Touching Lives - March 2005
Finding the right food
In particular he is looking at severe inflammation of the bowel walls, known as necrotising enterocolitis, which is almost like gangrene in its symptoms and effects. It is a serious condition — 1 in 5 of those babies will die. This condition particularly affects babies who haven’t grown normally in the womb, usually because something has gone wrong with the blood supply to the baby during pregnancy.
For these babies, the digestive system is not fully developed. This means that there may be problems in digesting milk, which would be the ‘normal’ feed for babies right from the start. Digestion requires oxygen, and these babies have already had defective oxygen supplies. Milk in underdeveloped digestive systems becomes a breeding ground for bacteria.
So the question is, should milk feeds be postponed for a few days to ward off infection, and intravenous nutrition be administered for the first few days of life? However, this carries with it risks of infection in the blood stream (sepsis).There’s also a risk of jaundice, because the baby isn’t producing bile and in any case, a later start with milk may only be postponing the inevitable.
Dr. Kempley and his team are setting up a randomised controlled trial in which half the babies will be started on milk within the first two days, and half will be fed intravenously for the first five days before being started on milk. ^Some surveys have been done on the problem before, but this is the first where it will be possible to make strictly like-for-like comparisons^, knowing that other variables have been eliminated.
About 400 babies need to take part to make sure the study is able to detect a clinically significant difference, and this in itself is a challenge. Because of the nature of the problem being studied, they have to identify potential subjects, get the parents’ consent to participate and set up the study conditions for that particular baby, all within 48 hours of birth. And this at a time when parents may be extremely worried for their child, even traumatised, and not at all keen to confront such decisions. However, Dr Kempley is confident that they will have enough volunteers. Every hospital with a neonatal unit in the country is being asked to take part. And for the babies, taking part in a trial, whichever group they are randomised to has the guarantee of additional attention in the process of monitoring.
Starting out on the project, the team is very enthusiastic: “We’ve been working together for two years to get this going, and it can be dispiriting constantly going after funding. So it’s very exciting to know that we can go on now, recruit a Trial Co-ordinator in June, and start in September.” The project will take three years — two studying the babies and one evaluating the results — and all thanks to £143,311 from Action Medical Research. At the end of the trial the team hope to be able to make general recommendations about good feeding practises for very underdeveloped babies, based on solid statistical evidence.