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Barbieri J, Cober MP. Select micronutrients for the preterm neonate. Nutr Clin Pract 2023; 38 Suppl 2:S66-S83. [PMID: 37721469 DOI: 10.1002/ncp.11054] [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: 03/02/2023] [Revised: 07/04/2023] [Accepted: 07/09/2023] [Indexed: 09/19/2023] Open
Abstract
If premature neonates are not provided with adequate nutrition, they will quickly become deficient because of increased requirements and a lack of nutrient stores to achieve adequate growth. The provision of many of the recommended micronutrients for pediatric and adult patients is challenging in premature neonates because of the limited data surrounding the true needs of premature neonates and the difficulty in assessing adequate serum levels of these nutrients in this patient population. Parenteral and enteral nutrition shortages further complicate providing adequate micronutrients to premature neonates. This review will discuss select micronutrients and their importance to the preterm neonate, with special emphasis on micronutrients with limited evidence and more challenging supplementation and repletion strategies.
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Affiliation(s)
- Jessica Barbieri
- Department of Nutritional Services, Akron Children's Hospital, Akron, Ohio, USA
| | - Mary Petrea Cober
- Department of Pharmacy, Akron Children's Hospital, Akron, Ohio, USA
- Department of Pharmacy Practice, Northeast Ohio Medical University, Rootstown, Ohio, USA
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Embleton ND, Jennifer Moltu S, Lapillonne A, van den Akker CHP, Carnielli V, Fusch C, Gerasimidis K, van Goudoever JB, Haiden N, Iacobelli S, Johnson MJ, Meyer S, Mihatsch W, de Pipaon MS, Rigo J, Zachariassen G, Bronsky J, Indrio F, Köglmeier J, de Koning B, Norsa L, Verduci E, Domellöf M. Enteral Nutrition in Preterm Infants (2022): A Position Paper From the ESPGHAN Committee on Nutrition and Invited Experts. J Pediatr Gastroenterol Nutr 2023; 76:248-268. [PMID: 36705703 DOI: 10.1097/mpg.0000000000003642] [Citation(s) in RCA: 58] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To review the current literature and develop consensus conclusions and recommendations on nutrient intakes and nutritional practice in preterm infants with birthweight <1800 g. METHODS The European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee of Nutrition (CoN) led a process that included CoN members and invited experts. Invited experts with specific expertise were chosen to represent as broad a geographical spread as possible. A list of topics was developed, and individual leads were assigned to topics along with other members, who reviewed the current literature. A single face-to-face meeting was held in February 2020. Provisional conclusions and recommendations were developed between 2020 and 2021, and these were voted on electronically by all members of the working group between 2021 and 2022. Where >90% consensus was not achieved, online discussion meetings were held, along with further voting until agreement was reached. RESULTS In general, there is a lack of strong evidence for most nutrients and topics. The summary paper is supported by additional supplementary digital content that provide a fuller explanation of the literature and relevant physiology: introduction and overview; human milk reference data; intakes of water, protein, energy, lipid, carbohydrate, electrolytes, minerals, trace elements, water soluble vitamins, and fat soluble vitamins; feeding mode including mineral enteral feeding, feed advancement, management of gastric residuals, gastric tube placement and bolus or continuous feeding; growth; breastmilk buccal colostrum, donor human milk, and risks of cytomegalovirus infection; hydrolyzed protein and osmolality; supplemental bionutrients; and use of breastmilk fortifier. CONCLUSIONS We provide updated ESPGHAN CoN consensus-based conclusions and recommendations on nutrient intakes and nutritional management for preterm infants.
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Affiliation(s)
| | | | | | - Chris H P van den Akker
- the Department of Pediatrics - Neonatology, Amsterdam UMC - Emma Children's Hospital, University of Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Virgilio Carnielli
- Polytechnic University of Marche and Division of Neonatology, Ospedali Riuniti, Ancona, Ancona, Italy
| | - Christoph Fusch
- the Department of Pediatrics, Nuremberg General Hospital, Paracelsus Medical School, Nuremberg, Germany
- the Division of Neonatology, Department of Pediatrics, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Konstantinos Gerasimidis
- the Human Nutrition, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Johannes B van Goudoever
- Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Emma Children's Hospital, Amsterdam, The Netherlands
| | - Nadja Haiden
- the Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Silvia Iacobelli
- the Réanimation Néonatale et Pédiatrique, Néonatologie - CHU La Réunion, Saint-Pierre, France
| | - Mark J Johnson
- the Department of Neonatal Medicine, University Hospital Southampton NHS Trust, Southampton, UK
- the National Institute for Health Research Biomedical Research Centre Southampton, University Hospital Southampton NHS Trust and University of Southampton, Southampton, UK
| | - Sascha Meyer
- the Department of General Paediatrics and Neonatology, University Hospital of Saarland, Homburg, Germany
| | - Walter Mihatsch
- the Department of Pediatrics, Ulm University, Ulm, Germany
- the Department of Health Management, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany
| | - Miguel Saenz de Pipaon
- the Department of Pediatrics-Neonatology, La Paz University Hospital, Autonoma University of Madrid, Madrid, Spain
| | - Jacques Rigo
- the Neonatal Unit, University of Liège, CHR Citadelle, Liège, Belgium
| | - Gitte Zachariassen
- H.C. Andersen Children's Hospital, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Jiri Bronsky
- the Department of Paediatrics, University Hospital Motol, Prague, Czech Republic
| | - Flavia Indrio
- the Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Jutta Köglmeier
- the Department of Paediatric Gastroenterology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Barbara de Koning
- the Paediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Lorenzo Norsa
- the Paediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIIII, Bergamo, Italy
| | - Elvira Verduci
- the Department of Health Sciences, University of Milan, Milan, Italy
- the Department of Paediatrics, Ospedale dei Bambini Vittore Buzzi, Milan, Italy
| | - Magnus Domellöf
- the Department of Clinical Sciences, Paediatrics, Umeå University, Umeå, Sweden
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Rebelo F, Mansur IR, Miglioli TC, Meio MDB, Junior SCG. Dietary and nutritional interventions in children with cerebral palsy: A systematic literature review. PLoS One 2022; 17:e0271993. [PMID: 35867728 PMCID: PMC9307182 DOI: 10.1371/journal.pone.0271993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 07/04/2022] [Indexed: 12/03/2022] Open
Abstract
Background Cerebral palsy is an extremely severe brain injury associated with multiple nutritional and clinical issues, such as underweight, gastroesophageal reflux, constipation, and nutrient deficiency. Evidence-based dietary and nutritional interventions may improve the quality of life of children with cerebral palsy. Aim Systematically review randomized clinical trials evaluating nutritional and dietary interventions in the clinical, nutritional, and neurodevelopmental aspects of children with cerebral palsy. Methods A search was performed in electronic databases (LILACS, Medline, Web of Science, Embase, Scopus, Cochrane Library, ClinicalTrials.gov, Brazilian Digital Library of Theses and Dissertations, ProQuest Dissertations and Theses Database, OpenGrey) using keywords. The search was firstly performed in May 2020 and updated on June 18th, 2021. Eligible studies were randomized clinical trials, that included children between 2 and 12 years old, and evaluated the effect of nutritional or dietetic interventions on clinical, nutritional or neurodevelopmental outcomes. Risk of bias was investigated using the RoB-2 tool. The study was registered on PROSPERO (CRD42020181284). Results Fifteen studies were selected. Positive results included the use of whey-based or pectin-enriched enteral formulas for gastroesophageal reflux (n = 6); 25-hydroxy-vitamin D supplementation for hypovitaminosis D (n = 2); supplementation with lipid mixture or diet with high-density energy for improvements in anthropometric measures (n = 2); supplementation with probiotics, prebiotics, symbiotics or magnesium for constipation (n = 2); nutritional support system for gross motor function (n = 1); lactoferrin and iron hydroxide polymaltose for iron deficiency anemia (n = 1); and educational intervention to improve feeding skills (n = 1). The overall risk of bias was high for 60% of the studies, and some concerns were raised for the remaining 40%. Conclusion Some promising dietary and nutritional interventions may promote important clinical improvements for patients with cerebral palsy. However, evidence is weak, as few clinical trials have been published with many methodological errors, leading to a high risk of bias.
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Affiliation(s)
- Fernanda Rebelo
- Clinical Research Unit, National Institute of Women, Children and Adolescents Health Fernandes Figueira (IFF), Oswaldo Cruz Foundation (Fiocuz), Rio de Janeiro, RJ, Brazil
- * E-mail:
| | - Isabela Rodrigues Mansur
- Clinical Research Unit, National Institute of Women, Children and Adolescents Health Fernandes Figueira (IFF), Oswaldo Cruz Foundation (Fiocuz), Rio de Janeiro, RJ, Brazil
- Undergraduate Program in Nutrition, Fluminense Federal University (UFF), Niterói, RJ, Brazil
| | - Teresa Cristina Miglioli
- Clinical Research Unit, National Institute of Women, Children and Adolescents Health Fernandes Figueira (IFF), Oswaldo Cruz Foundation (Fiocuz), Rio de Janeiro, RJ, Brazil
| | - Maria Dalva Baker Meio
- Clinical Research Unit, National Institute of Women, Children and Adolescents Health Fernandes Figueira (IFF), Oswaldo Cruz Foundation (Fiocuz), Rio de Janeiro, RJ, Brazil
| | - Saint Clair Gomes Junior
- Clinical Research Unit, National Institute of Women, Children and Adolescents Health Fernandes Figueira (IFF), Oswaldo Cruz Foundation (Fiocuz), Rio de Janeiro, RJ, Brazil
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Ito T, Uenoyama K, Kobayashi K, Kakumoto M, Mizumoto H, Katsura T, Onoue M. Administration of zinc to preterm infants with hypozincemia does not reduce serum copper concentrations in most cases: a single-center retrospective observational study. J Pharm Health Care Sci 2021; 7:46. [PMID: 34852847 PMCID: PMC8638113 DOI: 10.1186/s40780-021-00229-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/19/2021] [Indexed: 12/01/2022] Open
Abstract
Background Zinc is an essential trace element involved in various physiological functions. In Japan, zinc acetate dihydrate is administered to neonates and infants with hypozincemia. Since serum copper concentrations are reduced by the administration of zinc, we retrospectively investigated changes in serum zinc and copper concentrations in preterm infants with hypozincemia receiving zinc acetate dihydrate. Methods Sixty-three preterm infants were included in the present study. Serum zinc and copper concentrations, doses, and other clinical characteristics were retrieved from electronic medical records. Results The medians and interquartile ranges of the dosage and duration of zinc acetate dihydrate were 2.1 (1.8–2.5) mg/kg/day and 12.0 (10.0–13.0) days, respectively. Its administration increased serum zinc concentrations in 39 patients (61.9%) and to more than 70 μg/dL in 16 patients (25.4%). The group with a serum zinc concentration of 70 μg/dL or higher after administration had a significantly higher zinc dose of 2.5 mg/kg/day than the group with a serum zinc concentration of less than 70 μg/dL. Serum copper concentrations did not decrease in 44 patients (69.8%). In the group with a decreased serum copper concentration, postmenstrual age and body weight were significantly lower, while serum zinc concentrations were significantly higher at the start of administration. Conclusion The present results showed that when zinc acetate dihydrate was administered to preterm infants with hypozincemia, it was possible to increase serum zinc concentrations without decreasing serum copper concentrations in many cases. However, caution may be required when administering zinc to preterm infants with a lower postmenstrual age or milder hypozincemia because serum copper concentrations may decrease.
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Affiliation(s)
- Toshikazu Ito
- Department of Pharmacy, Kitano Hospital, Tazuke Kofukai Medical Research Institute. 2-4-20, Ogimachi, Kita-ku, Osaka, 530-8480, Japan. .,Laboratory of Clinical Pharmaceutics and Therapeutics, College of Pharmaceutical Sciences, Ritsumeikan University, 1-1-1, Noji-higashi, Kusatsu, Shiga, 525-8577, Japan.
| | - Kazuya Uenoyama
- Department of Pharmacy, Kitano Hospital, Tazuke Kofukai Medical Research Institute. 2-4-20, Ogimachi, Kita-ku, Osaka, 530-8480, Japan
| | - Kazuhiro Kobayashi
- Department of Pharmacy, Kitano Hospital, Tazuke Kofukai Medical Research Institute. 2-4-20, Ogimachi, Kita-ku, Osaka, 530-8480, Japan
| | - Mikio Kakumoto
- Laboratory of Clinical Pharmacy, College of Pharmaceutical Sciences, Ritsumeikan University, 1-1-1, Noji-higashi, Kusatsu, Shiga, 525-8577, Japan
| | - Hiroshi Mizumoto
- Department of Pediatrics, Kitano Hospital, Tazuke Kofukai Medical Research Institute, 2-4-20, Ogimachi, Kita-ku, Osaka, 530-8480, Japan
| | - Toshiya Katsura
- Laboratory of Clinical Pharmaceutics and Therapeutics, College of Pharmaceutical Sciences, Ritsumeikan University, 1-1-1, Noji-higashi, Kusatsu, Shiga, 525-8577, Japan
| | - Masahide Onoue
- Department of Pharmacy, Kitano Hospital, Tazuke Kofukai Medical Research Institute. 2-4-20, Ogimachi, Kita-ku, Osaka, 530-8480, Japan
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Zhou Z, Yu D, Chen G, Li P, Wang L, Yang J, Rao J, Lin D, Fan D, Wang H, Gou X, Guo X, Suo D, Huang F, Liu Z. Fasting Plasma Glucose Mediates the Prospective Effect of Maternal Metal Level on Birth Outcomes: A Retrospective and Longitudinal Population-Based Cohort Study. Front Endocrinol (Lausanne) 2021; 12:763693. [PMID: 34867806 PMCID: PMC8635137 DOI: 10.3389/fendo.2021.763693] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/22/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Previously, we found that the presence of maternal serum metals before the 24th week of gestation prospectively increased fasting plasma glucose (FPG) at 24-28 weeks. We further explored the prospective association between levels of metals and neonatal outcomes and assessed the mediating effects of FPG on these relationships. METHODS A total of 7,644 pregnant women were included in a retrospective cohort study, and the relationships between metals [manganese (Mn), copper (Cu), lead (Pb), zinc (Zn), and magnesium (Mg)] and birth outcomes were explored. Quantile and linear regressions were performed to detect the shifts and associations between metals and neonatal size distribution focused on the 10th, 50th, and 90th percentiles. Mediation analysis was performed to assess the mediating effect of FPG on metals and birth outcomes. RESULTS After adjustment, a 50% increase in Mn and Zn levels was related to a 0.136-cm (95% CI: 0.067-0.205) and 0.120-cm (95% CI: 0.046-0.193) increase in head circumference, respectively. Based on head circumference distribution, the magnitude of the association with Mn was smaller at the upper tail, while the magnitude of correlation with Zn was greater at the upper tail. A 50% increase in Mn and Zn levels was related to a 0.135-cm (95% CI: 0.058-0.212) and 0.095-cm (95% CI: 0.013-0.178) increase in chest circumference, respectively. The magnitude of the association with Mn increased with increasing chest circumference, while the magnitude of correlation with Zn decreased with increasing chest circumference. FPG explained 10.00% and 17.65% of the associations of Mn with head and chest circumference. A positive indirect effect of Zn associated with head circumference (0.004, 95% CI: 0.002-0.006) and chest circumference (0.005, 95% CI: 0.003-0.008) through FPG was also observed, and the estimated proportion of the mediating effect was 13.79% and 26.32%, respectively. CONCLUSION Maternal serum Mn and Zn levels before the 24th week of gestation may prospectively increase the circumference of the neonatal head and chest. FPG at 24-28 weeks had positive mediating effects on these relationships. Further research is needed to identify a balance between maternal blood glucose and birth size.
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Affiliation(s)
- Zixing Zhou
- Foshan Fetal Medicine Research Institute, Foshan Women and Children Hospital Affiliated to Southern Medical University, Foshan, China
- Department of Obstetrics, Foshan Women and Children Hospital Affiliated to Southern Medical University, Foshan, China
| | - Dandan Yu
- Department of Obstetrics, Foshan Women and Children Hospital Affiliated to Southern Medical University, Foshan, China
| | - Gengdong Chen
- Foshan Fetal Medicine Research Institute, Foshan Women and Children Hospital Affiliated to Southern Medical University, Foshan, China
- Department of Obstetrics, Foshan Women and Children Hospital Affiliated to Southern Medical University, Foshan, China
| | - Pengsheng Li
- Foshan Fetal Medicine Research Institute, Foshan Women and Children Hospital Affiliated to Southern Medical University, Foshan, China
- Department of Obstetrics, Foshan Women and Children Hospital Affiliated to Southern Medical University, Foshan, China
| | - Lijuan Wang
- Department of Obstetrics, Foshan Women and Children Hospital Affiliated to Southern Medical University, Foshan, China
| | - Jie Yang
- Department of Obstetrics, Foshan Women and Children Hospital Affiliated to Southern Medical University, Foshan, China
| | - Jiaming Rao
- Foshan Fetal Medicine Research Institute, Foshan Women and Children Hospital Affiliated to Southern Medical University, Foshan, China
- Department of Obstetrics, Foshan Women and Children Hospital Affiliated to Southern Medical University, Foshan, China
| | - Dongxin Lin
- Foshan Fetal Medicine Research Institute, Foshan Women and Children Hospital Affiliated to Southern Medical University, Foshan, China
- Department of Obstetrics, Foshan Women and Children Hospital Affiliated to Southern Medical University, Foshan, China
| | - Dazhi Fan
- Foshan Fetal Medicine Research Institute, Foshan Women and Children Hospital Affiliated to Southern Medical University, Foshan, China
- Department of Obstetrics, Foshan Women and Children Hospital Affiliated to Southern Medical University, Foshan, China
| | - Haiyan Wang
- Foshan Fetal Medicine Research Institute, Foshan Women and Children Hospital Affiliated to Southern Medical University, Foshan, China
- Department of Obstetrics, Foshan Women and Children Hospital Affiliated to Southern Medical University, Foshan, China
| | - Xiaoyan Gou
- Foshan Fetal Medicine Research Institute, Foshan Women and Children Hospital Affiliated to Southern Medical University, Foshan, China
- Department of Obstetrics, Foshan Women and Children Hospital Affiliated to Southern Medical University, Foshan, China
| | - Xiaoling Guo
- Foshan Fetal Medicine Research Institute, Foshan Women and Children Hospital Affiliated to Southern Medical University, Foshan, China
- Department of Obstetrics, Foshan Women and Children Hospital Affiliated to Southern Medical University, Foshan, China
| | - Dongmei Suo
- Department of Obstetrics, Foshan Women and Children Hospital Affiliated to Southern Medical University, Foshan, China
- *Correspondence: Zhengping Liu, ; Fang Huang, ; Dongmei Suo,
| | - Fang Huang
- Department of Obstetrics, Foshan Women and Children Hospital Affiliated to Southern Medical University, Foshan, China
- *Correspondence: Zhengping Liu, ; Fang Huang, ; Dongmei Suo,
| | - Zhengping Liu
- Foshan Fetal Medicine Research Institute, Foshan Women and Children Hospital Affiliated to Southern Medical University, Foshan, China
- Department of Obstetrics, Foshan Women and Children Hospital Affiliated to Southern Medical University, Foshan, China
- *Correspondence: Zhengping Liu, ; Fang Huang, ; Dongmei Suo,
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Viehl L, Kelly BA, McAlister W, Anadkat J, Julian S. Monteggia Fracture in an Extremely Preterm Infant with Biochemical Rickets: A Case Report. JBJS Case Connect 2020; 10:e0454. [PMID: 32649107 DOI: 10.2106/jbjs.cc.19.00454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A preterm neonate with biochemical rickets is found to have a Monteggia fracture. The infant underwent percutaneous pinning. There was loss of fixation; however, the infant has been followed since discharge from the hospital and has completely healed with full range of motion. CONCLUSIONS The medical management of this entity involves enteral feedings and optimization of nutrients. The optimal surgical treatment of this injury in the neonatal period is not yet known, although percutaneous pinning resulted in normal healing and function. These aspects require clinician awareness of this unique fracture type in a premature patient with fragile bone.
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Affiliation(s)
- Luke Viehl
- 1Department of Pediatrics, Washington University School of Medicine at St. Louis Children's Hospital, St. Louis, Missouri 2Department of Orthopaedic Surgery, Washington University School of Medicine at St. Louis Children's Hospital, St. Louis, Missouri 3Department of Pediatric Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine at St. Louis Children's Hospital, St. Louis, Missouri 4Department of Newborn Medicine, Washington University School of Medicine at St. Louis Children's Hospital, St. Louis, Missouri
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Development of a human milk concentrate with human milk lyophilizate for feeding very low birth weight preterm infants: A preclinical experimental study. PLoS One 2019; 14:e0210999. [PMID: 30785913 PMCID: PMC6382113 DOI: 10.1371/journal.pone.0210999] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 01/06/2019] [Indexed: 12/11/2022] Open
Abstract
Breast milk is considered the gold standard nutritional resource for very low birth weight (VLBW) infants in terms of nutrients and protective factors. If mother's milk is not available, the second choice is donated and fortified human milk (HM) from the Human Milk Bank (HMB). This study hypothesized that HM could be lyophilized and used as an additive to increase the levels of macronutrients and micronutrients available to VLBW infants. This study aimed to constitute a lyophilized HM concentrate and determine the osmolality and the concentration of macronutrients and micronutrients in HM samples at “baseline” and in “HM concentrates”, analyzed immediately (HMCI), and after 3 (HMC3m) and 6 (HMC6m) months of freezing. Osmolality was verified using the freezing point osmometric method. Macronutrient quantification was performed using the MIRIS Human Milk Analyzer. Micronutrients were determined by Flame Atomic Absorption Spectrophotometry and by the automated colorimetric method. Bayesian linear mixed effect models were adjusted using OpenBUGS to estimate mean differences and 95% credibility intervals (CrI) of osmolality and of macro- and micronutrients between the types of HM samples. A comparison of dosage values showed a significant increase between HM baseline and HMCI, HMC3m, and HMC6m. Comparing HM baseline and HMCI highlighted the increase in energy content and the concentration of carbohydrates and total lipids. The Ca and P contents increased and the levels of energy, total lipids, and Cu were reduced in HMC3m compared to HMCI. Ca, Mg, K, Zn, and P increased and the levels of energy, total lipids, and Cu were reduced in HMC6m, compared to HMCI. The present study confirms the possibility of formulation and utilization of the immediate concentrate. Partial stability of HM concentrates generated from freeze-drying of donated milk do not recommend storage.
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Serum 25 Hydroxy Vitamin D Levels in Very Low Birth Weight Infants Receiving Oral Vitamin D Supplementation. J Pediatr Gastroenterol Nutr 2018; 66:676-679. [PMID: 29112088 DOI: 10.1097/mpg.0000000000001831] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND OBJECTIVE Vitamin D supplementation in preterm infants has been recommended by American Academy of Pediatrics (AAP); however, its efficacy and safety has not been well studied. To study 25-hydroxy vitamin D (25OHD) levels as a marker of vitamin D status of very low birth weight infants while on vitamin D supplementation during neonatal intensive care unit hospitalization. METHODS Retrospective study of preterm infants with birth weight <1500 g admitted to our unit from January 2013 to December 2015 who were on oral vitamin D3 400 IU supplementation. Serum 25OHD level were checked at 4, 8, and 12 weeks of age or before discharge and the levels were stratified as deficient <20 ng/mL, insufficient 20 to 29 ng/mL, normal 30 to 60 ng/mL, high 61 to 100 ng/mL and very high >100 ng/mL. RESULTS A total of 301 infants were enrolled, 186 very low birth weight (VLBW; 1000-1499 g) infants and 115 extremely low birth weight (ELBW; <1000 g) infants. Approximately 80% of both VLBWs and ELBWs had deficient or insufficient 25OHD levels at 4 weeks of age. On oral vitamin D supplementation, VLBW infants increased their 25OHD levels significantly by 8 and 12 weeks of age, whereas ELBW infants lagged behind at 8 weeks and increased their 25OHD levels by 12 weeks of age. CONCLUSIONS Eighty percent of ELBW and VLBW infants have either deficient or insufficient vitamin D status at 4 weeks of age. Vitamin D supplementation helps in improving the vitamin D levels, VLBW infants significantly more than ELBW infants. AAP recommendation appears to be safe; however, if using higher supplement dosing, 25OHD level should be monitored to avoid high and very high vitamin D levels.
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Anderson-Berry A, Thoene M, Wagner J, Lyden E, Jones G, Kaufmann M, Van Ormer M, Hanson C. Randomized trial of two doses of vitamin D3 in preterm infants <32 weeks: Dose impact on achieving desired serum 25(OH)D3 in a NICU population. PLoS One 2017; 12:e0185950. [PMID: 29016653 PMCID: PMC5634602 DOI: 10.1371/journal.pone.0185950] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 09/23/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Recommendations for vitamin D supplementation for preterm infants span a wide range of doses. Response to vitamin D supplementation and impact on outcomes in preterm infants is not well understood. OBJECTIVE Evaluate serum 25(OH)D3 concentration changes after 4 weeks in response to two different doses of vitamin D3 supplementation in a population of premature infants and quantify the impact on NICU outcomes. DESIGN 32 infants born at 24-32 weeks gestation were prospectively randomized to receive 400 or 800 IU/day vitamin D3 supplementation. Serum 25(OH)D3 levels were measured every 4 weeks. The Wilcoxon signed rank test was used to compare serum levels of 25(OH)D3 at 4 weeks and each subsequent time point. A p-value of <0.05 was considered statistically significant. RESULTS Serum 25(OH)D3 levels at birth were 41.9 and 42.9 nmol/l for infants in the 400 IU group and 800 IU group, respectively (p = 0.86). Cord 25(OH)D3 concentrations significantly correlated with gestational age (r = 0.40, p = 0.04). After 4 weeks of D3 supplementation, median 25(OH)D3 levels increased in both groups (84.6vs. 105.3 nmol/l for 400 vs. 800 IU/day respectively, with significantly more improvement in the higher dose (p = 0.048). Infants in the 400 IU group were significantly more likely to have dual energy x-ray absorptiometry (DEXA) bone density measurements <10 percentile (56% vs 16%, p = 0.04). CONCLUSIONS Improvement in 25(OH)D3 levels at 4 weeks, bone density, and trends towards improvement in linear growth support consideration of a daily dose of 800 IU of vitamin D for infants <32 weeks cared for in the NICU.
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Affiliation(s)
- Ann Anderson-Berry
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Melissa Thoene
- Neonatal Intensive Care Unit, The Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Julie Wagner
- CHI Health, Omaha, Nebraska, United States of America
| | - Elizabeth Lyden
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Glenville Jones
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Martin Kaufmann
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Matthew Van Ormer
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Corrine Hanson
- Division of Medical Nutrition Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
- * E-mail:
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Bocca B, Ciccarelli S, Agostino R, Alimonti A. Trace elements, oxidative status and antioxidant capacity as biomarkers in very low birth weight infants. ENVIRONMENTAL RESEARCH 2017; 156:705-713. [PMID: 28478178 DOI: 10.1016/j.envres.2017.04.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/01/2017] [Accepted: 04/21/2017] [Indexed: 06/07/2023]
Abstract
Reference data on trace elements, oxidative status and antioxidants in very low birth weight infants (VLBW) are limited and need to be updated for use in clinical settings. Serum and urine of 30 VLBW infants (mean weight, 1167g) at mean age of 23.8 (t0) and 37.8 (t1) days were analyzed. Cadmium (Cd), copper (Cu), iron (Fe), mercury (Hg), manganese (Mn), selenium (Se) and zinc (Zn), nitrate/nitrite (NOx), catalase (CAT), CuZnFeMn-superoxide dismutases (CuZnFeMn-SODs), total antioxidant capacity (SAC: sum of thiols, proteins, bilirubin, uric acid, β-beta-carotene, ascorbic acid, vitamin E) and total oxidative status (SOS: sum of lipo- and hydroperoxides) were determined. A higher urinary excretion of Cu and Zn was observed at t0 than at t1; while an increase in urine Cd was found at t1 respect to t0. A deficiency in serum levels of Cu and Zn was also found. A lower CAT activity, a higher total oxidants level (SOS) and a reduction of total antioxidant barriers (SAC) were observed in some infants. No Fe and Mn deficiency or Hg overload was found; also CuZnFeMn-SODs and NOx levels did not change. The findings showed that losses of trace elements and incomplete mineral body stores were more pronounced in the earlier life stage (at 23.8th day) than later on; moreover, antioxidant defenses were poor and lipo- and hydroperoxides were higher still at 5 weeks of infants' life.
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Affiliation(s)
- Beatrice Bocca
- Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy.
| | - Simona Ciccarelli
- Neonatal Intensive Care Unit and Neonatal Pathology, S. Giovanni Calibita-Fatebenefratelli Hospital, Rome, Italy
| | - Rocco Agostino
- Member of Etic Committee, Bambino Gesù Paediatric Hospital, Rome, Italy
| | - Alessandro Alimonti
- Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy
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Blasig S, Kühnen P, Schuette A, Blankenstein O, Mittag J, Schomburg L. Positive correlation of thyroid hormones and serum copper in children with congenital hypothyroidism. J Trace Elem Med Biol 2016; 37:90-95. [PMID: 27267969 DOI: 10.1016/j.jtemb.2016.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 05/20/2016] [Accepted: 05/23/2016] [Indexed: 10/21/2022]
Abstract
Thyroid hormones are of central relevance for growth and development. However, the underlying molecular mechanisms are still not fully understood. Recent studies in humans and mice have demonstrated that serum levels of selenium (Se) and copper (Cu) are positively affected by thyroid hormones. Given the importance of these trace elements for many biochemical processes, we tested whether this interaction is found in children at risk for hypothyroidism, potentially providing a novel factor contributing to the disturbed development observed in congenital hypothyroidism (CH). We conducted a cross-sectional analysis of 84 children diagnosed with CH displaying a wide range of thyroid hormone concentrations. Serum Se and Cu concentrations were measured by total reflection X-ray fluorescence. Data for thyrotropin (TSH) were available in all, thyroxine (T4) and free thyroxine (fT4) in the majority and triiodothyronine (T3) in 29 of the children. Spearman rank analyzes were performed. Cu and thyroid hormones showed a strong positive correlation (Cu/T4, rho=0.5241, P=0.0003; Cu/T3, rho=0.6003, P=0.0006). Unlike in adults, no associations were found between Se and any of the thyroid hormones. Our data highlight that serum Cu and thyroid hormones are strongly associated already in early postnatal life. Severely hypothyroid children are thus at risk of developing a Cu deficiency if not adequately nourished or supplemented. This finding needs to be verified in larger groups of children in order not to miss an easily-avoidable risk factor for poor development.
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Affiliation(s)
- Sarah Blasig
- Institute for Experimental Endocrinology, Charité -Universitaetsmedizin Berlin, D-13353 Berlin, Germany
| | - Peter Kühnen
- Department for Pediatric Endocrinology, Charité-Universitaetsmedizin Berlin, D-13353 Berlin, Germany
| | - Andrea Schuette
- Institute for Experimental Endocrinology, Charité -Universitaetsmedizin Berlin, D-13353 Berlin, Germany
| | - Oliver Blankenstein
- Department for Pediatric Endocrinology, Charité-Universitaetsmedizin Berlin, D-13353 Berlin, Germany
| | - Jens Mittag
- Center of Brain, Behavior and Metabolism (CBBM), Universität zu Lübeck, D-23538 Lübeck, Germany
| | - Lutz Schomburg
- Institute for Experimental Endocrinology, Charité -Universitaetsmedizin Berlin, D-13353 Berlin, Germany.
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Abstract
OBJECTIVES The aim of the study was to describe micronutrient intakes and explore possible correlations to growth during the first 70 days of life in extremely preterm infants. METHODS Retrospective population-based study including extremely preterm infants (<27 weeks) born in Sweden during 2004-2007. Detailed nutritional and growth data were derived from hospital records. RESULTS Included infants (n = 531) had a mean gestational age of 25 weeks and 2 days and a mean birth weight of 765 g. Estimated and adjusted intakes of calcium, phosphorus magnesium, zinc, copper, selenium, vitamin D, and folate were lower than estimated requirements, whereas intakes of iron, vitamin K, and several water-soluble vitamins were higher than estimated requirements. High iron intakes were explained by blood transfusions. During the first 70 days of life, taking macronutrient intakes and severity of illness into account, folate intakes were positively associated with weight (P = 0.001) and length gain (P = 0.003) and iron intake was negatively associated with length gain (P = 0.006). CONCLUSIONS Intakes of several micronutrients were inconsistent with recommendations. Even when considering macronutrient intakes and severity of illness, several micronutrients were independent predictors of early growth. Low intake of folate was associated with poor weight and length gain. Furthermore, high iron supply was associated with poor growth in length and head circumference. Optimized early micronutrient supply may improve early growth in extremely preterm infants.
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13
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Serum hepcidin in infants born after 32 to 37 wk of gestational age. Pediatr Res 2016; 79:608-13. [PMID: 26672736 DOI: 10.1038/pr.2015.258] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 09/24/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND Preterm infants are at risk of iron deficiency (ID). Hepcidin has been suggested as a good additional indicator of ID in preterm infants, next to ferritin. METHODS In a prospective observational study, we analyzed serum hepcidin in 111 infants born after 32+0 to 36+6 wk gestational age during the first 4 mo of life. RESULTS Hepcidin concentrations decreased during the first 4 mo of life, and concentrations were lower in infants with ID compared to those without ID. Infants who developed ID at the age of 4 mo had already significantly lower levels of hepcidin at 1.5 mo of age, while ferritin was already significantly lower at the age of 1 wk. CONCLUSION Hepcidin concentrations of late preterm infants decrease during the first 4 mo of life. This decrease, which parallels a decrease of ferritin concentration, we interpret as a physiological response, aiming to increase iron availability. Hepcidin concentrations are lower in infants with ID compared with those without ID, with a notable change already observed at 1.5 mo of age. Hepcidin can be used as an early marker of ID, although an additive value of hepcidin over ferritin in the diagnosis of ID is not present.
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Nakamura A, Miyado K, Nasu M, Kono T, Umezawa A. Phosphorus-insufficient maternal milk is associated with ectopic expression of collagen I and female-specific bony changes in infant mouse cartilages. Regen Ther 2015; 1:5-10. [PMID: 31245436 PMCID: PMC6581765 DOI: 10.1016/j.reth.2014.11.002] [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] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 11/05/2014] [Accepted: 11/22/2014] [Indexed: 11/23/2022] Open
Abstract
Excessive phosphorus intake causes diseases such as hyperphosphatemia and hypocalcaemia, but the effect of dietary insufficiency of phosphorus is unclear. Here, we explored the effect of phosphorus dietary insufficiency on tissue growth and maintenance by using C57BL/6J mice fed a low phosphorus diet, which contained 18.5% of the phosphorus of a normal diet. We demonstrated that the phosphorus content in the maternal milk of mother mice was significantly reduced due to the consumption of a low phosphorus diet, which further resulted in bone deformation in infant mice in a female-specific manner. Polarizing microscopic analysis of low-phosphorus milk (LPM)-induced bone deformation resulted in unusually formed crystals inside cartilage. Furthermore, immunohistochemical analysis revealed ectopic expression of collagen I in the region where crystals were ectopically formed. Electron microscopic analysis showed morphological features similar to bone tissues. Immunochemical analysis demonstrated that the amount of interleukin-6 (IL-6), a cytokine known to trigger osteoclast formation, was significantly reduced in the maternal milk of mice fed the low-phosphorus diet. Our results suggest that phosphorus intake from maternal milk is involved in infant cartilage formation.
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Affiliation(s)
- Akihiro Nakamura
- Department of Bioscience, Tokyo University of Agriculture, Setagaya, Tokyo, Japan
| | - Kenji Miyado
- Department of Reproductive Biology, National Research Institute for Child Health and Development, Setagaya, Tokyo, Japan
| | - Michiyo Nasu
- Department of Reproductive Biology, National Research Institute for Child Health and Development, Setagaya, Tokyo, Japan
| | - Tomohiro Kono
- Department of Bioscience, Tokyo University of Agriculture, Setagaya, Tokyo, Japan
| | - Akihiro Umezawa
- Department of Reproductive Biology, National Research Institute for Child Health and Development, Setagaya, Tokyo, Japan
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Finch CW. Review of trace mineral requirements for preterm infants: what are the current recommendations for clinical practice? Nutr Clin Pract 2014; 30:44-58. [PMID: 25527182 DOI: 10.1177/0884533614563353] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Inadequate nutrient stores at birth are an inevitable consequence of being born prematurely. Preterm infants also have high nutrient requirements, which increase with earlier gestational ages. As a result, early nutrition intervention is required to prevent further deficits that, if not corrected, can affect growth and long-term outcomes. Preterm infants often require several weeks of parenteral nutrition (PN) support, which includes trace mineral supplementation. Trace minerals are considered essential nutrients, unable to be synthesized in the human body. Deficiencies of trace minerals have been reported, yet evidence-based guidelines for assessment and supplementation have not been clearly defined. Food and Drug Administration-approved parenteral trace mineral intake guidelines are more than 30 years old. In an effort to more clearly define trace mineral supplementation and monitoring guidelines for preterm infants, a review of literature was performed with the purpose to (1) summarize trace mineral roles in preterm infants, (2) describe clinical signs of deficiency and toxicity, and (3) present intake recommendations and considerations for preterm infants based on current available literature. Review of literature was completed using PubMed and Cochrane databases to find relevant studies specific to trace mineral requirements for preterm infants, trace mineral supplementation of PN, human milk fortifiers, and preterm infant formulas. Review of literature supports that trace mineral depletion can lead to clinical compromise in preterm infants; therefore, suggesting that every effort be made to ensure adequate provision of trace minerals is given to preterm infants. Practical considerations for the clinical nutrition management of preterm infants were also identified in this review.
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Nzegwu NI, Ehrenkranz RA. Post-discharge nutrition and the VLBW infant: To supplement or not supplement?: a review of the current evidence. Clin Perinatol 2014; 41:463-74. [PMID: 24873844 DOI: 10.1016/j.clp.2014.02.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Due to advancements in neonatology, the survival of very-low-birth-weight infants, especially extremely low-birth-weight infants continues to rise. The goal of nutrition in these preterm infants is to match the intrauterine growth curves of the normally growing fetus. Despite this recommendation from the American Academy of Pediatrics Committee on Nutrition, neonatologists struggle daily to meet this goal, and as a result, postnatal growth failure and restriction are common. This article reviews post-discharge nutrition in the VLBW population, examining different types of post-discharge nutrition, current evidence, and future and remaining questions. In addition, recommendations are provided for post-discharge nutrition in this population.
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Affiliation(s)
- Nneka I Nzegwu
- Section of Neonatal-Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, 333 Cedar Street, PO Box 208064, New Haven, CT 06520-8064, USA.
| | - Richard A Ehrenkranz
- Section of Neonatal-Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, 333 Cedar Street, PO Box 208064, New Haven, CT 06520-8064, USA
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Abstract
PURPOSE OF REVIEW Iron deficiency early in life is associated with impaired neurological development. This study reviews the latest research on how to best meet iron requirements in infants and children. RECENT FINDINGS There is concurrent evidence that delayed cord clamping is well tolerated and improves infant iron stores. Iron supplements or enriched complementary foods starting before 6 months of life do not reduce iron deficiency prevalence in low-risk populations. However, for low birth weight infants, iron supplements before 6 months of life have long-term benefits. Iron deficiency anaemia (IDA) during the second half year of life is rare in countries with high compliance to iron-rich complementary foods, but remains a major problem globally. In high-risk populations, iron supplementation reduces IDA and possibly improves growth. However, increased risk of infections is a concern and optimal preventive strategies have not yet been determined. Finally, there is concurrent evidence that iron supplementation of anaemic school-aged children reduces IDA and possibly improves neuropsychological outcomes. SUMMARY Interventions for prevention of iron deficiency should be prioritized in risk groups. However, the unclear long-term benefits and possible risk of adverse effects, particularly increased infections in developing countries, prompt further large-scale, double-blinded trials.
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Affiliation(s)
- Staffan Berglund
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
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18
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Abrams SA. Zinc for preterm infants: Who needs it and how much is needed? Am J Clin Nutr 2013; 98:1373-4. [PMID: 24132977 DOI: 10.3945/ajcn.113.076489] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Steven A Abrams
- USDA/Agriculture Research Service, Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, and Texas Children's Hospital, Houston, TX
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Prince A, Groh-Wargo S. Nutrition Management for the Promotion of Growth in Very Low Birth Weight Premature Infants. Nutr Clin Pract 2013; 28:659-68. [DOI: 10.1177/0884533613506752] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Allison Prince
- University Hospitals Rainbow Babies & Children’s Hospital, Cleveland, Ohio
| | - Sharon Groh-Wargo
- Case Western Reserve University School of Medicine, Department of Pediatrics, MetroHealth Medical Center, Cleveland, Ohio
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