Risk of parenteral nutrition in neonates- An overview

Nutrients

Volumn 4, Issue 10, 2012, Pages 1490-1503

  Zingg, Walter ^a   Tomaske, Maren ^b   Martin, Maria ^c  

^a GENEVA UNIVERSITY HOSPITALS   (Switzerland)

^b Neonatology Unit   (Switzerland)

^c UNIVERSITY OF FREIBURG   (Germany)

Author keywords

Bloodstream infection; Compounded formula; Healthcare associated infection; Intravenous catheter; Neonate; Newborn; Parenteral nutrition; Preterm; Ready to use

Indexed keywords

EID: 84868153128     PISSN: 20726643     EISSN: None     Source Type: Journal    
DOI: 10.3390/nu4101490     Document Type: Review

References (85)

1. Blencowe, H.; Cousens, S.; Oestergaard, M.Z.; Chou, D.; Moller, A.B.; Narwal, R.; Adler, A.; Vera Garcia, C.; Rohde, S.; Say, L.; et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: A systematic analysis and implications. Lancet 2012, 379, 2162-2172.
2. Zingg, W.; Posfay-Barbe, K.M.; Pittet, D. Healthcare-associated infections in neonates. Curr. Opin. Infect. Dis. 2008, 21, 228-234.
3. Stover, B.H.; Shulman, S.T.; Bratcher, D.F.; Brady, M.T.; Levine, G.L.; Jarvis, W.R. Nosocomial infection rates in us children's hospitals' neonatal and pediatric intensive care units. Am. J. Infect. Control 2001, 29, 152-157.
4. Hentschel, J.; Brungger, B.; Studi, K.; Muhlemann, K. Prospective surveillance of nosocomial infections in a Swiss NICU: Low risk of pneumonia on nasal continuous positive airway pressure? Infection 2005, 33, 350-355.
5. Schwab, F.; Geffers, C.; Barwolff, S.; Ruden, H.; Gastmeier, P. Reducing neonatal nosocomial bloodstream infections through participation in a national surveillance system. J. Hosp. Infect. 2007, 65, 319-325.
6. Posfay-Barbe, K.M.; Zerr, D.M.; Pittet, D. Infection control in paediatrics. Lancet Infect. Dis. 2008, 8, 19-31.
7. Mireya, U.A.; Marti, P.O.; Xavier, K.V.; Cristina, L.O.; Miguel, M.M.; Magda, C.M. Nosocomial infections in paediatric and neonatal intensive care units. J. Infect. 2007, 54, 212-220.
8. Stoll, B.J.; Hansen, N.I.; Adams-Chapman, I.; Fanaroff, A.A.; Hintz, S.R.; Vohr, B.; Higgins, R.D. Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection. JAMA 2004, 292, 2357-2365.
9. Benjamin, D.K., Jr.; Stoll, B.J.; Fanaroff, A.A.; McDonald, S.A.; Oh, W.; Higgins, R.D.; Duara, S.; Poole, K.; Laptook, A.; Goldberg, R. Neonatal candidiasis among extremely low birth weight infants: Risk factors, mortality rates, and neurodevelopmental outcomes at 18 to 22 months. Pediatrics 2006, 117, 84-92.
10. Couto, R.C.; Pedrosa, T.M.; Tofani Cde, P.; Pedroso, E.R. Risk factors for nosocomial infection in a neonatal intensive care unit. Infect. Control Hosp. Epidemiol. 2006, 27, 571-575.
11. Contreras-Cuellar, G.A.; Leal-Castro, A.L.; Prieto, R.; Carvajal-Hermida, A.L. Device-associated infections in a Colombian neonatal intensive care unit. Rev. Salud Publica (Bogota) 2007, 9, 439-447.
12. El-Nawawy, A.A.; Abd El-Fattah, M.M.; Metwally, H.A.; Barakat, S.S.; Hassan, I.A. One year study of bacterial and fungal nosocomial infections among patients in pediatric intensive care unit (PICU) in Alexandria. J. Trop. Pediatr. 2006, 52, 185-191.
13. Balkhy, H.H.; Cunningham, G.; Chew, F.K.; Francis, C.; Al Nakhli, D.J.; Almuneef, M.A.; Memish, Z.A. Hospital- and community-acquired infections: A point prevalence and risk factors survey in a tertiary care center in Saudi Arabia. Int. J. Infect. Dis. 2006, 10, 326-333.
14. Couto, R.C.; Carvalho, E.A.; Pedrosa, T.M.; Pedroso, E.R.; Neto, M.C.; Biscione, F.M. A 10-year prospective surveillance of nosocomial infections in neonatal intensive care units. Am. J. Infect. Control 2007, 35, 183-189.
15. Elward, A.M.; Fraser, V.J. Risk factors for nosocomial primary bloodstream infection in pediatric intensive care unit patients: A 2-year prospective cohort study. Infect. Control Hosp. Epidemiol. 2006, 27, 553-560.
16. Ben Jaballah, N.; Bouziri, A.; Mnif, K.; Hamdi, A.; Khaldi, A.; Kchaou, W. Epidemiology of hospital-acquired bloodstream infections in a tunisian pediatric intensive care unit: A 2-year prospective study. Am. I Infect. Control 2007, 35, 613-618.
17. Raka, L.; Zoutman, D.; Mulliqi, G.; Krasniqi, S.; Dedushaj, I.; Raka, N.; Ahmeti, S.; Shala, M.; Vishaj, A.; Elezi, Y. Prevalence of nosocomial infections in high-risk units in the university clinical center of Kosova. Infect. Control Hosp. Epidemiol. 2006, 27, 421-423.
18. Zingg, W.; Posfay-Barbe, K.M.; Pfister, R.E.; Touveneau, S.; Pittet, D. Individualized catheter surveillance among neonates: A prospective, 8-year, single-center experience. Infect. Control Hosp. Epidemiol. 2011, 32, 42-49.
19. Perlman, S.E.; Saiman, L.; Larson, E.L. Risk factors for late-onset health care-associated bloodstream infections in patients in neonatal intensive care units. Am. J. Infect. Control 2007, 35, 177-182.
20. Sengupta, A.; Lehmann, C.; Diener-West, M.; Perl, T.M.; Milstone, A.M. Catheter duration and risk of CLA-BSI in neonates with piccs. Pediatrics 2010, 125, 648-653.
21. Leroyer, A.; Bedu, A.; Lombrail, P.; Desplanques, L.; Diakite, B.; Bingen, E.; Aujard, Y.; Brodin, M. Prolongation of hospital stay and extra costs due to hospital-acquired infection in a neonatal unit. J. Hosp. Infect. 1997, 35, 37-45.
22. Zaoutis, T.E.; Heydon, K.; Localio, R.; Walsh, T.J.; Feudtner, C. Outcomes attributable to neonatal candidiasis. Clin. Infect. Dis. 2007, 44, 1187-1193.
23. Didier, M.E.; Fischer, S.; Maki, D.G. Total nutrient admixtures appear safer than lipid emulsion alone as regards microbial contamination: Growth properties of microbial pathogens at room temperature JPEN J. Parenter. Enteral Nutr. 1998, 22, 291-296.
24. Melly, M.A.; Meng, H.C.; Schaffner, W. Microbiol growth in lipid emulsions used in parenteral nutrition. Arch. Surg. 1975, 110, 1479-1481.
25. Rowe, C.E.; Fukuyama, T.T.; Martinoff, J.T. Growth of microorganisms in total nutrient admixtures. Drug Intell. Clin. Pharm. 1987, 21, 633-638.
26. D'Angio, R.; Quercia, R.A.; Treiber, N.K.; McLaughlin, J.C.; Klimek, J.J. The growth of microorganisms in total parenteral nutrition admixtures. JPEN J. Parenter. Enteral Nutr. 1987, 11, 394-397.
27. Austin, P.D.; Hand, K.S.; Elia, M. Factors that influence Staphylococcus epidermidis growth in parenteral nutrition with and without lipid emulsion: A study framework to inform maximum duration of infusion policy decisions. Clin. Nutr. 2012, doi:10.1016/j.clnu.2012.05.001
28. Merlino, R.; Gaillard, J.L.; Fauchere, J.L.; Chaumont, P.; Droy-Lefaix, M.T.; Descamps, P.; Ricour, C.; Veron, M. In vitro quantitative model of catheter infection during simulated parenteral nutrition. J. Clin. Microbiol. 1988, 26, 1659-1664.
29. Shiro, H.; Muller, E.; Takeda, S.; Tosteson, T.D.; Goldmann, D.A.; Pier, G.B. Potentiation of Staphylococcus epidermidis catheter-related bacteremia by lipid infusions. J. Infect. Dis. 1995, 171, 220-224.
30. Haase, B.; Faust, K.; Heidemann, M.; Scholz, T.; Demmert, M.; Troger, B.; Herz, A.; Hartel, C. The modulatory effect of lipids and glucose on the neonatal immune response induced by Staphylococcus epidermidis. Inflamm. Res. 2011, 60, 227-232.
31. Bizzarro, M.J.; Raskind, C.; Baltimore, R.S.; Gallagher, P.G. Seventy-five years of neonatal sepsis at Yale: 1928-2003. Pediatrics 2005, 116, 595-602.
32. Hira, V.; Sluijter, M.; Estevao, S.; Horst-Kreft, D.; Ott, A.; de Groot, R.; Hermans, P.W.; Kornelisse, R.F. Clinical and molecular epidemiologic characteristics of coagulase-negative staphylococcal bloodstream infections in intensive care neonates. Pediatr. Infect. Dis. J. 2007, 26, 607-612.
33. Stoll, B.J.; Hansen, N.; Fanaroff, A.A.; Wright, L.L.; Carlo, W.A.; Ehrenkranz, R.A.; Lemons, J.A.; Donovan, E.F.; Stark, A.R.; Tyson, J.E.; et al. Late-onset sepsis in very low birth weight neonates: The experience of the NICHD neonatal research network. Pediatrics 2002, 110, 285-291.
34. Edwards, J.R.; Peterson, K.D.; Mu, Y.; Banerjee, S.; Allen-Bridson, K.; Morrell, G.; Dudeck, M.A.; Pollock, D.A.; Horan, T.C. National healthcare safety network (NHSN) report: Data summary for 2006 through 2008, issued December 2009. Am. J. Infect. Control 2009, 37, 783-805.
35. Geffers, C.; Baerwolff, S.; Schwab, F.; Gastmeier, P. Incidence of healthcare-associated infections in high-risk neonates: Results from the German surveillance system for very-low-birthweight infants. J. Hosp. Infect. 2008, 68, 214-221.
36. Kandasamy, Y. Infection control during administration of parenteral nutrition in preterm babies. Arch. Dis. Child. Fetal Neonatal Ed. 2009, 94, F78.
37. Tavora, A.C.; Castro, A.B.; Militao, M.A.; Girao, J.E.; Ribeiro Kde, C.; Tavora, L.G. Risk factors for nosocomial infection in a Brazilian neonatal intensive care unit. Braz. J. Infect. Dis. 2008, 12, 75-79.
38. Aziz, K.; McMillan, D.D.; Andrews, W.; Pendray, M.; Qiu, Z.; Karuri, S.; Lee, S.K. Variations in rates of nosocomial infection among Canadian neonatal intensive care units may be practice-related. BMC Pediatr. 2005, 5, 22.
39. Hartung de Capriles, C.; Mata-Essayag, S.; Azpiroz, A.; Ponente, A.; Magaldi, S.; Perez, C.; Rosello, A.; Colella, M.T.; Machuca, J. Neonatal candidiasis in Venezuela: Clinical and epidemiological aspects. Rev. Latinoam. Microbiol. 2005, 47, 11-20.
40. Olsen, A.L.; Reinholdt, J.; Jensen, A.M.; Andersen, L.P.; Jensen, E.T. Nosocomial infection in a Danish neonatal intensive care unit: A prospective study. Acta Paediatr. 2009, 98, 1294-1299.
41. Auriti, C.; Ronchetti, M.P.; Pezzotti, P.; Marrocco, G.; Quondamcarlo, A.; Seganti, G.; Bagnoli, F.; De Felice, C.; Buonocore, G.; Arioni, C.; et al. Determinants of nosocomial infection in 6 neonatal intensive care units: An Italian multicenter prospective cohort study. Infect. Control Hosp. Epidemiol. 2010, 31, 926-933.
42. Avila-Figueroa, C.; Goldmann, D.A.; Richardson, D.K.; Gray, J.E.; Ferrari, A.; Freeman, J. Intravenous lipid emulsions are the major determinant of coagulase-negative staphylococcal bacteremia in very low birth weight newborns. Pediatr. Infect. Dis. J. 1998, 17, 10-17.
43. Mahfouz, A.A.; Al-Azraqi, T.A.; Abbag, F.I.; Al-Gamal, M.N.; Seef, S.; Bello, C.S. Nosocomial infections in a neonatal intensive care unit in south-western Saudi Arabia. East. Mediterr. Health J. 2010, 16, 40-44.
44. Van der Zwet, W.C.; Kaiser, A.M.; van Elburg, R.M.; Berkhof, J.; Fetter, W.P.; Parlevliet, G.A.; Vandenbroucke-Grauls, C.M. Nosocomial infections in a Dutch neonatal intensive care unit: Surveillance study with definitions for infection specifically adapted for neonates. J. Hosp. Infect. 2005, 61, 300-311.
45. Haque, K.N.; Khan, M.A.; Kerry, S.; Stephenson, J.; Woods, G. Pattern of culture-proven neonatal sepsis in a district general hospital in the united kingdom. Infect. Control Hosp. Epidemiol. 2004, 25, 759-764.
46. Holmes, A.; Dore, C.J.; Saraswatula, A.; Bamford, K.B.; Richards, M.S.; Coello, R.; Modi, N. Risk factors and recommendations for rate stratification for surveillance of neonatal healthcare-associated bloodstream infection. J. Hosp. Infect. 2008, 68, 66-72.
47. Bizzarro, M.J.; Jiang, Y.; Hussain, N.; Gruen, J.R.; Bhandari, V.; Zhang, H. The impact of environmental and genetic factors on neonatal late-onset sepsis. J. Pediatr. 2011, 158, 234-238.
48. Bizzarro, M.J.; Dembry, L.M.; Baltimore, R.S.; Gallagher, P.G. Case-control analysis of endemic Serratia marcescens bacteremia in a neonatal intensive care unit. Arch. Dis. Child. Fetal Neonatal Ed. 2007, 92, F120-F126.
49. Freeman, J.; Goldmann, D.A.; Smith, N.E.; Sidebottom, D.G.; Epstein, M.F.; Platt, R. Association of intravenous lipid emulsion and coagulase-negative staphylococcal bacteremia in neonatal intensive care units. N. Engl. J. Med. 1990, 323, 301-308.
50. Hoang, V.; Sills, J.; Chandler, M.; Busalani, E.; Clifton-Koeppel, R.; Modanlou, H.D. Percutaneously inserted central catheter for total parenteral nutrition in neonates: Complications rates related to upper versus lower extremity insertion. Pediatrics 2008, 121, e1152-e1159.
51. Aragao, P.A.; Oshiro, I.C.; Manrique, E.I.; Gomes, C.C.; Matsuo, L.L.; Leone, C.; Moretti-Branchini, M.L.; Levin, A.S. Pichia anomala outbreak in a nursery: Exogenous source?. Pediatr. Infect. Dis. J. 2001, 20, 843-848.
52. Perniola, R.; Faneschi, M.L.; Manso, E.; Pizzolante, M.; Rizzo, A.; Sticchi Damiani, A.; Longo, R. Rhodotorula mucilaginosa outbreak in neonatal intensive care unit: Microbiological features, clinical presentation, and analysis of related variables. Eur. J. Clin. Microbiol. Infect. Dis. 2006, 25, 193-196.
53. Sunenshine, R.H.; Tan, E.T.; Terashita, D.M.; Jensen, B.J.; Kacica, M.A.; Sickbert-Bennett, E.E.; Noble-Wang, J.A.; Palmieri, M.J.; Bopp, D.J.; Jernigan, D.B.; et al. A multistate outbreak of Serratia marcescens bloodstream infection associated with contaminated intravenous magnesium sulfate from a compounding pharmacy. Clin. Infect. Dis. 2007, 45, 527-533.
54. Sacks, G.S. Microbial contamination of parenteral nutrition-how could it happen? JPEN J. Parenter. Enteral Nutr. 2011, 35, 432.
55. Arslan, U.; Erayman, I.; Kirdar, S.; Yuksekkaya, S.; Cimen, O.; Tuncer, I.; Bozdogan, B. Serratia marcescens sepsis outbreak in a neonatal intensive care unit. Pediatr. Int. 2012, 52, 208-212.
56. Bou, G.; Luis Saleta, J.; Saez Nieto, J.A.; Tomas, M.; Valdezate, S.; Sousa, D.; Lueiro, F.; Villanueva, R.; Jose Pereira, M.; Llinares, P. Nosocomial outbreaks caused by Leuconostoc mesenteroides subsp. Mesenteroides. Emerg. Infect. Dis. 2008, 14, 968-971.
57. Campos, L.C.; Lobianco, L.F.; Seki, L.M.; Santos, R.M.; Asensi, M.D. Outbreak of Enterobacter hormaechei septicaemia in newborns caused by contaminated parenteral nutrition in Brazil. J. Hosp. Infect. 2007, 66, 95-97.
58. De Vegas, E.Z.; Nieves, B.; Araque, M.; Velasco, E.; Ruiz, J.; Vila, J. Outbreak of infection with Acinetobacter strain RUH 1139 in an intensive care unit. Infect. Control Hosp. Epidemiol. 2006, 27, 397-403.
59. Tresoldi, A.T.; Padoveze, M.C.; Trabasso, P.; Veiga, J.F.; Marba, S.T.; von Nowakonski, A.; Branchini, M.L. Enterobacter cloacae sepsis outbreak in a newborn unit caused by contaminated total parenteral nutrition solution. Am. J. Infect. Control 2000, 28, 258-261.
60. Doit, C.; Loukil, C.; Simon, A.M.; Ferroni, A.; Fontan, J.E.; Bonacorsi, S.; Bidet, P.; Jarlier, V.; Aujard, Y.; Beaufils, F.; et al. Outbreak of Burkholderia cepacia bacteremia in a pediatric hospital due to contamination of lipid emulsion stoppers. J. Clin. Microbiol. 2004, 42, 2227-2230.
61. Habsah, H.; Zeehaida, M.; Van Rostenberghe, H.; Noraida, R.; Wan Pauzi, W.I.; Fatimah, I.; Rosliza, A.R.; Nik Sharimah, N.Y.; Maimunah, H. An outbreak of Pantoea spp. in a neonatal intensive care unit secondary to contaminated parenteral nutrition. J. Hosp. Infect. 2005, 61, 213-218.
62. Maltezou, H.C.; Tryfinopoulou, K.; Katerelos, P.; Ftika, L.; Pappa, O.; Tseroni, M.; Kostis, E.; Kostalos, C.; Prifti, H.; Tzanetou, K.; et al. Consecutive Serratia marcescens multiclone outbreaks in a neonatal intensive care unit. Am. J. Infect. Control 2012, 40, 637-642.
63. Archibald, L.K.; Ramos, M.; Arduino, M.J.; Aguero, S.M.; Deseda, C.; Banerjee, S.; Jarvis, W.R. Enterobacter cloacae and Pseudomonas aeruginosa polymicrobial bloodstream infections traced to extrinsic contamination of a dextrose multidose vial. J. Pediatr. 1998, 133, 640-644.
64. Trissel, L.A.; Gentempo, J.A.; Anderson, R.W.; Lajeunesse, J.D. Using a medium-fill simulation to evaluate the microbial contamination rate for USP medium-risk-level compounding. Am. J. Health Syst. Pharm. 2005, 62, 285-288.
65. Chung, K.; Head, G. Microbiologic quality-control study for the purpose of extending the use of transfer sets on the automix 3 + 3 and micromix automated total nutrient admixture compounding pumps. JPEN J. Parenter. Enteral Nutr. 2005, 29, 118-124.
66. Crill, C.M.; Hak, E.B.; Robinson, L.A.; Helms, R.A. Evaluation of microbial contamination associated with different preparation methods for neonatal intravenous fat emulsion infusion. Am. J. Health Syst. Pharm. 2010, 67, 914-918.
67. Macias, A.E.; Munoz, J.M.; Galvan, A.; Gonzalez, J.A.; Medina, H.; Alpuche, C.; Cortes, G.; Ponce-de-Leon, S. Nosocomial bacteremia in neonates related to poor standards of care. Pediatr. Infect. Dis. J. 2005, 24, 713-716.
68. Pesce-Hammond, H.; Wessel, J. The A.S.P.E.N Nutrition Support Practice Manual, 2nd ed.; American Society for Parenteral and Enteral Nutrition: Silver Spring, MD, USA, 2005; pp. 3-26.
69. Allwood, M.C. Safe practices in parenteral nutrition compounding-An international consensus? Nutrition 1999, 15, 409-410.
70. Jetzer, J.; Maisonneuve, N.; Genton, L.; Muhlebach, S.; Pichard, C. Parenteral nutrition in the Swiss hospitals: A three years national survey. Rev. Med. Suisse Romande 2002, 122, 333-337.
71. Pichard, C.; Muhlebach, S.; Maisonneuve, N.; Sierro, C. Prospective survey of parenteral nutrition in Switzerland: A three-year nation-wide survey. Clin. Nutr. 2001, 20, 345-350.
72. Bischoff, S.C.; Kester, L.; Meier, R.; Radziwill, R.; Schwab, D.; Thul, P. Organisation, regulations, preparation and logistics of parenteral nutrition in hospitals and homes; the role of the nutrition support team-Guidelines on Parenteral Nutrition, Chapter 8. Ger. Med. Sci. 2009, 7, doi:10.3205/000079
73. Muhlebach, S.; Franken, C.; Stanga, Z. Practical handling of AIO admixtures-Guidelines on Parenteral Nutrition, Chapter 10. Ger. Med. Sci. 2009, 7, doi:10.3205/000077
74. Iacobelli, S.; Bonsante, F.; Gouyon, J.B. Fluid and electrolyte intake during the first week of life in preterm infants receiving parenteral nutrition according current guidelines. Minerva Pediatr. 2010, 62, 203-204.
75. Iacobelli, S.; Bonsante, F.; Vintejoux, A.; Gouyon, J.B. Standardized parenteral nutrition in preterm infants: Early impact on fluid and electrolyte balance. Neonatology 2010, 98, 84-90.
76. Lenclen, R.; Crauste-Manciet, S.; Narcy, P.; Boukhouna, S.; Geffray, A.; Guerrault, M.N.; Bordet, F.; Brossard, D. Assessment of implementation of a standardized parenteral formulation for early nutritional support of very preterm infants. Eur. J Pediatr. 2006, 165, 512-518.
77. Skouroliakou, M.; Koutri, K.; Stathopoulou, M.; Vourvouhaki, E.; Giannopoulou, I.; Gounaris, A. Comparison of two types of TPN prescription methods in preterm neonates. Pharm. World Sci. 2009, 31, 202-208.
78. Smolkin, T.; Diab, G.; Shohat, I.; Jubran, H.; Blazer, S.; Rozen, G.S.; Makhoul, I.R. Standardized versus individualized parenteral nutrition in very low birth weight infants: A comparative study. Neonatology 2010, 98, 170-178.
79. Senterre, T.; Rigo, J. Optimizing early nutritional support based on recent recommendations in vlbw infants allows abolishing postnatal growth restriction. J. Pediatr. Gastroenterol. Nutr. 2011, 53, 532-542.
80. Senterre, T.; Rigo, J. Reduction in postnatal cumulative nutritional deficit and improvement of growth in extremely preterm infants. Acta Paediatr. 2012, 101, e64-e70.
81. Kuwahara, T.; Kaneda, S.; Shimono, K.; Inoue, Y. Growth of microorganisms in total parenteral nutrition solutions without lipid. Int. J. Med. Sci. 2010, 7, 43-47.
82. Kuwahara, T.; Shimono, K.; Kaneda, S.; Tamura, T.; Ichihara, M.; Nakashima, Y. Growth of microorganisms in total parenteral nutrition solutions containing lipid. Int. J. Med. Sci. 2010, 7, 101-109.
83. Morgan, J.; Young, L.; McGuire, W. Delayed introduction of progressive enteral feeds to prevent necrotising enterocolitis in very low birth weight infants. Cochrane Database Syst. Rev. 2011, doi: 10.1002/14651858.CD001970.pub3
84. Morgan, J.; Young, L.; McGuire, W. Slow advancement of enteral feed volumes to prevent necrotising enterocolitis in very low birth weight infants. Cochrane Database Syst. Rev. 2011, doi: 10.1002/14651858.CD001241.pub3
85. Karagol, B.S.; Zenciroglu, A.; Okumus, N.; Polin, R.A. Randomized controlled trial of slow vs. rapid enteral feeding advancements on the clinical outcomes of preterm infants with birth weight 750-1250 g. JPEN J. Parenter. Enteral Nutr. 2012, doi:10.1177/0148607112449482