety by implementing a new call procedure for emergency life-threatening caesarean section in a non tertiary center
Anne-Sophie Morel, Hôpital de Nyon-GHOL
Jan. 21, 2020 · 2:54 p.m.
Ductus venosus atresia leading to severe hydrops fetalis in a very preterm infant
Sven-Eric Baller, Clinic of Neonatology, University Hospital Zurich
Jan. 21, 2020 · 2:59 p.m.
312 views
Neonatal transport in Switzerland:
Tanja Leemann, University Children’s Hospital Zurich
Jan. 21, 2020 · 3:02 p.m.
103 views
Perinatal Stroke and Placenta Pathology
Francisca Barcos, Service de Néonatologie, Hôpitaux Universitaires de Genève (HUG)
Jan. 21, 2020 · 3:06 p.m.
159 views
Correlation of bilirubin levels with the quality of General Movements in moderate preterms – a retrospective study
David Graßmugg, Medical University of Graz
Jan. 21, 2020 · 3:10 p.m.
192 views
Implementation of multidisciplinary In-House Resuscitation Training at Triemli Spital Zürich
Hanna Seewald, Paediatric Department, Stadtspital Triemli, ZH
Jan. 21, 2020 · 3:13 p.m.
Use of Donor Breast Milk at LMU München Perinatal Centre : Experiences and Results
Julia Kappeler, München (DE)
Jan. 21, 2020 · 3:38 p.m.
Milkbanks in Switzerland
Andreas Malzacher, St. Gallen
Jan. 21, 2020 · 3:59 p.m.
103 views
Feeding in late and moderately preterm infants : risks and benefits in the short and long-term
Nicholas D. Embleton, United Kingdom
Jan. 21, 2020 · 4:22 p.m.
235 views
