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Bone and fat mass in relation to postnatal levels of insulin-like growth factors in prematurely born children at 4 y of age. Pediatr Res 2014; 75:544-50. [PMID: 24441105 DOI: 10.1038/pr.2014.4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 09/27/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND Children born prematurely may be at risk of developing osteopenia. This study investigated whether insulin-like growth factors (IGFs) in the early postnatal period influence bone mass and body composition in prematurely born children. METHODS A total of 74 control (gestational age >36 wk; n = 37) and preterm (gestational age <32 wk; n = 37) infants were investigated (mean age ± SD: 4.59 ± 0.31 y). Bone mineral density, body composition, and markers of bone and mineral metabolism were investigated in relation to postnatal IGF levels. RESULTS After adjusting for confounders, we found no differences in bone mass, but significantly less lean mass, increased fat mass, and increased osteocalcin levels in ex-preterm infants. Forward stepwise multiple analysis revealed that higher late postnatal IGF-II levels predict lumbar spine bone mineral content (P < 0.05) and lean mass (P < 0.05). When the birth weight standard deviation score was included in the analysis, higher early postnatal IGF-I levels predicted both lumbar spine bone mineral density and bone mineral content (P < 0.05). Higher early postnatal IGF binding protein-3 (P < 0.01) predicted increased fat mass at 4-y follow-up. CONCLUSION Ex-preterm children have normal bone mass but different body composition compared with full-term controls. Higher early IGF-I and late postnatal IGF-II concentrations are positive predictors of lumbar spine bone mass.
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Methods to quantify soft tissue-based cranial growth and treatment outcomes in children: a systematic review. PLoS One 2014; 9:e89602. [PMID: 24586904 PMCID: PMC3937373 DOI: 10.1371/journal.pone.0089602] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 01/23/2014] [Indexed: 12/20/2022] Open
Abstract
Context Longitudinal assessment of cranial dimensions of growing children provides healthcare professionals with information about normal and deviating growth as well as treatment outcome. Objective To give an overview of soft tissue–based methods for quantitative longitudinal assessment of cranial dimensions in children until age 6 years and to assess the reliability of these methods in studies with good methodological quality. Data source PubMed, EMBASE, Cochrane Library, Web of Science, Scopus, and CINAHL were searched. A manual search was performed to check for additional relevant studies. Study selection Primary publications on facial growth and treatment outcomes in children younger than age 6 years were included. Data extraction Independent data extraction was performed by two observers. A quality assessment instrument was used to determine methodological quality. Methods used in studies with good methodological quality were assessed for reliability expressed as the magnitude of the measurement error and the correlation coefficient between repeated measurements. Results In total, 165 studies were included, forming three groups of methods: head circumference anthropometry, direct anthropometry, and 2D photography and 3D imaging techniques (surface laser scanning and stereophotogrammetry). In general, the measurement error was below 2 mm, and correlation coefficients were very good. Conclusion Various methods for measuring cranial dimensions have shown to be reliable. Stereophotogrammetry is the most versatile method for quantitative longitudinal assessment of cranial dimensions and shapes in children. However, direct anthropometry continues to be the best method for routine clinical assessments of linear cranial dimensions in growing children until age 6 years.
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Horemuzova E, Åmark P, Jacobson L, Söder O, Hagenäs L. Growth charts and long-term sequelae in extreme preterm infants--from full-term age to 10 years. Acta Paediatr 2014; 103:38-47. [PMID: 24354572 DOI: 10.1111/apa.12451] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 06/25/2013] [Accepted: 10/01/2013] [Indexed: 11/27/2022]
Abstract
AIM To describe growth pattern from full-term age to 10 years in infants born before 26 weeks of gestation. METHOD This retrospective longitudinal cohort contained 123 children from Karolinska Hospital, Stockholm, during 1990-2002. Length/height (Ht), weight (Wt) and head circumference (HC) were recorded monthly during the first year, every 3 months until 2 years and yearly thereafter, but HC at 15 months and at median age of 8.1/9.7 years (range 2-14) in boys/girls. RESULTS For boys/girls at birth, the mean Z-score for Ht was -0.2/-0.2, for Wt 0.0/-0.2 and for HC 0.0/-0.3. At term, the mean Z-score for Ht was -3.8/-3.1, for Wt -3.0/-2.5 and for HC -1.7/-1.2. At 1 year, the mean Z-score for Ht was-1.3/-1.3, for Wt -1.9/-1.7 and for HC -1.2/-1.0. At 2 years, the mean Z-score for Ht was -1.3/-1.1, for Wt -1.6/-1.2 and at 10 years for Ht -0.7/-0.4; that was on average -0.3 below mid-parental height; for Wt -0.2/-0.2. Long-term sequelae were found in 48% of the boys and 34% of the girls. CONCLUSION By 10 years of age, the attained mean Ht was in accordance with their genetic potential and almost half of these children had significant long-term sequelae.
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Affiliation(s)
- Eva Horemuzova
- Paediatric Endocrinology Unit; Department for Women′s and Children′s Health; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - Per Åmark
- Neuropediatric Unit; Department for Women′s and Children′s Health; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - Lena Jacobson
- Clinical Neuroscience, Opthalmology and Vision; Karolinska Institutet; Stockholm Sweden
| | - Olle Söder
- Paediatric Endocrinology Unit; Department for Women′s and Children′s Health; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - Lars Hagenäs
- Neuropediatric Unit; Department for Women′s and Children′s Health; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
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Efficacy of semielevated side-lying positioning during bottle-feeding of very preterm infants: a pilot study. J Perinat Neonatal Nurs 2014; 28:69-79. [PMID: 24476654 DOI: 10.1097/jpn.0000000000000004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Very preterm (VP, ≤30 wk gestational age) infants are at risk for impaired lung function, which significantly limits their ability to eat. A semielevated side-lying (ESL) position is a feeding strategy that may improve oral feeding by supporting breathing during feeding. The study evaluated the efficacy of the ESL position compared with the semielevated supine (ESU) position on physiological stability and feeding performance of bottle-fed VP infants. Using a within-subject crossover design, 6 VP infants were bottle-fed twice on 1 day, in both the ESL and ESU positions in a random order. Physiological stability (heart rate, oxygen saturation [SaO2], and respiratory characteristics) and feeding performance (percent intake, proficiency, efficiency, and duration of feeding) were measured before and/or during feeding. Very preterm infants fed in the ESL position demonstrated significantly less variation in heart rate, less severe and fewer decreases in heart rate, respiratory rate that was closer to the prefeeding state, shorter and more regular intervals between breaths, and briefer feeding-related apneic events. No significant differences for SaO2 or feeding performance were found. The findings indicate that the ESL position may support better regulation of breathing during feeding, thereby allowing VP infants to better maintain physiological stability throughout feeding.
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55
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Abstract
Although studies have shown cue-based feeding can lead to earlier achievement of full oral feeding, the successful implementation of cue-based feeding has been constrained by the volume-driven culture, which has existed for many years in the NIC U. This culture was built on the notion that a "better" nurse is one who could "get more in," and infants who are "poor feeders" are ones who "can't take enough." The infant who feeds faster is often viewed as more skilled in this task-oriented approach. The feeding relationship and the infant's communication about the experience of feeding may not be nurtured. This article will explain the central role of the preterm infant's communication in successful cue-based feeding. When the infant is perceived as having meaningful behavior (i.e., communicative intent), the focus changes from a volume-driven to a co-regulated approach, through which the infant guides the caregiver. This is cue-based feeding.
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56
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Cacciani L, Di Lallo D, Piga S, Corchia C, Carnielli V, Chiandotto V, Fertz M, Miniaci S, Rusconi F, Caravale B, Cuttini M. Interaction of child disability and stressful life events in predicting maternal psychological health. Results of an area-based study of very preterm infants at two years corrected age. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:3433-3441. [PMID: 23920026 DOI: 10.1016/j.ridd.2013.07.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 07/10/2013] [Accepted: 07/10/2013] [Indexed: 06/02/2023]
Abstract
This study aimed at exploring the relationship between severe neuromotor and/or sensory disability in very preterm infants assessed at 2 years corrected age and their mothers' psychological health. Data on 581 Italian singletons born at 22-31 weeks of gestation in five Italian regions and their mothers were analyzed. Maternal psychological distress was measured through the General Health Questionnaire short version (GHQ-12). The prevalence of any maternal distress (GHQ scores ≥ 2) and of clinical distress (scores ≥ 5) were 31.3% and 8.1% respectively. At multivariable analysis, we found a statistically significant association between child's disability and mothers' GHQ scoring ≥ 5 (OR 3.45, 95% CI 1.07-11.15). Also lower maternal education appeared to increase the likelihood of psychological distress (OR 1.38, 95% CI 1.14-1.66). The impact of child disability was weaker in women who had experienced additional stressful life events since delivery, pointing to the existence of a "ceiling" effect. Maternal psychological assessment and support should be included in follow-up programs targeting very preterm infants.
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Affiliation(s)
- Laura Cacciani
- Regional Health Agency of Lazio, Via di S. Costanza 53, 00198 Rome, Italy.
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Developing the role of the nurse as a link advisor for research and a champion for nutrition in the neonatal intensive care unit. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.jnn.2013.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Lingwood BE. Bioelectrical impedance analysis for assessment of fluid status and body composition in neonates--the good, the bad and the unknown. Eur J Clin Nutr 2013; 67 Suppl 1:S28-33. [PMID: 23299869 DOI: 10.1038/ejcn.2012.162] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES There is a critical need for improved technologies to monitor fluid balance and body composition in neonates, particularly those receiving intensive care. Bioelectrical impedance analysis meets many of the criteria required in this environment and appears to be effective for monitoring physiological trends. SUBJECT/METHODS The literature regarding the use of bioelectrical impedance in neonates was reviewed. RESULTS It was found that prediction equations for total body water, extracellular water and fat-free mass have been developed, but many require further testing and validation in larger cohorts. Alternative approaches based on Hanai mixture theory or vector analysis are in the early stages of investigation in neonates. CONCLUSIONS Further research is required into electrode positioning, bioimpedance spectroscopy and Cole analysis in order to realise the full potential of this technology.
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Affiliation(s)
- B E Lingwood
- UQ Centre for Clinical Research, The University of Queensland, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
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59
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Ross ES, Browne JV. Feeding Outcomes in Preterm Infants After Discharge From the Neonatal Intensive Care Unit (NICU): A Systematic Review. ACTA ACUST UNITED AC 2013. [DOI: 10.1053/j.nainr.2013.04.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Morgan C. Early amino acid administration in very preterm infants: Too little, too late or too much, too soon? Semin Fetal Neonatal Med 2013; 18:160-165. [PMID: 23490859 DOI: 10.1016/j.siny.2013.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Early postnatal growth failure is well described in very preterm infants. It reflects the nutritional deficits in protein and energy intake that accumulate in the first few weeks after birth. This coincides with the period of maximum parenteral nutrition (PN) dependency, so that protein intake is largely determined by intravenous amino acid (AA) administration. The contribution of PN manufacture, supply, formulation, prescribing and administration to the early postnatal nutritional deficit is discussed, focusing on total AA intake. The implications of postnatal deficits in AA and energy intake for growth are reviewed, with particular emphasis on early head/brain growth and long-term neurodevelopmental outcome. The rationale for maximising AA acid intake as soon as possible after birth is explained. This includes the benefits for very early postnatal nutritional intake and metabolic adaptation after birth. These benefits relate to total AA intake and so have to be interpreted with some caution, given the very limited evidence base surrounding the balance of individual AAs in neonatal PN formulations. This work mostly predates current nutritional recommendations and therefore may not provide a true reflection of individual AA utilisation in current clinical practice.
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Affiliation(s)
- Colin Morgan
- Neonatal Intensive Care Unit, Liverpool Women's Hospital, Crown Street, Liverpool L8 7SS, UK.
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61
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García P, San Feliciano L, Benito F, García R, Guzmán J, Salas S, Fernández C, Del Prado N, Ciprián D, Figueras J. [Outcome at two years corrected age of a cohort of very low birth weight infants from hospitals within the neonatal SEN1500 network]. An Pediatr (Barc) 2013; 79:279-87. [PMID: 23684170 DOI: 10.1016/j.anpedi.2013.03.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Revised: 03/21/2013] [Accepted: 03/22/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE To describe growth and neurodevelopmental status of 4,944 children who completed a follow-up at two years of corrected age out of the 10,456 newborns with weight ≤1500g born between the years 2002-2007 and discharged from hospitals within the network SEN1500. A total of 522 newborns were excluded as they had some type of malformation. The total number of children assessed represents the 49.76% of children discharged alive and without malformations. METHODS A retrospective review was conducted using prospectively collected data in the SEN1500 database. We compared growth data at two years of corrected age according to birth weight and sex. Motor impairment, incidence of cerebral palsy, visual and hearing disabilities, and abnormal neurodevelopment for gestational age were analysed between groups. We studied the associations between cerebral palsy (CP) and perinatal factors. RESULTS At 2 years of age 44.2% of children had a weight <2 SD for corrected age. Children with birth weight ≤1000g showed worse outcomes in growth. Some type of motor impairment was observed in 6.96% of the infants, and 4.56% of them were diagnosed with CP. The incidence was higher among males with birth weight ≤1000g. There was an incidence of 5.21% of visual disability, with 0.5% of children being blind in one or both eyes. Cerebral palsy was associated with retinopathy of prematurity, severe intraventricular haemorrhage, and periventricular leukomalacia, in particular cystic periventricular leukomalacia.
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Affiliation(s)
- P García
- Unidad de Neonatología, Hospital Universitario de Salamanca, Salamanca, España.
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Moyses HE, Johnson MJ, Leaf AA, Cornelius VR. Early parenteral nutrition and growth outcomes in preterm infants: a systematic review and meta-analysis. Am J Clin Nutr 2013; 97:816-26. [PMID: 23446896 DOI: 10.3945/ajcn.112.042028] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The achievement of adequate nutritional intakes in preterm infants is challenging and may explain the poor growth often seen in this group. The use of early parenteral nutrition (PN) is one potential strategy to address this problem, although the benefits and harms are unknown. OBJECTIVE We determined whether earlier administration of PN benefits growth outcomes in preterm infants. DESIGN We conducted a systematic review of randomized controlled trials (RCTs) and observational studies. RESULTS Eight RCTs and 13 observational studies met the inclusion criteria (n = 553 and 1796 infants). The meta-analysis was limited by disparate growth-outcome measures. An assessment of bias was difficult because of inadequate reporting. Results are given as mean differences (95% CIs). Early PN reduced the time to regain birth weight by 2.2 d (1.1, 3.2 d) for RCTs and 3.2 d (2.0, 4.4 d) in observational studies. The maximum percentage weight loss with early PN was lower by 3.1 percentage points (1.7, 4.5 percentage points) for RCTs and by 3.5 percentage points (2.6, 4.3 percentage points) for observational studies. Early PN improved weight at discharge or 36 wk postmenstrual age by 14.9 g (5.3, 24.5 g) (observational studies only), but no benefit was shown for length or head circumference. There was no evidence that early PN significantly affects risk of mortality, necrotizing enterocolitis, sepsis, chronic lung disease, intraventricular hemorrhage, or cholestasis. CONCLUSIONS The results of this review, although subject to some limitations, show that early PN provides a benefit for some short-term growth outcomes. No evidence that early PN increases morbidity or mortality was found. Neonatal research would benefit from the development of a set of core growth outcome measures.
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Affiliation(s)
- Helen E Moyses
- National Institute for Health Research Foundation Trust, Southampton, United Kingdom.
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63
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Abstract
The amount of milk a preemie drinks largely determines readiness for discharge from the neonatal intensive care unit. But just because an infant feeds well today doesn't mean it will last. In the long term, fostering a child's consistent, positive response to feeding may be more important.
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64
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Abstract
There is little known about family experiences with pediatric feeding problems after NICU or PICU discharge. The study purposes were to better understand the family experiences with and consequences of feeding problems among NICU and PICU graduates after they transitioned home. Using a qualitative, descriptive design, 15 parents and 10 health professionals completed in-depth interviews. Data were analyzed using qualitative content analysis. Analysis revealed that feeding problems greatly impacted families. Education and resources were considered important, but generally insufficient. Though some parent-provider partnerships were strong, many others were not, and at-times, partnerships were fraught with conflict, communication problems, and lack of collaboration. System barriers and financial concerns escalated parents' distress, affecting their emotional responses. Parents' perceptions of discrepancies between their family situation and those of "normal" families violated their expectations. Understanding the perspectives of parents and providers regarding feeding problems common among NICU and PICU graduates is essential to developing effective interventions.
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Affiliation(s)
- Kristin F Lutz
- Oregon Health & Science University School of Nursing, 3455 SW U.S. Veterans Hospital Road, Mail code: SN-6S, Portland, OR 97239-2941; Office: 503-494-5010
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65
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Johnson MJ, Wootton SA, Leaf AA, Jackson AA. Preterm birth and body composition at term equivalent age: a systematic review and meta-analysis. Pediatrics 2012; 130:e640-9. [PMID: 22891222 DOI: 10.1542/peds.2011-3379] [Citation(s) in RCA: 208] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Infants born preterm are significantly lighter and shorter on reaching term equivalent age (TEA) than are those born at term, but the relation with body composition is less clear. We conducted a systematic review to assess the body composition at TEA of infants born preterm. METHODS The databases MEDLINE, Embase, CINAHL, HMIC, "Web of Science," and "CSA Conference Papers Index" were searched between 1947 and June 2011, with selective citation and reference searching. Included studies had to have directly compared measures of body composition at TEA in preterm infants and infants born full-term. Data on body composition, anthropometry, and birth details were extracted from each article. RESULTS Eight studies (733 infants) fulfilled the inclusion criteria. Mean gestational age and weight at birth were 30.0 weeks and 1.18 kg in the preterm group and 39.6 weeks and 3.41 kg in the term group, respectively. Meta-analysis showed that the preterm infants had a greater percentage total body fat at TEA than those born full-term (mean difference, 3%; P = .03), less fat mass (mean difference, 50 g; P = .03), and much less fat-free mass (mean difference, 460 g; P < .0001). CONCLUSIONS The body composition at TEA of infants born preterm is different than that of infants born at term. Preterm infants have less lean tissue but more similar fat mass. There is a need to determine whether improved nutritional management can enhance lean tissue acquisition, which indicates a need for measures of body composition in addition to routine anthropometry.
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Affiliation(s)
- Mark J Johnson
- Southampton NIHR Nutrition, Diet and Lifestyle Biomedical Research Unit, Princess Anne Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
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66
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Cardoso-Demartini ADA, Bagatin AC, Silva RPGVCD, Boguszewski MCDS. [Growth of preterm-born children]. ACTA ACUST UNITED AC 2012; 55:534-40. [PMID: 22218434 DOI: 10.1590/s0004-27302011000800006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 10/21/2011] [Indexed: 11/22/2022]
Abstract
Children born prematurely might experience a period of growth restriction just after birth. Catch-up growth begins during the first months of life and can be slow and progressive. These children may remain shorter and thinner throughout infancy and childhood compared to children born at term. In some cases, complete catch-up growth occurs only during adolescence. However, some children do not completely recover growth, and adults born prematurely are at increased risk of short stature. Impaired growth is more frequent in those born preterm and small for gestational age. Factors such as target height, birth weight, gestational age, neonatal morbidities and maternal education interfere in growth potential. Special attention should be given to children born preterm during the whole growth period.
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67
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Haugen OH, Nepstad L, Standal OA, Elgen I, Markestad T. Visual function in 6 to 7 year-old children born extremely preterm: a population-based study. Acta Ophthalmol 2012; 90:422-7. [PMID: 21044277 DOI: 10.1111/j.1755-3768.2010.02020.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Progress in neonatal care has caused an increased survival of children born extremely preterm. The aims of this study were to examine the long-term visual function and ocular development in an unselected cohort of extremely preterm infants and relate the results to neonatal morbidity and long-term neurodevelopmental outcome. METHODS All children with gestational age of 22-27 completed weeks or birth weight of 500-999 g born in the years 1999-2000 in two counties of Western Norway (n = 52) were invited to an eye examination that included visual acuity, refractive error, binocular function, accommodative amplitude and fundus examination. Cognitive function was assessed with the WPSSI-R test and motor abilities with the ABC movement test. RESULTS Neonatal morbidities and neurodevelopmental outcome were known for all, while 37 of the 52 children underwent the eye examination. None were blind or visually impaired, but 46% had subnormal visual acuity (logMAR ≥0.1). Ninety per cent were emmetropic or slightly hypermetropic (0 to +3D), while 10% had manifest and 51% latent strabismus. Performance IQ on the WPSSI-R test and ABC total score were associated with best visual acuity (p = 0.03 and p < 0.01, respectively). In a multiple linear regression model, visual acuity in the best eye was significantly associated with performance IQ (p = 0.03) and ABC total score (p = 0.02). CONCLUSION This study suggests a more favourable long-term prognosis on important ocular and visual parameters in survivors of extreme prematurity than expected from similar reports on children born less prematurely and that performance IQ and motor function are related to visual acuity.
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Affiliation(s)
- Olav H Haugen
- Department of Ophthalmology, Haukeland University Hospital, Bergen, Norway.
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68
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Abstract
It is well recognised that birth before 32 weeks of gestation is associated with substantial neonatal morbidity and mortality and these risks have been extensively reported. The focus of perinatal research for many years has therefore been very preterm and extremely preterm delivery, since the likelihood and severity of adverse neonatal outcomes are highest within this group. In contrast, until recently, more mature preterm infants have been understudied and indeed, almost ignored by researchers.
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69
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Chan CY, Jadcherla SR. Clinical Perspectives on Esophageal Disorders in Infants. ASHA LEADER 2012; 21:10.1044/sasd21.2.52. [PMID: 24244099 PMCID: PMC3828998 DOI: 10.1044/sasd21.2.52] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Esophageal pathologies are complex and lend themselves to multivariable analysis before a definitive diagnosis can be considered. It is imperative that the clinician establish a methodology for selecting the appropriate technological assessment within scientific testing parameters to establish optimal clinicopathological presentation and determine best practice for patient care.
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Affiliation(s)
- Chin Yee Chan
- The Neonatal and Infant Feeding Disorders Program, Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital Columbus, OH
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70
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Harijan P, Boyle EM. Health outcomes in infancy and childhood of moderate and late preterm infants. Semin Fetal Neonatal Med 2012; 17:159-62. [PMID: 22417643 DOI: 10.1016/j.siny.2012.02.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
There has been a long-held belief that outcomes for babies born at moderate and late preterm gestations do not differ substantially from those of infants born at full term. This has recently been challenged by studies highlighting an increased risk of adverse neonatal outcomes, and of poorer cognitive, behavioural and educational outcomes in this population. Data about the effects of birth at moderate and late preterm gestations on later health outcomes are limited, but emerging evidence suggests that ongoing physical health may also be worse in those born just a few weeks before full term. This review summarises the available evidence, considers the factors influencing health outcomes and discusses the implications for the planning and provision of children's health care services.
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Affiliation(s)
- Pooja Harijan
- Department of Health Sciences, University of Leicester, 22-28 Princess Road West, Leicester LE1 6TP, UK
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Irby MB, Kolbash S, Garner-Edwards D, Skelton JA. Pediatric Obesity Treatment in Children With Neurodevelopmental Disabilities: A Case Series and Review of the Literature. ACTA ACUST UNITED AC 2012; 4:215-221. [PMID: 24723990 DOI: 10.1177/1941406412448527] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Obesity can affect any child, but it occurs disproportionately in children with developmental disabilities. Treatment efforts, however, have focused primarily on nondisabled children, and more research is needed to determine how current approaches can be modified for youth with neurodevelopmental disabilities. This article briefly reviews what is currently known about obesity treatment in these children and presents a case series describing methods employed by a family-based, multidisciplinary weight management program in the treatment of obesity. Lessons learned from clinical experience are also discussed, with implications for collaborating with families of children with disabilities in treatment, establishing healthy routines and schedules, setting the pace of treatment progression, and minimizing disruptions in the behavior change process. Though there are no expert recommendations specifically tailored to obesity treatment in children with neurodevelopmental disabilities, existing clinical programs such as the one described here can be adapted to better meet the needs of this underserved population. Further research is warranted to determine the most effective methods for addressing obesity in these children, as has been specified as a national health priority.
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Affiliation(s)
- Megan B Irby
- Department of Pediatrics, Wake Forest University School of Medicine (MBI, SK, JAS) and Brenner FIT Program, Brenner Children's Hospital (MBI, DE-G, JAS), Winston-Salem, North Carolina
| | - Stacy Kolbash
- Department of Pediatrics, Wake Forest University School of Medicine (MBI, SK, JAS) and Brenner FIT Program, Brenner Children's Hospital (MBI, DE-G, JAS), Winston-Salem, North Carolina
| | - Dara Garner-Edwards
- Department of Pediatrics, Wake Forest University School of Medicine (MBI, SK, JAS) and Brenner FIT Program, Brenner Children's Hospital (MBI, DE-G, JAS), Winston-Salem, North Carolina
| | - Joseph A Skelton
- Department of Pediatrics, Wake Forest University School of Medicine (MBI, SK, JAS) and Brenner FIT Program, Brenner Children's Hospital (MBI, DE-G, JAS), Winston-Salem, North Carolina
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72
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Horemuzova E, Söder O, Hagenäs L. Growth charts for monitoring postnatal growth at NICU of extreme preterm-born infants. Acta Paediatr 2012; 101:292-9. [PMID: 22040370 DOI: 10.1111/j.1651-2227.2011.02510.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To provide growth charts for clinical monitoring of extra-uterine growth from birth to full-term age, in infants born before 26 weeks of gestation, hospitalized at neonatal intensive care unit (NICU), and compare it to the commonly used Swedish preterm birth-size reference. METHODS This retrospective longitudinal cohort comprised all infants born before 26 + 0 weeks of gestation and surviving to full-term age (n = 162), admitted to the NICU, Karolinska Hospital during the period January 1990 to December 2002. Body weight was recorded daily, head circumference (HC) weekly and length twice a month. RESULTS Birth weight (BW), length and HC showed a normal distribution without significant gender difference. The majority of the infants showed a pronounced postnatal growth restriction for all growth variables with increasing deviation from the reference with age. The mean initial weight loss was 16% with nadir at 6 days of age and a mean time to regain BW of 18 days. At discharge from NICU, 75% of those initially appropriate for gestational age infants were below -2 standard deviation scores for at least one of the body size variables. CONCLUSION The poor extra-uterine growth pattern points to the need of growth curves for extra-uterine growth of extremely premature infants.
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Affiliation(s)
- E Horemuzova
- Department for Woman and Child Health, Karolinska Institute, Paediatric Endocrinology Unit, Karolinska University Hospital, Stockholm, Sweden.
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73
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Sharma R, Williams AN, Zaw W. Timing of gastrostomy insertion in children with a neurodisability: a cross-sectional study of early versus late intervention. BMJ Open 2012; 2:bmjopen-2012-001793. [PMID: 23175740 PMCID: PMC3533027 DOI: 10.1136/bmjopen-2012-001793] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES The aim of the study was to assess whether gastrostomy placement before 18 months of age results in a greater increase in z-score for weight and to assess whether admission rates were reduced postgastrostomy in this age group. DESIGN Retrospective cross-sectional study. SETTING Single-centre secondary care District General Hospital. PARTICIPANTS All children with a neurodisability with a gastrostomy in situ in September 2011 were included. Those with primary neoplasia and undergoing chemo or radiotherapy or being palliated for an aggressive neurodegenerative disorder were excluded. Those with cystic fibrosis, primary congenital heart disease or Inflammatory bowel disease were also excluded. Forty-one children underwent final analysis. Twenty-four children underwent gastrostomy insertion less than 18 months and 17 children were older than 18 months. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome was z-scores for weight immediately pregastrostomy and 12 months postgastrostomy. Secondary outcomes were hospital admission rates pregastrostomy and postgastrostomy. Values were compared for those with gastrostomy insertion less than or equal to 18 months against those older than 18 months at insertion. RESULTS Z-score for weight increased significantly in both age groups. There was significantly increased mean difference in the z-score for weight of +1.33 pregastrostomy and postgastrostomy in the less than 18 months age group as compared with an increased mean difference in the z-score for weight of +0.45 in the older age group (p=0.021). There was no significant difference in the admission rates postgastrostomy insertion in either age group. CONCLUSIONS Gastrostomy insertion before 18 months of age results in greater z-score for weight gain in children with a neurodisability. This conclusion is limited by the lack of height and skin-fold thickness measurements. Further long-term matched control studies are required to determine the neurodevelopmental and clinical benefit of early gastrostomy placement in such children.
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Affiliation(s)
- Raman Sharma
- Department of Paediatrics, Virtual Academic Unit, Child Development Centre, Northampton, Northants, UK
| | - Andrew N Williams
- Department of Paediatrics, Virtual Academic Unit, Child Development Centre, Northampton, Northants, UK
| | - Win Zaw
- Department of Paediatrics, Northampton General Hospital, Northampton, Northants, UK
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74
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Abstract
Many high-risk and preterm infants have difficulty with successful feeding and subsequent optimal growth during their stay in the neonatal intensive care unit as well as in the months after discharge. Environmental, procedural, and medical issues necessary for treatment of the hospitalized infant present challenges for the development of successful eating skills. Emerging data describe eating as a predictable neurodevelopmental process that depends on the infant's organization of physiologic processes, motor tone and movement, level of arousal, and ability to simultaneously regulate these processes.
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Affiliation(s)
- Joy V Browne
- JFK Partners Center for Family and Infant Interaction, University of Colorado Anschutz Medical Campus, 13121 East 19th Avenue, Aurora, CO USA.
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75
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Bocca-Tjeertes IFA, Kerstjens JM, Reijneveld SA, de Winter AF, Bos AF. Growth and predictors of growth restraint in moderately preterm children aged 0 to 4 years. Pediatrics 2011; 128:e1187-94. [PMID: 21987699 DOI: 10.1542/peds.2010-3781] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To describe growth in moderately preterm-born children, determine the prevalence of growth restraint at the age of 4, and identify predictors of growth restraint. We hypothesized that growth in moderately preterm-born children differs from growth in term-born children and that growth restraint is more prevalent in those born prematurely. PATIENTS AND METHODS This was a community-based cohort study of 1123 children born moderately prematurely (gestational age [GA]: 32-35 6/7 weeks) between January 2002 and June 2003. RESULTS On average, we found that moderately preterm-born children were shorter and weighed less at each assessment during the first 4 years of life than their term-born counterparts. Thirty-two boys (5.6%) and 18 girls (3.8%) were growth-restricted in height, and 21 boys (3.4%) and 27 girls (5.8%) were growth-restricted in weight. Their growth in head circumference was normal compared with term-born children. In addition, growth restraint was associated with being small for GA at birth (odds ratio [OR] for height: 7.7 [95% confidence interval (CI): 2.9-20.4]; OR for weight: 9.5 [95% CI: 3.9-23.1]) and maternal height below -1 SD (OR for height: 4.9 [95% CI: 2.6-10.2]; OR for weight: 2.6 [95% CI: 1.3-5.2]). Poor head-circumference growth was associated with a low level of maternal education (OR: 5.3 [95% CI: 1.4-20.8]). CONCLUSIONS Growth in moderately preterm-born children significantly differs from that of term-born children. Predictors at birth are being small for GA, maternal height below -1 SD, and a low level of maternal education. The fact that growth in moderately preterm-born children may lag warrants close monitoring during routine practice. Additional research on prevention of growth restraint is needed.
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Affiliation(s)
- Inger F A Bocca-Tjeertes
- Division of Neonatology, Department of Pediatrics, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
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76
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Abstract
Preterm birth, defined as a pregnancy ending at less than 37 completed weeks of gestation, is the leading cause of infant mortality in the United States. The occurrence of preterm births rose steadily from 9.4% of all pregnancies in the United States in 1981 to 12.8% in 2006, before declining to 12.7% in 2007 and 12.3% in 2008. Most of the increase was attributable to increases in multiple gestations. Recent research has sought to understand this condition by evaluating its familial occurrence and both clinical and pathologic information to derive an etiologically homogeneous categorization.
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Affiliation(s)
- Mark A Klebanoff
- Department of Pediatrics, The Ohio State University College of Medicine and Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA.
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77
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Eventov-Friedman S, Shinwell ES, Barnea E, Flidel-Rimon O, Juster-Reicher A, Levy R. Correlation between fetal heart rate reactivity and mortality and severe neurological morbidity in extremely low birth weight infants. J Matern Fetal Neonatal Med 2011; 25:654-5. [PMID: 21780854 DOI: 10.3109/14767058.2011.591457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine the correlation between specific fetal heart rate (FHR) abnormalities and the incidence of death, severe (grade 3-4) intraventricular hemorrhage (IVH) and periventricular echogenicity (PVE) in extremely low birth weight infants (ELBW) within the first 4 days after birth. METHODS The study included live-born ELBW infants ≤ 30 weeks' gestation who were born in 2000-2007 at Kaplan Medical Center, Rehovot, Israel, and, who had FHR monitoring during the 24 h before delivery and cranial ultrasound during the first 4 days of life. FHR pattern was analyzed for the presence of baseline rate, reactivity, variability and decelerations. RESULTS 96 infants with mean birth weight 757 ± 150 g and mean gestational age 25.8 ± 1.5 weeks were included. By 4 days of life, 23/96 (24%) died, 17/96 (18%) developed severe IVH and 31/96 (32%) had PVE. Absence of reactivity was significantly associated with increase in both death (p = 0.02, OR 3.45, 95% CI: 1.22-9.47 and severe IVH (p = 0.029, OR 3.33, 95% CI: 1.25-10) but not with PVE. Other FHR parameters were not associated with adverse outcome. CONCLUSION These results suggest that FHR reactivity may be of value in predicting short-term outcome in ELBW infants. This may be helpful in counseling parents with imminent extremely preterm birth.
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Affiliation(s)
- S Eventov-Friedman
- Department of Neonatology, Kaplan Medical Center, Rehovot and Hebrew University, Jerusalem, Israel
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78
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Claas MJ, de Vries LS, Koopman C, Uniken Venema MMA, Eijsermans MJC, Bruinse HW, Verrijn Stuart AA. Postnatal growth of preterm born children ≤ 750g at birth. Early Hum Dev 2011; 87:495-507. [PMID: 21550187 DOI: 10.1016/j.earlhumdev.2011.04.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Revised: 04/07/2011] [Accepted: 04/12/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Extremely low birth weight (ELBW) infants are at risk of impaired postnatal growth. Impaired postnatal growth has been reported to be associated with delayed cognitive and motor development. AIMS To describe postnatal growth patterns of appropriate and small for gestational age (AGA and SGA) ELBW children in relation to their cognitive and motor outcome at age 5.5. STUDY DESIGN Retrospective cohort study. SUBJECTS One hundred one children with a BW ≤ 750g, born between 1996 and 2005 in the University Hospital Utrecht, The Netherlands. OUTCOME MEASURES Height (Ht), weight (Wt), occipital-frontal circumference (OFC) at birth, 15 months and 2 years corrected age and 3.5 and 5.5 years. Cognitive and motor outcome at 5.5 years of age, classified as normal (Z-score ≥-1), mildly delayed (-2≤Z-score <-1) or severely delayed (Z-score <-2). AGA (Ht, Wt or OFC at birth ≥-2 SDS) infants were compared with SGA (Ht, Wt or OFC at birth <-2 SDS) infants. RESULTS Between birth and 5.5 years catch-up growth in Ht, weight for height (Wt/Ht), Wt and OFC was seen in 72.2%, 55.2%, 28.6% and 68.9% respectively of the SGA infants. For AGA infants we found substantial catch-down growth in Ht (15.4%) and Wt (33.8%). Cognitive and motor outcome was normal in 76.2% and 41.6% of the 101 children. A significantly higher percentage of normal cognitive outcome was found in AGA infants with Wt growth remaining at ≥-2 SDS compared to AGA infants with catch-down growth (83% vs 63%). Next, SGA infants who caught-up in OFC had a higher prevalence of normal cognitive outcome compared to SGA infants who did not catch-up in OFC. Furthermore, a higher percentage of severely delayed motor outcome was found in SGA infants without catch-up growth in Wt compared to SGA infants who caught-up in Wt (61.5% vs 32.2%). CONCLUSIONS Catch-up growth in Ht, Wt/Ht and OFC occurred in the majority of the SGA infants with a BW ≤ 750 g, but was less common in Wt. AGA children who remained their Wt at ≥-2 SDS have a better cognitive and motor developmental outcome at 5.5 years of age. Catch-up growth in OFC was associated with a better cognitive outcome at 5.5 years of age.
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Affiliation(s)
- M J Claas
- Department of Obstetrics, University Medical Centre, Wilhelmina Children's Hospital, Utrecht, The Netherlands
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79
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SCAMP: standardised, concentrated, additional macronutrients, parenteral nutrition in very preterm infants: a phase IV randomised, controlled exploratory study of macronutrient intake, growth and other aspects of neonatal care. BMC Pediatr 2011; 11:53. [PMID: 21663622 PMCID: PMC3141505 DOI: 10.1186/1471-2431-11-53] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 06/10/2011] [Indexed: 11/29/2022] Open
Abstract
Background Infants born <29 weeks gestation are at high risk of neurocognitive disability. Early postnatal growth failure, particularly head growth, is an important and potentially reversible risk factor for impaired neurodevelopmental outcome. Inadequate nutrition is a major factor in this postnatal growth failure, optimal protein and calorie (macronutrient) intakes are rarely achieved, especially in the first week. Infants <29 weeks are dependent on parenteral nutrition for the bulk of their nutrient needs for the first 2-3 weeks of life to allow gut adaptation to milk digestion. The prescription, formulation and administration of neonatal parenteral nutrition is critical to achieving optimal protein and calorie intake but has received little scientific evaluation. Current neonatal parenteral nutrition regimens often rely on individualised prescription to manage the labile, unpredictable biochemical and metabolic control characteristic of the early neonatal period. Individualised prescription frequently fails to translate into optimal macronutrient delivery. We have previously shown that a standardised, concentrated neonatal parenteral nutrition regimen can optimise macronutrient intake. Methods We propose a single centre, randomised controlled exploratory trial of two standardised, concentrated neonatal parenteral nutrition regimens comparing a standard macronutrient content (maximum protein 2.8 g/kg/day; lipid 2.8 g/kg/day, dextrose 10%) with a higher macronutrient content (maximum protein 3.8 g/kg/day; lipid 3.8 g/kg/day, dextrose 12%) over the first 28 days of life. 150 infants 24-28 completed weeks gestation and birthweight <1200 g will be recruited. The primary outcome will be head growth velocity in the first 28 days of life. Secondary outcomes will include a) auxological data between birth and 36 weeks corrected gestational age b) actual macronutrient intake in first 28 days c) biomarkers of biochemical and metabolic tolerance d) infection biomarkers and other intravascular line complications e) incidence of major complications of prematurity including mortality f) neurodevelopmental outcome at 2 years corrected gestational age Trial registration Current controlled trials: ISRCTN76597892; EudraCT Number: 2008-008899-14
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80
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Prevalence and predictors of later feeding disorders in children who underwent neonatal cardiac surgery for congenital heart disease. Cardiol Young 2011; 21:303-9. [PMID: 21272426 DOI: 10.1017/s1047951110001976] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIM We thought of assessing the prevalence and predictors of feeding disorders in patients with congenital heart defects after neonatal cardiac surgery. METHODS Retrospective study of 82 consecutive neonates (48 males, 34 females) who underwent surgery for congenital heart defects from 1999 to 2002. Information was taken from patient charts and nursing notes. The presence of a feeding disorder was assessed by a questionnaire sent to the paediatricians when the child was 2 years of age. A feeding disorder was defined as a need for tube feeding, inadequate food intake for age, or failure to thrive. Data were analysed with descriptive statistics and logistic regression. RESULTS Feeding disorders occurred in 22% of the study population. Reoperation and early feeding disorders were identified as independent risk factors for later feeding disorders (odds ratio 5.8, p 0.01; odds ratio 20.7, p 0.02). There was a trend towards more feeding disorders in patients with neurological abnormalities during the first hospital stay. CONCLUSION Feeding disorder is a frequent, long-term sequela after neonatal cardiac surgery. Patients with congenital heart defects who undergo multiple cardiac surgeries and those with early feeding disorders are at risk of developing later feeding disorders. Patients with these risk factors need to be selected for preventive strategies.
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81
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Lawn JE, Blencowe H, Pattinson R, Cousens S, Kumar R, Ibiebele I, Gardosi J, Day LT, Stanton C. Stillbirths: Where? When? Why? How to make the data count? Lancet 2011; 377:1448-63. [PMID: 21496911 DOI: 10.1016/s0140-6736(10)62187-3] [Citation(s) in RCA: 509] [Impact Index Per Article: 39.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Despite increasing attention and investment for maternal, neonatal, and child health, stillbirths remain invisible-not counted in the Millennium Development Goals, nor tracked by the UN, nor in the Global Burden of Disease metrics. At least 2·65 million stillbirths (uncertainty range 2·08 million to 3·79 million) were estimated worldwide in 2008 (≥1000 g birthweight or ≥28 weeks of gestation). 98% of stillbirths occur in low-income and middle-income countries, and numbers vary from 2·0 per 1000 total births in Finland to more than 40 per 1000 total births in Nigeria and Pakistan. Worldwide, 67% of stillbirths occur in rural families, 55% in rural sub-Saharan Africa and south Asia, where skilled birth attendance and caesarean sections are much lower than that for urban births. In total, an estimated 1·19 million (range 0·82 million to 1·97 million) intrapartum stillbirths occur yearly. Most intrapartum stillbirths are associated with obstetric emergencies, whereas antepartum stillbirths are associated with maternal infections and fetal growth restriction. National estimates of causes of stillbirths are scarce, and multiple (>35) classification systems impede international comparison. Immediate data improvements are feasible through household surveys and facility audit, and improvements in vital registration, including specific perinatal certificates and revised International Classification of Disease codes, are needed. A simple, programme-relevant stillbirth classification that can be used with verbal autopsy would provide a basis for comparable national estimates. A new focus on all deaths around the time of birth is crucial to inform programmatic investment.
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Affiliation(s)
- Joy E Lawn
- Saving Newborn Lives/Save the Children, Cape Town, South Africa.
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82
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Brosch JR, Sant RV, Golomb MR. Subacute onset of abnormal gait and head drop in a 3-year-old with history of extreme prematurity. J Child Neurol 2011; 26:373-6. [PMID: 21257840 DOI: 10.1177/0883073810382142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 3-year-old boy who had been a 23-week premature infant had subacute onset of abnormal gait, which progressed to generalized weakness with severe weakness of neck extensors. He had U waves on electrocardiography. His serum potassium was 1.8 mmol/L. The patient had a gastrostomy tube due to chronic feeding issues and was treated with inhaled albuterol for chronic lung disease. When his oral intake regressed, his family administered one of his oral supplements through the gastrostomy tube; the supplement was low in potassium. This feeding regression continued for several months. He had no additional gastrointestinal or renal loss of potassium. He had frequent exacerbations of his bronchopulmonary dysplasia. His history suggested he had chronic potassium depletion and that albuterol may have led to further potassium redistribution, exacerbating his hypokalemia. As more extremely premature infants survive with chronic feeding and respiratory issues, this presentation may become more common.
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Affiliation(s)
- Jared R Brosch
- Indiana University School of Medicine, Department of Neurology, Indianapolis, IN 46202, USA
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83
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Kytnarova J, Zlatohlavková B, Kubena A, Markova D, Dokoupilova M, Plavka R, Zeman J. Post-natal growth of 157 children born as extremely premature neonates. J Paediatr Child Health 2011; 47:111-6. [PMID: 21091582 DOI: 10.1111/j.1440-1754.2010.01897.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM With increasing survival rate of extremely premature neonates, their long-term outcomes including growth and risk factors for later disorders need to be considered. We prospectively evaluated anthropometric parameters in children born as extremely premature neonates. METHODS Anthropometric parameters were measured at the ages of 2 and 5 years in 72 extremely premature children born between the 22nd and 25 + 6th weeks of gestation (group I) and 85 children born between the 26th and 27 + 6th weeks of gestation (group II). RESULTS Although catch-up in the postnatal growth was observed in both groups of children, resulting in growth improvement, the height of the extremely premature children at the ages of 2 and 5 years remains lower (P < 0.01) compared with the control population. A decline in head growth was observed in both groups between the ages of 2 and 5 years, resulting in decrease of standard deviation score (SDS) for head circumference (HC) in comparison with that of the control population, accompanied by an increased number of children with microcephaly, defined as HC < -2 SD. At the age of five, microcephaly was found in 18% of children from group I and 11.7% of children from group II. At the age of 5 years, the waist and hip circumferences and ten skinfolds were not different between both groups of children. CONCLUSION Long-term follow-up of extremely premature neonates is important not only to establish their growth patterns but also for risk factors assessment including adiposity for later development of adult-onset diseases.
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Affiliation(s)
- Jitka Kytnarova
- Department of Pediatrics, First Faculty of Medicíne, Charles University in Prague, Prague, Czech Republic
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84
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Shaker CS. Improving Feeding Outcomes in the NICU: Moving From Volume-Driven to Infant-Driven Feeding. ACTA ACUST UNITED AC 2010. [DOI: 10.1044/sasd19.3.68] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Current research on feeding outcomes after discharge from the neonatal intensive care unit (NICU) suggests a need to critically look at the early underpinnings of persistent feeding problems in extremely preterm infants. Concepts of dynamic systems theory and sensitive care-giving are used to describe the specialized needs of this fragile population related to the emergence of safe and successful feeding and swallowing. Focusing on the infant as a co-regulatory partner and embracing a framework of an infant-driven, versus volume-driven, feeding approach are highlighted as best supporting the preterm infant's developmental strivings and long-term well-being.
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85
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Abstract
Advances in perinatal and neonatal care over the last 30 years have contributed to improved survival among extremely low birth weight (ELBW) infants. As the rate of neonatal morbidity has remained stable, parents and health care professionals involved in the care of these infants often raise questions regarding the prevalence of adverse neurodevelopmental outcomes. Existing data in the literature is heterogeneous and the reported prevalence of disability varies more than survival rates do. One of the key issues toward a better clinical management of ELBW infants is the knowledge of the nature of mortality and disability in this population of infants. Studies from individual centers report outcomes of ELBW infants and demonstrate several limitations as to the ways babies were treated. Advice to parents and decisions to be made regarding the care of these infants should be based on reliable, unbiased, and representative data drawn from geographically defined populations. Such data have recently become available. This report gives an overview of existing literature on this issue.
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Affiliation(s)
- Nicoletta Iacovidou
- 2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Aretaieion Hospital, Greece.
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86
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Motor trajectories from 4 to 18 months corrected age in infants born at less than 30 weeks of gestation. Early Hum Dev 2010; 86:573-80. [PMID: 20709474 DOI: 10.1016/j.earlhumdev.2010.07.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Revised: 07/01/2010] [Accepted: 07/19/2010] [Indexed: 11/23/2022]
Abstract
BACKGROUND Preterm infants are recognised as developing at a significantly slower rate than their full-term peers and with different movement quality. AIM This study aimed to describe the longitudinal gross motor trajectories of these infants in the first 18 months of (corrected) age and investigate factors associated with gross motor development. STUDY DESIGN A longitudinal study was conducted with convenience samples of 58 preterm infants born < or = 29 weeks of gestation and 52 control full-term infants in Australia. OUTCOME MEASURES The infants were assessed at 4, 8, 12 and 18 months of (corrected) age using the Alberta Infant Motor Scale (AIMS). RESULTS Forty-six preterm and 48 control infants completed all four assessments. The preterm group scored significantly lower on various sub-scores at all age levels. Almost half of the preterm infants demonstrated less progression in the sit sub-scale from 4 to 8 months (corrected) age, possibly due to an imbalance between flexor and extensor strength in the trunk. At 12 and 18 months of (corrected) age, lack of rotation and fluency in their movements were evident in some preterm infants. Presence of intra-ventricular haemorrhage and chronic lung disease were associated with poor motor performance at 4 months and use of postnatal steroids was associated with poor motor performance at 4, 8 and 18 months of corrected age. CONCLUSION The imbalance between flexor and extensor muscle strength in preterm infants had a stronger impact on motor development than usually expected. The AIMS appears to be a sensitive assessment tool to demonstrate the unique movement characteristics in this preterm cohort.
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87
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Rodriguez NA, Meier PP, Groer MW, Zeller JM, Engstrom JL, Fogg L. A pilot study to determine the safety and feasibility of oropharyngeal administration of own mother's colostrum to extremely low-birth-weight infants. Adv Neonatal Care 2010; 10:206-12. [PMID: 20697221 PMCID: PMC2924875 DOI: 10.1097/anc.0b013e3181e94133] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
UNLABELLED Own mother's colostrum is rich in cytokines and other immune agents that may stimulate oropharyngeal-associated lymphoid tissue if administered oropharyngeally to extremely low-birth-weight (ELBW) infants during the first days of life when enteral feeding is contraindicated. However, the safety and feasibility of the oropharyngeal route for the administration of colostrum have not been determined. PURPOSE To determine the safety of oropharyngeal administration of own mother's colostrum to ELBW infants in first days of life. A secondary purpose was to investigate the feasibility of (1) delivering this intervention to ELBW infants in the first days of life and (2) measuring concentrations of secretory immunoglobulin A and lactoferrin in tracheal aspirate secretions and urine of these infants. SUBJECTS Five ELBW infants (mean birth weight and gestational age = 657 g and 25.5 weeks, respectively). DESIGN Quasi-experimental, 1 group, pretest-posttest design. METHODS Subjects received 0.2 mL of own mother's colostrum administered oropharyngeally every 2 hours for 48 consecutive hours, beginning at 48 hours of life. Concentrations of secretory immunoglobulin A and lactoferrin were measured in tracheal aspirates and urine of each subject at baseline, at the completion of the intervention and again 2 weeks later. RESULTS All infants completed the entire treatment protocol, each receiving 24 treatments. A total of 15 urine specimens were collected and 14 were sufficient in volume for analysis. A total of 15 tracheal aspirates were collected, but only 7 specimens (47%) were sufficient in volume for analysis. There was wide variation in concentrations of secretory immunoglobulin A and lactoferrin in urine and tracheal aspirates among the 5 infants; however, several results were outside the limits of assay detection. All infants began to suck on the endotracheal tube during the administration of colostrum drops. Oxygen saturation measures remained stable or increased slightly during each of the treatment sessions. There were no episodes of apnea, bradycardia, hypotension, or other adverse effects associated with the administration of colostrum. CONCLUSIONS Oropharyngeal administration of own mother's colostrum is easy, inexpensive, and well-tolerated by even the smallest and sickest ELBW infants. Future research should continue to examine the optimal procedure for measuring the direct immune effects of this therapy, as well as the clinical outcomes such as infections, particularly ventilator-associated pneumonia.
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88
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Baron IS, Rey-Casserly C. Extremely Preterm Birth Outcome: A Review of Four Decades of Cognitive Research. Neuropsychol Rev 2010; 20:430-52. [DOI: 10.1007/s11065-010-9132-z] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Accepted: 04/27/2010] [Indexed: 02/05/2023]
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Siassakos D, O'Brien K, Draycott T. Healthcare evaluation of the use of atosiban and fibronectin for the management of pre-term labour. J OBSTET GYNAECOL 2010; 29:507-11. [DOI: 10.1080/01443610903003191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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90
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Mottram R, Holt J. “Is gestational age a factor in determining the health-related quality of life of children and young people born preterm?” A critical review of the literature. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.jnn.2009.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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91
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Lawn JE, Gravett MG, Nunes TM, Rubens CE, Stanton C. Global report on preterm birth and stillbirth (1 of 7): definitions, description of the burden and opportunities to improve data. BMC Pregnancy Childbirth 2010; 10 Suppl 1:S1. [PMID: 20233382 PMCID: PMC2841772 DOI: 10.1186/1471-2393-10-s1-s1] [Citation(s) in RCA: 475] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION This is the first of seven articles from a preterm birth and stillbirth report. Presented here is an overview of the burden, an assessment of the quality of current estimates, review of trends, and recommendations to improve data. PRETERM BIRTH Few countries have reliable national preterm birth prevalence data. Globally, an estimated 13 million babies are born before 37 completed weeks of gestation annually. Rates are generally highest in low- and middle-income countries, and increasing in some middle- and high-income countries, particularly the Americas. Preterm birth is the leading direct cause of neonatal death (27%); more than one million preterm newborns die annually. Preterm birth is also the dominant risk factor for neonatal mortality, particularly for deaths due to infections. Long-term impairment is an increasing issue. STILLBIRTH Stillbirths are currently not included in Millennium Development Goal tracking and remain invisible in global policies. For international comparisons, stillbirths include late fetal deaths weighing more than 1000g or occurring after 28 weeks gestation. Only about 2% of all stillbirths are counted through vital registration and global estimates are based on household surveys or modelling. Two global estimation exercises reached a similar estimate of around three million annually; 99% occur in low- and middle-income countries. One million stillbirths occur during birth. Global stillbirth cause-of-death estimates are impeded by multiple, complex classification systems. RECOMMENDATIONS TO IMPROVE DATA (1) increase the capture and quality of pregnancy outcome data through household surveys, the main data source for countries with 75% of the global burden; (2) increase compliance with standard definitions of gestational age and stillbirth in routine data collection systems; (3) strengthen existing data collection mechanisms--especially vital registration and facility data--by instituting a standard death certificate for stillbirth and neonatal death linked to revised International Classification of Diseases coding; (4) validate a simple, standardized classification system for stillbirth cause-of-death; and (5) improve systems and tools to capture acute morbidity and long-term impairment outcomes following preterm birth. CONCLUSION Lack of adequate data hampers visibility, effective policies, and research. Immediate opportunities exist to improve data tracking and reduce the burden of preterm birth and stillbirth.
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Affiliation(s)
- Joy E Lawn
- Saving Newborn Lives/Save the Children, 11 South Way, Pinelands Cape Town, South Africa
| | - Michael G Gravett
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington USA
| | - Toni M Nunes
- Global Alliance to Prevent Prematurity and Stillbirth, an initiative of Seattle Children's, Seattle, Washington, USA
| | - Craig E Rubens
- Global Alliance to Prevent Prematurity and Stillbirth, an initiative of Seattle Children's, Seattle, Washington, USA
- Department of Pediatrics at University of Washington School of Medicine, Seattle, Washington, USA
| | - Cynthia Stanton
- Department of Population, Family and Reproductive Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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92
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Madden J, Kobaly K, Minich NM, Schluchter M, Wilson-Costello D, Hack M. Improved weight attainment of extremely low-gestational-age infants with bronchopulmonary dysplasia. J Perinatol 2010; 30:103-11. [PMID: 19798043 PMCID: PMC2834327 DOI: 10.1038/jp.2009.142] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Revised: 07/20/2009] [Accepted: 08/13/2009] [Indexed: 12/05/2022]
Abstract
OBJECTIVE To determine whether changes in neonatal practice and morbidity since 2000 have improved the growth attainment of infants with bronchopulmonary dysplasia (BPD). STUDY DESIGN We compared the respective z-scores of the weight, length and head circumference of extremely low-gestational-age infants (aged <28 weeks) with BPD at birth, 40 weeks and 20 months corrected age (CA) during two time periods, namely period I, 1996-1999 (n=117) and period II, 2000-2003 (n=105), and examined the effects of significant changes in neonatal practice, morbidities and neurosensory outcome on 20-month growth outcomes. RESULT During the most recent period (2000-2003), there was a significant increase in mean weight z-scores (-1.60 vs -1.22) and decrease in rates of subnormal weight (40 vs 21%), P<0.05 at 20 months CA but not in those of length or head circumference. Significant predictors of the 20-month weight z-score included time period (period I vs II), duration of ventilator dependence and 20-month neurosensory abnormality (all P<0.05). CONCLUSION Despite an improvement in weight since 2000, poor growth attainment remains a major problem among infants with BPD.
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Affiliation(s)
- J Madden
- Departments of Pediatrics and Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA
| | - K Kobaly
- Departments of Pediatrics and Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA
| | - N M Minich
- Departments of Pediatrics and Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA
| | - M Schluchter
- Departments of Pediatrics and Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA
| | - D Wilson-Costello
- Departments of Pediatrics and Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA
| | - M Hack
- Departments of Pediatrics and Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA
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93
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Samara M, Johnson S, Lamberts K, Marlow N, Wolke D. Eating problems at age 6 years in a whole population sample of extremely preterm children. Dev Med Child Neurol 2010; 52:e16-22. [PMID: 19832883 DOI: 10.1111/j.1469-8749.2009.03512.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM The aim of this study was to investigate the prevalence of eating problems and their association with neurological and behavioural disabilities and growth among children born extremely preterm (EPC) at age 6 years. METHOD A standard questionnaire about eating was completed by parents of 223 children (125 males [56.1%], 98 females [43.9%]) aged 6 years who were born at 25 weeks' gestation or earlier (mean 24.5 wks, SD 0.7 wks; mean birthweight 749.1 g, SD 116.8 g), and parents of 148 classmates born at term (66 males [44.6%], 82 females [55.4%]). All children underwent neurological, cognitive, and anthropometric assessment, and parents and teachers completed a behaviour scale. RESULTS Eating problems were more common among the EPC than the comparison group (odds ratio [OR] 3.6, 95% confidence interval [CI] 2.1-6.3), including oral motor (OR 5.2, 95% CI 2.8-9.9), hypersensitivity (OR 3.0, 95% CI 1.6-5.6), and behavioural (OR 3.8, 95% CI 1.9-7.6) problems. Group differences were reduced after adjustment for cognitive impairment, neuromotor disability, and other behaviour problems. EPC with eating problems were shorter, lighter, and had lower mid-arm circumference and lower body mass index (BMI) even after adjusting for disabilities, gestational age, birthweight, and feeding problems at 30 months. INTERPRETATION Eating problems are still frequent in EPC at school age. They are only partly related to other disabilities but make an additional contribution to continued growth failure and may require early recognition and intervention.
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Affiliation(s)
- Muthanna Samara
- Department of Psychology, University of Warwick, Coventry, UK
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94
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Ross ES, Krebs NF, Shroyer ALW, Dickinson LM, Barrett PH, Johnson SL. Early growth faltering in healthy term infants predicts longitudinal growth. Early Hum Dev 2009; 85:583-8. [PMID: 19608359 PMCID: PMC2741018 DOI: 10.1016/j.earlhumdev.2009.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Revised: 06/13/2009] [Accepted: 06/16/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Early growth monitoring may not identify infants at-risk for later growth faltering because it is difficult for the provider to recognize how large of a negative shift might be problematic. AIM The aim of this study was to determine whether a slowing in early weight-for-age could be used to identify children at increased risk of later growth faltering. METHODS Longitudinal data for infants aged birth to two years were analyzed for 1978 healthy, term infants born between 1999-2001. Logistic regression techniques were used to determine whether a negative change in weight-for-age, across well-child visit intervals, can identify infants at risk for growth faltering. RESULTS The period prevalence of underweight was 24%. The odds ratio (OR) for infants with a negative shift in z-scores>or=-0.85 between four and six months was 2.4 (95% CI 1.5, 3.9) compared to those without this shift, holding birth weight constant. Sensitivity analyses revealed that the model was significant when either the 2000 CDC growth charts (p<0.0001) or the 2006 WHO growth charts (p<0.0001) were used as the reference, although the prevalence of underweight was lower (14.7%) when the 2006 WHO growth charts were the reference. CONCLUSION The findings support the hypothesis that a downward shift in weight-for-age of this magnitude during early infancy when well-child visits are most frequent can be used to identify children at risk of later poor growth.
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95
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Silberstein D, Feldman R, Gardner JM, Karmel BZ, Kuint J, Geva R. The Mother-Infant Feeding Relationship Across the First Year and the Development of Feeding Difficulties in Low-Risk Premature Infants. INFANCY 2009; 14:501-525. [PMID: 32693533 DOI: 10.1080/15250000903144173] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Although feeding problems are common during infancy and are typically accompanied by relational difficulties, little research observed the mother-infant feeding relationship across the first year as an antecedent to the development of feeding difficulties. We followed 76 low-risk premature infants and their mothers from the transition to oral feeding in the neonatal period to the end of the first year. Prior to hospital discharge, microlevel patterns of maternal touch and gaze were coded during feeding and nonfeeding interactions, global patterns of maternal adaptation were assessed, and infants' neurobehavioral status was tested. Psychomotor development was evaluated at 4 months. At 1 year, feeding difficulties were determined on the basis of maternal interview and direct observations of feeding interactions. Mothers of infants who exhibited feeding difficulties at 1 year showed less affectionate touch and gaze during nonfeeding interactions and more gaze aversion and lower adaptability during feeding interactions already in the neonatal period. Infants with feeding difficulties demonstrated poorer psychomotor performance at 4 months. Feeding interactions of infants with feeding difficulties at 1 year were characterized by higher maternal intrusiveness, lower infant involvement, and greater infant withdrawal. Less maternal affectionate touch and lower maternal adaptation in the neonatal period, poor infant psychomotor skills, and higher maternal intrusiveness and lower infant involvement at 1 year predicted feeding difficulties. The findings underscore the role of the relational components across the first year in the development of feeding difficulties.
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Affiliation(s)
- Dalia Silberstein
- Leslie and Susan Gonda (Goldschmied) Multidisciplinary Brain Research Center, Bar Ilan University
| | - Ruth Feldman
- Department of Psychology and The Leslie and Susan Gonda (Goldschmied) Multidisciplinary Brain Research Center, Bar Ilan University
| | | | | | - Jacob Kuint
- Department of Neonatology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, and Tel Aviv University
| | - Ronny Geva
- Department of Psychology and The Leslie and Susan Gonda (Goldschmied) Multidisciplinary Brain Research Center, Bar Ilan University
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96
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Abstract
Nutritional support to promote optimal postnatal growth for very low birth weight (VLBW) newborns less than 1500 g at birth during the initial prolonged hospitalization is a significant issue. This article reviews the concepts involved in the nutritional support of VLBW newborns, including definitions and discussions of growth, optimal postnatal growth, body composition, initial weight loss, growth expectations, growth assessment tools used during the postnatal period, the relation between inadequate nutrition and neurodevelopment, the relation between protein intake and cognitive outcome, postnatal nutrition balance, the potential for programming of future adult-onset chronic conditions, a review of fetal nutritional intake, and current recommendations for nutritional support of VLBW newborns.
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97
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98
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Whyte RK, Kirpalani H, Asztalos EV, Andersen C, Blajchman M, Heddle N, LaCorte M, Robertson CMT, Clarke MC, Vincer MJ, Doyle LW, Roberts RS. Neurodevelopmental outcome of extremely low birth weight infants randomly assigned to restrictive or liberal hemoglobin thresholds for blood transfusion. Pediatrics 2009; 123:207-13. [PMID: 19117884 DOI: 10.1542/peds.2008-0338] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Extremely low birth weight infants frequently receive red cell transfusions. We sought to determine whether a restrictive versus liberal hemoglobin transfusion threshold results in differences in death or adverse neurodevelopmental outcomes of extremely low birth weight infants. PATIENTS AND METHODS Extremely low birth weight infants previously enrolled in the Preterm Infants in Need of Transfusion Trial, a randomized, controlled trial of low versus high hemoglobin transfusion thresholds, were followed up at 18 to 21 months' corrected age. Erythrocyte transfusion was determined by an algorithm of low (restrictive) or high (liberal) hemoglobin transfusion thresholds, differing by 10 to 20 g/L and maintained until first hospital discharge. The primary composite outcome was death or the presence of cerebral palsy, cognitive delay, or severe visual or hearing impairment. RESULTS Of 451 enrolled infants, the primary outcome was available in 430. There was no statistically significant difference in the primary outcome, found in 94 (45%) of 208 in the restrictive group and 82 (38%) of 213 in the liberal group. There were no statistically significant differences in preplanned secondary outcomes. However, the difference in cognitive delay (Mental Development Index score < 70) approached statistical significance. A posthoc analysis with cognitive delay redefined (Mental Development Index score < 85) showed a significant difference favoring the liberal threshold group. CONCLUSIONS Maintaining the hemoglobin of extremely low birth weight infants at these restrictive rather than liberal transfusion thresholds did not result in a statistically significant difference in combined death or severe adverse neurodevelopmental outcome.
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Affiliation(s)
- Robin K Whyte
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.
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99
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Powers GC, Ramamurthy R, Schoolfield J, Matula K. Postdischarge growth and development in a predominantly Hispanic, very low birth weight population. Pediatrics 2008; 122:1258-65. [PMID: 19047243 DOI: 10.1542/peds.2007-3453] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The goals were to assess postdischarge growth and developmental progress of very low birth weight (birth weight: <1500 g) premature infants in a predominantly Hispanic population and to identify predictors for neurodevelopmental impairment at 3 years of age. METHODS A cohort of 135 very low birth weight infants (gestational age: 23 to 35 weeks) were monitored to 3 years of age. Maternal and neonatal characteristics, anthropometric z scores, and developmental performance (using corrected age until 24 months) were analyzed collectively and according to gestational age groups. Specific criteria for failure to thrive and microcephaly were used. RESULTS A characteristic pattern of poor weight gain in the first 12 months was followed by accelerated weight gain starting at 18 months, whereas head growth decreased at 18 months, with recovery beginning at 30 months of age. Infants born at gestational age of <or=26 weeks remained growth-impaired at 3 years of age, whereas infants born at gestational age of >or=27 weeks achieved catch-up growth by 30 months of age. Mean developmental scores also decreased in infancy, with improvements in motor development emerging at 18 months and cognitive skills at 30 months. Growth z scores, particularly for head growth, correlated with developmental scores. Infants born at gestational age of <or=26 weeks were most likely to have neonatal morbidities, failure to thrive, and neurodevelopmental impairment. With adjustment for gestational age and neonatal morbidities, Hispanic acculturation, failure to thrive, and microcephaly were predictive of neurodevelopmental impairment. CONCLUSIONS Very low birth weight infants exhibited growth patterns that coincided with developmental progress in the first 3 years of life. Birth at gestational age of <or=26 weeks was associated with greatest risk for developmental impairment, whereas failure to thrive and microcephaly increased neurodevelopmental impairment risk regardless of gestational age.
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Affiliation(s)
- George C Powers
- Department of Pediatrics, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MSC 7812, San Antonio, TX 78229-3900, USA.
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100
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Abstract
Extrauterine growth restriction (EUGR) is a common condition in very low birth weight (VLBW) preterm infants (< or = 1,500 g). Most affected infants have a birth weight that is average for gestational age, but by the time of hospital discharge have a weight that is less than the tenth percentile for corrected gestational age. EUGR is the most frequent morbidity among VLBW survivors at their time of discharge from the hospital. Studies to elucidate the causes of EUGR have been inconclusive. Recent research has found an association between EUGR, developmental outcomes, and long-term morbidity. Low birth weight has also been associated with chronic diseases later in life. These findings emphasize the critical nature of understanding the phenomenon of EUGR and ways it can be prevented.
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Affiliation(s)
- Valerie A Ruth
- Stanford University Medical Center, Division of Neonatal & Developmental Medicine, Stanford, CA 94305, USA.
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