Oral colonization in the preterm neonate:effect of oral care

The purpose of this study is twofold: to determine the nature of oral flora in the neonatal population and to compare and assess the effect of oral care, using sterile water, normal saline or colostrum/human milk and to note whether there is a difference in oral colonization between the three interventions over time: Subjects: The sample included 29 infants between 26 and 34 weeks gestation that are admitted to the level III Neonatal intensive care unit and require either intubation with mechanical ventilation or nasal continous positive airway pressure (NCPAP) for support of respiratory disease whose mother's plan to breastfeed.

Study Design: A prospective, randomized experimental design.

Methods: Once consent was obtained the infants were randomized to one of the three treatment groups by drawing an envelope. An oral buccal swab was obtained prior to initiation of oral care in the first 24 hours of life. Cultures are repeated at 7 and 14 days of life.

Results: 29 infants were enrolled between the ages of 27 and 32 6/7 weeks gestation. Eleven were randomized to colostrum/human milk, 10 to sterile water and 8 to saline.

Two infants were dropped due to mother's inability to produce breastmilk. Of the 27 infants remaining 15 were female and 12 males; 12 Caucasian, 5 African American, 5 Hispanic, 1 Asian and 4 other. Birthweight ranged from 590 to 2530 grams (mean 1294.827). Three of the second cultures and 4 of the third cultures were not reported due to either lost specimens or being cancelled by laboratory personnel. Of the remaining cultures all but 2 of the initial cultures were ne.gative; dfthe second cultures 4 of24 cultures were negative and for the third set of cultures all were positive for bacterial growth. The most common organism identified was coagulase negative staph (CONS) but other organisms were identified. While there were no harmful effects of the use of colostrum there was no change in the colonization by week 2 and 3. Conclusion: There remain potential benefits for the use of colostrum in the care of the premature infant. Further research is needed to determine the best protocol for administration in this vulnerable population.