Role of early feeds, breast milk and KMC in infection prevention

Failure to give enteral feedsrequires initiation of IV fluids, &hence increasesthe risk of infections, Early and exclusive Breast milk feeding gives survival advantage to neonates and prevents against infections, KMC decreases mortality and morbidity among low birth weight neonates, Therefore Early enteral feeding, breast milk feeding and KMC may play a very important role in preventing morbidity and mortality in neonates especially in resource constraint setting.
Dangers of not initiating early enteral feeds, Common myths regarding early enteral feeding, How breast milk prevents infection, Role of KMC in prevention of infections
Failure to initiate early enteral feeds leads to Establishment of intravenous line & IV fluids, Prolonged hospital stay, separation of mother and baby, All these factors increase theexposure of baby to microorganisms, which increases the chance of health care associated infections, It has been clearly shown that if breastfeeds are initiated within first hour of life,the Risk of death within 28 days is half as compared to those in whom breastfed are started after first hour of life
Certain situations lead to unnecessary delay in initiation of enteral feeds. These situations include but not limited to Neonate requiring CPAP/oxygen support, Maternal HIV Isolated episode(s) of regurgitation with otherwise healthy abdomen Occasional blood tinged aspirate with normal abdomen examination Isolated episode of apnea If the neonate has minor illness but the abdominal examination is normal, we shouldcontinue feeds.
Breast milk is rich in bioactive factors, which augment the infant’s immune system, and provides protection against infections. Such bioactive factors include Immunoglobulin, mainly secretory immunoglobulin A, whichprevents bacteria from entering the cells. heseimmunoglobulinsdevelop in mother and are against local pathogens, therefore are likely to protect the baby against pathogens prevalent in baby’s environment White blood cells- which fight against infection Lysozyme and lactoferrin, which have antibacterial anti-viral and antifungal properties; Oligosaccharides, which prevent bacteria from attaching to mucosal surfaces.
There are innumerable benefits of KMC. It prevent mortality by 40% especially in low birth weight neonates. It prevents incidence of nosocomial infection and neonatal sepsis by 55%. It improves temperature of the baby and prevents hypothermia by 66%. Hence reduces the handling of neonate. KMC results in in improved breastfeeding rates as well as duration of breastfeeding. It reduces unnecessary IV fluids and other interventions and thus reduces the risk of infections. It also reduces length of hospital stay and promotes early discharge Thus KMC is an effective strategy in reducing the incidence of infections.
To summarise, in this webinar we have learnt that- Delay in initiation of feeds increases the risk of death, acquired infections Enteral feeds should be initiated within first hour of life unless any contraindication exists In presence of normal abdominal examination, feeds should not be withheld for minor problems Numerous bioactive factors present in breast milk help in preventing infections. KMC prevents mortality and morbidity especially in LBW neonates. Thank you
  • Introduction...
  • 1. Benefits of ear...
  • 2. Learning object...
  • 3. Dangers of dela...
  • 4. Common myths...
  • 5. How breast milk...
  • 6. How KMC prevent...
  • 7. Summary...
 

Introduction

DR. SHIV SAJAN SAINI
MD, DM (Neonatology)

Assistant Professor
Department of Pediatrics
PGIMER, Chandigarh

1. Benefits of early feeding

â–º Failure to give early feeds
      ♦ Require IV fluids, increases risk of infection

â–º Early and exclusive breast milk feeding
      ♦ Prevents mortality, infections

â–º KMC in LBW neonates
      ♦ Decreases mortality and morbidity

â–º Early enteral feeding + breast milk feeding + KMC
      ♦ Important role in resource constraint setting

2. Learning objectives

â–º Dangers of not initiating early enteral feeds

â–º Common myths regarding early enteral feeding

â–º Role of breast milk in prevention infection

â–º Role of KMC in prevention of infections

3. Dangers of delayed feeds

* Khan J et al, Matern Child Health J. 2015

4. Common myths

â–º CPAP/oxygen support

â–º Maternal HIV

â–º Isolated regurgitation

â–º Occasional blood tinged aspirate

â–º Isolated apnea

If the neonate has minor illness but the abdominal examination is normal, we should continue feeds.

5. How breast milk prevents infection?

â–º Breast milk - rich in bioactive factors
â–º Augments immunity, prevent infections
â–º Secretory immunoglobulin A
     ♦ Prevents bacteria entry in gut cells
     ♦ Develop against local pathogens
â–º White blood cells
â–º Lysozyme and lactoferrin - antibacterial anti-viral
    and antifungal
â–º Oligosaccharides - prevent bacterial attachment to mucosa

6. How KMC prevents infection?

â–º Decreases mortality - 40% (especially LBW neonates)

â–º Decreases nosocomial infection - 55%

â–º Prevents hypothermia - 66%
      ♦ Less interventions - less infections

â–º Improved breastfeeding rates
      ♦ Decreases infection

â–º Decreases hospital stay
      ♦ Decreases exposure to pathogens

7. Summary

â–º Delay in feeds - increases the risk of death, acquired infections

â–º Enteral feeds - initiated within first hour of life unless
    contraindicated

â–º Minor problems & normal abdominal examination - continue
    feeds

â–º Numerous biofactors in breast milk - prevent infection

â–º KMC prevents mortality and morbidity especially in LBW
    neonates