Maternal colostrum administered intranasally to premature infants and the effect on the presence of intraventricular hemorrhage: A clinical trial

Abstract

Introduction: Intraventricular hemorrhage (IVH) is a problem that occurs in premature newborns (PTNBs) during the first 48 to 72 hours of life. Human colostrum (HC) may offer local and systemic benefits, influencing the systemic physiology of the preterm newborn (PTNB); however, nasal administration has been little studied.

Objective: To analyze the risk factors associated with early nCPAP failure in premature newborns weighing less than 1500 grams.

Materials and Methods: Double-blind, randomized clinical trial. PTNBs ≤36.6 weeks of gestation, <48 hours of age, receiving maternal colostrum were included; PTNBs with major congenital malformations, prior IVH, or hemodynamic instability were excluded. They were randomized to group A and administered 0.1 mL of colostrum per nostril once daily for 5 days, plus oropharyngeal colostrum (0.1 mL) for those ≤1000 g and 0.2 mL for those >1000 g, 6 times daily for 5 days. Group B received 0.1 mL of 0.9% saline and the same doses of oropharyngeal colostrum. Transfontanellar ultrasound (TFUS) reports were recorded on days 1, 3, and 7, in addition to clinical outcomes

Results: Eighty-four PTNBs were analyzed, 53.6% male, 31 (IQR 30.2-32.6) GD; birth weight 1200 (IQR 1215-1450) g; intention-to-treat (ITT) analysis; at day 7, IVH cases for the colostrum group 23.8% vs 30.9%, RR 0.76 (95% CI 0.38-1.55), p=0.46; late sepsis: colostrum group 28.6% vs 57.1%, RR: 0.50, (95% CI 0.28-0.86), p=0.008.

Conclusion: Intranasal CH showed an effect on IVH with fewer IVH cases on day 3 and 7 of follow-up, and there was also less late sepsis and a lower requirement for invasive ventilation.