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Optimizing nutrition of the preterm infant

The goal of nutrition of the preterm infant is to meet the growth rate of the healthy fetus of the same gestational age and to produce the same body composition of the healthy fetus in terms of organ growth, tissue components, and cell number and structure. Nutritional quantity and quality are fundamental for normal growth and development of preterm infants, including neurodevelopmental outcomes. Failure to provide the necessary amounts of all of the essential nutrients has produced not only growth failure, but also increased morbidity and less than optimal neurodevelopment. Growth velocities during the NICU hospitalization period for preterm infants exert a significant effect on neurodevelopmental and anthropometric outcomes. Despite the obvious need for optimal nutrition, growth failure is almost universal among preterm infants. There is every reason, therefore, to optimize nutrition of the preterm infant, in terms of total energy and protein, but also in terms of individual components such as amino acids, specific carbohydrates and lipids, and even oxygen. This review presents scientific rationale for nutrient requirements and practical guidelines and approaches to intravenous and enteral feeding for preterm infants. Intravenous feeding, including amino acids, should be started right after birth at rates that are appropriate for the gestational age of the infant. Enteral feeding should be started as soon as possible after birth, using mother's colostrum and milk as first choices. Enteral feeding should begin with trophic amounts and advanced as rapidly as tolerated, decreasing IV nutrition accordingly, while maintaining nutrient intakes at recommended rates. Feeding protocols are valuable for improving nutrition and related outcomes. Further research is needed to determine the optimal nutrition and rate of growth in preterm infants that will achieve optimal neurocognitive benefits while minimizing the longer-Term risk of chronic diseases.

Optimizing Nutrition in Preterm Low Birth Weight Infants

Preterm birth survivors are at a higher risk of growth and developmental disabilities compared to their term counterparts. Development of strategies to lower the complications of preterm birth forms the rising need of the hour. Appropriate nutrition is essential for the growth and development of preterm infants. Early administration of optimal nutrition to preterm birth survivors lowers the risk of adverse health outcomes and improves cognition in adulthood. A group of neonatologists, pediatricians, and nutrition experts convened to discuss and frame evidence-based recommendations for optimizing nutrition in preterm low birth weight (LBW) infants. The following were the primary recommendations of the panel: (1) enteral feeding is safe and may be preferred to parenteral nutrition due to the complications associated with the latter; however, parenteral nutrition may be a useful adjunct to enteral feeding in some critical cases; (2) early, fast, or continuous enteral feeding yields better outcomes compared to late, slow, or intermittent feeding, respectively; (3) routine use of nasogastric tubes is not advisable; (4) preterm infants can be fed while on ventilator or continuous positive airway pressure; (5) routine evaluation of gastric residuals and abdominal girth should be avoided; (6) expressed breast milk (EBM) is the first choice for feeding preterm infants due to its beneficial effects on cardiovascular, neurological, bone health, and growth outcomes; the second choice is donor pasteurized human milk; (7) EBM or donor milk may be fortified with human milk fortifiers, without increasing the osmolality of the milk, to meet the high protein requirements of preterm infants; (8) standard fortification is effective and safe but does not fulfill the high protein needs; (9) use of targeted and adjustable fortification, where possible, helps provide optimal nutrition; (10) optimizing weight gain in preterm infants prevents long-term cardiovascular complications; (11) checking for optimal weight and sucking/swallowing ability is essential prior to discharge of preterm infants; and (12) appropriate counseling and regular follow-up and monitoring after discharge will help achieve better long-term health outcomes. This consensus summary serves as a useful guide to clinicians in addressing the challenges and providing optimal nutrition to preterm LBW infants. KEYWORDS: donor pasteurized human milk; enteral feeding; expressed breast milk; fortification; optimizing nutrition; preterm low birth weight infants

DIU de cobre nas maternidades

O DIU é um método contraceptivo conhecido pelas mulheres, mas pouco utilizado. A oferta de DIU de cobre nas maternidades visa reduzir a gravidez não planejada e melhorar o acesso a esse método contraceptivo.

Immediate postpartum insertion of intrauterine device for contraception

Authors' conclusions: Recent trials compared different insertion times after vaginal or cesarean delivery. Evidence was limited because studies with full reports generally had small sample sizes. Overall, the quality of evidence was moderate; abstracts and older studies had limited reporting. Ongoing trials will add to the evidence, although some are small. Trials of adequate power are needed to estimate expulsion rates and side effects. The benefit of effective contraception immediately after delivery may outweigh the disadvantage of increased risk for expulsion. Frequent prenatal visits during the third trimester provide the opportunity to discuss effective contraceptive methods and desired timing for initiation. Clinical follow-up can help detect early expulsion, as can educating women about expulsion signs and symptoms.

Immediate postplacental insertion of an intrauterine contraceptive device…

An intrauterine device (IUD) is an effective reversible form of contraception. We determined the efficacy and safety of immediate postplacental IUD insertion during cesarean section. Two hundred forty-five women with term pregnancies delivering by cesarean section between September 2006 and December 2007 were included in the study. A copper IUD (TCu 380A) was inserted using a ring forceps within 10 min of removing the placenta. The participants were examined before hospital discharge and at 6 weeks, 6 months and 12 months postpartum. None of the patients were lost to follow-up. There was one case of an unplanned pregnancy (0.4%). There were no serious complications associated with immediate IUD insertion during cesarean section. The cumulative rates of expulsion, removal for bleeding/pain and other medical reasons were 17.6, 8.2 and 2.4 per 100 women per year, respectively. The continuation rates were 81.6% and 62% at 6 and 12 months, respectively. Immediate postplacental IUD insertion during cesarean section provides adequate protection against pregnancy. However, greater than one fourth of the participants discontinued IUD use due to spontaneous expulsion or other medical reasons.

Continuation Rates of Postpartum Intrauterine Contraceptive …

Continuation rates of postpartum intrauterine contraceptive device (IUCD) insertion: randomised trial of post placental versus immediate postpartum insertion. Introduction The postpartum period is a critical period with special needs for both mother and neonate. The unmet need of long acting contraception to space pregnancy in the postpartum period can be fulfilled by postpartum intrauterine contraceptive device (IUCD) insertion. This study was undertaken to compare the continuation and complication rates of postpartum CuT 380 A insertion in postplacental and immediate (<48 hours) postpartum period after vaginal delivery. Methods This randomised controlled trial with ethical clearance from institutional ethics committee was done in the Obstetrics and Gynecology Department, Lok Nayak Jaiprakash Hospital, New Delhi where 263 vaginally delivered women meeting the eligibility criteria as laid by Ministry of Health and Family Welfare, Government of India, willing for postpartum IUCD insertion were randomised to two groups- Group A (postplacental i.e. within 10 min of placental expulsion n = 131) and Group B (immediate postpartum i.e. 10 min-48 hours postdelivery n = 132) and followed-up upto 6 months. IUCD inserted was CuT 380 A using Kelly Placental Forceps curved or Sponge holder by trained health personal. Sample size calculation was done based on the mean incidence of expulsion in the two groups 11% in postplacental group versus 28% in immediate postpartum group with power of study 80% and confidence interval 95% was found to be 172 and with attrition rate of 25% the total size was calculated to be 215 with 108 in each group. The difference between means for quantitative data was calculated by Student 't' test and for qualitative data was computed using c-square/Fischer's exact test was used. P < 0.05 was the cut off point for statistical significance. Expulsion rates, continuation rates at 6 months, complications rate, removal rates for pain and bleeding, patients acceptability were compared in two groups. Results Continuation rates were 88.9% in postplacental group compared to 74.10% in immediate postpartum group (P = 0.0054). Expulsion rates were 24.11% in immediate postpartum group compared to 9.11 in postplacental group (P = 0.0037). Overall incidence of complications of PPIUCD was 6.7% including PID (1.3%) menorrhagia (3.1%) pain abdomen (0.83%) and prolonged lochia (1.3%) and the rates being similar in two groups however requiring removal in 2.17% women similar in each group. Conclusions Postpartum IUCD insertion is acceptable means of contraception and for women who accept postpartum IUCD insertion, postplacental insertion should be preferred over immediate postpartum insertion.

Immediate postabortal insertion of intrauterine devices

The use of an effective contraceptive may be necessary after an abortion. Insertion of an intrauterine device (IUD) may be done the same day or later. Immediate IUD insertion is an option since the woman is not pregnant, pain of insertion is less because the cervical os is open, and her motivation to use contraception may be high. However, insertion of an IUD immediately after a pregnancy ends carries risks, such as spontaneous expulsion. Moderate quality evidence shows that insertion of an IUD immediately after abortion is safe and practical. IUD expulsion rates appear higher immediately after abortions compared to delayed insertions. However, at six months postabortion, IUD use is higher following immediate insertion compared to delayed insertion.

Medical eligibility criteria for contraceptive use (WHO, 2015)

This document is part of the process for improving the quality of care in family planning. Medical eligibility criteria for contraceptive use (MEC), the first edition of which was published in 1996, presents current WHO guidance on the safety of various contraceptive methods for use in the context of specific health conditions and characteristics. This is the fifth edition of the MEC – the latest in the series of periodic updates. This edition is divided into two parts. Part I describes how the recommendations were developed and Part II contains the recommendations and describes how to use them. The recommendations contained within this document are based on the latest clinical and epidemiological data. Several tools and job aids are available from WHO and other sources to help providers use these recommendations in practice.

Barreiras organizacionais para disponibilização e inserção do dispositivo …

Objetivo: Identificar barreiras organizacionais para disponibilização do DIU nos serviços de Atenção Básica à Saúde na perspectiva dos coordenadores da área de saúde da mulher. Conclusão: Foram identificados problemas no acesso ao DIU, por meio de barreiras organizacionais para sua disponibilização e inserção, como a não disponibilização do método ou o excesso dos critérios desnecessários para disponibilizá-lo. DESCRITORES: Dispositivos Intrauterinos; Planejamento Familiar; Saúde Sexual e Reprodutiva; Enfermagem de Atenção Primária; Saúde da Mulher

Long-Acting Reversible Contraception: Implants and Intrauterine Devices

Intrauterine devices and contraceptive implants, also called long-acting reversible contraceptives (LARC), are the most effective reversible contraceptive methods. The major advantage of LARC compared with other reversible contraceptive methods is that they do not require ongoing effort on the part of the patient for long-term and effective use. In addition, after the device is removed, the return of fertility is rapid. The purpose of this Practice Bulletin is to provide information for appropriate patient selection and evidence-based recommendations for LARC initiation and management. The management of clinical challenges associated with LARC use is beyond the scope of this document and is addressed in Committee Opinion No. 672, Clinical Challenges of Long-Acting Reversible Contraceptive Methods.

Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher (PNDS-2006)

Brasil. Ministério da Saúde. Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher – PNDS 2006 : dimensões do processo reprodutivo e da saúde da criança/ Ministério da Saúde, Centro Brasileiro de Análise e Planejamento. – Brasília : Ministério da Saúde, 2009. 300 p. : il. – (Série G. Estatística e Informação em Saúde)

Por escolha não por acaso: planejamento familiar, direitos humanos e desenvolvimento

Todos os países devem tomar medidas para atender às necessidades de planejamento familiar de suas populações. [...] E devem procurar prover o acesso universal a toda uma série de métodos seguros e confiáveis de planejamento familiar e aos serviços correlatos de saúde reprodutiva, que não sejam contrários à lei. O objetivo deve ser o de ajudar casais e indivíduos a alcançar suas metas reprodutivas e a oferecer-lhes a plena oportunidade de exercer o direito que tem de ter filhos por escolha. O direito individual de decidir livre e responsavelmente sobre quantos filhos ter e quando tê-los vem sendo há décadas o princípio norteador do direito à saúde sexual e reprodutiva.