Nutrition for the most unwell babies

The study day was attended by over 100 health professionals including doctors, nurses, dietitians, pharmacists and other therapists from across the country and was organised by Dr Angela Huertas (Consultant Neonatologist, University College London Hospital, UCLH) and chaired by Dr Nick Embleton (Consultant Neonatologist, Royal Victoria Infirmary Newcastle, and current chair of the N3). Fresnius Kabi, Chiesi, Baxter, Medela and Bliss kindly supported the event, which was approved for CPD by the Royal College of Paediatrics and Child Health.

A full auditorium at the sixth Neonatal Nutrition Network study day.

The first lecture, by Dr Embleton, discussed the importance of nutrition and investigated the incredibly high energy requirements of preterm babies in the neonatal unit. Dr Embleton discussed just how crucial good nutrition is to survival and neurodevelopment. He also discussed how he encourages use of the dietetic ABCDE approach to nutrition on the ward by the medical team:¹

• A = anthropometry
• B = bloods/biochemistry
• C = clinical
• D = dietary intake
• E = evaluation.

Next was an update on current nutritional research by Dr Colin Morgan (Consultant Neonatologist, Liverpool Women’s Hospital). Dr Morgan assessed the latest research looking at amino acid dosages in parenteral nutrition, including recent work in paediatric intensive care that has suggested a possible risk in term neonates,² critically analysing the quality of these studies.

Dr Colin Morgan.

Dr Laura De Rooy (Neonatal Consultant, St George’s Hospital, London) and Dr Helen Mactier (Neonatal Consultant, Princess Royal Maternity Hospital, Glasgow) explored the latest guideline on parenteral nutrition from ESPGHAN,³ comparing this to previous guidance from other bodies. Dr Pam Cairns (Neonatal Consultant, St Michael’s Hospital, Bristol) and Pam Stepney (Senior Neonatal Dietitian, UCLH) followed. They considered the variable digestion and absorption of breast milk and formula feeds. Their talks covered the complex comparisons between different formula milks and different breast milks, including donor milk, and the changes in maternal milk over time. The degree of variation in bioactive proteins, growth factors, microbiome constituents, macronutrients, hormones, enzymes, cells and human milk oligosaccharides, means that decisions between them are not simple.

Dr Helen Mactier.

Susan Spencer from the charity NEC UK⁴ introduced a mini-symposium on necrotising enterocolitis (NEC). Susan told the audience about her very personal and moving experience of the disease. An interactive quick-fire collection of talks on different aspects of NEC prevention and management followed, presented by neonatal consultants Dr Christopher Gale (Chelsea and Westminster NHS Foundation Trust), Dr Janet Berrington (Newcastle Hospitals NHS Foundation Trust) and Dr Paul Fleming (Homerton University Hospital). Each attempted to elucidate some of the more complex aspects of NEC where there are no clear answers:

• should we stop feeding during blood transfusions?

• should we still be measuring gastric residual volumes?

• how do we define NEC and spontaneous intestinal perforation?
• do early antibiotics increase or reduce the risk of NEC?
• could probiotics be helpful in preventing NEC?
• what is the relationship between NEC and food protein induced enterocolitis syndrome?

In the afternoon, delegates could attend two of the five workshops:

1. Feeding after discharge – can we use a fortifier shot?
2. The surgical post-NEC baby. When should we replace the stoma losses? What formula to give? Can we give fortifiers?
3. Parenteral nutrition trouble shooting – BAPM/NICE guidelines, SCAMP and NEON.
4. Standardisation of abdominal X-ray interpretation for NEC – learn the tips and radiological signs.
5. Transition to oral feeds: the roles of the neonatologist, dietitian, speech and language therapist, physiotherapist, occupational therapist and neonatal nurse.

The workshop on parenteral nutrition.

The afternoon concluded with a guest lecture by Gillian Kennedy (Consultant Neonatal Speech and Language Therapist at UCLH). Gillian’s presentation considered the multifaceted bidirectional signalling in the gut/brain axis, and how important nutrition can be to ensure this relationship develops appropriately in the abnormal environment of the neonatal unit.

The meeting included a display of posters (TABLE 1) and a prize was awarded on the day for the best poster. The winning poster was by Dr Ilana Levene, Gillian Denton and Dr Frances O’Brien from John Radcliffe Hospital, Oxford. Their work on optimal milk expression in mothers of preterm babies to maximise long-term milk yield will be published in the next issue of Infant and they receive a free place at next year’s N3 study day.

TABLE 1 The poster presentations.