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Risk Factors of Growth Retardation and Developmental Deficits in Very Preterm Infants in a German Tertiary Neonatal Unit. CHILDREN-BASEL 2021; 8:children8050394. [PMID: 34068894 PMCID: PMC8156291 DOI: 10.3390/children8050394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 11/16/2022]
Abstract
Over the last two decades, improvements in perinatology have led to increased survival rates of preterm infants. A large number of studies and meta-analyses have investigated of preterm infants and/or the influence of developmental care. However, the combined influence of the most frequent risk factors and developmental care on the long-term somatic, motor, and cognitive outcome of preterm infants remains unclear. This retrospective, single-center cohort study includes 256 children treated in a tertiary neonatal intensive care unit in Rostock, Germany, between 2008 and 2013. Follow-up examinations (somatic, psychomotor, and mental development) were performed at (corrected) 24 months using Bayley Scales of Infant Development II (BSID-II). Developmental care was carried out according to the legal framework and national guidelines (physiotherapy and/or early education). Bronchopulmonary dysplasia (BPD) and an exclusive formula feeding showed a 2.8–4.6-fold higher risk (95% Confidence Interval: Mental Developmental Index 1.73–7.58; Psychomotor Developmental Index 1.44–14.54; body length 1.20–6.41) for developmental deficits (mental and psychomotor developmental index; body length). Developmental care after discharge according to national guidelines did not prevent this. Since this is a retrospective pilot study, no recommendations can be made based on this analysis. Therefore, future research should evaluate whether standard developmental care should be extended by tailored measures depending on individual risk factors.
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Gao C, Ehsan L, Jones M, Khan M, Middleton J, Vergales B, Perks P, Syed S. Time to regain birth weight predicts neonatal growth velocity: A single-center experience. Clin Nutr ESPEN 2020; 38:165-171. [PMID: 32690152 DOI: 10.1016/j.clnesp.2020.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/18/2020] [Accepted: 05/21/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Failure to Thrive (FTT) describes the development of an inappropriate pattern of growth, generally secondary to inadequate nutritional intake, and is associated with several negative outcomes. We describe key features among neonates with FTT as well as the variables that predicted their growth after birth at a Neonatal Intensive Care Unit. METHODS A retrospective single center study of 340 patients grouped into FTT (n = 100) and non-FTT (n = 240) was conducted. FTT was defined as having a weight <10th percentile on the Fenton 2013 curve at the time of discharge. For analyzing growth velocity, 204 patients were grouped into 4 quartiles based on their calculated growth velocity (grams/kilograms/day [g/kg/day]; 4th quartile had the highest velocity). Multivariate regression models were used to identify predictors of growth velocity. RESULTS When comparing FTT vs. non-FTT patients, lower birth weights (1897.9 ± 561.4 vs. 2445.9 ± 783.0 g, t(255.1) = -7.2, p < 0.001) and higher growth velocities (9.2 ± 3.9 vs. 8.0 ± 4.1 g/kg/day, t(153.6) = 2.2, p = 0.03) were noted. Among patients with higher growth velocities, birth weights were lower (1st to 4th quartiles: 2474.0 ± 677.0, 2000.0 ± 297.0, 1715.0 ± 285.0, 1533.0 ± 332.0 g, F(3, 200) = 46.5, p < 0.001, adjusted R2 = 0.4). Days to regain birth weight was the most consistent predictor of growth velocity in our overall patient sample (β [SE] = -0.3 [0.03], p < 0.001) and in the lowest growth velocity quartile subgroup (β [SE] = -0.3 [0.04], p < 0.001). CONCLUSIONS Days to regain birth weight was consistently the strongest predictor of neonatal growth velocity along with difference in gender positive predicting growth velocity in the total sample. This highlights the importance of the first week of life in growth pattern establishment.
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Affiliation(s)
- Calvin Gao
- School of Medicine, University of Virginia, Charlottesville, VA, USA; Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, OH, USA
| | - Lubaina Ehsan
- Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Marieke Jones
- Claude Moore Health Sciences Library, University of Virginia, Charlottesville, VA, USA
| | - Marium Khan
- Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Jeremy Middleton
- Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Brooke Vergales
- School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Patti Perks
- School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Sana Syed
- Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, VA, USA.
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Kashaki M, Samghabadi FM, Bordbar A. Effect of Fortification of Breast Milk in Conjugation with Protein Supplement on Neurodevelopment of Preterm Low Birth Weight Infants at 3 Years. Med Arch 2019; 73:344-350. [PMID: 31819309 PMCID: PMC6885211 DOI: 10.5455/medarh.2019.73.344-350] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 10/05/2019] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Choice of appropriate nutrition has a special place, which variations in dietary nutrient can potentially be involved in growth deficits in preterm neonates. AIM to investigate the effect of protein supplementation in very low birth weight (VLBW= birth weight under 1500 grams) infants on neurological growth in the third year of birth. MATERIAL AND METHODS We investigated neurological growth in two groups of control and intervention (each group, n= 18 subjects). The intervention group includes 3-year-old children who weighting less than 1200 grams at birth and have received protein supplementation at the course of NICU hospitalization, protein was added to maternal milk when the amount of milk reaches to 100 cc/kg/day, at this time parenteral nutrition was discontinued and the volume of feeding was increased 20cc/kg/day until reached to 150-180cc/kg/day. We also added the fortifier to breast milk at this time (FMS- Aptamil- DANON). The fortification and the protein supplementation were stopped when the weight of the baby reached to 1500 grams. The control group was fed similar to the intervention group, without protein supplemental intake. Neurodevelopmental outcomes were evaluated using ASQ, NEWSHA and BINS tools. RESULTS There was no significant difference between the mean head circumference in the two groups (p=0.209). There was no significant relationship between neurological growth rate evaluated by BINS tool in two groups (p=0.266). There was a significant correlation between the neurological development assessed by the ASQ tool in the areas of communication (p=0.014) and gross motor (p=0.001) in the two groups, however, no significant relationship was found in terms of fine motor (p=0.63), problem solving (p=0.07) and personal-social relationships in both groups (p=0.152). There was a significant correlation between neurological development evaluated using the NEWSHA tool in terms of auditory (p=0.031), verbal language (p=0.024), cognitive (p=0.007), social connection (p=0.034) and motor (p=0.002) in the two groups. CONCLUSION Protein intake in preterm infants didn't reveal long term effects on the growth of head circumference. Moreover, it was capable of improving neurological growth in the areas of communication and gross motor (based on the ASQ) and auditory, verbal language, cognitive, social connection, and motor (based on the NEWSHA).
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Affiliation(s)
- Mandana Kashaki
- Shahid Akbarabadi Clinical Research Development Unit (ShACRDU), Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Fatemeh Masoudi Samghabadi
- Shahid Akbarabadi Clinical Research Development Unit (ShACRDU), Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Arash Bordbar
- Shahid Akbarabadi Clinical Research Development Unit (ShACRDU), Iran University of Medical Sciences (IUMS), Tehran, Iran
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Kumar RK, Singhal A, Vaidya U, Banerjee S, Anwar F, Rao S. Optimizing Nutrition in Preterm Low Birth Weight Infants-Consensus Summary. Front Nutr 2017; 4:20. [PMID: 28603716 PMCID: PMC5445116 DOI: 10.3389/fnut.2017.00020] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 04/29/2017] [Indexed: 12/19/2022] Open
Abstract
Preterm birth survivors are at a higher risk of growth and developmental disabilities compared to their term counterparts. Development of strategies to lower the complications of preterm birth forms the rising need of the hour. Appropriate nutrition is essential for the growth and development of preterm infants. Early administration of optimal nutrition to preterm birth survivors lowers the risk of adverse health outcomes and improves cognition in adulthood. A group of neonatologists, pediatricians, and nutrition experts convened to discuss and frame evidence-based recommendations for optimizing nutrition in preterm low birth weight (LBW) infants. The following were the primary recommendations of the panel: (1) enteral feeding is safe and may be preferred to parenteral nutrition due to the complications associated with the latter; however, parenteral nutrition may be a useful adjunct to enteral feeding in some critical cases; (2) early, fast, or continuous enteral feeding yields better outcomes compared to late, slow, or intermittent feeding, respectively; (3) routine use of nasogastric tubes is not advisable; (4) preterm infants can be fed while on ventilator or continuous positive airway pressure; (5) routine evaluation of gastric residuals and abdominal girth should be avoided; (6) expressed breast milk (EBM) is the first choice for feeding preterm infants due to its beneficial effects on cardiovascular, neurological, bone health, and growth outcomes; the second choice is donor pasteurized human milk; (7) EBM or donor milk may be fortified with human milk fortifiers, without increasing the osmolality of the milk, to meet the high protein requirements of preterm infants; (8) standard fortification is effective and safe but does not fulfill the high protein needs; (9) use of targeted and adjustable fortification, where possible, helps provide optimal nutrition; (10) optimizing weight gain in preterm infants prevents long-term cardiovascular complications; (11) checking for optimal weight and sucking/swallowing ability is essential prior to discharge of preterm infants; and (12) appropriate counseling and regular follow-up and monitoring after discharge will help achieve better long-term health outcomes. This consensus summary serves as a useful guide to clinicians in addressing the challenges and providing optimal nutrition to preterm LBW infants.
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Affiliation(s)
| | - Atul Singhal
- Institute of Child Health, UCL, London, United Kingdom
| | | | | | - Fahmina Anwar
- Medical and Scientific Affairs, Nestle Nutrition, South Asia Region, Gurgaon, India
| | - Shashidhar Rao
- Medical and Scientific Affairs, Nestle Nutrition, South Asia Region, Gurgaon, India
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Raiten DJ, Steiber AL, Carlson SE, Griffin I, Anderson D, Hay WW, Robins S, Neu J, Georgieff MK, Groh-Wargo S, Fenton TR. Working group reports: evaluation of the evidence to support practice guidelines for nutritional care of preterm infants-the Pre-B Project. Am J Clin Nutr 2016; 103:648S-78S. [PMID: 26791182 PMCID: PMC6459074 DOI: 10.3945/ajcn.115.117309] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The "Evaluation of the Evidence to Support Practice Guidelines for the Nutritional Care of Preterm Infants: The Pre-B Project" is the first phase in a process to present the current state of knowledge and to support the development of evidence-informed guidance for the nutritional care of preterm and high-risk newborn infants. The future systematic reviews that will ultimately provide the underpinning for guideline development will be conducted by the Academy of Nutrition and Dietetics' Evidence Analysis Library (EAL). To accomplish the objectives of this first phase, the Pre-B Project organizers established 4 working groups (WGs) to address the following themes: 1) nutrient specifications for preterm infants, 2) clinical and practical issues in enteral feeding of preterm infants, 3) gastrointestinal and surgical issues, and 4) current standards of infant feeding. Each WG was asked to 1) develop a series of topics relevant to their respective themes, 2) identify questions for which there is sufficient evidence to support a systematic review process conducted by the EAL, and 3) develop a research agenda to address priority gaps in our understanding of the role of nutrition in health and development of preterm/neonatal intensive care unit infants. This article is a summary of the reports from the 4 Pre-B WGs.
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Affiliation(s)
- Daniel J Raiten
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD;
| | | | | | | | | | | | - Sandra Robins
- Fairfax Neonatal Associates at Inova Children's Hospital, Fairfax, VA
| | - Josef Neu
- University of Florida, Gainesville, FL
| | | | - Sharon Groh-Wargo
- Case Western Reserve University-School of Medicine, Cleveland, OH; and
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Rozé JC, Darmaun D, Boquien CY, Flamant C, Picaud JC, Savagner C, Claris O, Lapillonne A, Mitanchez D, Branger B, Simeoni U, Kaminski M, Ancel PY. The apparent breastfeeding paradox in very preterm infants: relationship between breast feeding, early weight gain and neurodevelopment based on results from two cohorts, EPIPAGE and LIFT. BMJ Open 2012; 2:e000834. [PMID: 22492388 PMCID: PMC3323805 DOI: 10.1136/bmjopen-2012-000834] [Citation(s) in RCA: 141] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
CONTEXT Supplementation of breast milk is difficult once infants suckle the breast and is often discontinued at end of hospitalisation and after discharge. Thus, breastfed preterm infants are exposed to an increased risk of nutritional deficit with a possible consequence on neurodevelopmental outcome. OBJECTIVE To assess the relationship between breast feeding at time of discharge, weight gain during hospitalisation and neurodevelopmental outcome. DESIGN Observational cohort study. SETTING Two large, independent population-based cohorts of very preterm infants: the Loire Infant Follow-up Team (LIFT) and the EPIPAGE cohorts. PATIENTS 2925 very preterm infants alive at discharge. MAIN OUTCOME MEASURE Suboptimal neurodevelopmental outcome, defined as a score in the lower tercile, using Age and Stages Questionnaire at 2 years in LIFT and Kaufman Assessment Battery for Children Test at 5 years in EPIPAGE. Two propensity scores for breast feeding at discharge, one for each cohort, were used to reduce bias. RESULTS Breast feeding at time of discharge concerned only 278/1733 (16%) infants in LIFT and 409/2163 (19%) infants in EPIPAGE cohort. Breast feeding is significantly associated with an increased risk of losing one weight Z-score during hospitalisation (LIFT: n=1463, adjusted odd ratio (aOR)=2.51 (95% CI 1.87 to 3.36); EPIPAGE: n=1417, aOR=1.55 (95% CI 1.14 to 2.12)) and with a decreased risk for a suboptimal neurodevelopmental assessment (LIFT: n=1463, aOR=0.63 (95% CI 0.45 to 0.87); EPIPAGE: n=1441, aOR=0.65 (95% CI 0.47 to 0.89) and an increased chance of having a head circumference Z-score higher than 0.5 at 2 years in LIFT cohort (n=1276, aOR=1.43 (95% CI 1.02 to 2.02)) and at 5 years in EPIPAGE cohort (n=1412, aOR=1.47 (95% CI 1.10 to 1.95)). CONCLUSIONS The observed better neurodevelopment in spite of suboptimal initial weight gain could be termed the 'apparent breastfeeding paradox' in very preterm infants. Regardless of the mechanisms involved, the current data provide encouragement for the use of breast feeding in preterm infants.
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Affiliation(s)
- Jean-Christophe Rozé
- Department of Neonatal Medicine, Nantes University, CHU of Nantes, Nantes, France
- Centre d'Investigation Clinique INSERM CIC004, CHU de Nantes, Nantes, France
- INRA UMR 1280, Physiologie des Adaptations Nutritionnelles, Nantes University, Nantes, France
- “Loire Infant Follow-up Team” (LIFT) Network, Ppays de Loire, France
| | - Dominique Darmaun
- “Loire Infant Follow-up Team” (LIFT) Network, Ppays de Loire, France
| | | | - Cyril Flamant
- Department of Neonatal Medicine, Nantes University, CHU of Nantes, Nantes, France
- Centre d'Investigation Clinique INSERM CIC004, CHU de Nantes, Nantes, France
- INRA UMR 1280, Physiologie des Adaptations Nutritionnelles, Nantes University, Nantes, France
| | - Jean-Charles Picaud
- Department of Neonatal Medicine, Hopital de la Croix-Rousse, CHU de Lyon, Lyon, France
| | | | - Olivier Claris
- Department of Neonatal Medicine, Hôpital Edouard Herriot, Lyon, France
| | - Alexandre Lapillonne
- Paris Descartes University, Assistance Publique-Hôpitaux de Paris, Necker hospital, Paris, France
| | - Delphine Mitanchez
- Assistance Publique-Hôpitaux de Paris, Réanimation Néonatale et Pédiatrique, Hôpital Trousseau, Paris, France
- UPMC, Université Paris, Paris, France
| | - Bernard Branger
- INRA UMR 1280, Physiologie des Adaptations Nutritionnelles, Nantes University, Nantes, France
| | - Umberto Simeoni
- Neonatal Intensive Care Unit, La Conception University Hospital, Marseille, France
| | - Monique Kaminski
- INSERM, UMR 953, Epidemiological Research in Perinatal Health and Women's and Children Health, Hôpital Tenon, Paris, France
| | - Pierre-Yves Ancel
- INSERM, UMR 953, Epidemiological Research in Perinatal Health and Women's and Children Health, Hôpital Tenon, Paris, France
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