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Mustapha M, Blair H, Leake N, Johnson V, van den Akker CHP, Embleton ND. The evolution of nutritional care in preterm infants with a focus on the extreme preterm infant. J Hum Nutr Diet 2024. [PMID: 39054762 DOI: 10.1111/jhn.13353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 07/08/2024] [Indexed: 07/27/2024]
Abstract
The evolution of nutritional care in preterm infants, particularly those classified as extremely preterm, has undergone significant advancements in recent years. These infants, born at less than 28 weeks of gestation, face unique challenges related to their elevated nutrient requirements, underdeveloped organ systems and minimal reserves, posing a need for timely and specialised nutritional strategies. Historically, the nutritional management of preterm infants focussed on short-term goals to promote survival. In recent years, the focus has shifted to the quality of nutrient provision to optimise neurodevelopment and longer-term health outcomes. This review highlights the shift from a generalised nutritional approach to a robust, evidence-based approach for preterm infants, acknowledging the intricate interplay between nutrition, holistic care and developmental outcomes. As neonatal care continues to evolve, ongoing research will refine nutritional interventions, optimise growth and enhance the long-term health outcomes of these vulnerable infants.
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Affiliation(s)
| | | | - Nadia Leake
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | - Chris H P van den Akker
- Department of Pediatrics-Neonatology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Emma Children's Hospital, University of Amsterdam, Amsterdam, The Netherlands
| | - Nicholas D Embleton
- Ward 35, Royal Victoria Infirmary, Newcastle Hospitals NHS Trust, Newcastle upon Tyne, UK
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2
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Wilson BM, Ko FC, Moran MM, Adra A, Rasmussen MB, Thymann T, Sangild PT, Sumner DR. Skeletal consequences of preterm birth in pigs as a model for preterm infants. J Bone Miner Res 2024; 39:791-803. [PMID: 38655758 DOI: 10.1093/jbmr/zjae064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 03/18/2024] [Accepted: 04/22/2024] [Indexed: 04/26/2024]
Abstract
Preterm birth affects about 10% of all live births with many resultant health challenges, including metabolic bone disease of prematurity (MBDP), which is characterized by elevated alkaline phosphatase, suppressed phosphate, and deficient skeletal development. Because of the lack of an animal model, very little is known about bone structure, strength, and quality after preterm birth. This study investigated the utility of a pig model to replicate clinical features of preterm birth, including MBDP, and sought to determine if early postnatal administration of IGF-1 was an effective treatment. Preterm pigs, born by caesarean section at 90% gestation, were reared in intensive care facilities (respiratory, thermoregulatory, and nutritional support) and compared with sow-reared term pigs born vaginally. Preterm pigs were systemically treated with vehicle or IGF-1 (recombinant human IGF-1/BP-3, 2.25 mg/kg/d). Tissues were collected at postnatal days 1, 5, and 19 (the normal weaning period in pigs). Most bone-related outcomes were affected by preterm birth throughout the study period, whereas IGF-1 supplementation had almost no effect. By day 19, alkaline phosphatase was elevated, phosphate and calcium were reduced, and the bone resorption marker C-terminal crosslinks of type I collagen was elevated in preterm pigs compared to term pigs. Preterm pigs also had decrements in femoral cortical cross-sectional properties, consistent with reduced whole-bone strength. Thus, the preterm pig model replicates many features of preterm bone development in infants, including features of MBDP, and allows for direct interrogation of skeletal tissues, enhancing the field's ability to examine underlying mechanisms.
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Affiliation(s)
- Brittany M Wilson
- Department of Anatomy & Cell Biology, Rush University Medical Center, Chicago, IL, 60612, United States
| | - Frank C Ko
- Department of Anatomy & Cell Biology, Rush University Medical Center, Chicago, IL, 60612, United States
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, 60612, United States
| | - Meghan M Moran
- Department of Anatomy & Cell Biology, Rush University Medical Center, Chicago, IL, 60612, United States
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, 60612, United States
| | - Amal Adra
- Department of Anatomy & Cell Biology, Rush University Medical Center, Chicago, IL, 60612, United States
| | - Martin B Rasmussen
- Comparative Pediatrics and Nutrition, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, DK-1958, Denmark
| | - Thomas Thymann
- Comparative Pediatrics and Nutrition, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, DK-1958, Denmark
| | - Per T Sangild
- Comparative Pediatrics and Nutrition, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, DK-1958, Denmark
- Department of Neonatology, Rigshospitalet, Copenhagen, DK-2100, Denmark
- Department of Pediatrics, Odense University Hospital, Odense, DK-5000, Denmark
- Faculty of Theology, University of Copenhagen, Copenhagen, DK-2300, Denmark
| | - Dale Rick Sumner
- Department of Anatomy & Cell Biology, Rush University Medical Center, Chicago, IL, 60612, United States
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, 60612, United States
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van de Lagemaat M, Ruys CA, Muts J, Finken MJ, Rotteveel J, van Goudoever JB, Lafeber HN, van den Akker CH, Schrijver-Levie NS, Boonstra V, von Lindern JS, de Winter P, van Brakel MJ, Drewes AJ, Westra M. Growth and body composition of infants born moderate-to-late preterm fed a protein- and mineral-enriched postdischarge formula compared with a standard term formula until 6 months corrected age, a randomized controlled trial. Am J Clin Nutr 2024; 120:111-120. [PMID: 38719093 DOI: 10.1016/j.ajcnut.2024.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 04/25/2024] [Accepted: 04/29/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Infants born moderate-to-late preterm (i.e., 32 wk-35 wk 6 d gestation) are, analogous to those born very preterm, at risk of later obesity, hypertension, and diabetes. Appropriate early life nutrition is key for ensuring optimal growth and body composition, thereby mitigating potential cardiometabolic risks. OBJECTIVES We aimed to compare growth and body composition between infants born moderate-to-late preterm fed isocaloric but protein- and mineral-enriched postdischarge formula (PDF) or standard term formula (STF) until 6 mo corrected age (CA; i.e., after term equivalent age [TEA]). METHODS After enrollment (≤7 d postpartum), infants received PDF if (fortified) mother's own milk (MOM) was insufficient. At TEA, those receiving >25% of intake as formula were randomized to either continue the same PDF (n = 47) or switch to STF (n = 50); those receiving ≥75% of intake as MOM (n = 60) served as references. At TEA and 6 mo CA, we assessed anthropometry and body composition using both dual-energy x-ray absorptiometry (DXA) and air displacement plethysmography (ADP). RESULTS Feeding groups had similar gestational age (median [25th percentile;75th percentile]: 34.3 [33.5; 35.1] wk), birthweight (mean ± standard deviation [SD]: 2175 ± 412 g), anthropometry, and body composition at TEA. At 6 mo CA, infants fed PDF had slightly, but significantly, greater length (67.6 ± 2.5 and 66.9 ± 2.6 cm, P < 0.05) and larger head circumference (43.9 ± 1.3 and 43.4 ± 1.5 cm, P < 0.05) compared to infants fed STF. Also, infants fed PDF had higher lean mass (LM) and bone mineral content estimated by DXA (4772 ± 675 and 4502 ± 741 g; 140 ± 20 and 131 ± 23 g, respectively; P < 0.05). ADP estimates, however, were not statistically different between feeding groups. CONCLUSIONS Infants born moderate-to-late preterm demonstrated modest increases in length, head circumference, LM, and bone mineral content when fed PDF compared to STF for 6 mo after TEA. This trial was registered at the International Clinical Trial Registry Platform as NTR5117 and NTR NL4979.
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Affiliation(s)
- Monique van de Lagemaat
- Department of Pediatrics/Neonatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands.
| | - Charlotte A Ruys
- Department of Pediatrics/Neonatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Jacqueline Muts
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Martijn Jj Finken
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands; Department of Pediatric Endocrinology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Joost Rotteveel
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands; Department of Pediatric Endocrinology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Johannes B van Goudoever
- Department of Pediatrics/Neonatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Harrie N Lafeber
- Department of Pediatrics/Neonatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Chris Hp van den Akker
- Department of Pediatrics/Neonatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
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Liu X, Wang L, Qian M. Analysis of clinical risk factors for metabolic bone disease of prematurity. Front Pediatr 2024; 12:1345878. [PMID: 38818348 PMCID: PMC11137184 DOI: 10.3389/fped.2024.1345878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/09/2024] [Indexed: 06/01/2024] Open
Abstract
Objective To analyze clinical data related to preterm infants and identify risk factors for metabolic bone disease of prematurity (MBDP). Methods This study involved 856 newborns with a gestational age of less than 37 weeks or a weight of less than 1,500g at the Second Hospital of Jilin University. Multifactorial analysis was performed using logistic regression models to explore the risk factors for MBDP. Linear regression was used to investigate the factors affecting the time of alkaline phosphatase (ALP) exceedance and the peak value of ALP in the MBDP group. Results In the MBDP group, ALP excesses occurred in preterm infants at an average of 39.33 days after birth, and the mean value of peak ALP was 691.41 IU/L. Parenteral nutrition and the application of assisted ventilation were independent risk factors for MBDP, with ORs of 1.02 and 1.03 respectively. Gestational age was found to be a protective factor for earlier time of onset of ALP exceedance (β = 2.24,) and the increase in the peak value of ALP (β = -16.30). Conclusion Parenteral nutrition and the application of assisted ventilation are independent risk factors for MBDP. Gestational age is a major factor influencing the time of onset of ALP exceedance and the peak value of ALP in infants with MBDP.
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Affiliation(s)
- Xiumin Liu
- Department of Clinical Laboratory, The Second Hospital of Jilin University, Changchun City, Jilin Province, China
| | - Ling Wang
- Chongqing Yubei Center for Disease Control and Prevention, Chongqing, China
| | - Min Qian
- Department of Neonatology, The Second Hospital of Jilin University, Changchun City, Jilin Province, China
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Cui A, Xiao P, Wei X, Wen H, Liang S, Wang P, He J, Zhuang Y. Associations Between Serum Selenium and Bone Mineral Density in 8-19-year-old children and adolescents: NHANES 2013-2018. Biol Trace Elem Res 2024; 202:1928-1936. [PMID: 37606880 DOI: 10.1007/s12011-023-03808-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/07/2023] [Indexed: 08/23/2023]
Abstract
The peak bone mass (PBM) in puberty has been proven to be a critical determinant of osteoporosis and brittle fractures in the elderly. Selenium is an essential trace element that could influence bone metabolism in our bodies. However, no study has investigated the impact of selenium status on bone mineral density (BMD) among children and adolescents. This was a cross-section study from National Health and Nutrition Examination Survey (NHANES) in the USA involving participants aged 8-19 years. We conducted multiple linear regression models to assess the relationship between selenium status and BMD among children and adolescents, and then stratified analyses were performed according to genders and races. Smooth curve fits and two-piecewise linear regression models were conducted to explore their nonlinear relationship. A total of 4570 participants (2338 boys and 2232 girls) were included in the present study, with a mean age of 13.57 ± 3.41 years. In the multivariable adjustment model, serum selenium was positively associated with lumbar spine BMD (β = 0.021 95% CI: 0.008, 0.034, P = 0.001). The dose-response analyses indicated a non-linear inverted U-shaped relationship between serum selenium and lumbar spine BMD. Lower and higher selenium concentrations were related to decreased BMD, and the inflection point of serum selenium was 2.60 umol/L. The inverted U-shaped association was also observed in females (inflection point: 2.49 umol/L), males (inflection point: 2.65 umol/L), Non-Hispanic White (inflection point: 2.50 umol/L), Non-Hispanic Black (inflection point: 2.50 umol/L), and other races (Including multi-racial) (inflection point: 2.81 umol/L). Our study first shows a non-linear inversed U-shaped association between selenium status and BMD among children and adolescents. The proper selenium status will benefit bone health in children and adolescents. More research is still required to verify our findings and their potential mechanisms.
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Affiliation(s)
- Aiyong Cui
- Department of Orthopaedics, Honghui Hospital, Xi'an Jiao Tong University, Xi'an, 710000, China
| | - Peilun Xiao
- Department of Orthopaedics, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China
| | - Xing Wei
- Department of Orthopaedics, Honghui Hospital, Xi'an Jiao Tong University, Xi'an, 710000, China
| | - Hongquan Wen
- Department of Orthopaedics, Honghui Hospital, Xi'an Jiao Tong University, Xi'an, 710000, China
| | - Shaobo Liang
- Department of Orthopaedics, Honghui Hospital, Xi'an Jiao Tong University, Xi'an, 710000, China
| | - Pengfei Wang
- Department of Orthopaedics, Honghui Hospital, Xi'an Jiao Tong University, Xi'an, 710000, China.
| | - Jing He
- Department of Orthopaedics, Honghui Hospital, Xi'an Jiao Tong University, Xi'an, 710000, China.
| | - Yan Zhuang
- Department of Orthopaedics, Honghui Hospital, Xi'an Jiao Tong University, Xi'an, 710000, China.
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Pagano F, Gaeta E, Morlino F, Riccio MT, Giordano M, De Bernardo G. Long-term benefits of exclusive human milk diet in small for gestational age neonates: a systematic review of the literature. Ital J Pediatr 2024; 50:88. [PMID: 38679716 PMCID: PMC11057117 DOI: 10.1186/s13052-024-01648-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 04/07/2024] [Indexed: 05/01/2024] Open
Abstract
Evidence about feeding practices' consequences in small for gestational age newborns is not well established because they are less likely to initiate and continue breastfeeding than other newborns. Our aim was to study current knowledge about the benefits of exclusive human milk diet after 2 years of age in small for gestational age newborns. A systematic review of the literature was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline criteria. Pubmed and Scopus were searched for studies published from databases inception until June 2, 2023. Included articles were analysed and synthesised. Risk of bias and level of evidence assessments were performed. They were enrolled small for gestational age newborns fed by breastfeeding, breast milk or donor milk. The systematic review included 9 articles which were related to 4 health domains: neurodevelopment, cardiovascular, somatic growth and bone mineralization and atopy. Extracted data support a beneficial effect of breastfeeding on these outcomes. Better quality of evidence and longer follow-up are needed.
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Affiliation(s)
- Federica Pagano
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Emanuele Gaeta
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Francesca Morlino
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Maria Teresa Riccio
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Maurizio Giordano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Giuseppe De Bernardo
- Department of Woman and Child, Ospedale Buon Consiglio Fatebenefratelli, Naples, Italy.
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Sánchez-González JL, Sanz-Esteban I, Menéndez-Pardiñas M, Navarro-López V, Sanz-Mengíbar JM. Critical review of the evidence for Vojta Therapy: a systematic review and meta-analysis. Front Neurol 2024; 15:1391448. [PMID: 38711552 PMCID: PMC11070493 DOI: 10.3389/fneur.2024.1391448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 03/29/2024] [Indexed: 05/08/2024] Open
Abstract
Introduction It is essential to link the theoretical framework of any neurophysiotherapy approach with a detailed analysis of the central motor control mechanisms that influence motor behavior. Vojta therapy (VT) falls within interventions aiming to modify neuronal activity. Although it is often mistakenly perceived as exclusively pediatric, its utility spans various functional disorders by acting on central pattern modulation. This study aims to review the existing evidence on the effectiveness of VT across a wide range of conditions, both in the adult population and in pediatrics, and analyze common therapeutic mechanisms, focusing on motor control modulation. Aim The goals of this systematic review are to delineate the existing body of evidence concerning the efficacy of Vojta therapy (VT) in treating a broad range of conditions, as well as understand the common therapeutic mechanisms underlying VT with a specific focus on the neuromodulation of motor control parameters. Methods PubMed, Cochrane Library, SCOPUS, Web of Science, and Embase databases were searched for eligible studies. The methodological quality of the studies was assessed using the PEDro list and the Risk-Of-Bias Tool to assess the risk of bias in randomized trials. Methodological quality was evaluated using the Risk-Of-Bias Tool for randomized trials. Random-effects meta-analyses with 95% CI were used to quantify the change scores between the VT and control groups. The certainty of our findings (the closeness of the estimated effect to the true effect) was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). Results Fifty-five studies were included in the qualitative analysis and 18 in the meta-analysis. Significant differences in cortical activity (p = 0.0001) and muscle activity (p = 0.001) were observed in adults undergoing VT compared to the control, as well as in balance in those living with multiple sclerosis (p < 0.03). Non-significant differences were found in the meta-analysis when evaluating gross motor function, oxygen saturation, respiratory rate, height, and head circumference in pediatrics. Conclusion Although current evidence supporting VT is limited in quality, there are indications suggesting its potential usefulness for the treatment of respiratory, neurological, and orthopedic pathology. This systematic review and meta-analysis show the robustness of the neurophysiological mechanisms of VT, and that it could be an effective tool for the treatment of balance in adult neurological pathology. Neuromodulation of motor control areas has been confirmed by research focusing on the neurophysiological mechanisms underlying the therapeutic efficacy of VT.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=476848, CRD42023476848.
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Affiliation(s)
- Juan Luis Sánchez-González
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Ismael Sanz-Esteban
- Department of Physiotherapy, Physical Therapy and Health Sciences Research Group, Universidad Europea de Madrid, Madrid, Spain
| | - Mónica Menéndez-Pardiñas
- Early Intervention and Child Rehabilitation Department, Women & Children’s “Teresa Herrera Hospital”, A Coruña University Hospital (CHUAC), A Coruña, Spain
- Physiotherapy, Medicine and Biomedical Sciences Department, University of A Coruña, A Coruña, Spain
| | - Víctor Navarro-López
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Madrid, Spain
| | - José Manuel Sanz-Mengíbar
- Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, University College London Queen Square, London, United Kingdom
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Embleton ND, Chmelova K. Oropharyngeal colostrum and reduction in mortality for preterm infants. J Pediatr (Rio J) 2024; 100:1-3. [PMID: 37832592 PMCID: PMC10751687 DOI: 10.1016/j.jped.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2023] Open
Affiliation(s)
- Nicholas D Embleton
- Newcastle Neonatal Service, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.
| | - Kristina Chmelova
- Newcastle Neonatal Service, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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Dao T, Robinson DL, Doyle LW, Lee PVS, Olsen J, Kale A, Cheong JLY, Wark JD. Quantifying Bone Strength Deficits in Young Adults Born Extremely Preterm or Extremely Low Birth Weight. J Bone Miner Res 2023; 38:1800-1808. [PMID: 37850817 PMCID: PMC10946901 DOI: 10.1002/jbmr.4926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 08/28/2023] [Accepted: 10/13/2023] [Indexed: 10/19/2023]
Abstract
The long-term bone health of young adults born extremely preterm (EP; <28 weeks' gestation) or extremely low birth weight (ELBW; <1000 g birth weight) in the post-surfactant era (since the early 1990s) is unclear. This study investigated their bone structure and estimated bone strength using peripheral quantitative computed tomography (pQCT)-based finite element modeling (pQCT-FEM). Results using this technique have been associated with bone fragility in several clinical settings. Participants comprised 161 EP/ELBW survivors (46.0% male) and 122 contemporaneous term-born (44.3% male), normal birth weight controls born in Victoria, Australia, during 1991-1992. At age 25 years, participants underwent pQCT at 4% and 66% of tibia and radius length, which was analyzed using pQCT-FEM. Groups were compared using linear regression and adjusted for height and weight. An interaction term between group and sex was added to assess group differences between sexes. Parameters measured included compressive stiffness (kcomp ), torsional stiffness (ktorsion ), and bending stiffness (kbend ). EP/ELBW survivors were shorter than the controls, but their weights were similar. Several unadjusted tibial pQCT-FEM parameters were lower in the EP/ELBW group. Height- and weight-adjusted ktorsion at 66% tibia remained lower in EP/ELBW (mean difference [95% confidence interval] -180 [-352, -8] Nm/deg). The evidence for group differences in ktorsion and kbend at 66% tibia was stronger among males than females (pinteractions <0.05). There was little evidence for group differences in adjusted radial models. Lower height- and weight-adjusted pQCT-FEM measures in EP/ELBW compared with controls suggest a clinically relevant increase in predicted long-term fracture risk in EP/ELBW survivors, particularly males. Future pQCT-FEM studies should utilize the tibial pQCT images because of the greater variability in the radius possibly related to lower measurement precision. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Thang Dao
- Melbourne Medical SchoolThe University of MelbourneMelbourneAustralia
| | - Dale Lee Robinson
- Department of Biomedical EngineeringUniversity of MelbourneMelbourneAustralia
| | - Lex W Doyle
- Clinical SciencesMurdoch Children's Research InstituteMelbourneAustralia
- Department of Obstetrics and GynecologyUniversity of MelbourneMelbourneAustralia
- Newborn ResearchRoyal Women's HospitalMelbourneAustralia
- Department of PediatricsUniversity of MelbourneMelbourneAustralia
| | - Peter VS Lee
- Department of Biomedical EngineeringUniversity of MelbourneMelbourneAustralia
| | - Joy Olsen
- Clinical SciencesMurdoch Children's Research InstituteMelbourneAustralia
| | - Ashwini Kale
- Department of Medicine, The Royal Melbourne HospitalThe University of MelbourneMelbourneAustralia
- Bone and Mineral Medicine, Department of Diabetes and EndocrinologyThe Royal Melbourne HospitalMelbourneAustralia
| | - Jeanie LY Cheong
- Clinical SciencesMurdoch Children's Research InstituteMelbourneAustralia
- Department of Obstetrics and GynecologyUniversity of MelbourneMelbourneAustralia
- Newborn ResearchRoyal Women's HospitalMelbourneAustralia
| | - John D Wark
- Department of Medicine, The Royal Melbourne HospitalThe University of MelbourneMelbourneAustralia
- Bone and Mineral Medicine, Department of Diabetes and EndocrinologyThe Royal Melbourne HospitalMelbourneAustralia
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Wu TM, Chin LS. Spontaneous long bone fractures in metabolic bone disease of prematurity: A case series and literature review. J Orthop Sci 2023; 28:1518-1524. [PMID: 34711491 DOI: 10.1016/j.jos.2021.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 08/02/2021] [Accepted: 08/22/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Tsung-Mu Wu
- Chi-Mei Medical Center, Orthopedic Department, No.901, Zhonghua Rd., Yongkang Dist., Tainan City, Taiwan.
| | - Lin-Shaw Chin
- Chi-Mei Medical Center, Orthopedic Department, No.901, Zhonghua Rd., Yongkang Dist., Tainan City, Taiwan.
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Elmrayed S, Pinto J, Tough SC, McDonald SW, Scime NV, Wollny K, Lee Y, Kramer MS, Ospina MB, Lorenzetti DL, Madubueze A, Leung AA, Kumar M, Fenton TR. Small for gestational age preterm infants and later adiposity and height: A systematic review and meta-analysis. Paediatr Perinat Epidemiol 2023; 37:652-668. [PMID: 37580882 DOI: 10.1111/ppe.13002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 07/21/2023] [Accepted: 07/29/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Overweight and obesity and their consequent morbidities are important worldwide health problems. Some research suggests excess adiposity origins may begin in fetal life, but unknown is whether this applies to infants born preterm. OBJECTIVE The objective of the study was to assess the association between small for gestational age (SGA) birth and later adiposity and height among those born preterm. DATA SOURCES MEDLINE, EMBASE and CINAHL until October 2022. STUDY SELECTION AND DATA EXTRACTION Studies were included if they reported anthropometric (adiposity measures and height) outcomes for participants born preterm with SGA versus non-SGA. Screening, data extraction and risks of bias assessments were conducted in duplicate by two reviewers. SYNTHESIS We meta-analysed across studies using random-effects models and explored potential heterogeneity sources. RESULTS Thirty-nine studies met the inclusion criteria. In later life, preterm SGA infants had a lower body mass index (-0.66 kg/m2 , 95% CI -0.79, -0.53; 32 studies, I2 = 16.7, n = 30,346), waist circumference (-1.20 cm, 95% CI -2.17, -0.23; 13 studies, I2 = 19.4, n = 2061), lean mass (-2.62 kg, 95% CI -3.45, 1.80; 7 studies, I2 = 0, n = 205) and height (-3.85 cm, 95% CI -4.73, -2.96; 26 studies, I2 = 52.6, n = 4174) compared with those preterm infants born non-SGA. There were no differences between preterm SGA and preterm non-SGA groups in waist/hip ratio, body fat, body fat per cent, truncal fat per cent, fat mass index or lean mass index, although power was limited for some analyses. Studies were rated at high risk of bias due to potential residual confounding and low risk of bias in other domains. CONCLUSIONS Compared to their preterm non-SGA peers, preterm infants born SGA have lower BMI, waist circumference, lean body mass and height in later life. No differences in adiposity were observed between SGA preterm infants and non-SGA preterm infants.
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Affiliation(s)
- Seham Elmrayed
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Institute of Global Health and Human Ecology, American University in Cairo, Cairo, Egypt
- Virginia Mason Franciscan Health, Seattle, Washington, USA
| | - Jahaira Pinto
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Suzanne C Tough
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sheila W McDonald
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Natalie V Scime
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Krista Wollny
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Senior Persons Living Connected, Toronto, Ontario, Canada
| | - Yoonshin Lee
- Senior Persons Living Connected, Toronto, Ontario, Canada
| | - Michael S Kramer
- Departments of Pediatrics and of Epidemiology and Biostatistics, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Maria B Ospina
- Department of Public Health Sciences, Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Diane L Lorenzetti
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Health Sciences Library and Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Ada Madubueze
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alexander A Leung
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Manoj Kumar
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Tanis R Fenton
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Cui A, Xiao P, He J, Fan Z, Xie M, Chen L, Zhuang Y, Wang H. Association between caffeine consumption and bone mineral density in children and adolescent: Observational and Mendelian randomization study. PLoS One 2023; 18:e0287756. [PMID: 37384670 PMCID: PMC10309635 DOI: 10.1371/journal.pone.0287756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/11/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Coffee is the most commonly consumed beverage among children and adolescences. Caffeine was demonstrated to be associated with bone metabolism. However, the relationship between caffeine intake and BMD in children and adolescents remains unclear. This study aimed to identified relationship between caffeine consumption and bone mineral density (BMD) in children and adolescents. METHODS Based on National Health and Nutrition Examination Survey (NHANES), we conducted an epidemiological cross-section study to measure the relationship between caffeine consumption and BMD in children and adolescents by multivariate linear regression models. Then, five methods of Mendelian randomization (MR) analyses were performed to estimate their causal relationship between coffee and caffeine intake and BMD in children and adolescents. MR-Egger and inverse-variance weighted (IVW) were used to evaluate the heterogeneity effect of instrumental variables (IVs). RESULTS In epidemiological studies, individuals with the highest quartile of caffeine intake do not have a significant change in femur neck BMD (β = 0.0016, 95% CI: -0.0096, 0.0129, P = 0.7747), total femur BMD (β = 0.0019, P = 0.7552), and total spine BMD (β = 0.0081, P = 0.1945) compared with the lowest quartile. In MR analysis, the IVW-random effect indicates no causal relationship between coffee consumption and TB- BMD (β = 0.0034, P = 0.0910). Other methods of MR analyses and sensitivity analysis reveals consistent findings. Similarly, the fixed-effects IVW method shows no causal association between caffeine intake and TB-BMD in children and adolescents (β = 0.0202, P = 0.7828). CONCLUSIONS Our study does not support a causal relationship between caffeine consumption and BMD in children and adolescents. However, more studies are needed to verify our findings, such as its underlying molecular mechanisms and the long-term impact of early caffeine exposure at a younger age.
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Affiliation(s)
- Aiyong Cui
- Department of Orthopaedics, Honghui Hospital, Xi’an Jiao Tong University, Xi’an, China
| | - Peilun Xiao
- Department of Orthopaedics, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, China
| | - Jing He
- Department of Orthopaedics, Honghui Hospital, Xi’an Jiao Tong University, Xi’an, China
| | - Zhiqiang Fan
- Department of Orthopaedics, Honghui Hospital, Xi’an Jiao Tong University, Xi’an, China
| | - Mengli Xie
- Department of Orthopaedics, Honghui Hospital, Xi’an Jiao Tong University, Xi’an, China
| | - Long Chen
- Department of Orthopaedics, Honghui Hospital, Xi’an Jiao Tong University, Xi’an, China
| | - Yan Zhuang
- Department of Orthopaedics, Honghui Hospital, Xi’an Jiao Tong University, Xi’an, China
| | - Hu Wang
- Department of Orthopaedics, Honghui Hospital, Xi’an Jiao Tong University, Xi’an, China
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Embleton ND, Sproat T, Uthaya S, Young GR, Garg S, Vasu V, Masi AC, Beck L, Modi N, Stewart CJ, Berrington JE. Effect of an Exclusive Human Milk Diet on the Gut Microbiome in Preterm Infants: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e231165. [PMID: 36857051 PMCID: PMC9978942 DOI: 10.1001/jamanetworkopen.2023.1165] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
IMPORTANCE The effect of using an exclusive human milk diet compared with one that uses bovine products in preterm infants is uncertain, but some studies demonstrate lower rates of key neonatal morbidities. A potential mediating pathway is the gut microbiome. OBJECTIVE To determine the effect of an exclusive human milk diet on gut bacterial richness, diversity, and proportions of specific taxa in preterm infants from enrollment to 34 weeks' postmenstrual age. DESIGN, SETTING, AND PARTICIPANTS In this randomized clinical trial conducted at 4 neonatal intensive care units in the United Kingdom from 2017 to 2020, microbiome analyses were blind to group. Infants less than 30 weeks' gestation who had only received own mother's milk were recruited before 72 hours of age. Statistical analysis was performed from July 2019 to September 2021. INTERVENTIONS Exclusive human milk diet using pasteurized human milk for any shortfall in mother's own milk supply and human milk-derived fortifiers (intervention) compared with bovine formula and bovine-derived fortifier (control) until 34 weeks' postmenstrual age. Fortifier commenced less than 48 hours of tolerating 150 mL/kg per day. MAIN OUTCOMES AND MEASURES Gut microbiome profile including alpha and beta diversity, and presence of specific bacterial taxa. RESULTS Of 126 preterm infants enrolled in the study, 63 were randomized to control (median [IQR] gestation: 27.0 weeks [26.0-28.1 weeks]; median [IQR] birthweight: 910 g [704-1054 g]; 32 [51%] male) and 63 were randomized to intervention (median [IQR] gestation: 27.1 weeks [25.7-28.1 weeks]; median [IQR] birthweight: 930 g [733-1095 g]; 38 [60%] male); 472 stool samples from 116 infants were analyzed. There were no differences in bacterial richness or Shannon diversity over time, or at 34 weeks between trial groups. The exclusive human milk diet group had reduced relative abundance of Lactobacillus after adjustment for confounders (coefficient estimate, 0.056; P = .03), but not after false discovery rate adjustment. There were no differences in time to full feeds, necrotizing enterocolitis, or other key neonatal morbidities. CONCLUSIONS AND RELEVANCE In this randomized clinical trial in preterm infants using human milk-derived formula and/or fortifier to enable an exclusive human milk diet, there were no effects on overall measures of gut bacterial diversity but there were effects on specific bacterial taxa previously associated with human milk receipt. These findings suggest that the clinical impact of human milk-derived products is not modulated via microbiomic mechanisms. TRIAL REGISTRATION ISRCTN trial registry identifier: ISRCTN16799022.
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Affiliation(s)
- Nicholas D. Embleton
- Newcastle Hospitals NHS Trust, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Thomas Sproat
- Newcastle Hospitals NHS Trust, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Sabita Uthaya
- Section of Neonatal Medicine, School of Public Health, Imperial College London, London, United Kingdom
- Chelsea and Westminster Hospital, NHS Foundation Trust, London, United Kingdom
| | | | - Shalabh Garg
- James Cook University Hospital, Middlesbrough, United Kingdom
| | - Vimal Vasu
- William Harvey Hospital, Ashford, Kent, United Kingdom
| | - Andrea C. Masi
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Lauren Beck
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Neena Modi
- Section of Neonatal Medicine, School of Public Health, Imperial College London, London, United Kingdom
- Chelsea and Westminster Hospital, NHS Foundation Trust, London, United Kingdom
| | - Christopher J. Stewart
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Janet E. Berrington
- Newcastle Hospitals NHS Trust, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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Cui A, Xiao P, Fan Z, Zeng Y, Wang H, Zhuang Y. Associations between vitamin E status and bone mineral density in children and adolescents aged 8-19 years: Evidence based on NHANES 2005-2006, 2017-2018. PLoS One 2023; 18:e0283127. [PMID: 36928218 PMCID: PMC10019693 DOI: 10.1371/journal.pone.0283127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/03/2023] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION Bone mineral density (BMD) in adolescence is a crucial determinant in osteoporosis and fragility fractures in older age. Vitamin E is the most abundant lipid-soluble antioxidant present in the blood. However, the association of vitamin E status with BMD in children and adolescents remains unclear. METHODS We first measured the association of vitamin E status (serum α- and γ tocopherol) with BMD in children and adolescents with the National Health and Nutrition Examination Survey (NHANES). Multiple linear regression models were performed to evaluate their relationship after adjusting for a large range of covariates. Stratified analyses and interaction tests were used to explore their effects on different genders, ages, and races/ethnicities. RESULTS 13,606 children and adolescents from NHANES (2005-2006, 2017-2018) were included in our analysis. Compared with the lowest α-tocopherol quartile, individuals in the highest α-tocopherol quartile are likelier to be Non-Hispanic White and have a higher value of poverty income ratio (PIR). They have a lower value of serum phosphorus and lumbar spine BMD. Every 1umol/L increase in serum α- and γ- tocopherol, the lumbar spine BMD decreased by -0.0016 and -0.0068 g/cm2. Compared with the lowest quartile serum α- and γ- tocopherol concentration, individuals in the highest quartile have a -0.0223 and -0.0329 g/cm2 lower mean BMD, respectively. Interaction effects suggest that the negative effect is more prominent among female youth, individuals aged 8-13 years, non-Hispanic whites, Mexican Americans, and non-Hispanic blacks. CONCLUSIONS Our study indicates serum α- and γ-tocopherol are negatively correlated with lumbar BMD. Age, gender, and race may have a modifying effect on this relationship. Our study has an important clinical implication. A higher vitamin E status for children and adolescents could not improve BMD, even decrease BMD. More prospective research with stronger evidence is needed to verify our findings and their underlying mechanisms.
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Affiliation(s)
- Aiyong Cui
- Department of Orthopaedics, Honghui Hospital, Xi’an Jiao Tong University, Xi’an, China
| | - Peilun Xiao
- Department of Orthopaedics, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, China
| | - Zhiqiang Fan
- Department of Orthopaedics, Honghui Hospital, Xi’an Jiao Tong University, Xi’an, China
| | - Yuan Zeng
- Department of Orthopaedics, Honghui Hospital, Xi’an Jiao Tong University, Xi’an, China
| | - Hu Wang
- Department of Orthopaedics, Honghui Hospital, Xi’an Jiao Tong University, Xi’an, China
- * E-mail: (HW); (YZ)
| | - Yan Zhuang
- Department of Orthopaedics, Honghui Hospital, Xi’an Jiao Tong University, Xi’an, China
- * E-mail: (HW); (YZ)
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Torró-Ferrero G, Fernández-Rego FJ, Agüera-Arenas JJ, Gomez-Conesa A. Effect of physiotherapy on the promotion of bone mineralization in preterm infants: a randomized controlled trial. Sci Rep 2022; 12:11680. [PMID: 35804078 PMCID: PMC9270394 DOI: 10.1038/s41598-022-15810-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 06/29/2022] [Indexed: 11/21/2022] Open
Abstract
Preterm infants have a low level of bone mineralization compared to those born at term. The purpose of the present study was to investigate the effect of reflex locomotion therapy (RLT) on bone mineralization and growth in preterm infants and compare its effect to other physiotherapy procedures. Forty-six preterm infants born at 29–34 weeks were randomized into three groups: one group received RLT (n = 17); the other group received passive movements with gentle joint compression (n = 14); and the control group received massages (n = 15). All the treatments were performed at the neonatal unit for one month. The main outcome measure was bone mineralization, which was measured using the tibial speed of sound (Tibial-SOS). All the groups were similar in terms of gestational age (31.8 ± 1.18), birth weight (1,583.41 ± 311.9), and Tibia-SOS (1,604.7 ± 27.9) at the beginning of the intervention. At the end of the study, significant differences were found among the groups in the Tibial-SOS [F(4,86) = 2.77, p = 0.049, ηp2 = 0.114] in terms of the benefit to the RLT group. In conclusion, RLT has been effective at improving Tibial-SOS levels and has been more effective than other physical therapy modalities; therefore, it could be considered an effective physiotherapeutic modality for the prevention and treatment of osteopenia from prematurity.
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Affiliation(s)
- Galaad Torró-Ferrero
- International School of Doctorate of the University of Murcia (EIDUM), University of Murcia, Murcia, Spain.
| | | | - Juan José Agüera-Arenas
- Neonatal Intensive Care Unit, Clinic Hospital University Virgen de La Arrixaca, Murcia, Spain
| | - Antonia Gomez-Conesa
- Research Group Research Methods and Evaluation in Social Sciences, Mare Nostrum Campus of International Excellence, University of Murcia, Murcia, Spain
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16
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Torró-Ferrero G, Fernández-Rego FJ, Jiménez-Liria MR, Agüera-Arenas JJ, Piñero-Peñalver J, Sánchez-Joya MDM, Fernández-Berenguer MJ, Rodríguez-Pérez M, Gomez-Conesa A. Effect of physical therapy on bone remodelling in preterm infants: a multicenter randomized controlled clinical trial. BMC Pediatr 2022; 22:362. [PMID: 35739544 PMCID: PMC9229521 DOI: 10.1186/s12887-022-03402-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 06/07/2022] [Indexed: 12/02/2022] Open
Abstract
Background Preterm infants have a low level of bone mineralization compared to those born at term, since 80% of calcium incorporation occurs at the end of pregnancy. The purpose of the present study was to investigate the effect of reflex locomotion therapy on bone modeling and growth in preterm infants and to compare its effect with those of other Physiotherapy modalities. Methods A multicentre randomized controlled clinical trial was conducted (02/2016 – 07/2020). 106 preterm infants born at the Virgen de la Arrixaca University Clinical Hospital, the General University Hospital of Elche and the Torrecárdenas University Hospital of Almería, between 26 and 34 weeks with hemodynamic stability, complete enteral nutrition and without any metabolic, congenital, genetic, neurological or respiratory disorders were evaluated for inclusion. Infants were randomly assigned to three groups: one group received reflex locomotion therapy (EGrlt); another group received passive mobilizations with gentle joint compression (EGpmc); and the control group received massage (CG). All treatments were carried out in the neonatal units lasting one month. The main outcome measure was bone formation and resorption measured with bone biomarkers. A mixed ANOVA was used to compare the results of bone biomarkers, and anthropometric measurements. Results Infants were randomized to EGrlt (n = 38), EGpmc (n = 32), and CG (n = 36). All groups were similar in terms of gender (p = 0.891 female 47.2%), gestational age (M = 30.753, SD = 1.878, p = 0.39) and birth weight (M = 1413.45, SD = 347.36, p = 0.157). At the end of the study, significant differences were found between the groups in their interaction in bone formation, measured with osteocalcin [F (2,35) = 4.92, p = 0.013, ηp2 = 0.043], in benefit of the EGrlt. Conclusions Reflex locomotion therapy has been effective in improving bone formation, more so than other Physiotherapy modalities. Therefore, reflex locomotion therapy could be considered one of the most effective physiotherapeutic modalities for the prevention and treatment of osteopenia of prematurity. Trial registrstion Trial retrospectively registered at ClinicalTrials.gov. First posted on 22/04/2020. Registration number: NCT04356807. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03402-2.
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Affiliation(s)
- Galaad Torró-Ferrero
- International School of Doctorate of the University of Murcia (EIDUM), University of Murcia, 30100, Murcia, Spain.
| | - Francisco Javier Fernández-Rego
- Department of Physical Therapy, Faculty of Medicine University of Murcia, Espinardo, 30100, Murcia, Spain.,Early Intervention Center of Lorca City Council, Lorca, 30800, Murcia, Spain
| | | | | | - Jessica Piñero-Peñalver
- Department of Developmental and Educational Psychology, University of Murcia, Murcia, Spain.,Faculty of Psicology, University of Murcia, Espinardo, 30100, Murcia, Spain
| | | | | | | | - Antonia Gomez-Conesa
- Research Group Research Methods and Evaluation in Social Sciences. Mare Nostrum Campus of International Excellence, University of Murcia, Murcia, Spain
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Cui A, Xiao P, Hu B, Ma Y, Fan Z, Wang H, Zhou F, Zhuang Y. Blood Lead Level Is Negatively Associated With Bone Mineral Density in U.S. Children and Adolescents Aged 8-19 Years. Front Endocrinol (Lausanne) 2022; 13:928752. [PMID: 35846292 PMCID: PMC9283721 DOI: 10.3389/fendo.2022.928752] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/03/2022] [Indexed: 11/13/2022] Open
Abstract
CONTEXT The relationship of lead (Pb) exposure with bone health in children and adolescents remains controversial. OBJECTION We aimed to investigate the association of blood lead levels (BLL) with bone mineral density (BMD) in American children and adolescents using data from the National Health and Nutrition Examination Survey (NHANES), 2005-2010. METHODS We analyzed 5,583 subjects aged 8-19 years (mean age, 13.49 ± 3.35 years) from the NHANES 2005-2010. BLL was tested using inductively coupled plasma mass spectrometry. BMD was measured by dual-energy X-ray absorptiometry (DXA) at the lumbar spine, total femur, and femur neck. Multivariate linear regression models were used to explore the association between BLL and BMD, adjusting for age, gender, race/ethnicity, poverty income ratio (PIR), body mass index (BMI), serum calcium, and serum phosphorus. RESULTS BLL was negatively correlated with BMD at different sites of interest in children and adolescents. For every 1mg/dl increase in BLL, the BMD of the total spine, total hip, and femoral neck decreased by 0.011 g/cm2, 0.008 g/cm2, and 0.006 g/cm2. In addition, Pb affected the lumbar spine more than the femur. The effect estimates were stronger in girls than boys at the lumbar spine (P for interaction= 0.006). This negative association remained significant in American children and adolescents after excluding individuals with BLL more than 3.5 ug/dl. CONCLUSION Our study indicates that BLL is negatively correlated with BMD at different sites of interest in children and adolescents aged 8-19 years, even in the reference range. More research is needed to elucidate the relationships between Pb and bone health in children and adolescents, including specific mechanisms and confounding factors like race/ethnicity, gender, and age.
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Affiliation(s)
- Aiyong Cui
- Department of Pelvic and Acetabular Surgery, HongHui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Peilun Xiao
- Department of Orthopaedics, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
| | - Baoliang Hu
- Department of gastroenterology surgery, HongHui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Yuzhuo Ma
- Department of Orthopedics, HongHui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Zhiqiang Fan
- Department of Pelvic and Acetabular Surgery, HongHui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Hu Wang
- Department of Pelvic and Acetabular Surgery, HongHui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Fengjin Zhou
- Department of Pelvic and Acetabular Surgery, HongHui Hospital, Xi’an Jiaotong University, Xi’an, China
- *Correspondence: Yan Zhuang, ; Fengjin Zhou,
| | - Yan Zhuang
- Department of Pelvic and Acetabular Surgery, HongHui Hospital, Xi’an Jiaotong University, Xi’an, China
- *Correspondence: Yan Zhuang, ; Fengjin Zhou,
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Abstract
As survival of infants born extremely preterm increases, more are now reaching adulthood. It is well documented that survivors born extremely preterm experience more developmental delay and disability in multiple domains compared with term-born controls in early childhood and school age. However, with increasing age, health problems involving physical and mental health become more evident. Despite these challenges, it is reassuring that self-reported quality of life remains good. Future directions of research include development of age-appropriate interventions to optimise health and development of individuals born extremely preterm beyond school age.
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Jensen GB, Ahlsson F, Domellöf M, Elfvin A, Naver L, Abrahamsson T. Nordic study on human milk fortification in extremely preterm infants: a randomised controlled trial-the N-forte trial. BMJ Open 2021; 11:e053400. [PMID: 34815288 PMCID: PMC8611420 DOI: 10.1136/bmjopen-2021-053400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION The mortality rate of extremely low gestational age (ELGA) (born <gestational week 28+0) infants remains high, and severe infections and necrotising enterocolitis (NEC) are common causes of death. Preterm infants receiving human milk have lower incidence of sepsis and NEC than those fed a bovine milk-based preterm formula. Despite this, fully human milk fed ELGA infants most often have a significant intake of cow's milk protein from bovine-based protein fortifier. The aim of this study is to evaluate whether the supplementation of human milk-based, as compared with bovine-based, nutrient fortifier reduces the prevalence of NEC, sepsis and mortality in ELGA infants exclusively fed with human milk. METHODS AND ANALYSIS A randomised-controlled multicentre trial comparing the effect of a human breast milk-based fortifier with a standard bovine protein-based fortifier in 222-322 ELGA infants fed human breast milk (mother's own milk and/or donor milk). The infants will be randomised to either fortifier before reaching 100 mL/kg/day in oral feeds. The intervention, stratified by centre, will continue until the target postmenstrual week 34+0. The primary outcome is a composite of NEC, sepsis or death. Infants are characterised with comprehensive clinical and nutritional data collected prospectively from birth until hospital discharge. Stool, urine, blood and breast milk samples are collected for analyses in order to study underlying mechanisms. A follow-up focusing on neurological development and growth will be performed at 2 and 5.5 years of age. Health economic analyses will be made. ETHICS AND DISSEMINATION The study is conducted according to ICH/GCP guidelines and is approved by the regional ethical review board in Linköping Sweden (Dnr 2018/193-31, Dnr 2018/384-32). Results will be presented at scientific meetings and published in peer-reviewed publications. TRIAL REGISTRATION NUMBER The study was registered with ClinicalTrials.gov NCT03797157, 9 January 2019.
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Affiliation(s)
- Georg Bach Jensen
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Paediatrics, Linköping University, Linköping, Östergötland, Sweden
| | - Fredrik Ahlsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Anders Elfvin
- Institute of Clinical Sciences, Department of Paediatrics, Sahlgrenska Academy, Göteborg, Sweden
- Queen Silvia Children's Hospital, Department of Paediatrics, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Lars Naver
- Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden
| | - Thomas Abrahamsson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Paediatrics, Linköping University, Linköping, Östergötland, Sweden
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Calor AK, Yumani DF, van Weissenbruch MM. Early Nutrition during Hospitalization in Relation to Bone Health in Preterm Infants at Term Age and Six Months Corrected Age. Nutrients 2021; 13:nu13041192. [PMID: 33916331 PMCID: PMC8065483 DOI: 10.3390/nu13041192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/26/2021] [Accepted: 03/30/2021] [Indexed: 11/25/2022] Open
Abstract
Aim: to evaluate the potential association of macronutrient intake in the first postnatal weeks on bone mineral content (BMC) and bone mineral density (BMD) in extremely and very preterm infants. Methods: fifty-eight extremely and very preterm infants were included. Daily macronutrient intake was calculated in g kg−1 day−1 from birth up to 36 weeks postmenstrual age. A dual-energy X-ray absorptiometry whole body scan was used to assess BMC and BMD in preterm infants at term corrected age (TCA) and six months corrected age (CA). Results: fat intake (g kg−1 day−1) in the first four postnatal weeks was positively associated with BMC and BMD at TCA. At six months CA, protein and fat intake (g kg−1 day−1) in the first weeks of life were both individual predictors for BMD. Fat intake (g kg−1 day−1) in the first four postnatal weeks was significantly associated with BMC at six months CA. Conclusion: the association of macronutrient intake in the first postnatal weeks on BMC or BMD, at TCA and six months CA, suggest that early nutritional intervention immediately after birth and during early infancy is important for bone health in the first months of life.
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21
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Haikerwal A, Doyle LW, Patton G, Garland SM, Cheung MM, Wark JD, Cheong JLY. Bone health in young adult survivors born extremely preterm or extremely low birthweight in the post surfactant era. Bone 2021; 143:115648. [PMID: 32950698 DOI: 10.1016/j.bone.2020.115648] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/18/2020] [Accepted: 09/12/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Most infants born extremely preterm (EP; <28 weeks' gestation) or extremely low birthweight (ELBW; <1000 g birthweight) in the post surfactant era (early 1990s) are now surviving into adulthood. Preterm birth/low birthweight are risk factors for reduced bone growth and mineralisation in infants and children. However, little is known about their bone health around peak bone mass and through adult life. OBJECTIVE To compare bone health (bone mineral measures, bone structure and strength) in young adults born EP/ELBW with controls (>2499 g birthweight), and within the EP/ELBW group examine perinatal and later variables associated with long term bone health. METHODS A geographic cohort comprising all 297 survivors born EP/ELBW in 1991-92 in the state of Victoria, Australia, and 260 contemporaneous controls (>2499 g birthweight) were recruited into a longitudinal study from birth. At age 25 years, investigations included dual energy X ray absorptiometry and peripheral quantitative computed tomography to measure bone, muscle and soft tissue variables, and fasting blood samples to measure serum 25 hydroxyvitamin D (25(OH)D) and bone turnover markers (BTM). Linear regression analysis, with models fitted using generalised estimating equations, was used to compare outcomes between groups, adjusting for height and weight. RESULTS Compared with controls (n = 129), young adults born EP/ELBW (n = 162) had lower areal bone mineral density (g/cm2) (mean difference [MD] -0.044; 95% confidence interval [CI] -0.076,-0.013) and Z-scores (MD -0.53; 95% CI -0.75, -0.30) in the femoral neck, and lower total hip Z-score (MD -0.35; 95% CI -0.54, -0.15) after adjusting for height and weight. EP/ELBW males generally displayed more bone and soft tissue deficits than females, compared with their respective controls. Within the EP/ELBW group, early growth, male sex, height and lean mass, muscle measures, 25(OH)D levels, and BTM were independently associated with bone mineral measures, structure or strength. CONCLUSIONS Young adults born EP/ELBW had evidence of impaired bone health around the age of peak bone mass compared with controls. Further follow-up of the EP/ELBW groups will determine if they have a heightened low-trauma fracture risk in later life.
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Affiliation(s)
- Anjali Haikerwal
- Newborn Services, The Royal Women's Hospital, Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.
| | - Lex W Doyle
- Newborn Services, The Royal Women's Hospital, Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Department of Obstetrics and Gynecology, The Royal Women's Hospital, The University of Melbourne, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - George Patton
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia
| | - Suzanne M Garland
- Department of Obstetrics and Gynecology, The Royal Women's Hospital, The University of Melbourne, Melbourne, Australia; Centre for Women's Infectious Diseases Research, The Royal Women's Hospital, Parkville, Australia; Infection & Immunity Theme, Murdoch Children's Research Institute, Parkville, Australia
| | - Michael M Cheung
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Heart Research, Murdoch Children's Research Institute, Melbourne, Australia; Department of Cardiology, Royal Children's Hospital, Melbourne, Australia
| | - John D Wark
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia; Bone and Mineral Medicine, The Royal Melbourne Hospital, Melbourne, Australia
| | - Jeanie L Y Cheong
- Newborn Services, The Royal Women's Hospital, Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Department of Obstetrics and Gynecology, The Royal Women's Hospital, The University of Melbourne, Melbourne, Australia
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22
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Yang Y, Wu F, Dwyer T, Antony B, Winzenberg T, Jones G. Associations of Breastfeeding, Maternal Smoking, and Birth Weight With Bone Density and Microarchitecture in Young Adulthood: a 25-Year Birth-Cohort Study. J Bone Miner Res 2020; 35:1652-1659. [PMID: 32638468 DOI: 10.1002/jbmr.4044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/17/2020] [Accepted: 04/27/2020] [Indexed: 11/07/2022]
Abstract
We have found that early-life exposures are associated with areal bone mineral density (aBMD) at ages 8 and 16 years. This study aimed to assess whether these associations persist into young adulthood when peak bone mass (PBM) is achieved and extend this analysis to microarchitecture. Participants were followed from perinatal period to 25 years old (n = 201). Outcomes were total body, spine, and hip aBMD (by dual-energy X-ray absorptiometry [DXA]), and cortical and trabecular bone measures at the distal radius and tibia (by high-resolution peripheral quantitative computed tomography [HRpQCT]). Early-life exposures including breastfeeding, maternal smoking during pregnancy, and birth weight. Sex, weight, height, vegetables, fruit and calcium intake at age 25 years were regarded as potential confounders in the analysis. There were significant interactions between period of gestation and early-life exposures for bone measures, so all analyses were stratified by period of gestation. Breastfeeding was beneficially associated with hip and total body aBMD, total, cortical and trabecular volumetric BMD (vBMD), cortical thickness, porosity, trabecular number (Tb.N), separation (Tb.Sp), and bone volume fraction (Tb.BV/TV) at radius and/or tibia at age 25 years in participants born prematurely (β ranged from -0.92 to 0.94), but there were no associations in those born at term. Maternal smoking had no association with any DXA/HRpQCT measures in those born prematurely but was detrimentally associated with inner transitional zone porosity and Tb.N (β = 0.40 and β = -0.37, respectively) in those full-term participants. Associations of birth weight with bone measures did not persist after adjustment for weight gain since birth. Breastfeeding was associated with a lower risk of lower limb fractures and maternal smoking had a deleterious association with upper limb fractures. In conclusion, breastfeeding and maternal smoking may have effects on peak bone microarchitecture whereas the association with birth weight is countered by subsequent growth. © 2020 American Society for Bone and Mineral Research.
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Affiliation(s)
- Yi Yang
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Feitong Wu
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Terry Dwyer
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia.,The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Benny Antony
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Tania Winzenberg
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
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23
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Bergner EM, Shypailo R, Visuthranukul C, Hagan J, O'Donnell AR, Hawthorne KM, Abrams SA, Hair AB. Growth, Body Composition, and Neurodevelopmental Outcomes at 2 Years Among Preterm Infants Fed an Exclusive Human Milk Diet in the Neonatal Intensive Care Unit: A Pilot Study. Breastfeed Med 2020; 15:304-311. [PMID: 32298596 PMCID: PMC7360515 DOI: 10.1089/bfm.2019.0210] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: Long-term outcomes of preterm infants fed an exclusive human milk-based (EHM) diet using a donor human milk-based fortifier are not well defined. Materials and Methods: Infants ≤1,250 g birth weight (BW) were studied prospectively at two outpatient visits: 12-15 and 18-22 months corrected age (CA). Dual-energy X-ray absorptiometry and Bayley Scales of Infant and Toddler Development III (BSID-III) were performed at 18-22 months CA. Results: In this pilot study, 51 preterm infants (gestational age 27.8 ± 2.6 weeks and BW 893 ± 204 g) were evaluated. While anthropometric z-scores were significantly lower at discharge compared with birth, z-scores returned to birth levels by 12-15 months CA (length and head circumference [HC]) and 18-22 months CA (weight). Body composition at 2 years of age was similar to term-matched controls. Inpatient growth was significantly correlated with bone density, lean mass (LM), and fat-free mass at 18-22 months CA. Increased mother's own milk (MOM) was significantly correlated with decreased fat mass indices. BSID-III showed that 0% of cognitive composite scores were <70. Conclusions: In addition to returning to BW, length, and HC z-scores by 2 years of age, body composition analysis revealed that increase in body size was appropriate as reflected by LM and bone density similar to matched term controls without an increase in fat mass. No child had severe cognitive developmental delay using a cutoff score of 70. Inpatient growth and increased receipt of MOM correlated with favorable growth and body composition outcomes. Positive outcomes as shown in this study to confirm postdischarge safety of an EHM diet during hospitalization.
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Affiliation(s)
- Erynn M Bergner
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA.,Department of Pediatrics, Section of Neonatology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Roman Shypailo
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Chonnikant Visuthranukul
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA.,USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.,Department of Pediatrics, Section of Nutrition, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand.,Pediatric Nutrition STAR, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Joseph Hagan
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Andrea R O'Donnell
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Keli M Hawthorne
- Department of Pediatrics, Dell Medical School, Dell Pediatric Research Institute, University of Texas at Austin, Austin, Texas, USA
| | - Steven A Abrams
- Department of Pediatrics, Dell Medical School, Dell Pediatric Research Institute, University of Texas at Austin, Austin, Texas, USA
| | - Amy B Hair
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
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24
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Lucas A, Boscardin J, Abrams SA. Preterm Infants Fed Cow's Milk-Derived Fortifier Had Adverse Outcomes Despite a Base Diet of Only Mother's Own Milk. Breastfeed Med 2020; 15:297-303. [PMID: 32239968 PMCID: PMC7232708 DOI: 10.1089/bfm.2019.0133] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objective: An increasingly common practice is to feed preterm infants a base diet comprising only human milk (HM), usually fortified with a cow's milk (CM)-derived fortifier (CMDF). We evaluated the safety of CMDF in a diet of 100% mother's own milk (MOM) against a HM-derived fortifier (HMDF). To date, this has received little research attention. Study Design: We reanalyzed a 12-center randomized trial, originally comparing exclusive HM feeding, including MOM, donor milk (DM), and HMDF, versus a CM exposed group fed MOM, preterm formula (PTF), and CMDF1. However, for the current study, we performed a subgroup analysis (n = 114) selecting only infants receiving 100% MOM base diet plus fortification, and fed no DM or PTF. This allowed for an isolated comparison of fortifier type: CMDF versus HMDF to evaluate the primary outcomes: necrotizing enterocolitis (NEC) and a severe morbidity index of NEC surgery or death; and several secondary outcomes. Results: CMDF and HMDF groups had similar baseline characteristics. CMDF was associated with higher risk of NEC; relative risk (RR) 4.2 (p = 0.038), NEC surgery or death (RR 5.1, p = 0.014); and reduced head circumference gain (p = 0.04). Conclusions: In neonates fed, as currently recommended with a MOM-based diet, the safety of CMDF when compared to HMDF has been little researched. We conclude that available evidence points to an increase in adverse outcomes with CMDF, including NEC and severe morbidity comprising NEC surgery or death.
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Affiliation(s)
- Alan Lucas
- Institute of Child Health, University College, London, United Kingdom
| | - John Boscardin
- Department of Medicine and University of California, San Francisco, California, USA
- Department of Epidemiology & Biostatistics, University of California, San Francisco, California, USA
| | - Steven A. Abrams
- Department of Pediatrics, Dell Medical School, The University of Texas, Austin, Texas, USA
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25
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Baş EK, Bülbül A, Şirzai H, Arslan S, Uslu S, Baş V, Zubarioglu U, Celik M, Dursun M, Güran Ö, Kuran B. The long-term impacts of preterm birth and associated morbidities on bone health in preschool children: a prospective cross-sectional study from Turkey. J Matern Fetal Neonatal Med 2020; 35:677-684. [PMID: 32102581 DOI: 10.1080/14767058.2020.1730801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: To evaluate the impact of preterm birth on bone health in preschool children.Methods: A total of 166 preschool children (aged 7-8 years) born preterm (n = 86, <37-week gestation) and at term (n = 80, ≥37 weeks of gestation) in our hospital were included in this prospective cross-sectional study. Data on antenatal, perinatal, and early postnatal characteristics and maternal obstetric history were obtained from medical records. Bone densitometry data including total bone mineral content (BMC), bone mineral density (BMD; total, lumbar, and femoral), z-scores, and bone loss were collected for each participant.Results: Current height, weight, and BMI values were significantly lower in the preterm group (p < .001). Serum calcium, phosphorus and alkaline phosphatase (ALP) levels did not differ among groups, whereas VitD3 levels were significantly higher in the preterm group (p = .039). The mean total BMC, total BMD, lumbar (L2-L4) BMD, femur BMD, total z-score, and L2-L4 z-score values were significantly lower for the preterm group, whereas the total, lumbar, and femoral bone loss were significantly higher (p < .001), regardless of the severity of prematurity. Intraventricular hemorrhage (IVH) and retinopathy were significantly associated with lower total BMC (p = .004, p = .012, respectively). Fortified breastfeeding was associated with lumbar bone loss (p = .043), and formula feeding was associated with both femur and lumbar bone loss (p = .006, p = .012, respectively).Conclusions: Our findings revealed long-term adverse effects of preterm birth on bone health, with significantly lower anthropometric values (weight, height, and BMI), lower scores for total BMC, BMD (total, lumbar, femoral), and z-scores (total, femur), along with higher bone loss (total, lumbar, femoral) and higher rates of osteopenia and osteoporosis in preschool children born preterm (whether moderate or very preterm) compared with those born at term. Exclusive breastfeeding appears to reduce the likelihood of long-term bone loss in preterm infants.
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Affiliation(s)
- Evrim Kıray Baş
- Department of neonatology, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Ali Bülbül
- Department of neonatology, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Hülya Şirzai
- Department of neonatology, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Selda Arslan
- Department of neonatology, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Sinan Uslu
- Department of neonatology, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Vedat Baş
- Department of pediatrics, Istanbul Arel University, Istanbul, Turkey
| | - Umut Zubarioglu
- Department of neonatology, Istanbul Yeni Yüzyıl University, Istanbul, Turkey
| | - Muhittin Celik
- Department of neonatology, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Mesut Dursun
- Department of neonatology, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Ömer Güran
- Department of neonatology, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Banu Kuran
- Department of neonatology, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
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26
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Abstract
BACKGROUND The dose-response benefits of human milk for preterm infants are well documented. Understanding factors that influence duration of mother's own milk (MOM) receipt may have important clinical implications. PURPOSE To identify variables that significantly affect whether or not preterm infants receive their own mother's milk at discharge. METHODS Maternal-infant dyads were eligible for inclusion if the infant was born between August 1, 2010, and July 31, 2015, was born at 32 weeks' gestation or less, or was 1800 g or less (institutional donor milk receipt criteria). Bivariate and multivariable regression analyses were performed. RESULTS Of 428 observations, 258 (60.3%) received MOM at discharge and 170 (39.7%) did not. Maternal characteristics that were protective for MOM receipt at discharge were non-Hispanic race, married, partner support, more educated, and private insurance. Protective infant characteristics were higher gestational age at birth, higher percentage of MOM feedings, fewer ventilator days, and more days of direct lactation. In multivariable logistic regression, the odds of receiving MOM at discharge significantly (odds ratio = 1.93; 95% confidence interval, 1.72-2.16; P < .001) increased with the increasing proportion of MOM. Regression analysis showed that gestational age and increased maternal age increased the likelihood of MOM receipt at discharge. IMPLICATIONS FOR PRACTICE Clinicians will understand the significant effects even small increases in milk volume have on duration of MOM receipt at discharge, informing them of the importance of strategies to encourage and improve milk expression. IMPLICATIONS FOR RESEARCH Future research studying critical time periods when mothers are most likely to reduce milk expression may have significant clinical importance.
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27
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Jílková M, Kaupová S, Černíková A, Poláček L, Brůžek J, Velemínský P. Early medieval diet in childhood and adulthood and its reflection in the dental health of a Central European population (Mikulčice, 9th–10th centuries, Czech Republic). Arch Oral Biol 2019; 107:104526. [DOI: 10.1016/j.archoralbio.2019.104526] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 08/10/2019] [Accepted: 08/12/2019] [Indexed: 11/16/2022]
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28
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Chinoy A, Mughal MZ, Padidela R. Metabolic bone disease of prematurity: causes, recognition, prevention, treatment and long-term consequences. Arch Dis Child Fetal Neonatal Ed 2019; 104:F560-F566. [PMID: 31079069 DOI: 10.1136/archdischild-2018-316330] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/08/2019] [Accepted: 03/10/2019] [Indexed: 12/12/2022]
Abstract
Metabolic bone disease of prematurity (MBDP) is characterised by skeletal demineralisation, and in severe cases it can result in fragility fractures of long bones and ribs during routine handling. MBDP arises from prenatal and postnatal factors. Infants who are born preterm are deprived of fetal mineral accumulation, 80% of which occurs in the third trimester. Postnatally, it is difficult to maintain a comparable intake of minerals, and medications, such as corticosteroids and diuretic therapy, lead to bone resorption. With improvements in neonatal care and nutrition, the incidence of MBDP in preterm infants appears to have decreased, although the recent practice of administering phosphate supplements alone will result in secondary hyperparathyroidism and associated bone loss, worsening MBDP. Postnatal immobilisation and loss of placental supply of oestrogen also contribute to skeletal demineralisation. There is no single diagnostic or screening test for MBDP, with pitfalls existing for most radiological and biochemical investigations. By reviewing the pathophysiology of calcium and phosphate homeostasis, one can establish that plasma parathyroid hormone is important in determining the aetiology of MBDP - primarily calcipaenia or phosphopaenia. This will then direct treatment with the appropriate supplements while considering optimal physiological calcium to phosphate ratios.
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Affiliation(s)
- Amish Chinoy
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, UK.,Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Mohamed Zulf Mughal
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, UK.,Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Raja Padidela
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, UK.,Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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29
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[The value of human milk for preterm infants-overview and practical aspects]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 61:952-959. [PMID: 29971449 DOI: 10.1007/s00103-018-2777-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Over the last decades the immense benefit of human milk on the nutrition of preterm infants has become increasingly evident. Research has confirmed that human milk has significant advantages for the preterm infant in terms of host defense, gastrointestinal development and maturation, neurological development, reduction of necrotizing enterocolitis, retinopathy of prematurity and chronic lung disease as well as mental and physical benefits for the mother. Computing these factors into a health-cost-benefit equation, positive economic consequences for a national public health system were demonstrated.Therefore, international feeding guidelines recommend human milk to be the first choice for preterm infants, the primary source being the infant's mother. The first alternative is milk from an established donor milk bank. To meet the unique nutritional demands of preterm infants and to avoid postnatal growth restriction, human milk must be fortified with additional micro- and macronutrients. Concerns about microbial colonization and contamination and hygienic aspects concerning milk handling need to be addressed when feeding human milk to preterm infants.Early initiation and maintenance of lactation is challenging for mothers of preterm infants and their caregivers. Providing lactation support from educated staff, optimal nursing environments, and the positive attitude of an experienced NICU (neonatal intensive care unit) team will contribute to successful lactation and breastfeeding even beyond discharge of the infant.
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30
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Walsh V, Brown JVE, Askie LM, Embleton ND, McGuire W. Nutrient-enriched formula versus standard formula for preterm infants. Cochrane Database Syst Rev 2019; 7:CD004204. [PMID: 31314903 PMCID: PMC6636703 DOI: 10.1002/14651858.cd004204.pub3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Preterm infants may accumulate nutrient deficits leading to extrauterine growth restriction. Feeding preterm infants with nutrient-enriched rather than standard formula might increase nutrient accretion and growth rates and might improve neurodevelopmental outcomes. OBJECTIVES To compare the effects of feeding with nutrient-enriched formula versus standard formula on growth and development of preterm infants. SEARCH METHODS We used the Cochrane Neonatal standard search strategy. This included electronic searches of the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 11), MEDLINE, Embase, and the Cumulative Index to Nursing and Allied Health Literature (until November 2018), as well as conference proceedings, previous reviews, and clinical trials databases. SELECTION CRITERIA Randomised and quasi-randomised controlled trials that compared feeding preterm infants with nutrient-enriched formula (protein and energy plus minerals, vitamins, or other nutrients) versus standard formula. DATA COLLECTION AND ANALYSIS We extracted data using the Cochrane Neonatal standard methods. Two review authors separately evaluated trial quality and extracted and synthesised data using risk ratios (RRs), risk differences, and mean differences (MDs). We assessed certainty of evidence at the outcome level using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods. MAIN RESULTS We identified seven trials in which a total of 590 preterm infants participated. Most participants were clinically stable preterm infants of birth weight less than 1850 g. Few participants were extremely preterm, extremely low birth weight, or growth restricted at birth. Trials were conducted more than 30 years ago, were formula industry funded, and were small with methodological weaknesses (including lack of masking) that might bias effect estimates. Meta-analyses of in-hospital growth parameters were limited by statistical heterogeneity. There is no evidence of an effect on time to regain birth weight (MD -1.48 days, 95% confidence interval (CI) -4.73 to 1.77) and low-certainty evidence suggests that feeding with nutrient-enriched formula increases in-hospital rates of weight gain (MD 2.43 g/kg/d, 95% CI 1.60 to 3.26) and head circumference growth (MD 1.04 mm/week, 95% CI 0.18 to 1.89). Meta-analysis did not show an effect on the average rate of length gain (MD 0.22 mm/week, 95% CI -0.70 to 1.13). Fewer data are available for growth and developmental outcomes assessed beyond infancy, and these do not show consistent effects of nutrient-enriched formula feeding. Data from two trials did not show an effect on Bayley Mental Development Index scores at 18 months post term (MD 2.87, 95% CI -1.38 to 7.12; moderate-certainty evidence). Infants who received nutrient-enriched formula had higher Bayley Psychomotor Development Index scores at 18 months post term (MD 6.56. 95% CI 2.87 to 10.26; low-certainty evidence), but no evidence suggested an effect on cerebral palsy (typical RR 0.79, 95% CI 0.30 to 2.07; 2 studies, 377 infants). Available data did not indicate any other benefits or harms and provided low-certainty evidence about the effect of nutrient-enriched formula feeding on the risk of necrotising enterocolitis in preterm infants (typical RR 0.72, 95% CI 0.41 to 1.25; 3 studies, 489 infants). AUTHORS' CONCLUSIONS Available trial data show that feeding preterm infants nutrient-enriched (compared with standard) formulas has only modest effects on growth rates during their initial hospital admission. No evidence suggests effects on long-term growth or development. The GRADE assessment indicates that the certainty of this evidence is low, and that these findings should be interpreted and applied with caution. Further randomised trials would be needed to resolve this uncertainty.
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Affiliation(s)
- Verena Walsh
- University of YorkCentre for Reviews and DisseminationYorkUKY010 5DD
| | | | - Lisa M Askie
- University of SydneyNHMRC Clinical Trials CentreLocked Bag 77CamperdownNSWAustralia2050
| | - Nicholas D Embleton
- Newcastle Hospitals NHS Foundation Trust and University of NewcastleNewcastle Neonatal ServiceRichardson RoadNewcastle upon TyneUKNE1 4LP
| | - William McGuire
- University of YorkCentre for Reviews and DisseminationYorkUKY010 5DD
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31
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Wagner K, Wagner S, Susi A, Gorman G, Hisle-Gorman E. Prematurity Does Not Increase Early Childhood Fracture Risk. J Pediatr 2019; 207:148-153. [PMID: 30528571 DOI: 10.1016/j.jpeds.2018.11.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 10/17/2018] [Accepted: 11/06/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate the impact of prematurity on fracture by age 5, controlling for medications and comorbidities of prematurity. STUDY DESIGN We performed a retrospective cohort study of infants born in Military Treatment Facilities in 2009-2010 with ≥5 years of follow-up care. Gestational age, low birth weight, comorbidities of prematurity (osteopenia, necrotizing enterocolitis, chronic lung disease, and cholestasis) and fractures were identified by International Classification of Disease, 9th Edition, codes. Pharmaceutical records identified treatment with caffeine, diuretics, postnatal corticosteroids, and antacids. Poisson regression analysis determined fracture rate by 5 years of life. RESULTS There were 65 938 infants born in 2009-2010 who received care in the military health system for ≥5 years, including 3589 born preterm; 165 born at ≤286/7 weeks of gestation, 380 born at 29-316/7 weeks of gestation, and 3044 born at 32-366/7 weeks of gestation. Preterm birth at any gestational age was not associated with fracture rate in adjusted models. The fracture rate was increased with cholestasis, proton pump inhibitor exposure, and male sex. CONCLUSIONS Prematurity was not associated with fracture rate. Neonatal cholestasis and proton pump inhibitor treatment were associated with increased fractures by age 5.
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Affiliation(s)
- Kari Wagner
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD; Department of Pediatrics, Uniformed Services University, Bethesda, MD
| | - Scott Wagner
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD; Department of Orthopedic Surgery, Uniformed Services University, Bethesda, MD
| | - Apryl Susi
- Department of Pediatrics, Uniformed Services University, Bethesda, MD
| | - Gregory Gorman
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD; Department of Pediatrics, Uniformed Services University, Bethesda, MD
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Xie LF, Alos N, Cloutier A, Béland C, Dubois J, Nuyt AM, Luu TM. The long-term impact of very preterm birth on adult bone mineral density. Bone Rep 2018; 10:100189. [PMID: 30627597 PMCID: PMC6319299 DOI: 10.1016/j.bonr.2018.100189] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 12/05/2018] [Accepted: 12/11/2018] [Indexed: 12/31/2022] Open
Abstract
Introduction Preterm infants are at increased risk of osteopenia of prematurity due to insufficient bone mineral accretion. Data on long term effects of prematurity on bone health are conflicting. This study aimed to compare bone mineral density (BMD) in young adults born very preterm and full-term controls and to examine factors associated with long-term bone health. Methods This observational cross-sectional study enrolled 101 young adults (18–29 years) born <29 weeks of gestation and 95 sex- and age-matched full-term controls. Participants underwent dual-energy X-ray absorptiometry to measure areal BMD and body composition. Generalized estimated equations were used to compare groups adjusting for height Z-score, lean body mass and fat mass. Results Adults born preterm were shorter and lighter than full-term controls. Areal BMD was reduced at the lumbar spine, the femoral neck and whole body in the preterm versus full-term group, but after adjustment, areal BMD Z-score was only significantly lower at the femoral neck by −0.3 unit (95% confidence interval −0.6 to −0.0). Low BMD (Z-score ≤ −1 standard deviation) at any site was observed in 53% of adults born preterm versus 28% of full-term controls, but this was not statistically significantly different. We did not identify any neonatal factors associated with lower BMD within the preterm group. Conclusions Very preterm birth is associated with lower areal BMD at the femoral neck in young adulthood, even after accounting for body size. Whether this will translate into higher risk of osteoporotic fractures later in life remains unknown.
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Affiliation(s)
- Li Feng Xie
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Nathalie Alos
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada.,Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Anik Cloutier
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Chanel Béland
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Josée Dubois
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada.,Department of Radiology, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Anne Monique Nuyt
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada.,Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Thuy Mai Luu
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada.,Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada
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Chin LK, Doan J, Teoh YS, Stewart A, Forrest P, Simm PJ. Outcomes of standardised approach to metabolic bone disease of prematurity. J Paediatr Child Health 2018; 54:665-670. [PMID: 29292538 DOI: 10.1111/jpc.13813] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 09/30/2017] [Accepted: 10/25/2017] [Indexed: 11/28/2022]
Abstract
AIM To assess the current protocol of metabolic bone disease (MBD) at three Monash Health neonatal units (Melbourne, Australia). METHODS Retrospective audit of 171 infants born at <32 weeks' gestation over 18 months. Mean gestational age was 28.6 ± 2.1 weeks, and birthweight was 1190 ± 374 g. Risk factors of MBD include intra-uterine growth retardation (n = 33, 19.3%), maternal pre-eclampsia (n = 17, 9.9%), necrotising enterocolitis (n = 9, 5.4%) and medications like methylxanthines (94.2%; mean 54.8 days), diuretics (38.6%; mean 49.2 days) and glucocorticoids (5.3%; mean 35 days). RESULTS In total, 84.8% infants had an initial MBD screen (mean age 36.3 days), with 45% having repeated monitoring (mean age 71.9 days), and 14.2% had initial alkaline phosphatase levels >500 U/L, decreasing to 10.1% on follow-up. All infants received additional vitamin D supplementation of 400 IU/day, phosphate of 25.1% (n = 43) and calcium of 19.9% (n = 34). Fractures were identified from clinical documentation in 2.9% (n = 5) of infants. Stratifying into phosphate-treated and untreated groups revealed significant differences (P < 0.001) for gestational age and birthweight: 26.7 ± 1.7 weeks/918 ± 272 g for treated versus 29.2 ± 1.9 weeks/1283 ± 359 g for untreated. In the phosphate-treated group, improvement was seen in mean alkaline phosphatase (pre-treatment 467 ± 204 U/L and post-treatment 342 ± 221 U/L, P < 0.01) and mean phosphate levels (1.8 ± 0.4 vs. 2.2 ± 1.0 mmol/L, P < 0.01). Linear growth difference between phosphate-treated (n = 10) and untreated groups (n = 24) was insignificant at >6 months of age (P = 0.13), although this may reflect limited data. CONCLUSION Adequate first-line supplementation with vitamin D and phosphate appeared to improve biochemical markers of MBD, but given the observational nature of this study, further longitudinal/prospective studies are required to confirm these findings.
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Affiliation(s)
- Lit Kim Chin
- Department of Paediatrics, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
| | - John Doan
- Department of Neonatology, Monash Health, Melbourne, Victoria, Australia
| | - Yvonne Sl Teoh
- Department of Neonatology, Monash Health, Melbourne, Victoria, Australia
| | - Alice Stewart
- Department of Endocrinology and Diabetes, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Peter Forrest
- Department of Neonatology, Monash Health, Melbourne, Victoria, Australia
| | - Peter J Simm
- Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Victoria, Australia.,Centre for Hormone Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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Christmann V, van der Putten ME, Rodwell L, Steiner K, Gotthardt M, van Goudoever JB, van Heijst AFJ. Effect of early nutritional intake on long-term growth and bone mineralization of former very low birth weight infants. Bone 2018; 108:89-97. [PMID: 29289790 DOI: 10.1016/j.bone.2017.12.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 12/11/2017] [Accepted: 12/21/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Preterm infants are at risk for impaired bone mineralization and growth in length later in life due to inadequate nutritional intake in the early postnatal period. OBJECTIVE To investigate whether increased nutritional supplementation of calcium, phosphate and protein in Very Low Birth Weight (VLBW) infants during the first 14days after birth was associated with improvement in length and bone development until 9-10years of age. DESIGN Observational follow-up study of VLBW infants (birth weight<1500g or gestational age<32weeks) born in two consecutive years (eligible infants: 2004 n: 63 and 2005: n: 66). Cohort 2005 received higher intake of calcium, phosphate and protein with parenteral nutrition compared to Cohort 2004. Anthropometric data were collected during standard follow-up visits until five years, and additionally at 9-10years of age including measurements of bone mineral content, bone mineral density of the whole body and lumbar spine determined by dual-energy X-ray absorptiometry. Long-term growth trajectories of both cohorts were evaluated separately for participants born appropriate (AGA) and small for gestational age (SGA), stratified by gender. Multivariate linear regression was used to examine the effect of nutritional intake and clinical covariates on length and bone mineralization. RESULTS Both cohorts achieved a catch-up in length to SDS within the normal range by 6months (length SDS: estimated mean (95% confidence interval (CI): 6months: Cohort 2004: -0.7 (-1.1, -0.3) Cohort 2005: -0.5 (-0.8, -0.2)). Bone mineral content and density were within the normal range and not different between the cohorts. SGA children achieved a catch-up in length at 5years with bone mineralization comparable to AGA children. Only for girls birth weight was significantly associated with length SDS (per gram: β 0.001; 95% CI (0.000, 0.003); p=0.03) There was no evidence of an association between early nutritional intake and bone mineralization. CONCLUSION Children born as appropriate or small for gestational age preterm infants are able to catch up in length after the postnatal period, and achieve a normal length and bone mineralization at age nine-ten years. An improvement of calcium and phosphate intake during the first 14days after birth was not associated with improvement in length and bone development.
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Affiliation(s)
- V Christmann
- Department of Pediatrics, Subdivision of Neonatology, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands.
| | - M E van der Putten
- Department of Pediatrics, Subdivision of Neonatology, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands; Department of Pediatrics, Subdivision of Neonatology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - L Rodwell
- Department for Health Evidence, Radboud Institute for Health Science, Subdivision of Biostatistics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - K Steiner
- Department of Pediatrics, Subdivision of Neonatology, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands
| | - M Gotthardt
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J B van Goudoever
- Department of Pediatrics, VU University Medical Center Amsterdam, Amsterdam, The Netherlands; Department of Pediatrics, Emma Children's Hospital - AMC Amsterdam, Amsterdam, The Netherlands
| | - A F J van Heijst
- Department of Pediatrics, Subdivision of Neonatology, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands
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Alasagheirin MH, Clark MK. Skeletal growth, body composition, and metabolic risk among North Sudanese immigrant children. Public Health Nurs 2018; 35:91-99. [PMID: 29423945 DOI: 10.1111/phn.12386] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Children of immigrants and refugees from developing countries are at risk for poor growth that could contribute to adult chronic disease. This study describes the physical growth, bone growth, body composition, metabolic risks, physical activity, and food security of Sudanese children living in the United States. DESIGN AND SAMPLE Cross-sectional descriptive study of 64 Sudanese children age 5-18. MEASURES Bone mineral content (BMC), bone density (aBMD), and body composition (fat, lean mass, percent body fat) were measured using DXA. Lipids, insulin, glucose, and hs-CRP were analyzed using standardized laboratory methods. Food security was assessed with the U.S. Household Food Security Survey. Physical activity was measured through self-report questionnaire and pedometers. RESULTS About 1/3 of children had low BMC and aBMD. Lean mass was low in 46%, and 32% were obese. Cholesterol, triglycerides, and HOMA-IR were elevated in 23.4%, 32.8%, and 15.6% of children, respectively; only 22% of children were physically active and 40% experienced food insecurity. CONCLUSION Sudanese children may have unique risks related to low bone mass low muscle mass, high percent body fat metabolic biomarkers, inactivity, and food insecurity potentially contributing to adult osteoporosis, diabetes, and cardiovascular disease.
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Affiliation(s)
- Mohammad H Alasagheirin
- College of Nursing and Health Sciences, University of Wisconsin - Eau Claire, Eau Claire, WI, USA
| | - Mary K Clark
- College of Nursing, The University of Iowa, Iowa City, IA, USA
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Blanco E, Burrows R, Reyes M, Lozoff B, Gahagan S, Albala C. Breastfeeding as the sole source of milk for 6 months and adolescent bone mineral density. Osteoporos Int 2017; 28:2823-2830. [PMID: 28589419 PMCID: PMC5840801 DOI: 10.1007/s00198-017-4106-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 05/29/2017] [Indexed: 10/19/2022]
Abstract
UNLABELLED Little is known regarding the relationship between early life factors and bone mineral density (BMD). We found a positive association between breastfeeding for at least 6 months, without formula supplementation, and whole body adolescent BMD z-score. INTRODUCTION The aim of the study is to assess the role of breastfeeding BF on adolescent bone mineral density (BMD) in a cohort prospectively followed since infancy. METHODS We studied 679 participants from an infancy iron deficiency anemia preventive trial in Santiago, Chile, followed to adolescence. Breast and bottle feeding were ascertained weekly from 4 to 12 months. At 16 years, whole body BMD was assessed by DEXA. Using linear regression, we evaluated associations between BF duration and BF as the sole source of milk and adolescent BMD z-score, adjusting for possible infancy, adolescent, and background confounders. RESULTS Mean birth weight and length were 3.5 (0.3) kg and 50.7 (1.6) cm. For at least 6 months, BF was the sole source of milk for 26.3% and with supplementation for 36.7%. For 37%, BF was provided for less than 6 months. Mean 16-year BMD z-score was 0.25 (1.0). Covariates included male sex, birth length, and gestational age. BF as the sole source of milk ≥6 months, compared to BF < 6 months, was associated with higher adolescent BMD z-score adjusting for covariates (β = 0.29, p < 0.05). Mixed BF was not significantly related to adolescent BMD z-score (β = 0.06, p = 0.47). For every 30 days of BF as the sole source of milk, adolescent BMD z-score increased by 0.03 (p = 0.01). CONCLUSION BF without formula supplementation for at least 6 months was associated with higher adolescent BMD z-score and a suggestive trend in the same direction for BMD suggests that exclusivity and duration of BF may play a role in adolescent bone health.
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Affiliation(s)
- E Blanco
- Department of Pediatrics, UC San Diego, 9500 Gilman Drive, MC 0927, La Jolla, CA, 92093-0927, USA.
| | - R Burrows
- Public Health Nutrition Unit, Institute of Nutrition and Food Technology (INTA), University of Chile, Avenida El Líbano 5524, Macul, Santiago de Chile, Chile
| | - M Reyes
- Public Health Nutrition Unit, Institute of Nutrition and Food Technology (INTA), University of Chile, Avenida El Líbano 5524, Macul, Santiago de Chile, Chile
| | - B Lozoff
- Center for Human Growth and Development, University of Michigan, 300 North Ingalls, Ann Arbor, MI, 48109-5406, USA
| | - S Gahagan
- Department of Pediatrics, UC San Diego, 9500 Gilman Drive, MC 0927, La Jolla, CA, 92093-0927, USA
- Center for Human Growth and Development, University of Michigan, 300 North Ingalls, Ann Arbor, MI, 48109-5406, USA
| | - C Albala
- Public Health Nutrition Unit, Institute of Nutrition and Food Technology (INTA), University of Chile, Avenida El Líbano 5524, Macul, Santiago de Chile, Chile
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37
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Ruys CA, van de Lagemaat M, Finken MJ, Lafeber HN. Follow-up of a randomized trial on postdischarge nutrition in preterm-born children at age 8 y. Am J Clin Nutr 2017; 106:549-558. [PMID: 28637773 DOI: 10.3945/ajcn.116.145375] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 05/18/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Early nutritional interventions may modulate health risks in preterm-born infants. Previously, we showed that preterm-born infants fed an isocaloric protein- and mineral-enriched postdischarge formula (PDF) from term age to 6-mo corrected age (CA) gained more lean mass than did those fed term formula (TF). Long-term follow-up of randomized nutritional trials is important to test the hypothesis that short-term positive effects on health are sustainable.Objective: The aim of this follow-up study was to compare body size, body composition, and metabolic health at age 8 y in preterm-born children who were randomly assigned to receive either PDF or TF from term age until 6-mo CA.Design: A total of 79 of 152 children (52%) from the original randomized controlled trial were enrolled for follow-up at age 8 y. Weight, height, and head circumference were measured by using standard methods. Body composition, including fat mass, lean mass, bone mineral content, and bone mineral density, was determined by dual-energy X-ray absorptiometry. Blood pressure was measured in the supine position by using an automatic device. Metabolic variables, including glucose, insulin, insulin-like growth factor I, triglycerides, cholesterol, cortisol, and leptin, were measured after an overnight fast. Nutritional habits at age 8 y were assessed by using a 3-d nutritional diary.Results: At age 8 y, no differences were found in body size, body composition, bone variables, and metabolic health variables when comparing children fed PDF with those fed TF. Adjustment for known and possible confounders did not change these results.Conclusions: In this follow-up study in preterm-born children, we showed that the favorable effects of PDF at 6-mo CA either were not maintained or could not be confirmed because of attrition at the age of 8 y. We suggest that future research should focus on nutritional interventions in the pre- and postdischarge period as a continuum rather than as separate entities. This trial was registered at www.trialregister.nl as NTR 2972 (follow-up study [STEP-2 (Study Towards the Effects of Post-discharge Nutrition 2)]) and NTR 55 [original randomized controlled trial (STEP)].
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Affiliation(s)
| | | | - Martijn Jj Finken
- Pediatric Endocrinology, VU University Medical Center, Amsterdam, Netherlands
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Balasuriya CND, Evensen KAI, Mosti MP, Brubakk AM, Jacobsen GW, Indredavik MS, Schei B, Stunes AK, Syversen U. Peak Bone Mass and Bone Microarchitecture in Adults Born With Low Birth Weight Preterm or at Term: A Cohort Study. J Clin Endocrinol Metab 2017; 102:2491-2500. [PMID: 28453635 DOI: 10.1210/jc.2016-3827] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 04/19/2017] [Indexed: 02/05/2023]
Abstract
CONTEXT AND OBJECTIVES Peak bone mass (PBM) is regarded as the most important determinant of osteoporosis. Growing evidence suggests a role of intrauterine programming in skeletal development. We examined PBM and trabecular bone score (TBS) in adults born preterm with very low birth weight (VLBW) or small for gestational age (SGA) at term compared with term-born controls. DESIGN, SETTING, PARTICIPANTS, AND OUTCOMES This follow-up cohort study included 186 men and women (25 to 28 years); 52 preterm VLBW (≤1500 g), 59 term-born SGA (<10th percentile), and 75 controls (>10th percentile). Main outcome was bone mineral density (BMD) by dual x-ray absorptiometry. Secondary outcomes were bone mineral content (BMC), TBS, and serum bone markers. RESULTS VLBW adults had lower BMC and BMD vs controls, also when adjusted for height, weight, and potential confounders, with the following BMD Z-score differences: femoral neck, 0.6 standard deviation (SD) (P = 0.003); total hip, 0.4 SD (P = 0.01); whole body, 0.5 SD (P = 0.007); and lumbar spine, 0.3 SD (P = 0.213). The SGA group displayed lower spine BMC and whole-body BMD Z-scores, but not after adjustment. Adjusted odds ratios for osteopenia/osteoporosis were 2.4 and 2.0 in VLBW and SGA adults, respectively. TBS did not differ between groups, but it was lower in men than in women. Serum Dickkopf-1 was higher in VLBW subjects vs controls; however, it was not significant after adjustment for multiple comparisons. CONCLUSIONS Both low-birth-weight groups displayed lower PBM and higher frequency of osteopenia/osteoporosis, implying increased future fracture risk. The most pronounced bone deficit was seen in VLBW adults.
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Affiliation(s)
- Chandima N D Balasuriya
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, 7489 Trondheim, Norway
- Department of Endocrinology, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Kari Anne I Evensen
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, 7489 Trondheim, Norway
- Department of Public Health and General Practice, Norwegian University of Science and Technology, 7489 Trondheim, Norway
- Department of Physiotherapy, Trondheim Municipality, Trondheim, Norway
| | - Mats P Mosti
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, 7489 Trondheim, Norway
| | - Ann-Mari Brubakk
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, 7489 Trondheim, Norway
| | - Geir W Jacobsen
- Department of Public Health and General Practice, Norwegian University of Science and Technology, 7489 Trondheim, Norway
| | - Marit S Indredavik
- Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology, 7489 Trondheim, Norway
- Department of Child and Adolescent Psychiatry, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Berit Schei
- Department of Public Health and General Practice, Norwegian University of Science and Technology, 7489 Trondheim, Norway
- Department of Gynecology at the Women's Clinic, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Astrid Kamilla Stunes
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, 7489 Trondheim, Norway
| | - Unni Syversen
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, 7489 Trondheim, Norway
- Department of Endocrinology, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
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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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Parkinson JRC, Wijeyesekera AD, Hyde MJ, Singhal A, Lucas A, Holmes E, Modi N. Early preterm nutrition and the urinary metabolome in young adult life: follow-up of a randomised controlled trial. BMJ Paediatr Open 2017; 1:e000192. [PMID: 29637175 PMCID: PMC5862206 DOI: 10.1136/bmjpo-2017-000192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/05/2017] [Accepted: 10/06/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE We aimed to test the hypothesis that early diet programmes the metabolic profile of young adults born preterm. DESIGN We analysed banked urine samples obtained at a 20-year follow-up visit from adults that had participated as neonates in controlled trials involving randomisation within 48 hours of birth to feeds of preterm formula (PTF), banked breast milk (BBM) or term formula (TF) for 1 month postnatally. MAIN OUTCOME MEASURES We performed proton nuclear magnetic resonance spectroscopy, analysing spectra by dietary group and sex. Orthogonal projections to latent structure discriminant analyses was used to model class differences and identify metabolites contributing to the differences between groups. Additionally, spectra were correlated with birth weight, gestational age and weight z score at 2 weeks of age. RESULTS Of the original number of 926 trial participants, urine samples were available from 197 (21%) healthy young adults (42% men) born preterm (mean 30.7±2.8 weeks) and randomised to BBM (n=55; 28 men), TF (n=48; 14 men) and PTF (n=93; 40 men). We found no significant differences in urinary spectra between dietary groups including when stratified by sex. Correlation analysis revealed a weak association between metabolic profile and gestational age that was lost on controlling for ethanol excretion. CONCLUSIONS We found no evidence that dietary exposures in the neonatal period influence the metabolic phenotype in young adult life.
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Affiliation(s)
| | - Anisha D Wijeyesekera
- Division of Computational and Systems Medicine, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Matthew J Hyde
- Section of Neonatal Medicine, Imperial College London, London, UK
| | - Atul Singhal
- Department of Nutrition, Institute of Child Health, London, UK
| | - Alan Lucas
- Department of Nutrition, Institute of Child Health, London, UK
| | - Elaine Holmes
- Division of Computational and Systems Medicine, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Neena Modi
- Section of Neonatal Medicine, Imperial College London, London, UK
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Khalil A, Buffin R, Sanlaville D, Picaud JC. Milk kinship is not an obstacle to using donor human milk to feed preterm infants in Muslim countries. Acta Paediatr 2016; 105:462-7. [PMID: 26659819 DOI: 10.1111/apa.13308] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 04/06/2015] [Accepted: 12/08/2015] [Indexed: 11/27/2022]
Abstract
UNLABELLED The development of human milk banks in Muslim countries is challenging because of the tradition of milk kinship. In other countries, this tradition imposes restrictions on Muslim mothers with regard to donating their milk or receiving donor milk for their preterm baby. However, Muslim law does allow the use of donated human milk under certain conditions, for example if it comes from a single known donor or is pooled from the milk of at least three donors. CONCLUSION Muslim parents need to be made aware that human milk banks can be used for preterm babies if strict conditions are met.
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Affiliation(s)
- Aliaa Khalil
- Lactarium Régional Rhône-Alpes; Hôpital de la croix rousse; Lyon France
- Service de Néonatologie; Hôpital de la croix rousse; Lyon France
- Senghor University; Alexandrie Egypt
| | - Rachel Buffin
- Lactarium Régional Rhône-Alpes; Hôpital de la croix rousse; Lyon France
- Service de Néonatologie; Hôpital de la croix rousse; Lyon France
| | - Damien Sanlaville
- Service de Génétique; Hôpital Femme-Mère-Enfant; Bron France
- Faculté de Médecine Lyon-Sud Charles Mérieux; Université Claude Bernard Lyon 1; Pierre Bénite France
| | - Jean-Charles Picaud
- Lactarium Régional Rhône-Alpes; Hôpital de la croix rousse; Lyon France
- Service de Néonatologie; Hôpital de la croix rousse; Lyon France
- Faculté de Médecine Lyon-Sud Charles Mérieux; Université Claude Bernard Lyon 1; Pierre Bénite France
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42
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Wood CL, Stenson C, Embleton N. The Developmental Origins of Osteoporosis. Curr Genomics 2016; 16:411-8. [PMID: 27018386 PMCID: PMC4765528 DOI: 10.2174/1389202916666150817202217] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 05/14/2015] [Accepted: 06/20/2015] [Indexed: 12/26/2022] Open
Abstract
Osteoporosis is one of the most prevalent skeletal disorders and has enormous public health consequences due to the morbidity and mortality of the resulting fractures. This article discusses the developmental origins of osteoporosis and outlines some of the modifiable and non-modifiable risk factors in both intrauterine and postnatal life that contribute to the later onset of osteoporosis. Evidence for the effects of birth size and early growth in both preterm and term born infants are discussed and the role of epigenetics within the programming hypothesis is highlighted. This review provides compelling evidence for the developmental origins of osteoporosis and highlights the importance of osteoporosis prevention at all stages of the life course.
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Affiliation(s)
- Claire L Wood
- Newcastle University, Newcastle upon Tyne, UK;; Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Nicholas Embleton
- Newcastle University, Newcastle upon Tyne, UK;; Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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43
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Associations of breast-feeding patterns and introduction of solid foods with childhood bone mass: The Generation R Study. Br J Nutr 2016; 115:1024-32. [PMID: 26856234 DOI: 10.1017/s0007114515005462] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Breast-feeding has been associated with later bone health, but results from previous studies are inconsistent. We examined the associations of breast-feeding patterns and timing of introduction of solids with bone mass at the age of 6 years in a prospective cohort study among 4919 children. We collected information about duration and exclusiveness of breast-feeding and timing of introduction of any solids with postnatal questionnaires. A total body dual-energy X-ray absorptiometry scan was performed at 6 years of age, and bone mineral density (BMD), bone mineral content (BMC), area-adjusted BMC (aBMC) and bone area (BA) were analysed. Compared with children who were ever breast-fed, those never breast-fed had lower BMD (-4·62 mg/cm2; 95 % CI -8·28, -0·97), BMC (-8·08 g; 95 % CI -12·45, -3·71) and BA (-7·03 cm2; 95 % CI -12·55, -1·52) at 6 years of age. Among all breast-fed children, those who were breast-fed non-exclusively in the first 4 months had higher BMD (2·91 mg/cm2; 95 % CI 0·41, 5·41) and aBMC (3·97 g; 95 % CI 1·30, 6·64) and lower BA (-4·45 cm2; 95 % CI -8·28, -0·61) compared with children breast-fed exclusively for at least 4 months. Compared with introduction of solids between 4 and 5 months, introduction <4 months was associated with higher BMD and aBMC, whereas introduction between 5 and 6 months was associated with lower aBMC and higher BA. Additional adjustment for infant vitamin D supplementation did not change the results. In conclusion, results from the present study suggest that ever breast-feeding compared with never breast-feeding is associated with higher bone mass in 6-year-old children, but exclusive breast-feeding for 4 months or longer was not positively associated with bone outcomes.
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44
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Buttazzoni C, Rosengren B, Tveit M, Landin L, Nilsson JÅ, Karlsson M. Preterm Children Born Small for Gestational Age are at Risk for Low Adult Bone Mass. Calcif Tissue Int 2016; 98:105-13. [PMID: 26472429 DOI: 10.1007/s00223-015-0069-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 10/01/2015] [Indexed: 10/22/2022]
Abstract
Cross-sectional studies suggest that premature birth and low birth weight may both be associated with low peak bone mass. We followed bone traits in preterm individuals and controls for 27 years and examined the effects of birth weight relative to gestational age [stratified as small for gestational age (SGA) or appropriate for gestational (AGA)] on adult bone mineral density (BMD). We measured distal forearm BMC (g/cm) and BMD (g/cm(2)) with single-photon absorptiometry (SPA) in 46 preterm children (31 AGA and 15 SGA) at mean age 10.1 years (range 4-16) and in 84 healthy age-matched children. The measurements were repeated 27 years later with the same SPA apparatus but then also with dual energy absorptiometry and peripheral computed tomography (pQCT). Preterm individuals were shorter (p = 0.03) in adulthood than controls. Preterm AGA individuals had similar BMC and BMD height-adjusted Z-scores in adulthood compared to controls. Preterm SGA individuals had lower distal forearm BMC and BMD height-adjusted Z-scores in adulthood than both controls and preterm AGA individuals. Preterm SGA individuals had lower gain from childhood to adulthood in distal forearm BMC height-adjusted Z-scores than controls (p = 0.03). The deficits in preterm SGA individuals in adulthood were also captured by DEXA in height-adjusted femoral neck (FN) BMC Z-score and height-adjusted FN BMD Z-score and by pQCT in tibial cross-sectional area (CSA) Z-score and stress strain index (SSI) Z-score, where all measurements were lower than controls (all p values <0.05). Preterm SGA individuals are at increased risk of reaching low adult bone mass, at least partly due to a deficit in the accrual of bone mineral during growth. In our cohort, we were unable to find a similar risk in preterm AGA individuals.
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Affiliation(s)
- Christian Buttazzoni
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, 205 02, Malmō, Sweden.
| | - Björn Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, 205 02, Malmō, Sweden
| | - Magnus Tveit
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, 205 02, Malmō, Sweden
| | - Lennart Landin
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, 205 02, Malmō, Sweden
| | - Jan-Åke Nilsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, 205 02, Malmō, Sweden
| | - Magnus Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, 205 02, Malmō, Sweden
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45
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Attrition in Long-Term Nutrition Research Studies: A Commentary by the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition Early Nutrition Research Working Group. J Pediatr Gastroenterol Nutr 2016; 62:180-2. [PMID: 26418210 DOI: 10.1097/mpg.0000000000000992] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Long-term follow-up of randomised trials and observational studies provide the best evidence presently available to assess long-term effects of nutrition, and such studies are an important component in determining optimal infant feeding practices. Attrition is, however, an almost inevitable occurrence with increasing age at follow-up. There is a common assumption that studies with <80% follow-up rates are invalid or flawed, and this criticism seems to be more frequently applied to follow-up studies involving randomised trials than observational studies. In this article, we explore the basis and evidence for this "80% rule" and discuss the need for greater consensus and clear guidelines for analysing and reporting results in this specific situation.
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46
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Li J, Funato M, Tamai H, Wada H, Nishihara M, Morita T, Miller SL, Egashira K. Impact of intra- and extrauterine growth on bone mineral density and content in the neonatal period of very-low-birth-weight infants. Early Hum Dev 2016; 92:1-6. [PMID: 26619067 DOI: 10.1016/j.earlhumdev.2015.10.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 10/20/2015] [Accepted: 10/21/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Very-low-birthweight infants (VLBWIs) are at high risk for suboptimal bone mineral density (BMD) and bone mineral content (BMC). Small-for-gestational-age (SGA) status also causes reduced bone mineralization in full-term infants. However, the impact of intrauterine and postnatal extrauterine growth on BMD and BMC in VLBWIs is inconclusive. METHODS We retrospectively investigated n=68 VLBWIs, comprising 45 appropriate-for-gestational-age (AGA) and 23 SGA infants who underwent lumbar spine dual-energy X-ray absorptiometry at term-equivalent age. RESULTS BMD and BMC did not differ between AGA and SGA VLBWIs. Subgroup analyses of infants with birthweight<1000 g vs 1000-1500 g, and GA<27 weeks vs ≥ 27 weeks also showed no differences in BMD and BMC between AGA and SGA infants. In contrast, infants with extrauterine growth restriction (EUGR) showed significantly lower values than those without (BMD: 0.124 ± 0.023 vs 0.141 ± 0.032 g/cm(2), P=0.02; BMC: 0.80 ± 0.26 vs 0.94 ± 0.23 g, P=0.04). There were no differences between AGA and SGA infants with EUGR. However, in the AGA cohort, infants with EUGR showed significantly lower values than those without (BMD: 0.121 ± 0.022; 0.141 ± 0.03 g/cm(2), P=0.02; BMC: 0.73 ± 0.23 vs 0.94 ± 0.23 g, P=0.005). Multiple regression analyses showed GA, weight and head circumference at birth, and weight percentile at term correlated with term BMD. Conversely, only weight percentile at term significantly correlated with term BMC. CONCLUSION EUGR, rather than IUGR, is a risk factor for reduced BMD and BMC in the neonatal period in VLBWIs.
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Affiliation(s)
- Jingang Li
- Department of Pediatrics, Yodogawa Christian Hospital, Osaka, Japan; The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Clayton, VIC Australia.
| | - Masahisa Funato
- Department of Pediatrics, Yodogawa Christian Hospital, Osaka, Japan
| | - Hiroshi Tamai
- Department of Pediatrics, Yodogawa Christian Hospital, Osaka, Japan
| | - Hiroshi Wada
- Department of Pediatrics, Yodogawa Christian Hospital, Osaka, Japan
| | - Masato Nishihara
- Department of Pediatrics, Yodogawa Christian Hospital, Osaka, Japan
| | - Takashi Morita
- Department of Pediatrics, Yodogawa Christian Hospital, Osaka, Japan
| | - Suzanne L Miller
- The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Clayton, VIC Australia; The Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC Australia
| | - Kayo Egashira
- Department of Neonatal Intensive Care Unit, Yodogawa Christian Hospital, Osaka, Japan
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47
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Isojima T, Kushima R, Goishi K, Tsuchida S, Watanabe T, Takahashi N, Kitanaka S. Mineral status of premature infants in early life and linear growth at age 3. Pediatr Int 2015; 57:864-9. [PMID: 25865080 DOI: 10.1111/ped.12657] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 02/01/2015] [Accepted: 02/19/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Preterm infants are at significant risk of reduced bone mineral content and subsequent bone disease (metabolic bone disease of prematurity, MBDP). MBDP is frequently found in very low-birthweight (VLBW) infants, but long-term height prognosis is not well known. METHODS VLBW infants from two major neonatal intensive care units were studied. Medical records were reviewed. A total of 143 subjects were analyzed after excluding subjects who died, or who had severe complications that could affect linear growth, Silver-Russell syndrome, severe cholestasis, and/or chromosomal abnormality. The relationship between MBDP and height at age 3 was investigated. RESULTS Height standard deviation score (SDS) at age 3 negatively correlated with peak serum alkaline phosphatase (ALP) activity in early life (r = -0.30, P = 0.0003) and positively correlated with serum phosphorus (P) at peak ALP (r = 0.33, P = 0.0002). In addition, serum P independently affected height SDS at 3 years of age (β = 0.19, P = 0.018), and was significantly different between infants with and without catch-up growth in height (difference: 0.23 mmol/L, 95%CI: 0.09-0.36, P = 0.0010). CONCLUSIONS MBDP, particularly hypophosphatemia in the early period of life, is associated with linear growth until 3 years of age in VLBW infants.
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Affiliation(s)
- Tsuyoshi Isojima
- Department of Pediatrics, Graduate School of Medicine, University of Tokyo, Bunkyo-ku
| | - Reiko Kushima
- Department of Neonatology, Tokyo Metropolitan Bokutoh Hospital, Sumida-ku, Tokyo, Japan
| | - Keiji Goishi
- Department of Pediatrics, Graduate School of Medicine, University of Tokyo, Bunkyo-ku
| | - Shinya Tsuchida
- Department of Pediatrics, Graduate School of Medicine, University of Tokyo, Bunkyo-ku.,Department of Neonatology, Tokyo Metropolitan Bokutoh Hospital, Sumida-ku, Tokyo, Japan
| | - Toyoko Watanabe
- Department of Neonatology, Tokyo Metropolitan Bokutoh Hospital, Sumida-ku, Tokyo, Japan
| | - Naoto Takahashi
- Department of Pediatrics, Graduate School of Medicine, University of Tokyo, Bunkyo-ku
| | - Sachiko Kitanaka
- Department of Pediatrics, Graduate School of Medicine, University of Tokyo, Bunkyo-ku
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48
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Cohen RS, Mayer O, Fogleman AD. Managing the Human-Milk-Fed, Preterm, VLBW Infant at NICU Discharge. ACTA ACUST UNITED AC 2015. [DOI: 10.1177/1941406415590684] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Feeding prematurely born infants after their stay in the neonatal intensive care unit (NICU) remains problematic. Growth in the NICU is almost always well below the intrauterine rate, and extrauterine growth restriction is common. Breastfeeding is difficult in the NICU, and human milk alone may not always provide adequate protein or minerals for optimal growth. At the time of NICU discharge, a regimen is needed that is supportive of both ongoing lactation and optimal nutrition. However, there is no one regimen that suits all babies and families. We propose a simplified algorithm to help guide the clinical team in deciding what dietary regimen is best suited for their patients.
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Affiliation(s)
- Ronald S. Cohen
- Stanford University, Stanford, California (RSC)
- Lucile Packard Children’s Hospital Stanford, Palo Alto, California (OM)
- North Carolina State University, Raleigh, North Carolina (ADF)
| | - Olivia Mayer
- Stanford University, Stanford, California (RSC)
- Lucile Packard Children’s Hospital Stanford, Palo Alto, California (OM)
- North Carolina State University, Raleigh, North Carolina (ADF)
| | - April D. Fogleman
- Stanford University, Stanford, California (RSC)
- Lucile Packard Children’s Hospital Stanford, Palo Alto, California (OM)
- North Carolina State University, Raleigh, North Carolina (ADF)
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49
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Omarsdottir S, Adling A, Bonamy AKE, Legnevall L, Tessma MK, Vanpée M. Predictors of sustained maternal milk feeds in extremely preterm infants. J Perinatol 2015; 35:367-72. [PMID: 25429384 DOI: 10.1038/jp.2014.212] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 09/14/2014] [Accepted: 10/20/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate the predictors of maternal milk feeds (MMFs) in extremely preterm (EPT) infants during neonatal stay. STUDY DESIGN Maternal characteristics, obstetrical data and infant characteristics were correlated to MMFs in 97 EPT infants during the first 6 weeks of life and at hospital discharge. RESULT High MMFs (>90%) at second week predicted sustained MMFs the first 6 weeks of life; nonuniversity education and non-Nordic origin were unfavorable predictors. The proportion of MMFs the first 6 weeks of life and maternal age were positively associated with MMFs at discharge, whereas overweight was an unfavorable predictor. High MMFs at second week, assisted reproduction technology and employment were predictive factors for exclusive MMFs at discharge. CONCLUSION High MMFs at week 2 promote sustained MMFs in EPT infants and exclusive MMFs at discharge. Mothers who are either young, overweight, non-Nordic or without university education may need special interventions to establish successful lactation.
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Affiliation(s)
- S Omarsdottir
- Department of Medicine, Solna, Karolinska Institute, Stockholm, Sweden
| | - A Adling
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - A K E Bonamy
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - L Legnevall
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - M K Tessma
- Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden
| | - M Vanpée
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
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50
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Kovacs CS. Bone development and mineral homeostasis in the fetus and neonate: roles of the calciotropic and phosphotropic hormones. Physiol Rev 2014; 94:1143-218. [PMID: 25287862 DOI: 10.1152/physrev.00014.2014] [Citation(s) in RCA: 129] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Mineral and bone metabolism are regulated differently in utero compared with the adult. The fetal kidneys, intestines, and skeleton are not dominant sources of mineral supply for the fetus. Instead, the placenta meets the fetal need for mineral by actively transporting calcium, phosphorus, and magnesium from the maternal circulation. These minerals are maintained in the fetal circulation at higher concentrations than in the mother and normal adult, and such high levels appear necessary for the developing skeleton to accrete a normal amount of mineral by term. Parathyroid hormone (PTH) and calcitriol circulate at low concentrations in the fetal circulation. Fetal bone development and the regulation of serum minerals are critically dependent on PTH and PTH-related protein, but not vitamin D/calcitriol, fibroblast growth factor-23, calcitonin, or the sex steroids. After birth, the serum calcium falls and phosphorus rises before gradually reaching adult values over the subsequent 24-48 h. The intestines are the main source of mineral for the neonate, while the kidneys reabsorb mineral, and bone turnover contributes mineral to the circulation. This switch in the regulation of mineral homeostasis is triggered by loss of the placenta and a postnatal fall in serum calcium, and is followed in sequence by a rise in PTH and then an increase in calcitriol. Intestinal calcium absorption is initially a passive process facilitated by lactose, but later becomes active and calcitriol-dependent. However, calcitriol's role can be bypassed by increasing the calcium content of the diet, or by parenteral administration of calcium.
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Affiliation(s)
- Christopher S Kovacs
- Faculty of Medicine-Endocrinology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
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