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De Rose DU, Lapillonne A, Iacobelli S, Capolupo I, Dotta A, Salvatori G. Nutritional Strategies for Preterm Neonates and Preterm Neonates Undergoing Surgery: New Insights for Practice and Wrong Beliefs to Uproot. Nutrients 2024; 16:1719. [PMID: 38892652 PMCID: PMC11174646 DOI: 10.3390/nu16111719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 05/22/2024] [Accepted: 05/30/2024] [Indexed: 06/21/2024] Open
Abstract
The nutrition of preterm infants remains contaminated by wrong beliefs that reflect inexactitudes and perpetuate old practices. In this narrative review, we report current evidence in preterm neonates and in preterm neonates undergoing surgery. Convictions that necrotizing enterocolitis is reduced by the delay in introducing enteral feeding, a slow advancement in enteral feeds, and the systematic control of residual gastric volumes, should be abandoned. On the contrary, these practices prolong the time to reach full enteral feeding. The length of parenteral nutrition should be as short as possible to reduce the infectious risk. Intrauterine growth restriction, hemodynamic and respiratory instability, and patent ductus arteriosus should be considered in advancing enteral feeds, but they must not translate into prolonged fasting, which can be equally dangerous. Clinicians should also keep in mind the risk of refeeding syndrome in case of high amino acid intake and inadequate electrolyte supply, closely monitoring them. Conversely, when preterm infants undergo surgery, nutritional strategies are still based on retrospective studies and opinions rather than on randomized controlled trials. Finally, this review also highlights how the use of adequately fortified human milk is strongly recommended, as it offers unique benefits for immune and gastrointestinal health and neurodevelopmental outcomes.
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Affiliation(s)
- Domenico Umberto De Rose
- Neonatal Intensive Care Unit, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (I.C.); (A.D.); (G.S.)
- PhD Course in Microbiology, Immunology, Infectious Diseases, and Transplants (MIMIT), Faculty of Medicine and Surgery, “Tor Vergata” University of Rome, 00133 Rome, Italy
| | - Alexandre Lapillonne
- Department of Neonatology, APHP, Necker-Enfants Malades University Hospital, EHU 7328 Paris Cite University Paris, 75015 Paris, France;
- Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX 77024, USA
| | - Silvia Iacobelli
- Réanimation Néonatale et Pédiatrique, Centre Hospitalier Universitaire Saint-Pierre, BP 350, 97448 Saint Pierre CEDEX, France;
- Centre d’Études Périnatales de l’Océan Indien (UR 7388), Université de La Réunion, BP 350, 97448 Saint Pierre CEDEX, France
| | - Irma Capolupo
- Neonatal Intensive Care Unit, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (I.C.); (A.D.); (G.S.)
| | - Andrea Dotta
- Neonatal Intensive Care Unit, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (I.C.); (A.D.); (G.S.)
| | - Guglielmo Salvatori
- Neonatal Intensive Care Unit, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (I.C.); (A.D.); (G.S.)
- Donor Human Milk Bank, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy
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Kim MS, Koh JW, Shin J, Kim SY. Postnatal Growth Assessment and Prediction of Neurodevelopment and Long-Term Growth in Very Low Birth Weight Infants: A Nationwide Cohort Study in Korea. J Clin Med 2024; 13:2930. [PMID: 38792471 PMCID: PMC11122437 DOI: 10.3390/jcm13102930] [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: 04/03/2024] [Revised: 05/09/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
Background/Objectives: Extrauterine growth restriction (EUGR) is associated with high mortality and an increased incidence of poor neurodevelopmental outcomes in preterm infants. In this study, we aimed to compare the Intergrowth-21ST (IG-21ST) and Fenton charts in predicting long-term neurodevelopmental and anthropometric outcomes of very low birth weight (VLBW) infants. Methods: Data were collected from 2649 VLBW infants registered in the Korean Neonatal Network born between 240/7 and 316/7 weeks of gestational age from January 2013 to December 2017. Follow-up assessments were conducted at 18-24 months of age, corrected for prematurity. Multiple logistic regression analysis was performed to evaluate the association between EUGR and long-term outcomes. Results: Among the 2649 VLBW infants, 60.0% (1606/2649) and 36.9% (977/2649) were diagnosed as having EUGR defined by the Fenton chart (EUGRF) and by the IG-21ST chart (EUGRIG), respectively. The EUGRIG group exhibited a higher proportion of infants with cerebral palsy, neurodevelopmental impairment (NDI), and growth failure. In multiple logistic regression analysis, adjusted for risk factors for long-term outcome, the EUGRIG group showed higher risk of cerebral palsy (adjusted odds ratio [aOR], 1.66; 95% confidence interval [CI], 1.04-2.65), NDI (aOR, 2.09; 95% CI, 1.71-2.55), and growth failure (aOR, 1.57; 95% CI, 1.16-2.13). Infants with EUGRF tended to develop NDI (aOR, 1.29; 95%CI, 1.03-1.63) and experience growth failure (aOR, 2.44; 95% CI, 1.77-3.40). Conclusions: The IG-21ST chart demonstrated a more effective prediction of long-term neurodevelopmental outcomes, whereas the Fenton chart may be more suitable for predicting growth failure at 18-24 months.
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Affiliation(s)
| | | | | | - Sae Yun Kim
- Department of Pediatrics, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea; (M.S.K.); (J.W.K.); (J.S.)
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González-López C, Solís-Sánchez G, Lareu-Vidal S, Mantecón-Fernández L, Ibáñez-Fernández A, Rubio-Granda A, Suárez-Rodríguez M. Variability in Definitions and Criteria of Extrauterine Growth Restriction and Its Association with Neurodevelopmental Outcomes in Preterm Infants: A Narrative Review. Nutrients 2024; 16:968. [PMID: 38613002 PMCID: PMC11013404 DOI: 10.3390/nu16070968] [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: 02/29/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
Extrauterine growth restriction (EUGR) has been used in the literature and clinical practice to describe inadequate growth in preterm infants. Significant variability is seen in the criteria for EUGR, with no standard definition reached to date. Moreover, no consensus on the optimal timing for assessment or the ideal growth monitoring tool has been achieved, and an ongoing debate persists on the appropriate terminology to express poor postnatal growth. To ensure an adequate understanding of growth and early intervention in preterm infants at higher risk, it is critical to relate the diagnostic criteria of EUGR to the ability to predict adverse outcomes, such as neurodevelopmental outcomes. This narrative review was conducted to present evidence that evaluates neurodevelopmental outcomes in preterm infants with EUGR, comparing separately the different definitions of this concept by weight (cross-sectional, longitudinal and "true" EUGR). In this article, we highlight the challenges of comparing various published studies on the subject, even when subclassifying by the definition of EUGR, due to the significant variability on the criteria used for each definition and for the evaluation of neurodevelopmental outcomes in different papers. This heterogeneity compromises the obtention of a single firm conclusion on the relation between different definitions of EUGR and adverse neurodevelopmental outcomes.
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Affiliation(s)
- Clara González-López
- Unidad de Neonatología, Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.G.-L.); (S.L.-V.); (L.M.-F.); (A.I.-F.); (A.R.-G.); (M.S.-R.)
| | - Gonzalo Solís-Sánchez
- Unidad de Neonatología, Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.G.-L.); (S.L.-V.); (L.M.-F.); (A.I.-F.); (A.R.-G.); (M.S.-R.)
- Instituto Investigación Sanitaria Principado de Asturias, ISPA, 33011 Oviedo, Spain
- Medical Department, University of Oviedo, 33003 Oviedo, Spain
| | - Sonia Lareu-Vidal
- Unidad de Neonatología, Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.G.-L.); (S.L.-V.); (L.M.-F.); (A.I.-F.); (A.R.-G.); (M.S.-R.)
- Instituto Investigación Sanitaria Principado de Asturias, ISPA, 33011 Oviedo, Spain
| | - Laura Mantecón-Fernández
- Unidad de Neonatología, Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.G.-L.); (S.L.-V.); (L.M.-F.); (A.I.-F.); (A.R.-G.); (M.S.-R.)
- Instituto Investigación Sanitaria Principado de Asturias, ISPA, 33011 Oviedo, Spain
| | - Aleida Ibáñez-Fernández
- Unidad de Neonatología, Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.G.-L.); (S.L.-V.); (L.M.-F.); (A.I.-F.); (A.R.-G.); (M.S.-R.)
| | - Ana Rubio-Granda
- Unidad de Neonatología, Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.G.-L.); (S.L.-V.); (L.M.-F.); (A.I.-F.); (A.R.-G.); (M.S.-R.)
| | - Marta Suárez-Rodríguez
- Unidad de Neonatología, Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.G.-L.); (S.L.-V.); (L.M.-F.); (A.I.-F.); (A.R.-G.); (M.S.-R.)
- Instituto Investigación Sanitaria Principado de Asturias, ISPA, 33011 Oviedo, Spain
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Nyakotey DA, Clarke AM, Cormack BE, Bloomfield FH, Harding JE. Postnatal growth and neurodevelopment at 2 years' corrected age in extremely low birthweight infants. Pediatr Res 2024:10.1038/s41390-024-03054-1. [PMID: 38337041 DOI: 10.1038/s41390-024-03054-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 11/28/2023] [Accepted: 01/17/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Faltering postnatal growth in preterm babies is associated with adverse neurodevelopment. However, which growth reference is most helpful for predicting neurodevelopment is unknown. We examined associations between faltering growth and developmental delay in extremely low birthweight (ELBW) infants. METHODS We categorized faltering growth (z-score decrease ≥0.8 for weight/length, >1 for head circumference) between birth, 4 weeks, 36 weeks' postmenstrual age and 2 years' corrected age using fetal (Fenton, UK-WHO and Olsen) and healthy preterm (INTERGROWTH-21st) references. Associations between faltering growth and developmental delay were examined using binary logistic regression and area under the receiver operating curve (AUC). RESULTS In 327 infants, Olsen charts identified the highest prevalence of faltering growth (weight 37%, length 63%, head 45%). Agreement in classification was higher amongst fetal references (kappa coefficient, ĸ = 0.46-0.94) than between INTERGROWTH-21st and fetal references (ĸ = 0.10-0.81). Faltering growth in all measures between 4-36 weeks (odds ratio, OR 2.0-4.7) compared with other time intervals (OR 1.7-2.7) were more strongly associated with developmental delay, particularly motor delay (OR 2.0-4.7). All growth references were poorly predictive of developmental delay at 2 years (AUC ≤ 0.62). CONCLUSIONS Faltering postnatal growth in ELBW infants is associated with, but is poorly predictive of, developmental delay at 2 years. IMPACT In babies born preterm, different growth references result in wide variation in categorization of faltering postnatal growth. Faltering growth in weight, length, and head circumference from 4 weeks to 36 weeks' postmenstrual age are associated with developmental delay at 2 years' corrected age, particularly motor delay. However, postnatal growth is a poor predictor of later developmental delay in extremely low birthweight infants irrespective of the growth reference used.
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Affiliation(s)
- David A Nyakotey
- Liggins Institute, University of Auckland, Auckland, 1023, New Zealand
| | - Angelica M Clarke
- Liggins Institute, University of Auckland, Auckland, 1023, New Zealand
| | - Barbara E Cormack
- Liggins Institute, University of Auckland, Auckland, 1023, New Zealand
- Starship Child Health, Auckland City Hospital, Auckland, 1023, New Zealand
| | | | - Jane E Harding
- Liggins Institute, University of Auckland, Auckland, 1023, New Zealand.
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Huang XR, Shen W, Wu F, Mao J, Liu L, Chang YM, Zhang R, Ye XZ, Qiu YP, Ma L, Cheng R, Wu H, Chen DM, Chen L, Xu P, Mei H, Wang SN, Xu FL, Ju R, Zheng Z, Lin XZ, Tong XM. Real-world evidence regarding the growth of very premature infants with small for gestational age after birth: a multicenter survey in China. BMC Pediatr 2023; 23:437. [PMID: 37653371 PMCID: PMC10468850 DOI: 10.1186/s12887-023-04245-1] [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: 01/08/2023] [Accepted: 08/11/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND To analyze the real-world growth pattern of very premature infants (VPI) with small for gestational age (SGA) after birth by using the ΔZ value of weight at discharge. METHODS The clinical data were collected from 28 hospitals in China from September 2019 to December 2020. They were divided into the EUGR(Extrauterine Growth Restriction) and the non-EUGR group according to the criterion of ΔZ value of weight at discharge < -1.28. RESULTS This study included 133 eligible VPI with SGA. Following the criterion of ΔZ value, the incidence of EUGR was 36.84% (49/133). The birth weight, the 5-min Apgar score, and the proportion of male infants in the EUGR group were lower (P < 0.05). The average invasive ventilation time, cumulative duration of the administration of antibiotics, blood transfusion time, blood transfusion ratio, and total days of hospitalization were significantly higher in the EUGR group (P < 0.05). In the EUGR group, several factors exhibited higher values (P < 0.05), including the initiation of enteral feeding, the volume of milk supplemented with human milk fortifier (HMF), the duration to achieve complete fortification, the cumulative duration of fasting, the duration to achieve full enteral feeding, the length of parenteral nutrition (PN), the number of days required to attain the desired total calorie intake and oral calorie intake, as well as the age at which birth weight was regained. The average weight growth velocity (GV) was significantly lower in the EUGR group (P < 0.001). The incidences of patent ductus arteriosus with hemodynamic changes (hsPDA), neonatal necrotizing enterocolitis (NEC) stage≥ 2, late-onset sepsis (LOS), and feeding intolerance (FI) in the EUGR group were higher (P < 0.05). Multivariate logistic regression analysis showed that birth weight, male, and GV were the protective factors, while a long time to achieve full-dose fortification, slow recovery of birth weight, and NEC stage ≥2 were the independent risk factors. CONCLUSION SGA in VPI can reflect the occurrence of EUGR more accurately by using the ΔZ value of weight at discharge. Enhancing enteral nutrition support, achieving prompt and complete fortification of breast milk, promoting greater GV, reducing the duration of birth weight recovery, and minimizing the risk of NEC can contribute to a decreased occurrence of EUGR. TRIAL REGISTRATION CHICTR, ChiCTR1900023418. Registered 26/05/2019, http://www.chictr.org.cn .
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Affiliation(s)
- Xue-Rong Huang
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, 361003, Fujian, China
- Xiamen Key Laboratory of Perinatal-Neonatal Infection, Xiamen, 361003, Fujian, China
| | - Wei Shen
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, 361003, Fujian, China
- Xiamen Key Laboratory of Perinatal-Neonatal Infection, Xiamen, 361003, Fujian, China
| | - Fan Wu
- Department of Neonatology, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, Guangdong, China
| | - Jian Mao
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110000, China
| | - Ling Liu
- Department of Neonatology, Guiyang Maternal, and Child Health Hospital Guiyang Children's Hospital, Guiyang, Guizhou, 550002, China
| | - Yan-Mei Chang
- Department of Pediatrics, Peking University Third Hospital, Beijing, 100191, China
| | - Rong Zhang
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Xiu-Zhen Ye
- Department of Neonatology, Guangdong Province Maternal and Children's Hospital, Guangzhou, 510030, Guangdong, China
| | - Yin-Ping Qiu
- Department of Neonatology, General Hospital of Ningxia Medical University, Yinchuan, 750001, Ningxia, China
| | - Li Ma
- Department of Neonatology, Children's Hospital of Hebei Province, Shijiazhuang, 050031, Hebei, China
| | - Rui Cheng
- Department of Neonatology, Children' Hospital of Nanjing Medical University, Nanjing, 210000, Jiangsu, China
| | - Hui Wu
- Department of Neonatology, the First Hospital of Jilin University, Changchun, Jilin, 130000, China
| | - Dong-Mei Chen
- Department of Neonatology, Quanzhou Maternity and Children's Hospital, Quanzhou, 362000, Fujian, China
| | - Ling Chen
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, Hubei, China
| | - Ping Xu
- Department of Neonatology, Liaocheng People's Hospital, Liaocheng, 252000, Shandong, China
| | - Hua Mei
- Department of Neonatology, the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, 010010, Inner Mongolia, China
| | - San-Nan Wang
- Department of Neonatology, Suzhou Municipal Hospital, Suzhou, 215002, Jiangsu, China
| | - Fa-Lin Xu
- Department of Neonatology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Rong Ju
- Department of Neonatology, Chengdu Women' and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, Sichuan, China
| | - Zhi Zheng
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, 361003, Fujian, China
- Xiamen Key Laboratory of Perinatal-Neonatal Infection, Xiamen, 361003, Fujian, China
| | - Xin-Zhu Lin
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, 361003, Fujian, China.
- Xiamen Key Laboratory of Perinatal-Neonatal Infection, Xiamen, 361003, Fujian, China.
| | - Xiao-Mei Tong
- Department of Pediatrics, Peking University Third Hospital, Beijing, 100191, China.
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Morniroli D, Tiraferri V, Maiocco G, De Rose DU, Cresi F, Coscia A, Mosca F, Giannì ML. Beyond survival: the lasting effects of premature birth. Front Pediatr 2023; 11:1213243. [PMID: 37484764 PMCID: PMC10360124 DOI: 10.3389/fped.2023.1213243] [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: 04/27/2023] [Accepted: 06/23/2023] [Indexed: 07/25/2023] Open
Abstract
Preterm birth, defined as birth before 37 weeks of gestation, is a major public health concern. It affects about 10% of all newborns globally and is the main cause of infant death and morbidity. Prematurity increases the likelihood of respiratory distress syndrome, cerebral palsy, and developmental abnormalities. Furthermore, premature newborns are at risk of acquiring chronic noncommunicable diseases later in life due to interference with organ system development during the in-utero and perinatal period. Because of the greater risk of long-term repercussions, preterm birth should be considered a chronic disorder, and gestational age and other birth histories should be included in all medical records for patients of all ages, especially when assessing the risk of multiple chronic diseases. Conventional methods for assessing preterm infant development, as well as reliable and precise growth monitoring, can lead to the early detection of growth decline and the adjustment of feeding regimens as needed. Because of its unique composition and useful components, human milk is a powerful tool for mitigating the negative outcomes associated with prematurity. It contains a variety of growth factors that promote the development of organs and systems, counteracting the negative effects of the abrupt interruption of intrauterine development and promoting better outcomes in all altered functions. Despite its multiple benefits, human milk cannot totally restore the lasting damage caused by premature birth. Premature infants cannot be completely overcome by nutrition alone, and yet adequate nutritional intake and human milk feeding are critical to their health and development.
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Affiliation(s)
- Daniela Morniroli
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Valentina Tiraferri
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giulia Maiocco
- Neonatology of the University, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
- City of Health and Science of Turin, Turin, Italy
| | | | - Francesco Cresi
- Neonatology of the University, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
- City of Health and Science of Turin, Turin, Italy
| | - Alessandra Coscia
- Neonatology of the University, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
- City of Health and Science of Turin, Turin, Italy
| | - Fabio Mosca
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Neonatal Intensive Care Unit (NICU), Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Lorella Giannì
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Neonatal Intensive Care Unit (NICU), Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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Consales A, Porro M, Gangi S, Pesenti N, Gardon L, Squarza C, Frigerio A, Lezzi I, Vizzari G, Morniroli D, Macchi M, Fontana C, Fumagalli M, Picciolini O, Mosca F, Giannì ML. In-hospital growth and long-term neurodevelopmental outcomes of very low birth weight infants. Front Pediatr 2023; 11:1180068. [PMID: 37252047 PMCID: PMC10211263 DOI: 10.3389/fped.2023.1180068] [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: 03/05/2023] [Accepted: 04/17/2023] [Indexed: 05/31/2023] Open
Abstract
Background and Objectives Very low birth weight infants (VLBW) are at risk for adverse growth and neurodevelopmental outcomes. We aimed to evaluate the association between growth during Neonatal Intensive Care Unit (NICU) stay and long-term neurodevelopmental outcomes in a cohort of preterm VLBW newborns. Methods We conducted a longitudinal observational study in the Follow-up Service of our Clinic from January 2014 to April 2017. All preterm VLBW infants born at our hospital and enrolled in our follow-up program were considered eligible for the study. The neurodevelopmental assessment was performed using the Griffiths Mental Development Scales at 12 and 24 months corrected age. Results Study population included 172 subjects (47.1% males) with a mean gestational age of 29 weeks and a mean birth weight of 1,117 g. A unitarian Δz-score increase in head circumference from birth to discharge was associated with a 1.6-point increase in General Quotient at 24 months corrected age. An association with subscales C and D was also found. Likewise, an increase in length Δz-score was associated with better 24-month subscale C scores although not reaching statistical significance. No relationship with the outcome at 24 months was found for weight gain. Conclusions Growth during NICU stay appears to be related to a more favorable neurodevelopmental outcome at 24 months corrected age, especially in the hearing and language domain (subscale C). The longitudinal evaluation of auxological parameters during hospitalization can contribute to the identification of subjects at risk for adverse neurodevelopmental outcomes in the first years of life.
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Affiliation(s)
- Alessandra Consales
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Matteo Porro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Physical Medicine & Rehabilitation Service, Milan, Italy
| | - Silvana Gangi
- NICU, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Pesenti
- NICU, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Division of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Laura Gardon
- NICU, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Squarza
- NICU, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Frigerio
- NICU, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Irene Lezzi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giulia Vizzari
- NICU, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniela Morniroli
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Marta Macchi
- NICU, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Camilla Fontana
- NICU, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Monica Fumagalli
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- NICU, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Odoardo Picciolini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Physical Medicine & Rehabilitation Service, Milan, Italy
| | - Fabio Mosca
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- NICU, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Lorella Giannì
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- NICU, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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Peter C, Abukhris A, Brendel J, Böhne C, Bohnhorst B, Pirr S. Growth and Duration of Inflammation Determine Short- and Long-Term Outcome in Very-Low-Birth-Weight Infants Requiring Abdominal Surgery. Nutrients 2023; 15:nu15071668. [PMID: 37049507 PMCID: PMC10097180 DOI: 10.3390/nu15071668] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 04/14/2023] Open
Abstract
Necrotizing enterocolitis (NEC), spontaneous intestinal perforation (SIP) and meconium-related ileus (MI) requiring surgical intervention are associated with a high risk of severe short- and long-term complications in very-low-birth-weight (VLBW) infants including poor growth, cholestasis and neurodevelopmental impairment. This retrospective study aimed to identify risk factors for such complications in a cohort of 55 VLBW preterm infants requiring surgery with enterostomy creation due to NEC, SIP or MI. Long-term follow-up was available for 43 (78%) infants. Multiple regression analyses revealed that the duration of inflammation and longitudinal growth determined the risk of cholestasis and neurodevelopmental outcome at 2 years corrected age independent of the aetiology of the intestinal complication. Direct bilirubin increased by 4.9 μmol/L (95%CI 0.26-9.5), 1.4 μmol/L (95%CI 0.6-2.2) and 0.8 μmol/L (95%CI 0.22-1.13) with every day of elevated (Interleukin-6) IL-6, (C-reactive protein) CrP and parenteral nutrition. The mental development index at 2 years corrected age decreased by 3.8 (95%CI -7.3--0.36), 0.4 (95%CI 0.07-0.80) and 0.3 (95%CI 0.08-0.57) with every day of elevated IL-6 and every 1 point decrease in weight percentile at discharge and 2 years. These data stress the importance of optimal timing for the initial surgery in order to prevent prolonged inflammation and an early reversal of the enterostomy in case of poor growth or insufficient enteral nutrition.
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Affiliation(s)
- Corinna Peter
- Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Abdulmonem Abukhris
- Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Julia Brendel
- Department of Paediatric Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Carolin Böhne
- Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Bettina Bohnhorst
- Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Sabine Pirr
- Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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Lin YC, Chu CH, Chen YJ, Chen RB, Huang CC. Early-Life Slow Enteral Feeding Progression Pattern Is Associated with Longitudinal Head-Size Growth Faltering and Neurodevelopmental Impairment Outcomes in Extremely Preterm Infants. Nutrients 2023; 15:nu15051277. [PMID: 36904276 PMCID: PMC10005088 DOI: 10.3390/nu15051277] [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: 02/04/2023] [Revised: 03/02/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVE To determine whether feeding progression patterns in the first eight postnatal weeks, depicted by clustering analysis of daily enteral feeding volume, are associated with longitudinal head-circumference (HC) growth and neurodevelopmental outcomes in extremely preterm (EP) infants. METHODS 200 infants who were admitted at gestational ages 23-27 weeks between 2011 and 2018; survived to discharge; and underwent longitudinal HC growth measurements at birth, term-equivalent age (TEA), corrected age (CA) 6-month, 12-month, and 24-month; and neurodevelopmental assessment using the Bayley Scales of Infant Development at CA 24 months were included for analysis. RESULTS kmlShape analysis identified two distinct enteral feeding progression patterns: fast progression in 131 (66%) infants and slow progression in 69 (34%) infants. Compared to the fast progression group, the slow progression group showed significantly lower daily enteral volumes after day 13, was older in postnatal age reaching full feeding, had a higher rate of Delta z scores of HC (zHC) < -1 (p < 0.001) between birth and TEA, and displayed lower longitudinal zHC from TEA to CA 24 months. The slow progression group also showed higher rates of microcephaly [42% vs. 16%, p < 0.001; adjusted odd ratio (aOR): 3.269, p = 0.001] and neurodevelopmental impairment (NDI) (38% vs. 19%, p = 0.007; aOR: 2.095, p = 0.035) at CA 24 months. For NDI, the model including feeding progression patterns showed a lower Akaike information criterion score and a better goodness of fit than the model that did not include feeding patterns. CONCLUSION Characterizing feeding progression pattern may help identify EP infants at high-risk of head-size growth faltering and NDI at early childhood.
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Affiliation(s)
- Yung-Chieh Lin
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Cheng-Kung University, Tainan 701401, Taiwan
| | - Chi-Hsiang Chu
- Department of Statistics, Tunghai University, Taichung 407224, Taiwan
- Department of Statistics, Institute of Data Science, National Cheng Kung University, Tainan 701401, Taiwan
| | - Yen-Ju Chen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Cheng-Kung University, Tainan 701401, Taiwan
| | - Ray-Bing Chen
- Department of Statistics, Institute of Data Science, National Cheng Kung University, Tainan 701401, Taiwan
| | - Chao-Ching Huang
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan
- Department of Pediatrics, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
- Correspondence: ; Tel.: +886-62353535-5273
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10
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Hu X, Lu J, Zhang J, Zhang M, Yu Z, Lee SK, Han S, Chen X. Survey on human milk feeding and enteral feeding practices for very-low-birth-weight infants in NICUs in China Neonatal Network. BMC Pediatr 2023; 23:75. [PMID: 36765301 PMCID: PMC9918398 DOI: 10.1186/s12887-023-03862-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/24/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND The breastfeeding rate in China is lower than that in many other countries and the extent of adoption of the "Feeding Recommendations for Preterm Infants and Low Birth Weight Infants" guideline in NICUs remains unclear. METHOD A web-based survey about the current status of human milk feeding and enteral feeding practices at NICUs was sent to all China Neonatal Network's cooperation units on September 7, 2021, and the respondents were given a month to send their responses. RESULTS All sixty NICUs responded to the survey, the reply rate was 100%. All units encouraged breastfeeding and provided regular breastfeeding education. Thirty-six units (60.0%) had a dedicated breastfeeding/pumping room, 55 (91.7%) provided kangaroo care, 20 (33.3%) had family rooms, and 33 (55.0%) routinely provided family integrated care. Twenty hospitals (33.3%) had their own human milk banks, and only 13 (21.7%) used donor human milk. Eight units (13.3%) did not have written standard nutrition management guidelines for infants with body weight < 1500 g. Most units initiated minimal enteral nutrition with mother's milk for infants with birth weight ˂1500 g within 24 h after birth. Fifty NICUs (83.3%) increased the volume of enteral feeding at 10-20 ml/kg daily. Thirty-one NICUs (51.7%) assessed gastric residual content before every feeding session. Forty-one NICUs (68.3%) did not change the course of enteral nutrition management during drug treatment for patent ductus arteriosus, and 29 NICUs (48.3%) instated NPO for 1 or 2 feeds during blood transfusion. CONCLUSION There were significant differences in human milk feeding and enteral feeding strategies between the NICUs in CHNN, but also similarities. The data obtained would be useful in the establishment of national enteral feeding guidelines for preterm infants and quality improvement of cooperation at the national level.
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Affiliation(s)
- Xiaoshan Hu
- grid.89957.3a0000 0000 9255 8984Department of Pediatrics, Maternity Hospital Affiliated to Nanjing Medical University/ Nanjing Maternal and Child Health Hospital, Nanjing, Jiangsu China
| | - Junjie Lu
- grid.89957.3a0000 0000 9255 8984Department of Pediatrics, Maternity Hospital Affiliated to Nanjing Medical University/ Nanjing Maternal and Child Health Hospital, Nanjing, Jiangsu China
| | - Jun Zhang
- grid.89957.3a0000 0000 9255 8984Department of Pediatrics, Maternity Hospital Affiliated to Nanjing Medical University/ Nanjing Maternal and Child Health Hospital, Nanjing, Jiangsu China
| | - Min Zhang
- grid.89957.3a0000 0000 9255 8984Department of Pediatrics, Maternity Hospital Affiliated to Nanjing Medical University/ Nanjing Maternal and Child Health Hospital, Nanjing, Jiangsu China
| | - Zhangbin Yu
- grid.89957.3a0000 0000 9255 8984Department of Pediatrics, Maternity Hospital Affiliated to Nanjing Medical University/ Nanjing Maternal and Child Health Hospital, Nanjing, Jiangsu China
| | - Shoo K. Lee
- grid.17063.330000 0001 2157 2938Department of Pediatrics, University of Toronto Faculty of Medicine, Toronto, ON Canada
| | - Shuping Han
- Department of Pediatrics, Maternity Hospital Affiliated to Nanjing Medical University/ Nanjing Maternal and Child Health Hospital, Nanjing, Jiangsu, China.
| | - Xiaohui Chen
- Department of Pediatrics, Maternity Hospital Affiliated to Nanjing Medical University/ Nanjing Maternal and Child Health Hospital, Nanjing, Jiangsu, China.
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11
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Belyaeva IA, Bombardirova EP, Prihodko EA, Kruglyakov AY, Mikheeva AA, Larina AR. Clinical Phenotypes of Malnutrition in Young Children: Differential Nutritional Correction. CURRENT PEDIATRICS 2023. [DOI: 10.15690/vsp.v21i6.2495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This review article summarizes current data on malnutrition etiology and pathogenesis in infants. Topical requirements for revealing this condition, its diagnosis and severity assessment via centile metrics are presented. The characteristics of the most common clinical phenotypes of postnatal growth insufficiency in infants (premature infants with different degree of maturation, including patients with bronchopulmonary dysplasia) are described. Differential approaches for malnutrition nutritional correction in these children are presented. The final section of the article describes special nutritional needs for children with congenital heart defects in terms of hemodynamic disorders nature and severity. Modern nutritional strategies for preparation of these patients to surgery and for their postoperative period are presented. The use of high-calorie/high-protein product for malnutrition correction in the most vulnerable patients with described in this review phenotypes is worth noticing.
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Affiliation(s)
- I. A. Belyaeva
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery; Pirogov Russian National Research Medical University; Morozovskaya Children’s City Hospital
| | - E. P. Bombardirova
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery
| | | | | | - A. A. Mikheeva
- Research Institute for Healthcare Organization and Medical Management
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12
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Gallini F, Pelosi MS, De Rose DU, Coppola M, Costa S, Romeo DM, Cocca C, Maggio L, Cota F, Piersanti A, Ricci D, Vento G. Neurodevelopmental Outcomes in Preterm Infants Receiving a Multicomponent vs. a Soybean-Based Lipid Emulsion: 24 Month Follow-Up of a Randomized Controlled Trial. Nutrients 2022; 15:nu15010058. [PMID: 36615716 PMCID: PMC9824491 DOI: 10.3390/nu15010058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 12/18/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Few studies in the literature have analyzed the long-term neurodevelopmental outcomes of the administration of a multicomponent versus a soybean-based lipid emulsion (LE) in preterm infants receiving parenteral nutrition (PN). A recent randomized controlled trial conducted in our unit provided evidence of better growth in head circumference during the hospital stay in those who received a multicomponent LE. METHODS This is a 24 month follow-up study of preterm infants, previously enrolled in a randomized trial, who received a multicomponent LE (SMOFlipid®) or a standard soybean-based one (Intralipid®). We evaluated neurodevelopmental outcomes at 24 months of corrected age (CA) in the two groups. RESULTS Ninety-three children were followed up to the age of 24 months CA. Due to the peculiar time frame of the SARS-CoV-2 pandemic, neurodevelopmental outcomes were evaluated only in 77 children: 37 in the SMOFlipid® group and 40 in the Intralipid® group. No differences in major disability rates or in Griffith's evaluation were found between the two groups. CONCLUSIONS In our population study, the administration of a multicomponent LE containing fish oil, compared to a soybean-based LE, had no significant effects on neurodevelopmental outcomes in preterm infants at 24 months CA.
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Affiliation(s)
- Francesca Gallini
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy
- Dipartimento di Scienze della Vita e Sanità Pubblica, Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-6-3015-4475/5165; Fax: +39-6-3052-751
| | - Maria Sofia Pelosi
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy
| | - Domenico Umberto De Rose
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus-Newborn-Infant, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy
| | - Maria Coppola
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy
| | - Simonetta Costa
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy
| | - Domenico Marco Romeo
- Dipartimento di Scienze della Vita e Sanità Pubblica, Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Pediatric Neurology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy
| | - Carmen Cocca
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy
| | - Luca Maggio
- Dipartimento di Scienze della Vita e Sanità Pubblica, Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Neonatology Unit, San Camillo Forlanini Hospital, 00152 Rome, Italy
| | - Francesco Cota
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy
| | - Alessandra Piersanti
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy
| | - Daniela Ricci
- Pediatric Neurology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy
- National Centre of Services and Research for the Prevention of Blindness and Rehabilitation of Low Vision Patients-International Agency for the Prevention of Blindness (IAPB) Italia Onlus, 00185 Rome, Italy
| | - Giovanni Vento
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy
- Dipartimento di Scienze della Vita e Sanità Pubblica, Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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13
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Lucaccioni L, Iughetti L, Berardi A, Predieri B. Challenges in the growth and development of newborns with extra-uterine growth restriction. Expert Rev Endocrinol Metab 2022; 17:415-423. [PMID: 35941822 DOI: 10.1080/17446651.2022.2110468] [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: 04/03/2022] [Accepted: 08/03/2022] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Extra-uterine growth restriction (EUGR) is a condition caused by the failure of very preterm infants to reach their potential growth during the NICU hospital stay. Despite enormous improvements in nutritional support and strategies, the growth pattern of preterm infants is still far from the one expected. AREAS COVERED This review focuses on what EUGR is, highlighting controversial aspects of this topic. EUGR is still missing a univocal definition, and the international debate is also open on what is the best growth chart to use. Moreover, professionals in NICU may not be trained on how to perform anthropometric measurements, increasing the risk of over- or underestimation, especially for length assessment. EUGR has recently been described as one of the main comorbidities in NICU, influencing growth, metabolism, and neurodevelopment later in life. EXPERT OPINION There is still much to investigate about what the best growth pattern in the NICU should be. What is known so far is that the majority of preterm neonates develop EUGR, and this leads to several short- and long-term consequences. It is imperative that neonatologists and pediatric endocrinologists work together, to modulate growth in the NICU.
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Affiliation(s)
- Laura Lucaccioni
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Lorenzo Iughetti
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Alberto Berardi
- Neonatology Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Barbara Predieri
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
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14
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Salvatori G, De Rose DU, Massolo AC, Patel N, Capolupo I, Giliberti P, Evangelisti M, Parisi P, Toscano A, Dotta A, Di Nardo G. Current Strategies to Optimize Nutrition and Growth in Newborns and Infants with Congenital Heart Disease: A Narrative Review. J Clin Med 2022; 11:jcm11071841. [PMID: 35407451 PMCID: PMC8999967 DOI: 10.3390/jcm11071841] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 11/24/2022] Open
Abstract
(1) Objective: This review aims to identify the clinical and practical barriers to optimizing nutrition in newborn infants with congenital heart disease (CHD) and to describe updated evidence-based recommendations for clinical and nutritional management of these patients in a narrative review. (2) Research Methods and Procedures: We conducted a search of the relevant literature published from 2000 to December 2021. (3) Results: CHD patients undergo several nutritional challenges related to the underlying cardiac disease anomaly, the potential increased risk of NEC, and delayed enteral feeding, resulting in inadequate energy intake and sub-optimal growth, increased morbidity and mortality. (4) Conclusions: To optimize nutrition and growth in newborn infants with CHD, standardized protocols should be implemented. Regular nutritional and growth assessment with a multi-disciplinary team is essential. We propose a decisional algorithm that may represent a potentially useful tool to guide clinicians to optimize growth and nutrition.
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Affiliation(s)
- Guglielmo Salvatori
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus-Newborn-Infant, “Bambino Gesù” Children’s Hospital, IRCCS, 00165 Rome, Italy; (D.U.D.R.); (A.C.M.); (I.C.); (P.G.); (A.D.)
- Human Milk Bank, Medical and Surgical Department of Fetus-Newborn-Infant, “Bambino Gesù” Children’s Hospital, IRCCS, 00165 Rome, Italy
- Correspondence: ; Tel.: +39-06-6859-2427; Fax: +39-06-6859-3916
| | - Domenico Umberto De Rose
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus-Newborn-Infant, “Bambino Gesù” Children’s Hospital, IRCCS, 00165 Rome, Italy; (D.U.D.R.); (A.C.M.); (I.C.); (P.G.); (A.D.)
- PhD Course in Microbiology, Immunology, Infectious Diseases, and Transplants (MIMIT), Faculty of Medicine and Surgery, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Anna Claudia Massolo
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus-Newborn-Infant, “Bambino Gesù” Children’s Hospital, IRCCS, 00165 Rome, Italy; (D.U.D.R.); (A.C.M.); (I.C.); (P.G.); (A.D.)
- Human Milk Bank, Medical and Surgical Department of Fetus-Newborn-Infant, “Bambino Gesù” Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Neil Patel
- Department of Neonatology, Royal Hospital for Children, Glasgow G51 4TF, UK;
| | - Irma Capolupo
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus-Newborn-Infant, “Bambino Gesù” Children’s Hospital, IRCCS, 00165 Rome, Italy; (D.U.D.R.); (A.C.M.); (I.C.); (P.G.); (A.D.)
- Human Milk Bank, Medical and Surgical Department of Fetus-Newborn-Infant, “Bambino Gesù” Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Paola Giliberti
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus-Newborn-Infant, “Bambino Gesù” Children’s Hospital, IRCCS, 00165 Rome, Italy; (D.U.D.R.); (A.C.M.); (I.C.); (P.G.); (A.D.)
- Human Milk Bank, Medical and Surgical Department of Fetus-Newborn-Infant, “Bambino Gesù” Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Melania Evangelisti
- NESMOS Department, Chair of Pediatrics, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, 00189 Rome, Italy; (M.E.); (P.P.); (G.D.N.)
| | - Pasquale Parisi
- NESMOS Department, Chair of Pediatrics, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, 00189 Rome, Italy; (M.E.); (P.P.); (G.D.N.)
| | - Alessandra Toscano
- Perinatal Cardiology Unit, Medical and Surgical Department of Fetus-Newborn-Infant, “Bambino Gesù” Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Andrea Dotta
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus-Newborn-Infant, “Bambino Gesù” Children’s Hospital, IRCCS, 00165 Rome, Italy; (D.U.D.R.); (A.C.M.); (I.C.); (P.G.); (A.D.)
- Human Milk Bank, Medical and Surgical Department of Fetus-Newborn-Infant, “Bambino Gesù” Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Giovanni Di Nardo
- NESMOS Department, Chair of Pediatrics, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, 00189 Rome, Italy; (M.E.); (P.P.); (G.D.N.)
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15
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Lin YC, Chu CH, Chen YJ, Chen RB, Huang CC. Gestational Age-Related Associations between Early-Life Feeding Trajectories and Growth Outcomes at Term Equivalent Age in Very Preterm Infants. Nutrients 2022; 14:nu14051032. [PMID: 35268013 PMCID: PMC8912445 DOI: 10.3390/nu14051032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 11/16/2022] Open
Abstract
Establishing the different feeding trajectories based on daily enteral feeding data in preterm infants at different gestational ages (GAs), may help to identify the risks and extrauterine growth restriction (EUGR) outcomes associated with the adverse feeding pattern. In a single center, we retrospectively included 625 infants born at 23-30 weeks of gestation who survived to term-equivalent age (TEA) from 2009 to 2020. The infants were designated into three GA groups: 23-26, 27-28, and 29-30 weeks. The daily enteral feeding amounts in the first 56 postnatal days were analyzed to determine the feeding trajectories. The primary outcomes were EUGR in body weight and head circumference calculated, respectively, by the changes between birth and TEA. Clustering analysis identified two feeding trajectories, namely the improving and adverse patterns in each GA group. The adverse feeding pattern that occurred in 49%, 20%, and 17% of GA 23-26, 27-28, and 29-30 weeks, respectively, was differentiated from the improving feeding pattern as early as day 7 in infants at GA 23-26 and 27-28 weeks, in contrast to day 21 in infants at GA 29-30 weeks. The adverse feeding patterns were associated with sepsis, respiratory, and gastrointestinal morbidities at GA 23-26 weeks; sepsis, hemodynamic and gastrointestinal morbidities at GA 27-28 weeks; and preeclampsia, respiratory, and gastrointestinal morbidities at GA 29-30 weeks. Using the improving feeding group as a reference, the adverse feeding group showed significantly higher adjusted odds ratios of EUGR in body weight and head circumference in infants at GA 23-26 and 27-28 weeks. Identifying the early-life adverse feeding trajectories may help recognize the related EUGR outcomes of preterm infants in a GA-related manner.
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Affiliation(s)
- Yung-Chieh Lin
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan; (Y.-C.L.); (Y.-J.C.)
- Graduate Institute of Clinical Medicine, College of Medicine, National Cheng-Kung University, Tainan 701401, Taiwan
| | - Chi-Hsiang Chu
- Department of Statistics, Tunghai University, Taichung 407224, Taiwan;
- Department of Statistics, Institute of Data Science, National Cheng Kung University, Tainan 701401, Taiwan;
| | - Yen-Ju Chen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan; (Y.-C.L.); (Y.-J.C.)
- Graduate Institute of Clinical Medicine, College of Medicine, National Cheng-Kung University, Tainan 701401, Taiwan
| | - Ray-Bing Chen
- Department of Statistics, Institute of Data Science, National Cheng Kung University, Tainan 701401, Taiwan;
| | - Chao-Ching Huang
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan; (Y.-C.L.); (Y.-J.C.)
- Department of Pediatrics, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
- Correspondence: ; Tel.: +886-6235-3535-5273
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16
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Lan S, Fu H, Zhang R, Zhong G, Pan L, Bei F, Hong L. Extrauterine growth restriction in preterm infants: Postnatal growth pattern and physical development outcomes at age 3-6 years. Front Pediatr 2022; 10:945422. [PMID: 35967552 PMCID: PMC9372328 DOI: 10.3389/fped.2022.945422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/07/2022] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To investigate the postnatal growth trajectories of preterm infants and evaluate the association between extrauterine growth restriction (EUGR) at discharge and adverse physical growth outcomes at age 3-6 years. METHODS Premature infants admitted to Shanghai Children's Medical Center within 24 h after birth from 1 January 2016 to 31 December 2018 were enrolled. Neonatal complications, nutrition support, and anthropometric data were collected and analyzed to diagnose EUGR on different definitions at discharge. The weight and the height of each subject were collected by telephone investigation from 1 September 2021 to 31 November 2021 to access the incidences of overweight/obesity, short stature, and thinness at age 3-6 years. RESULTS A total of 527 preterm infants were included in the final sample. The overall mean weight and height Z-scores were -0.37 ± 0.97 SD and -0.29 ± 1.18 SD at birth, and increased to -0.03 ± 1.11 SD and 0.13 ± 1.2 SD at follow-up, respectively. The logistic regression analysis indicated longitudinal EUGR on head circumference as the risk factor of overweight or obesity, cross-sectional EUGR on height as the risk factor of short stature, and delayed EN as the risk factor of thinness. CONCLUSION The growth trajectories of the preterm newborns tended toward the normal direction. Longitudinal EUGR on the head circumference and cross-sectional EUGR on height at discharge were associated with adverse physical growth outcomes at age 3-6 years.
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Affiliation(s)
- Siyuan Lan
- Department of Clinical Nutrition, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Huanhuan Fu
- Department of Clinical Nutrition, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Rui Zhang
- Department of Pediatrics, Fujian Provincial Maternity and Children's Hospital, Fujian Medical University, Fujian, China
| | - Guimei Zhong
- Department of Neonatal Intensive Care Unit, Quanzhou First Hospital, Fujian, China
| | - Liya Pan
- Department of Clinical Nutrition, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Fei Bei
- Department of Neonatology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Li Hong
- Department of Clinical Nutrition, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Yang YN. Current concepts of very low birth weight infants with extra-uterine growth restriction. Pediatr Neonatol 2022; 63:3-4. [PMID: 34965911 DOI: 10.1016/j.pedneo.2021.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/07/2021] [Indexed: 10/19/2022] Open
Affiliation(s)
- Yung-Ning Yang
- Department of Pediatrics, E-DA Hospital, Kaohsiung, Taiwan; School of Medicine, I-Shou University, Kaohsiung, Taiwan.
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18
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Gallini F, De Rose DU, Coppola M, Pelosi MS, Cota F, Bottoni A, Ricci D, Romeo DM, Spanu T, Maggio L, Mercuri E, Vento G. Maternal Ureaplasma/Mycoplasma colonization during pregnancy and neurodevelopmental outcomes for preterm infants. Front Pediatr 2022; 10:893812. [PMID: 36046478 PMCID: PMC9420904 DOI: 10.3389/fped.2022.893812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/19/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Ureaplasma (U.) and Mycoplasma (M.) species have been related to pregnancy complications (including preterm birth) and worse neonatal outcomes. The aim of our work is to evaluate neurodevelopmental outcomes in preterm infants born to mothers with Ureaplasma/Mycoplasma colonization during pregnancy. METHODS Preterm infants with gestational age (GA) of ≤ 30 weeks were included in a retrospective follow-up study. To evaluate the effects of maternal vaginal colonization, we divided preterm infants into two groups: exposed and unexposed infants. All infants were assessed at 24 ± 3 months of age using Griffith's Mental Developmental Scales (GMDS). RESULTS Among 254 preterm infants, only 32 infants (12.6%) were exposed to U. /M. colonization during pregnancy. Exposed infants and unexposed ones had a similar Griffith's Developmental Quotient (106 ± 27.2 vs. 108.9 ± 19.5, respectively), without significant differences (p = 0.46). However, exposed infants had a significantly poorer outcome than their unexposed peers in terms of locomotor abilities (100.7 ± 28.3 exposed vs. 111.5 ± 26.1 unexposed, p = 0.03). CONCLUSION For visual and hearing impairment, exposed and unexposed infants had similar incidences of cognitive and motor impairment. However, exposed infants had significantly lower locomotor scores than unexposed peers.
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Affiliation(s)
- Francesca Gallini
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.,Università Cattolica del Sacro Cuore, Milan, Italy
| | - Domenico Umberto De Rose
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.,Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus-Newborn-Infant, "Bambino Gesù" Children's Hospital Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Maria Coppola
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Maria Sofia Pelosi
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Francesco Cota
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.,Università Cattolica del Sacro Cuore, Milan, Italy
| | - Anthea Bottoni
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Daniela Ricci
- National Centre of Services and Research for the Prevention of Blindness and Rehabilitation of Low Vision Patients-International Agency for the Prevention of Blindness (IAPB) Italia Onlus, Rome, Italy.,Pediatric Neurology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Domenico Marco Romeo
- Università Cattolica del Sacro Cuore, Milan, Italy.,Pediatric Neurology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Teresa Spanu
- Università Cattolica del Sacro Cuore, Milan, Italy.,Department of Laboratory and Infectious Sciences, Fondazione Policlinico Universitario "Agostino Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Luca Maggio
- Università Cattolica del Sacro Cuore, Milan, Italy.,Neonatology Unit, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Eugenio Mercuri
- Università Cattolica del Sacro Cuore, Milan, Italy.,Pediatric Neurology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Giovanni Vento
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.,Università Cattolica del Sacro Cuore, Milan, Italy
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19
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蒋 仁, 申 玉, 刘 晓, 李 禄, 程 茜. Long-term effect of active parenteral nutrition support regimen in preterm infants with a gestational age of <34 weeks. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:1221-1227. [PMID: 34911604 PMCID: PMC8690710 DOI: 10.7499/j.issn.1008-8830.2108113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/26/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To study the long-term effect of active parenteral nutrition support regimen in preterm infants with a gestational age of <34 weeks. METHODS According to the different doses of fat emulsion and amino acids used in the early stage, the preterm infants with a gestational age of <34 weeks, who were admitted to the hospital within 24 hours after birth from May to December 2019, were divided into an active parenteral nutrition group and a conventional parenteral nutrition group (n=50). Physical indices and the measurements of the Gesell Development Scale were collected at the age of 6 months and 13 months. RESULTS At the age of 6 months, the active parenteral nutrition group (n=46) had higher developmental quotients of gross motor, fine motor, and personal-social behavior than the conventional parenteral nutrition group (n=34) (P<0.05). At the age of 13 months, the active parenteral nutrition group (n=25) had higher developmental quotients of adaptive behavior, gross motor, and personal-social behavior than the conventional parenteral nutrition group (n=19) (P<0.05). There were no significant differences in the physical development indices such as body weight, body height, and head circumference between the two groups during follow-up (P>0.05). CONCLUSIONS For preterm infants with a gestational age of <34 weeks, an active parenteral nutrition support strategy with high doses of fat emulsion and amino acids within 24 hours after birth can improve their long-term neurodevelopment.
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Affiliation(s)
| | - 玉洁 申
- 重庆医科大学附属 儿童医院新生儿中心重庆400014
- 儿科学重庆市重点实验室重庆400014
- 国家儿童健康与疾病临床医学研究中心重庆400014
| | - 晓晨 刘
- 重庆医科大学附属 儿童医院新生儿中心重庆400014
- 儿童发育疾病研究教育部 重点实验室重庆400014
- 儿童发育重大疾病国家国际科技合作基地重庆400014
| | - 禄全 李
- 重庆医科大学附属 儿童医院新生儿中心重庆400014
- 儿科学重庆市重点实验室重庆400014
- 儿童发育疾病研究教育部 重点实验室重庆400014
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20
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Rao S, Simmer K. Postnatal weight gain in very preterm infants: are we aiming too high? THE LANCET. CHILD & ADOLESCENT HEALTH 2021; 5:683-685. [PMID: 34450108 DOI: 10.1016/s2352-4642(21)00247-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/02/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Shripada Rao
- Neonatal Directorate, King Edward Memorial and Perth Children's Hospitals, Perth, WA 6009, Australia; School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Karen Simmer
- Neonatal Directorate, King Edward Memorial and Perth Children's Hospitals, Perth, WA 6009, Australia; School of Medicine, University of Western Australia, Perth, WA, Australia.
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