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Wang N, Ma M, Mu G, Qian F, Xuemei Z. Lipid analysis of breast milk and formula for preterm infants and the application and prospects of novel structural lipids - a comprehensive review. Crit Rev Food Sci Nutr 2024:1-14. [PMID: 39066633 DOI: 10.1080/10408398.2024.2383964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
Preterm infants, often characterized by lower birth weights and underdeveloped physiologies, necessitate specialized nutritional care. While breast milk stands as the ideal nutritional source, offering substantial energy through its fatty acid content to support the infants' growth and developmental needs, its usage might not always be feasible. Fatty acids in breast milk are critical for the development of these infants. In scenarios where breast milk is not an option, formula feeding becomes a necessary alternative. Thus, a comprehensive understanding of the fatty acid profiles in both breast milk and formulas is crucial for addressing the distinct nutritional requirements of preterm infants. This paper aims to summarize the effects of lipid composition, structure, and positioning in breast milk and formula on the growth and development of preterm infants. Furthermore, it explores recent advancements in the use of novel structural lipids in formulas, laying the groundwork for future innovations in formula design specifically catered to the needs of preterm infants.
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Affiliation(s)
- Ning Wang
- School of Food Science and Technology, Dalian Polytechnic University, Dalian, China
| | - Mingyang Ma
- School of Food Science and Technology, Dalian Polytechnic University, Dalian, China
| | - Guangqing Mu
- School of Food Science and Technology, Dalian Polytechnic University, Dalian, China
| | - Fang Qian
- School of Food Science and Technology, Dalian Polytechnic University, Dalian, China
| | - Zhu Xuemei
- School of Food Science and Technology, Dalian Polytechnic University, Dalian, China
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Lecot-Connan T, Jeannin AC, Baptiste A, Dechartres A, Genser L, Oppert JM, Nizard J, Ciangura C. Pregnancy Outcomes After Bariatric Surgery: Importance of Maternal Ferritin on Birth Weight. Obes Surg 2024; 34:2305-2314. [PMID: 38842761 DOI: 10.1007/s11695-024-07285-3] [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: 01/13/2024] [Revised: 04/24/2024] [Accepted: 05/09/2024] [Indexed: 06/07/2024]
Abstract
PURPOSE The risks carried by pregnancy after bariatric surgery (BS) include small-for-gestational age (SGA) newborn and prematurity. However, the underlying mechanisms are not yet fully understood in pregnant women after BS. MATERIAL AND METHODS This single-center retrospective observational cohort study includes all women with a first and single pregnancy after BS who completed at least one clinical and biological nutritional assessment during pregnancy between 2010 and 2016. The quarterly biological assessment comprised blood count, ferritin, calcium, 25OH vitamin D, parathyroid hormone, fasting glucose, albumin, prealbumin, vitamin A, vitamin B12, folic acid, and zinc. RESULTS Among 120 pregnancies analysed, two-thirds underwent gastric bypass (Roux-en-Y and one-anastomosis) and one-third a restrictive procedure (adjustable gastric band or sleeve gastrectomy). The median [Q1-Q3] preoperative BMI was 43.8 [41.1-47.7] kg/m2 and the mean age at pregnancy was 32.6 ± 5.3 years. Weight loss and time from surgery to pregnancy were 35.1 ± 15.4 kg and 2.9 [1.3-4.5] years, respectively. Ten women (8%) gave birth prematurely, and 22 newborns (19%) were SGA. Univariate analysis shows that ferritin was significantly higher in mothers with SGA than in those without SGA (35.5 [22.3-69.5] vs. 15 [10-32] ng/ml) at third trimester of pregnancy. Women who received pre-pregnancy nutritional assessment seemed less likely to give birth to a SGA newborn (32% vs. 54%, p = 0.07). CONCLUSION Iron supplementation should be carefully prescribed and closely monitored during pregnancy in women who have undergone BS.
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Affiliation(s)
- Tatiana Lecot-Connan
- Department of Nutrition, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, 75013, Paris, France
| | - Anne-Caroline Jeannin
- Department of Nutrition, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, 75013, Paris, France
| | - Amandine Baptiste
- Clinical Research Unit, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, 75013, Paris, France
| | - Agnès Dechartres
- Sorbonne University, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Pitié Salpêtrière Hospital, Department of Public Health, 75013, Paris, France
| | - Laurent Genser
- Department of Digestive Surgery, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, 75013, Paris, France
| | - Jean-Michel Oppert
- Department of Nutrition, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, 75013, Paris, France
| | - Jacky Nizard
- Department of Obstetrics and Gynecology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, 75013, Paris, France
| | - Cécile Ciangura
- Department of Nutrition, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, 75013, Paris, France.
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Yu T, Chiu LH, Chen TS. Assisted Reproductive Technology, Multiple Births, and Perinatal Outcomes in Taiwan from 2001 to 2020. J Pediatr 2024; 273:114146. [PMID: 38878961 DOI: 10.1016/j.jpeds.2024.114146] [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: 03/18/2024] [Revised: 05/13/2024] [Accepted: 06/11/2024] [Indexed: 07/15/2024]
Abstract
OBJECTIVE To investigate the effect of the Assisted Reproduction Act, implemented in 2007 in Taiwan to reduce the number of embryos to transfer, on the trends over time regarding the rate of multiple births, preterm delivery, low birth weight (LBW), and small for gestational age (SGA) among deliveries using assisted reproductive technology (ART). STUDY DESIGN From the Birth Reporting Registry and the Assisted Reproduction Registry, we retrieved data of 4 016 530 live birth deliveries between 2001 and 2020; among them 71 000 (1.77%) were after ART. We calculated the rate of multiples and perinatal outcomes per 1000 deliveries annually from 2001 to 2020 for deliveries using and not using ART and computed the population attributable risk. We performed interrupted time series to assess the effect of the intervention, ie, the Assisted Reproduction Act. RESULTS The proportion of deliveries following ART was 0.57% in 2001 and increased to 4.03% in 2020. After the intervention, there were decreasing trends over time for rates of multiples (-10.63 per year, P < .001), preterm delivery (-6.74, P = .003), LBW (-9.38, P < .001), and SGA (-4.48, P = .001) among ART deliveries. There was also an immediate decrease right after intervention (-53.45, P = .005) for SGA after ART. The population attributable risk trends before and after intervention were both increasing for all outcomes. CONCLUSIONS The Assisted Reproduction Act in Taiwan was associated with a decreasing trend of multiples, preterm delivery, LBW, and SGA over time since 2008 among ART deliveries. In particular, there was an immediate decrease of SGA right after the intervention.
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Affiliation(s)
- Tsung Yu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Li-Hsien Chiu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ta-Sheng Chen
- Department of Obstetrics and Gynecology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
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Zhang L, Liu J, Gao D, Li D. Role of ghrelin in promoting catch-up growth and maintaining metabolic homeostasis in small-for-gestational-age infants. Front Pediatr 2024; 12:1395571. [PMID: 38903769 PMCID: PMC11187245 DOI: 10.3389/fped.2024.1395571] [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: 03/04/2024] [Accepted: 05/27/2024] [Indexed: 06/22/2024] Open
Abstract
Small-for-gestational age (SGA) has been a great concern in the perinatal period as it leads to adverse perinatal outcomes and increased neonatal morbidity and mortality, has an impact on long-term health outcomes, and increases the risk of metabolic disorders, cardiovascular, and endocrine diseases in adulthood. As an endogenous ligand of the growth hormone secretagotor (GHS-R), ghrelin may play an important role in regulating growth and energy metabolic homeostasis from fetal to adult life. We reviewed the role of ghrelin in catch-up growth and energy metabolism of SGA in recent years. In addition to promoting SGA catch-up growth, ghrelin may also participate in SGA energy metabolism and maintain metabolic homeostasis. The causes of small gestational age infants are very complex and may be related to a variety of metabolic pathway disorders. The related signaling pathways regulated by ghrelin may help to identify high-risk groups of SGA metabolic disorders and formulate targeted interventions to prevent the occurrence of adult dwarfism, insulin resistance-related metabolic syndrome and other diseases.
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Affiliation(s)
- Li Zhang
- Department of Pediatrics, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jingfei Liu
- Department of Neonatology, Dalian Women and Children’s Medical Group, Dalian, China
| | - Dianyong Gao
- Department of Orthopedics, Lushunkou District People’s Hospital, Dalian, China
| | - Dong Li
- Department of Neonatology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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Pagano F, Gaeta E, Morlino F, Riccio MT, Giordano M, De Bernardo G. Long-term benefits of exclusive human milk diet in small for gestational age neonates: a systematic review of the literature. Ital J Pediatr 2024; 50:88. [PMID: 38679716 PMCID: PMC11057117 DOI: 10.1186/s13052-024-01648-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 04/07/2024] [Indexed: 05/01/2024] Open
Abstract
Evidence about feeding practices' consequences in small for gestational age newborns is not well established because they are less likely to initiate and continue breastfeeding than other newborns. Our aim was to study current knowledge about the benefits of exclusive human milk diet after 2 years of age in small for gestational age newborns. A systematic review of the literature was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline criteria. Pubmed and Scopus were searched for studies published from databases inception until June 2, 2023. Included articles were analysed and synthesised. Risk of bias and level of evidence assessments were performed. They were enrolled small for gestational age newborns fed by breastfeeding, breast milk or donor milk. The systematic review included 9 articles which were related to 4 health domains: neurodevelopment, cardiovascular, somatic growth and bone mineralization and atopy. Extracted data support a beneficial effect of breastfeeding on these outcomes. Better quality of evidence and longer follow-up are needed.
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Affiliation(s)
- Federica Pagano
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Emanuele Gaeta
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Francesca Morlino
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Maria Teresa Riccio
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Maurizio Giordano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Giuseppe De Bernardo
- Department of Woman and Child, Ospedale Buon Consiglio Fatebenefratelli, Naples, Italy.
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Vento M. Adequate nutrition for bronchopulmonary dysplasia, but do not forget oxygen. Pediatr Res 2024:10.1038/s41390-024-03205-4. [PMID: 38594423 DOI: 10.1038/s41390-024-03205-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/11/2024]
Affiliation(s)
- Maximo Vento
- Instituto de Investigación Sanitaria La Fe (IISLAFE), (Health Research Institute La Fe), Avenida de Fernando Abril Martorell 106, 46026, Valencia, Spain.
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Zhang J, He X, Ma L, Li Z, Shen W, Hua M, Sun L, Bai G. Growth trajectory of full-term small-for-gestational-age infants: a 3-year longitudinal study in China. BMJ Paediatr Open 2024; 8:e002278. [PMID: 38508659 PMCID: PMC10952887 DOI: 10.1136/bmjpo-2023-002278] [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: 09/14/2023] [Accepted: 01/19/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVE Small-for-gestational-age (SGA) infants are at risk of impaired growth and developmental outcomes, even for those who were born at full term. The growth trajectory of full-term SGA infants remains unknown. Therefore, this study aimed to evaluate the growth trajectory of full-term SGA infants from birth to 3 years old in East China. METHODS Full-term SGA infants were followed up from birth to 3 years old. The weight and length were measured at 3, 6, 12, 18, 24, 30 and 36 months. Rate of catch-up growth and rates of growth deviations including short stature, emaciation, underweight, overweight and obesity, were calculated at different time points. Latent class analysis was applied to describe growth trajectories from birth to 36 months. RESULTS A total of 816 full-term SGA infants were enrolled in this study and 303 had complete follow-up data at 3, 6, 12, 18, 24, 30 and 36 months. At 24 months, the rate of catch-up growth was 42.4% in girls and 48.6% in boys; while at 36 months, this rate was 43.3% in girls and 52.1% in boys. The latent class analysis identified two trajectories of weight and length in boys and girls. Girls showed different growth trajectories of weight since 12 months compared with boys. CONCLUSIONS Our study reported a relatively low rate of catch-up growth in full-term SGA infants and has identified different growth trajectories of length and weight in boys and girls. We call for attention from health professionals on the growth trajectory of full-term SGA infants to eventually promote their health potentials.
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Affiliation(s)
- Jianwei Zhang
- Shaoxing Maternity and Child Health Care Hospital, Shaoxing, Zhejiang, China
| | - Xinyu He
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Lujia Ma
- Shaoxing Maternity and Child Health Care Hospital, Shaoxing, Zhejiang, China
| | - Ziqiao Li
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Wenxia Shen
- Shaoxing Maternity and Child Health Care Hospital, Shaoxing, Zhejiang, China
| | - Mengdi Hua
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Lidan Sun
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Guannan Bai
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
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Calek E, Binder J, Palmrich P, Eibensteiner F, Thajer A, Kainz T, Harreiter K, Berger A, Binder C. Effects of Intrauterine Growth Restriction (IUGR) on Growth and Body Composition Compared to Constitutionally Small Infants. Nutrients 2023; 15:4158. [PMID: 37836441 PMCID: PMC10574227 DOI: 10.3390/nu15194158] [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: 08/24/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
(1) Intrauterine growth restriction (IUGR) is associated with multiple morbidities including growth restriction and impaired neurodevelopment. Small for gestational age (SGA) is defined as a birth weight <10th percentile, regardless of the etiology. The term is commonly used as a proxy for IUGR, but it may represent a healthy constitutionally small infant. Differentiating between IUGR and constitutionally small infants is essential for the nutritional management. (2) Infants born at <37 weeks of gestation between 2017 and 2022, who underwent body composition measurement (FFM: fat-free mass; FM: fat mass) at term-equivalent age, were included in this study. Infants with IUGR and constitutionally small infants (SGA) were compared to infants appropriate for gestational age (AGA). (3) A total of 300 infants (AGA: n = 249; IUGR: n = 40; SGA: n = 11) were analyzed. FFM (p < 0.001) and weight growth velocity (p = 0.022) were significantly lower in IUGR compared to AGA infants, but equal in SGA and AGA infants. FM was not significantly different between all groups. (4) The FFM Z-score was significantly lower in IUGR compared to AGA infants (p = 0.017). Being born constitutionally small compared to AGA had no impact on growth and body composition. These data showed that early aggressive nutritional management is essential in IUGR infants to avoid impaired growth and loss of FFM.
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Affiliation(s)
- Elisabeth Calek
- Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.C.); (A.T.); (T.K.); (K.H.); (A.B.)
| | - Julia Binder
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria; (J.B.); (P.P.)
| | - Pilar Palmrich
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria; (J.B.); (P.P.)
| | - Felix Eibensteiner
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria;
| | - Alexandra Thajer
- Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.C.); (A.T.); (T.K.); (K.H.); (A.B.)
| | - Theresa Kainz
- Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.C.); (A.T.); (T.K.); (K.H.); (A.B.)
| | - Karin Harreiter
- Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.C.); (A.T.); (T.K.); (K.H.); (A.B.)
| | - Angelika Berger
- Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.C.); (A.T.); (T.K.); (K.H.); (A.B.)
| | - Christoph Binder
- Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.C.); (A.T.); (T.K.); (K.H.); (A.B.)
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Bouferoua F, El Mokhtar Khiari M, Benhalla N, Donaldson M. Predictive factors of catch-up growth in term, small for gestational age infants: a two-year prospective observational study in Algeria. J Pediatr Endocrinol Metab 2023; 36:842-850. [PMID: 37497768 DOI: 10.1515/jpem-2023-0043] [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: 01/28/2023] [Accepted: 06/30/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVES Most small for gestational age (SGA) infants show catch-up growth but the minority who do not may benefit from growth-promoting treatment. We determined the prevalence of, and risk factors for, failure to show catch-up growth in term SGA infants. METHODS Prospective observational study of infants born at 37-42 weeks gestation between December 2012 and March 2014 with birth weight <10th percentile. Length, weight and head circumference were measured from birth to 2 years. RESULTS Of 457 (3.9 %) term infants with SGA, 446 (97.6 %) were followed up until 2 years. At 24 months, supine length, weight and head circumference were ≥-2 standard deviation score (SDS) in 87.9 , 96.4 and 97.1 % subjects, with persistent short stature in 12.1 %. In a multivariate analysis, the independent predictors of failure to show catch-up growth at 24 months were: maternal height <150 cm, difference between mid-parental height and birth length of ≥2.2 SDS, height at 24 months <-2 SDS below mid-parental height SDS, history of SGA, ponderal index <3rd centile and duration of breast feeding <3 months. CONCLUSIONS This study provides data concerning the epidemiology of SGA in Algeria and the factors associated with post-natal growth. Establishing which children remain short at 2 years has identified a cohort of patients requiring continuing follow up, with a view to instituting growth hormone therapy in selected cases. These results favour the setting up of an integrated national program to register SGA infants at birth, with re-evaluation at 2 years. (250 words).
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Affiliation(s)
- Fadila Bouferoua
- Pediatric Department "A", Beni Messous Hospital, Algiers, Algeria
| | | | - Nafissa Benhalla
- Pediatric Department "A", Beni Messous Hospital, Algiers, Algeria
| | - Malcolm Donaldson
- Section of Child Health, Glasgow University School of Medicine, Glasgow, UK
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Kosmeri C, Giapros V, Rallis D, Balomenou F, Serbis A, Baltogianni M. Classification and Special Nutritional Needs of SGA Infants and Neonates of Multiple Pregnancies. Nutrients 2023; 15:2736. [PMID: 37375640 DOI: 10.3390/nu15122736] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/01/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023] Open
Abstract
Data regarding the nutritional management of preterm small for gestational age (SGA) infants are scarce. In the recent report of ESPGHAN, the recommended energy for very preterm infants during hospitalization has been increased, yet this may not fit the needs of all preterm infants. It is important to distinguish fetal growth-restricted (FGR) infants from constitutional SGA infants, as well as preterm SGA from preterm AGA infants, since they may have different nutritional needs. Preterm FGR infants, and specifically infants < 29 weeks' gestation, accumulate nutrient deficits due to intrauterine malnutrition, prematurity, morbidities, delayed initiation of feeding, and feeding intolerance. Therefore, these infants may need more aggressive nutrition for optimal catch-up growth and neurologic development. However, a balance should be kept between optimal and excessive catch-up growth, since the combination of intrauterine malnutrition and excessive postnatal growth has been linked with later adverse metabolic consequences. Furthermore, multiple gestation is often complicated by FGR and prematurity. There is controversy in the definition of FGR in multiple gestations, and it should be noted that FGR in multiple gestation usually differs etiologically from FGR in singletons. The aim of this review is to summarize existing knowledge regarding the nutritional needs of preterm FGR and FGR infants of multiple gestation.
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Affiliation(s)
- Chrysoula Kosmeri
- Department of Pediatrics, University Hospital of Ioannina, 455 00 Ioannina, Greece
| | - Vasileios Giapros
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, 455 00 Ioannina, Greece
| | - Dimitrios Rallis
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, 455 00 Ioannina, Greece
| | - Foteini Balomenou
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, 455 00 Ioannina, Greece
| | - Anastasios Serbis
- Department of Pediatrics, University Hospital of Ioannina, 455 00 Ioannina, Greece
| | - Maria Baltogianni
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, 455 00 Ioannina, Greece
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Chen W, Li B, Gan K, Liu J, Yang Y, Lv X, Ma H. Gestational Weight Gain and Small for Gestational Age in Obese Women: A Systematic Review and Meta-Analysis. Int J Endocrinol 2023; 2023:3048171. [PMID: 36686320 PMCID: PMC9848811 DOI: 10.1155/2023/3048171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/10/2022] [Accepted: 12/13/2022] [Indexed: 01/13/2023] Open
Abstract
Objective This systematic review and meta-analysis evaluates the relationship between gestational weight gain and the risk of small for gestational age in obese pregnant women. Methods Studies were identified by searching the Web of Science, Embase, and PubMed databases up to June 30th, 2022. The meta-analysis was carried out to determine the risk of small for gestational age with gestational weight gain (GWG) below the 2009 Institute of Medicine (IOM) guidelines compared with within the guidelines in obese women. The Newcastle-Ottawa Scale was used to assess the methodological quality. The chi-squared test, Q test, and I2 test were used to evaluate statistical heterogeneity. Subgroup analyses were conducted, and publication bias was assessed by funnel plots and Egger's test. Sensitivity analyses were performed for three groups of obese people (I: BMI 30-34.9 kg/m2, II: BMI 35-39.9 kg/m2, and III: BMI ≥ 40 kg/m2) to examine the association of obesity and SGA. Results A total of 788 references were screened, and 29 studies (n = 1242420 obese women) were included in the systematic review. Obese women who gained weight below the IOM guideline had a higher risk of SGA than those who gained weight within the guideline (OR = 1.27, 95% CI = 1.16-1.38, Z = 5.36). Both weight loss (<0 kg) and inadequate weight (0-4.9 kg) during pregnancy in obese women are associated with an increased risk of SGA (OR = 1.50, 95% CI = 1.37-1.64, Z = 8.82) (OR = 1.18, 95% CI = 1.14-1.23, Z = 8.06). The same conclusions were also confirmed for the three obesity classes (I: OR = 1.38, 95% CI = 1.29-1.47; II: OR = 1.39, 95% CI = 1.30-1.49; and III: OR = 1.26, 95% CI = 1.16-1.37). Subgroup analysis by country showed that GWG below guidelines in obese women of the USA and Europe was associated with risk for SGA (USA (OR = 1.30, 95% CI = 1.15-1.46), Europe (OR = 1.24, 95% CI = 1.11-1.40)) and not in Asia (OR = 1.17, 95% CI = 0.91-1.50). Conclusion Our findings indicated that obese pregnant women who had weight loss or inadequate weight (0-4.9 kg) according to the IOM guideline had increased risks for SGA. Moreover, we also evaluated that gestational weight loss (<0 kg) in these pregnancies was associated with an increased risk for SGA compared with inadequate weight (0-4.9 kg) in these pregnancies. Therefore, the clinical focus should assist obese women to achieve GWG within the IOM guidelines to decrease the risk for SGA.
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Affiliation(s)
- Wen Chen
- Department of Anus and Intestine Surgery, Shijiazhuang People Hospital, Shijiazhuang 050000, Hebei, China
| | - Beiyi Li
- Department of Internal Medicine, Hebei Medical University, Shijiazhuang 050017, Hebei, China
| | - Kexin Gan
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang 050017, Hebei, China
| | - Jing Liu
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang 050017, Hebei, China
| | - Yajing Yang
- Graduate School of North China University of Science and Technology, Tangshan 063000, Hebei, China
| | - Xiuqin Lv
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang 050017, Hebei, China
| | - Huijuan Ma
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang 050017, Hebei, China
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Li P, Lu Y, Qie D, Feng L, He G, Yang S, Yang F. Early-life weight gain patterns of term small-for-gestational-age infants and the predictive ability for later childhood overweight/obesity: A prospective cohort study. Front Endocrinol (Lausanne) 2022; 13:1030216. [PMID: 36482989 PMCID: PMC9723138 DOI: 10.3389/fendo.2022.1030216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 10/31/2022] [Indexed: 11/24/2022] Open
Abstract
Objectives We aimed to identify the weight gain patterns of small-for-gestational age (SGA) infants in early life and to explore the predictive value for later overweight/obesity in childhood. Methods We obtained data from a prospective cohort including term SGA infants born between January 2006 and November 2015 who received regular health care from birth to 5 years in West China Second University Hospital, Chengdu, China. A latent class growth analysis (LCGA) was applied to group children with similar growth trajectory patterns. Multiple logistic regression was performed to examine the association between weight gain patterns and later overweight/obesity. Results A total of 296 term SGA infants were finally included. Five weight gain trajectories were identified, including excessive rapid catch-up growth (ERCG) (class 1, 10.9%), rapid catch-up growth (RCG) (class 2, 17.9%), appropriate catch-up growth (ACG) (class 3, 53.0%), slow catch-up growth (SCG) (class 4, 13.4%) and almost no catch growth (NCG) (class 5, 4.8%). SGA infants in class 1 and class 2 had a higher BMI according to age- and sex-specific Z scores from 2-5 years of age. In addition, 25% of SGA infants in class 1 and 13.2% of SGA infants in class 2 were found to be overweight/obese at 2-5 years of age. After adjusting for confounders, we found that extremely rapid weight gain (class 1) in the first 2 years of life increased the risk of overweight/obesity by 2.1 times at 2 to 5 years of age (aOR=2.1, 95% CI: 1.3~4.8; P<0.05). Furthermore, the increment of ΔWAZ between 0 and 4 mo was prominently related to the risk of overweight/obesity at 2 to 5 years for term SGA infants (aOR=3.2, 95% CI: 1.7~8.1; P<0.001). A receiver operating characteristic (ROC) curve showed the area under curve (AUC) was 0.7, with a 95% confidence interval (CI) from 0.6 to 0.8 (P<0.001). Conclusions The extremely rapid weight gain pattern of term SGA infants in the first 2 years of life increased the risk of overweight/obesity at 2 to 5 years of age. It suggests monitoring weight gain across the infant period represents a first step towards primary prevention of childhood obesity.
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Affiliation(s)
- Ping Li
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Chengdu, China
| | - You Lu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Chengdu, China
| | - Di Qie
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Chengdu, China
| | - Ling Feng
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Chengdu, China
| | - Guoqian He
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Chengdu, China
| | - Sufei Yang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Chengdu, China
| | - Fan Yang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Chengdu, China
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Kebede AN, Sahile AT, Kelile BC. Dietary Diversity and Associated Factors Among Pregnant Women in Addis Ababa, Ethiopia, 2021. Int J Public Health 2022; 67:1605377. [PMID: 36405528 PMCID: PMC9668879 DOI: 10.3389/ijph.2022.1605377] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/25/2022] [Indexed: 08/04/2023] Open
Abstract
Objective: This study aimed to assess the dietary diversity and its associated factors among pregnant women in Addis Ababa, Ethiopia, 2021. Methods: An institution-based Cross-sectional was conducted among 320 participants from four health facilities in Addis Ababa selected based on a simple random sampling method from 01 September to 30 December 2021. An Interviewer-administered structured questionnaire was used, following informed consent. Binary (Bivariate and multivariate) logistics regression was applied for the identification factors associated with dietary diversity with their respective 95% confidence interval and less than 5% p-value. Results: The prevalence of inadequate dietary diversity during pregnancy was 51.6% (95% CI: 46.1%-57.0%). Being illiterate (AOR: 0.591; 95% CI: 1.88-1.901; p < 0.05) and primary education (AOR: 0.347; 95% CI: 0.166-0.728; p < 0.05), having poor knowledge (AOR: 0.437; 95% CI: 0.252-0.757; p < 0.05) and lower monthly income (AOR: 0.395; 95% CI: 0.184-0.845; p < 0.05) were factors associated with inadequate dietary diversity. Conclusion: A higher level of inadequate dietary diversity was reported. Being illiterate, having primary education, having poor knowledge, and having lower monthly income were associated with inadequate dietary diversity during pregnancy. Concerned bodies were suggested to work on the identified factors.
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Нагаева ЕВ. [Short stature due to intrauterine growth retardation. Clinical and hormonal-metabolic features, possibilities of growth-stimulating therapy]. PROBLEMY ENDOKRINOLOGII 2022; 68:4-13. [PMID: 36337013 PMCID: PMC9762449 DOI: 10.14341/probl13178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 10/23/2022] [Indexed: 11/09/2022]
Abstract
The article presents data about short stature due to intrauterine development delay. This type of short stature - separate nosology, unites children born small for gestation age. The majority of them in the first years of life have accelerated growth rates, allowing the child to normalize their weight-growth indicators and catch up in the development of peers. In the absence of an accelerated growth rates, children have a high risk of lagging behind in physical development throughout childhood, achieving low final growth and becoming short adults. In addition, the fact of birth with small body sizes is associated with a number of hormonal and metabolic features, a risk of metabolic syndrome in adult years.It is assumed that the absence of postnatal growth acceleration is due to various damages to the GH-IGF1 axis (partial GH deficiency, partial resistance to GH, partial resistance to IGF1). Growth hormone therapy, initiated early in life, is able to normalize growth rates in childhood and ultimately significantly improve or normalize the final growth of short stature children born small for gestational age.
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Affiliation(s)
- Е. В. Нагаева
- Национальный медицинский исследовательский центр эндокринологии
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Hofi L, Flidel-Rimon O, Hershkovich–Shporen C, Zaharoni H, Birk R. Differences in growth patterns and catch up growth of small for gestational age preterm infants fed on fortified mother's own milk versus preterm formula. Br J Nutr 2022; 129:1-24. [PMID: 35748057 PMCID: PMC10197085 DOI: 10.1017/s0007114522000599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 02/13/2022] [Accepted: 02/18/2022] [Indexed: 11/06/2022]
Abstract
Small for gestational age (SGA) is typically defined as birthweight < 10th percentile for age. Limited data are available regarding the growth of SGA preterm infants in relation to feeding type. We aimed to study SGA preterm infants fed fortified mother's own milk (MOM) or preterm formula (PF) on growth patterns and catch-up growth at discharge and two-years corrected age (CA). Our retrospective cohort study included data from medical records and follow-up questionnaires about SGA preterm infants born at <37 weeks fed on MOM (n=40) and PF (n=40). Weight, length/height and head circumference (HC) were collected at birth, discharge and at two years CA, and Δ z-scores were calculated.The MOM group had significantly larger negative change in weight and length z-scores between birth and discharge, and smaller positive change in HC z-score (-0.47 (±0.41) v. -0.25 (±0.36), P= 0.01; -0.63 (±0.75) v. -0.27 (±0.75), P= 0.03; 0.13 (±0.67) v. 0.41 (±0.55), P= 0.04, respectively). Almost half the MOM fed infants experienced poor length growth by discharge compared to 22% of PF fed infants (P=0.03). By two years CA, both groups had similar positive change in weight and HC z-scores, but MOM fed infants had a slower increase in height z-score (0.64 (±1.30) v. 1.33 (±1.33), P=0.02), and only 40% had achieved catch-up height compared with 68% of the PF group (P=0.02).Our study indicates that fortified MOM fed SGA preterm infants may need extra nutritional support in the first two years of life to achieve height growth potential.
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Affiliation(s)
- Lilach Hofi
- Department of Nutritional Sciences, School of Health Sciences, Ariel University, Ariel, Israel
- Department of Neonatology, Kaplan Medical Center, Rehovot, Hebrew University, Jerusalem, Israel
- Department of Clinical Nutrition, Kaplan Medical Center, Rehovot, Hebrew University, Jerusalem, Israel
| | - Orna Flidel-Rimon
- Department of Neonatology, Kaplan Medical Center, Rehovot, Hebrew University, Jerusalem, Israel
| | | | - Hilla Zaharoni
- Department of Clinical Nutrition, Kaplan Medical Center, Rehovot, Hebrew University, Jerusalem, Israel
| | - Ruth Birk
- Department of Nutritional Sciences, School of Health Sciences, Ariel University, Ariel, Israel
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Ghnaimawi S, Zhang S, Baum JI, Huang Y. The Effects of Maternal Intake of EPA and DHA Enriched Diet During Pregnancy and Lactation on Offspring's Muscle Development and Energy Homeostasis. Front Physiol 2022; 13:881624. [PMID: 35733999 PMCID: PMC9207413 DOI: 10.3389/fphys.2022.881624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/04/2022] [Indexed: 11/13/2022] Open
Abstract
EPA and DHA are n-3 long-chain polyunsaturated fatty acids with a diversity of health benefits on offspring. The objective of this study was to test the in vivo effect of maternal ingestion of EPA and DHA on fetal and offspring muscle development and energy balance. Two groups of female C57BL/6 mice were fed EPA and DHA enriched diet (FA) and diet devoid of EPA and DHA (CON) respectively throughout the entire period of gestation and lactation. Embryos at E13 and offspring at age of D1 and D21 were selected for sample collection and processing. No change in birth number and body weight were observed between groups at D1 and D21. Transient increase in the expression levels of myogenesis regulating genes was detected at D1 (p < 0.05) in FA group. Most of the expression of muscle protein synthesis regulating genes were comparable (p > 0.05) between FA and CON groups at D1 and D21. The significant increase in MHC4, and IGF-1 was not linked to increased muscle mass. A persistent increase in ISR expression (p < 0.05) but not in GLUT-4 (p > 0.05) was detected in offspring. Up-regulation of adipogenesis regulating genes was accompanied by increasing intramuscular fat accumulation in the offspring of FA group. Considerable increase in transcripts of genes regulating lipid catabolism and thermogenesis in liver (p < 0.05) was noticed in FA group at D21; whereas, only the levels of carnitine palmitoyl transferase 1A (Cpt1α) and Enoyl-CoA Hydratase And 3-Hydroxyacyl CoA Dehydrogenase (Ehhadh) increased at D1. Similarly, genes regulating lipolysis were highly expressed at D21 in FA group. EPA and DHA treatment promoted BAT development and activity by increasing the expression of BAT signature genes (p < 0.05). Also, maternal intake of EPA and DHA enriched diet enhanced browning of sWAT. Taken together, maternal ingestion of EPA/DHA may be suggested as a therapeutic option to improve body composition and counteract childhood obesity- related metabolic disorders and confer lifelong positive metabolic impact on offspring.
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Affiliation(s)
- Saeed Ghnaimawi
- Medical Laboratory Techniques Department, Kut University College, Alkut, Iraq
| | - Shilei Zhang
- College of Animal Science and Technology, Shihezi University, Shihezi, China
| | - Jamie I. Baum
- Department of Food Science, Division of Agriculture, University of Arkansas, Fayetteville, AR, United States
| | - Yan Huang
- Department of Animal Science, Division of Agriculture, University of Arkansas, Fayetteville, AR, United States
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Fukushima S, Nakanishi N, Fujioka K, Suga K, Shirakawa T, Osawa K, Hara K, Tsutsumi R, Urushihara M, Nakagawa R, Awano H, Oto J, Sakaue H, Iijima K, Matsuo M. Assessment of catabolic state in infants with the use of urinary titin N-fragment. Pediatr Res 2022; 91:1748-1753. [PMID: 34274960 DOI: 10.1038/s41390-021-01658-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/30/2021] [Accepted: 07/02/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Urinary titin N-fragment levels have been used to assess the catabolic state, and we used this biomarker to evaluate the catabolic state of infants. METHODS We retrospectively measured urinary titin N-fragment levels of urinary samples. The primary outcome was its changes according to postmenstrual age. The secondary outcomes included differences between gestational age, longitudinal change after birth, influence on growth, and relationship with blood tests. RESULTS This study included 219 patients with 414 measurements. Urinary titin N-fragment exponentially declined with postmenstrual age. These values were 12.5 (7.1-19.6), 8.1 (5.1-13.0), 12.8 (6.0-21.3), 26.4 (16.4-52.0), and 81.9 (63.3-106.4) pmol/mg creatinine in full, late, moderate, very, and extremely preterm infants, respectively (p < 0.01). After birth, urinary levels of titin N-fragment exponentially declined, and the maximum level within a week was associated with the time to return to birth weight in preterm infants (ρ = 0.39, p < 0.01). This was correlated with creatine kinase in full-term infants (ρ = 0.58, p < 0.01) and with blood urea nitrogen in preterm infants (ρ = 0.50, p < 0.01). CONCLUSIONS The catabolic state was increased during the early course of the postmenstrual age and early preterm infants. IMPACT Catabolic state in infants, especially in preterm infants, was expected to be increased, but no study has clearly verified this. In this retrospective study of 219 patients with 414 urinary titin measurements, the catabolic state was exponentially elevated during the early postmenstrual age. The use of the urinary titin N-fragment clarified catabolic state was prominently increased in very and extremely preterm infants.
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Affiliation(s)
- Sachiyo Fukushima
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Nobuto Nakanishi
- Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, Japan. .,Department of Disaster and Emergency Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan.
| | - Kazumichi Fujioka
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kenichi Suga
- Department of Pediatrics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Taku Shirakawa
- Department of Physical Therapy, Faculty of Rehabilitation, Kobe Gakuin University, Kobe, Japan
| | - Kayo Osawa
- Department of Medical Technology, Kobe Tokiwa University, Kobe, Japan
| | - Kanako Hara
- Department of Nutrition and Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Rie Tsutsumi
- Department of Nutrition and Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Maki Urushihara
- Department of Pediatrics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Ryuji Nakagawa
- Department of Pediatrics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Hiroyuki Awano
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Jun Oto
- Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Hiroshi Sakaue
- Department of Nutrition and Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Kazumoto Iijima
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masafumi Matsuo
- Research Center for Locomotion Biology, Kobe Gakuin University, Kobe, Japan
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Manapurath R, Gadapani B, Pereira-da-Silva L. Body Composition of Infants Born with Intrauterine Growth Restriction: A Systematic Review and Meta-Analysis. Nutrients 2022; 14:1085. [PMID: 35268060 PMCID: PMC8912478 DOI: 10.3390/nu14051085] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 12/24/2022] Open
Abstract
Intrauterine growth restriction (IUGR) may predispose metabolic diseases in later life. Changes in fat-free mass (FFM) and fat mass (FM) may explain this metabolic risk. This review studied the effect of IUGR on body composition in early infancy. Five databases and included studies from all countries published from 2000 until August 2021 were searched. Participants were IUGR or small-for-gestational age (SGA) infants, and the primary outcomes were FFM and FM. Eighteen studies met the inclusion criteria, of which seven were included in the meta-analysis of primary outcomes. Overall, intrauterine growth-restricted and SGA infants were lighter and shorter than normal intrauterine growth and appropriate-for-gestational age infants, respectively, from birth to the latest follow up. They had lower FFM [mean difference −429.19 (p = 0.02)] and FM [mean difference −282.9 (p < 0.001)]. The issue of whether lower FFM and FM as reasons for future metabolic risk in IUGR infants is intriguing which could be explored in further research with longer follow-up. This review, the first of its kind can be useful for developing nutrition targeted interventions for IUGR infants in future.
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Affiliation(s)
- Rukman Manapurath
- Maternal and Child Health (Nutrition), Society for Applied Studies, Centre for Health Research and Development, 45-Kalusarai, New Delhi 110016, India;
| | - Barsha Gadapani
- Maternal and Child Health (Implementation Research), Society for Applied Studies, Centre for Health Research and Development, 45-Kalusarai, New Delhi 110016, India;
| | - Luís Pereira-da-Silva
- Comprehensive Health Research Centre, Medicine of Woman, Childhood and Adolescence, NOVA Medical School|Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo dos Mártires da Pátria, Nr 130, 1169-056 Lisbon, Portugal
- NICU, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Rua Jacinta Marto, 1169-045 Lisbon, Portugal
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Ruiz NM, García Íñiguez JP, Rite Gracia S, Samper Villagrasa MP. Prospective study on influence of perinatal factors on the development of early neonatal hypoglycemia in late preterm and term infants. An Pediatr (Barc) 2022; 96:230-241. [DOI: 10.1016/j.anpede.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 04/06/2021] [Indexed: 10/18/2022] Open
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Nurani N, Wibowo T, Susilowati R, Hastuti J, Julia M, Van Weissenbruch MM. Growth of exclusively breastfed small for gestational age term infants in the first six months of life: a prospective cohort study. BMC Pediatr 2022; 22:73. [PMID: 35105325 PMCID: PMC8805422 DOI: 10.1186/s12887-021-03080-6] [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: 03/30/2021] [Accepted: 12/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Compared to their appropriate-for-gestational-age (AGA) peers, small-for-gestational-age (SGA) infants are prone to growth deficits. As the first 6 months of exclusive breastfeeding is generally recommended, it is essential to understand how this intervention might impact SGA infants' growth. This study aims to assess growth of exclusively breastfed SGA term infants in the first 6 months of life. METHODS A prospective cohort study was conducted on term infants born in Dr. Sardjito General Hospital and two private hospitals in Yogyakarta, Indonesia. SGA was defined as birth weight less than the 10th percentile according to Fenton criteria. Weight, length, and head circumference (HC) were measured at birth and monthly until 6 months old. RESULTS A total of 39 AGA and 17 SGA term infants who were exclusively breastfed in their first 6 months were included and followed. In SGA compared to AGA, birth weight, length, and HC (mean ± SD) were significantly lower (p < 0.001). During the first 6 months, the SGAs grew in weight and length in parallel with the AGAs. At sixth months of age, the weight and length (mean ± SD) of the SGAs were significantly lower compared to the AGAs (p < 0.001). However, HC (mean ± SD) of SGAs grew significantly faster than the AGAs (p < 0.005). At sixth months of age, there were no significant differences in HC between the two groups (p = 0.824). CONCLUSIONS In the first 6 months, exclusively breastfed SGA term infants, in contrast to weight and length, only show catch up growth in HC, leading to HC comparable to their AGA peers at the age of 6 months.
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Affiliation(s)
- Neti Nurani
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/ Dr. Sardjito General Hospital, Yogyakarta, Indonesia.
| | - Tunjung Wibowo
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/ Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Rina Susilowati
- Department of Histology and Cell Biology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Janatin Hastuti
- Department of Health Nutrition, Laboratory of Bioanthropology & Paleoanthropology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Madarina Julia
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/ Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Mirjam M Van Weissenbruch
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands
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Lin L, Gamble GD, Crowther CA, Bloomfield FH, Agosti M, Atkinson SA, Biasini A, Embleton ND, Lamy Filho F, Fusch C, Gianni ML, Kutman HGK, Koo W, Litmanovitz I, Morgan C, Mukhopadhyay K, Neri E, Picaud JC, Rochow N, Roggero P, Stroemmen K, Tan MJ, Tandoi FM, Wood CL, Zachariassen G, Harding JE. Sex-Specific Effects of Nutritional Supplements for Infants Born Early or Small: An Individual Participant Data Meta-Analysis (ESSENCE IPD-MA) II: Growth. Nutrients 2022; 14:nu14020392. [PMID: 35057573 PMCID: PMC8781781 DOI: 10.3390/nu14020392] [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: 11/24/2021] [Revised: 01/11/2022] [Accepted: 01/14/2022] [Indexed: 12/10/2022] Open
Abstract
Neonatal nutritional supplements may improve early growth for infants born small, but effects on long-term growth are unclear and may differ by sex. We assessed the effects of early macronutrient supplements on later growth. We searched databases and clinical trials registers from inception to April 2019. Participant-level data from randomised trials were included if the intention was to increase macronutrient intake to improve growth or development of infants born preterm or small-for-gestational-age. Co-primary outcomes were cognitive impairment and metabolic risk. Supplementation did not alter BMI in childhood (kg/m2: adjusted mean difference (aMD) -0.11[95% CI -0.47, 0.25], p = 0.54; 3 trials, n = 333). Supplementation increased length (cm: aMD 0.37[0.01, 0.72], p = 0.04; 18 trials, n = 2008) and bone mineral content (g: aMD 10.22[0.52, 19.92], p = 0.04; 6 trials, n = 313) in infancy, but not at older ages. There were no differences between supplemented and unsupplemented groups for other outcomes. In subgroup analysis, supplementation increased the height z-score in male toddlers (aMD 0.20[0.02, 0.37], p = 0.03; 10 trials, n = 595) but not in females, and no significant sex interaction was observed (p = 0.21). Macronutrient supplementation for infants born small may not alter BMI in childhood. Supplementation increased growth in infancy, but these effects did not persist in later life. The effects did not differ between boys and girls.
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Affiliation(s)
- Luling Lin
- Liggins Institute, University of Auckland, Auckland 1023, New Zealand; (L.L.); (G.D.G.); (C.A.C.); (F.H.B.)
| | - Greg D. Gamble
- Liggins Institute, University of Auckland, Auckland 1023, New Zealand; (L.L.); (G.D.G.); (C.A.C.); (F.H.B.)
| | - Caroline A. Crowther
- Liggins Institute, University of Auckland, Auckland 1023, New Zealand; (L.L.); (G.D.G.); (C.A.C.); (F.H.B.)
| | - Frank H. Bloomfield
- Liggins Institute, University of Auckland, Auckland 1023, New Zealand; (L.L.); (G.D.G.); (C.A.C.); (F.H.B.)
| | - Massimo Agosti
- NICU, Woman and Child Department, Ospedale Del Ponte, Insubria University, 21100 Varese, Italy; (M.A.); (F.M.T.)
| | - Stephanie A. Atkinson
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4L8, Canada; (S.A.A.); (C.F.); (N.R.)
| | - Augusto Biasini
- Donor Human Milk Bank Italian Association (AIBLUD), 20126 Milan, Italy;
| | - Nicholas D. Embleton
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK;
| | - Fernando Lamy Filho
- Departamento de Medicina, Universidade Federal do Maranhão (UFMA), São Luís 65080-805, Brazil;
| | - Christoph Fusch
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4L8, Canada; (S.A.A.); (C.F.); (N.R.)
- Department of Pediatrics, Nuremberg General Hospital, Paracelsus Medical University, 90471 Nuremberg, Germany
| | - Maria L. Gianni
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122 Milan, Italy; (M.L.G.); (P.R.)
- Department of Clinical Sciences and Community Health, University of Milan, Via Commenda 19, 20122 Milan, Italy
| | | | - Winston Koo
- Department of Nutrition and Food Science, Wayne State University, Detroit, MI 48202, USA;
| | - Ita Litmanovitz
- Department of Neonatology, Meir Medical Center, Kfar Saba 4428164, Israel;
| | - Colin Morgan
- Department of Neonatology, Liverpool Women’s Hospital, Liverpool L8 7SS, UK;
| | - Kanya Mukhopadhyay
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India;
| | - Erica Neri
- Department of Psychology, University of Bologna, 40126 Bologna, Italy;
| | - Jean-Charles Picaud
- Division of Neonatology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France;
- CarMen Laboratory, INSERM, INRA, Claude Bernard University Lyon 1, 69310 Pierre Benite, France
| | - Niels Rochow
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4L8, Canada; (S.A.A.); (C.F.); (N.R.)
- Department of Pediatrics, Nuremberg General Hospital, Paracelsus Medical University, 90471 Nuremberg, Germany
| | - Paola Roggero
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122 Milan, Italy; (M.L.G.); (P.R.)
| | - Kenneth Stroemmen
- Department of Neonatal Intensive Care, Division of Paediatric and Adolescent Medicine, Rikshospitalet, Oslo University Hospital, 0188 Oslo, Norway;
| | - Maw J. Tan
- Department of Developmental Paediatrics, Alder Hey Children’s NHS Foundation Trust, Liverpool L12 2AP, UK;
| | - Francesco M. Tandoi
- NICU, Woman and Child Department, Ospedale Del Ponte, Insubria University, 21100 Varese, Italy; (M.A.); (F.M.T.)
| | - Claire L. Wood
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4AX, UK;
| | - Gitte Zachariassen
- H.C. Andersen Children’s Hospital, Odense University Hospital and University of Southern Denmark, 5000 Odense, Denmark;
| | - Jane E. Harding
- Liggins Institute, University of Auckland, Auckland 1023, New Zealand; (L.L.); (G.D.G.); (C.A.C.); (F.H.B.)
- Correspondence: ; Tel.: +64-99236439
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Zhao Y, Fan X, Wen J, Gan W, Xiao G. Analysis of longitudinal follow-up data of physical growth in singleton full-term small for gestational age infants. J Int Med Res 2021; 49:3000605211060672. [PMID: 34855533 PMCID: PMC8647279 DOI: 10.1177/03000605211060672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the catch-up growth pattern of singleton full-term small for gestational age (SGA) infants in the first year after birth. METHODS A single-center retrospective cohort study was performed to assess singleton full-term SGA infants. Weight, length, and head circumference were measured at birth, and at 1, 3, 6, and 12 months of age. RESULTS Two hundred ten SGA infants were included in this study. Boys (n = 90) and girls (n = 120) showed a similar gestational age, birth weight, and body length. Weight, length, and head circumference in SGA infants in all age groups increased with age, with the fastest growth stage from birth to 3 months. The speed of weight and head circumference catch-up was higher than that of body length. At 12 months, significant associations of height in boys with height of the fathers, mothers, and both parents combined appeared. The height of girls showed associations with the mothers' and the parents' height. CONCLUSIONS Full-term SGA infants grow rapidly after birth, with the fastest growth rate in the first 3 months, as examined by weight, body length, and head circumference. However, the catch-up speed of weight and body length were not balanced in this study.
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Affiliation(s)
- Yan Zhao
- Department of Child Health Care, Chongqing Health Center for Women and Children, Chongqing, China
| | - Xin Fan
- Department of Child Health Care, Chongqing Health Center for Women and Children, Chongqing, China
| | - Jing Wen
- Department of Child Health Care, Chongqing Health Center for Women and Children, Chongqing, China
| | - Wenling Gan
- Department of Child Health Care, Chongqing Health Center for Women and Children, Chongqing, China
| | - Guiyuan Xiao
- Department of Child Health Care, Chongqing Health Center for Women and Children, Chongqing, China
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Sivakumar S, Arunprasath TS, Ramanan PV. Factors Associated with Catch-up Growth in Term, Asymmetrical Small-for-Gestational Age Infants in the First Year of Life. Rambam Maimonides Med J 2021; 12:RMMJ.10452. [PMID: 34709168 PMCID: PMC8549837 DOI: 10.5041/rmmj.10452] [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] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Catch-up growth (CUG) in small-for-gestational age (SGA) infants is essential for their overall development. Knowledge about the factors influencing CUG might be critical in their effective management. Hence this study was performed with the aim of identifying factors that may influence CUG in SGA infants. METHODS Asymmetrical SGA infants born at term were included in the study as per defined criteria, and their demographic details were recorded. Anthropometric data, feeding practice details, and intercurrent illnesses data were collected on follow-up at 6 weeks, 6 months, and 12-15 months of age. Catch-up growth weight was defined as improvement of weight to the normal range of -2 to +2 weight-for-age Z score (WAZ). Analysis was carried out using SPSS Expand 17 software. Chi-square test was used to find association between variables. Logistic regression analysis was used to measure effect. A P value of less than 0.05 was taken as significant. RESULTS Out of 324 SGA infants born at term, 119 completed 12-15-month follow-up, of which 69.7% had achieved CUG weight. Exclusive breastfeeding >4 months, continued breastfeeding until 12-15 months, and absence of diarrheal episodes were positively associated with CUG. Pregnancy-induced hypertension, gestational diabetes, and maternal overweight/obesity were negatively associated with CUG. Maternal education status, conception age, gravida status, mode of delivery, vitamin D and iron supplementation, and intercurrent respiratory infections were not associated with CUG. On multivariate analysis, continued breastfeeding and absence of diarrheal episodes were independent factors associated with CUG. CONCLUSION Breastfeeding practice, especially continued breastfeeding, and the absence of diarrheal illness are the key determinants for achieving CUG weight in term SGA infants, particularly in settings where resources are limited.
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Birthweight-for-gestational-age z-scores are associated with early childhood cardiometabolic health in the Peri/Postnatal Epigenetic Twin Study. J Dev Orig Health Dis 2021; 13:514-522. [PMID: 34420534 DOI: 10.1017/s2040174421000465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Birthweight has been consistently related to risk of cardiometabolic disorders in later life. Twins are at higher risk of low birthweight than singletons, so understanding the links between birthweight and cardiometabolic health may be particularly important for twins. However, evidence for the association of birthweight with childhood markers of cardiometabolic health in twins is currently lacking. Previous studies have often failed to appropriately adjust for gestational age or fully implement twin regression models. Therefore, we aimed to evaluate the association of birthweight-for-gestational-age z-scores with childhood cardiometabolic health in twins, using within-between regression models. The Peri/Postnatal Epigenetic Twins Study is a Melbourne-based prospective cohort study of 250 twin pairs. Birthweight was recorded at delivery, and childhood anthropometric measures were taken at 18-month and 6-year follow-up visits. Associations of birthweight with markers of cardiometabolic health were assessed at the individual, between- and within-pair level using linear regression with generalised estimating equations. Birthweight-for-gestational-age z-scores were associated with height, weight and BMI at 18 months and 6 years, but not with blood pressure (twins-as-individual SBP: β = 0.15, 95% CI: -0.81, 1.11; twins-as-individual DBP: β = 0.22, 95% CI: -0.34, 0.77). We found little evidence to indicate that the within-between models improved on the twins-as-individuals models. Birthweight was associated with childhood anthropometric measures, but not blood pressure, after appropriately adjusting for gestational age. These associations were consistent across the within-between and twins-as-individuals models. After adjusting for gestational age, results from the twins-as-individuals models are consistent with singleton studies, so these results can be applied to the general population.
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North K, Marx Delaney M, Bose C, Lee ACC, Vesel L, Adair L, Semrau K. The effect of milk type and fortification on the growth of low-birthweight infants: An umbrella review of systematic reviews and meta-analyses. MATERNAL & CHILD NUTRITION 2021; 17:e13176. [PMID: 33733580 PMCID: PMC8189224 DOI: 10.1111/mcn.13176] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 01/29/2021] [Accepted: 02/16/2021] [Indexed: 01/08/2023]
Abstract
Approximately 15% of infants worldwide are born with low birthweight (<2500 g). These children are at risk for growth failure. The aim of this umbrella review is to assess the relationship between infant milk type, fortification and growth in low-birthweight infants, with particular focus on low- and lower middle-income countries. We conducted a systematic review in PubMed, CINAHL, Embase and Web of Science comparing infant milk options and growth, grading the strength of evidence based on standard umbrella review criteria. Twenty-six systematic reviews qualified for inclusion. They predominantly focused on infants with very low birthweight (<1500 g) in high-income countries. We found the strongest evidence for (1) the addition of energy and protein fortification to human milk (donor or mother's milk) leading to increased weight gain (mean difference [MD] 1.81 g/kg/day; 95% confidence interval [CI] 1.23, 2.40), linear growth (MD 0.18 cm/week; 95% CI 0.10, 0.26) and head growth (MD 0.08 cm/week; 95% CI 0.04, 0.12) and (2) formula compared with donor human milk leading to increased weight gain (MD 2.51 g/kg/day; 95% CI 1.93, 3.08), linear growth (MD 1.21 mm/week; 95% CI 0.77, 1.65) and head growth (MD 0.85 mm/week; 95% CI 0.47, 1.23). We also found evidence of improved growth when protein is added to both human milk and formula. Fat supplementation did not seem to affect growth. More research is needed for infants with birthweight 1500-2500 g in low- and lower middle-income countries.
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Affiliation(s)
- Krysten North
- Department of PediatricsUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Megan Marx Delaney
- Ariadne LabsBrigham Women's Hospital and Harvard TH Chan School of Public HealthBostonMassachusettsUSA
| | - Carl Bose
- Department of PediatricsUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Anne C. C. Lee
- Department of Pediatric Newborn MedicineBrigham and Women's HospitalBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
| | - Linda Vesel
- Ariadne LabsBrigham Women's Hospital and Harvard TH Chan School of Public HealthBostonMassachusettsUSA
| | - Linda Adair
- Department of Nutrition, Carolina Population Center, Gillings School of Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Katherine Semrau
- Ariadne LabsBrigham Women's Hospital and Harvard TH Chan School of Public HealthBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
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Martín Ruiz N, García Íñiguez JP, Rite Gracia S, Samper Villagrasa MP. [Prospective study on influence of perinatal factors on the development of early neonatal hypoglycemia in late-preterm and term infants]. An Pediatr (Barc) 2021; 96:S1695-4033(21)00170-3. [PMID: 34001463 DOI: 10.1016/j.anpedi.2021.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/27/2020] [Accepted: 04/06/2021] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE Neonatal hypoglycemia offers multiple controversies. The study aims to assess the main factors involved in the development of early hypoglycemia in term and late preterm infants, and the implication of different environmental circumstances. METHODS A prospective cohort study, in infants born between 34 0/7 weeks and 36 6/7 weeks of gestation. Three capillary blood glucose determinations were performed during the eight first hours after birth. SAMPLE SIZE 207; 59 neonates developed hypoglycemia. RESULTS Prenatal risk factors include gestational diabetes with poor glycemic control, twin pregnancy and gestational age. The presence of meconium amniotic fluid and planned cesarean delivery are associated with a higher probability of hypoglycemia. After birth, skin to skin contact, breastfeeding, soft lightening, and normothermia are described as protective factors. The predictive model that combines the type of lightening, body temperature and the excess of bases level, correctly classifies 98% of the severe hypoglycemia cases, with a high Nagelkerke R2 value (0.645) and specificity of 99.5%. CONCLUSIONS Postnatal environmental factors seem to be directly related to early hypoglycemia development, so it is essential to support the maternal-child union and breastfeeding. Our results allow better identification of neonates who are not subsidiary to performing blood glucose determinations because they have little risk of developing it.
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Affiliation(s)
| | | | - Segundo Rite Gracia
- Unidad de Cuidados Intensivos Neonatales, Hospital Infantil Miguel Servet, Zaragoza, España
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Influence of different breast expression techniques on human colostrum macronutrient concentrations. J Perinatol 2021; 41:1065-1068. [PMID: 33795790 DOI: 10.1038/s41372-021-00989-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 01/16/2021] [Accepted: 02/03/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the effects of breast expression methods on macronutrient and caloric concentrations in human colostrum. STUDY DESIGN A cross-sectional study in which colostrum samples were collected simultaneously from each breast using different milk expression methods, including manual expression or electric pumping, assigned by simple randomization. Macronutrients were measured by infrared spectroscopy, and their concentrations were compared by the Wilcoxon test. RESULTS Ninety-six samples from each breast of selected donors were evaluated. There were no differences in carbohydrate (6.1 vs. 6.1 g/dL; p: 0.218) and protein (2.1 vs. 2.1 g/dL; p: 0.772) concentrations between the samples collected by manual expression and electric pumping. However, in those collected by manual expression, lipid concentrations (2.6 vs. 2.2 g/dL; p < 0.001) and caloric content (60 vs. 57 Kcal/dL; p = 0.001) were higher. CONCLUSIONS Colostrum collected by hand expression had a higher lipid concentration and caloric content than that collected by an electric pump.
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Sánchez-García AM, Zaragoza-Martí A, Murcia-López AC, Navarro-Ruiz A, Noreña-Peña A. Adequacy of Parenteral Nutrition in Preterm Infants According to Current Recommendations: A Study in A Spanish Hospital. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17062131. [PMID: 32210085 PMCID: PMC7142515 DOI: 10.3390/ijerph17062131] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/15/2020] [Accepted: 03/21/2020] [Indexed: 12/25/2022]
Abstract
Background: In preterm infants, it is important to ensure adequate nutritional intake to accomplish foetal growth requirements. This study evaluated clinical practice regarding the prescription of parenteral nutrition in preterm infants in the neonatology unit of a tertiary hospital. Methods: It was a retrospective observational study of a sample of preterm infants (n = 155) born between January 2015 and December 2017 who were prescribed parenteral nutrition. Compliance with the hospital’s protocol and with the guidelines of the scientific societies American Society for Parenteral and Enteral Nutrition (ASPEN), European Society for Clinical Nutrition and Metabolism (ESPEN) and Spanish Society of Clinical Nutrition and Metabolism (SENPE) was evaluated. The differences in macronutrient intake and total duration of parenteral nutrition were analysed according to gestational age and birth weight. Results: The established protocol was followed in a high percentage (95.5%–100%) except with respect to the initiation of supplying established trace elements (64.9%). Compliance with the recommendations set forth in the guidelines was between 82.1% and 100%, with the exception of the initial carbohydrate intake recommended by ASPEN and ESPEN, for which compliance was 8.3%. Lower gestational age and birth weight were correlated with longer duration of parenteral nutrition (p < 0.001). Conclusions: A lower gestational age and birth weight are related to a longer duration of parenteral nutrition. The results of this study demonstrate the importance of developing and evaluating protocols in clinical practice.
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Affiliation(s)
- Ana María Sánchez-García
- Department of Pharmacy Services, University General Hospital of Elche, 03203 Elche, Spain; (A.M.S.G.); (A.C.M.L.); (A.N.R.)
| | - Ana Zaragoza-Martí
- Department of Nursing, Faculty of Health Science, University of Alicante, 03690 Alicante, Spain;
- Correspondence: ; Tel.: +34-965-903-240
| | - Ana Cristina Murcia-López
- Department of Pharmacy Services, University General Hospital of Elche, 03203 Elche, Spain; (A.M.S.G.); (A.C.M.L.); (A.N.R.)
| | - Andrés Navarro-Ruiz
- Department of Pharmacy Services, University General Hospital of Elche, 03203 Elche, Spain; (A.M.S.G.); (A.C.M.L.); (A.N.R.)
| | - Ana Noreña-Peña
- Department of Nursing, Faculty of Health Science, University of Alicante, 03690 Alicante, Spain;
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Briana DD, Fotakis C, Kontogeorgou A, Gavrili S, Georgatzi S, Zoumpoulakis P, Malamitsi-Puchner A. Early Human-Milk Metabolome in Cases of Intrauterine Growth-Restricted and Macrosomic Infants. JPEN J Parenter Enteral Nutr 2020; 44:1510-1518. [PMID: 32026505 DOI: 10.1002/jpen.1783] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/07/2019] [Accepted: 12/17/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Abnormal fetal growth is associated with short-term and long-term metabolic dysregulation and susceptibility to obesity-related disorders. Maternal milk, the ideal source of infantile nutrition, protects from metabolic diseases in adulthood. By applying nuclear magnetic resonance (NMR) metabolomics, this study investigated the metabolic profile of early human milk/colostrum (EHM/C) at the extremes of fetal-growth conditions, which could affect its nutritional value. METHODS From 98 mothers delivering 60 appropriate-for-gestational-age (AGA), 19 large-for-gestational-age (LGA), and 19 intrauterine growth-restricted (IUGR) full-term neonates, milk samples collected on the third to fourth day post partum were examined by NMR spectroscopy. Multivariate data analysis elicited information from NMR spectra and probed to metabolic signatures of EHM/C. RESULTS LGA and IUGR EHM/C samples depicted increased content in lactose, citric acid, choline, phosphocholine, and N-acetylglutamine. AGA samples exhibited increased isoleucine and valine. Metabolic pathways involved were valine, leucine/isoleucine biosynthesis and degradation, glycerophospholipid metabolism, aminoacyl-transfer RNA biosynthesis, and citrate cycle. Orthogonal projections to latent structures discriminant analysis models were validated. CONCLUSION This holistic metabolomics study framed an increased content of certain essential nutrients in EHM/C samples following the birth of LGA and IUGR infants prone to short- and long-term metabolic disorders, thus stressing additional benefits of early breastfeeding. Assessing the metabolic profile of EHΜ/C enables evaluation of its nutrition value, adjusted to fetal growth, and introduction of appropriate dietary interventions.
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Affiliation(s)
- Despina D Briana
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Charalambos Fotakis
- Institute of Biology, Medicinal Chemistry and Biotechnology, National Hellenic Research Foundation, Athens, Greece
| | - Anna Kontogeorgou
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavroula Gavrili
- Neonatal Intensive Care Unit, "Alexandra" University and State Maternity Hospital, Athens, Greece
| | - Sophia Georgatzi
- Neonatal Intensive Care Unit, "Alexandra" University and State Maternity Hospital, Athens, Greece
| | - Panagiotis Zoumpoulakis
- Institute of Biology, Medicinal Chemistry and Biotechnology, National Hellenic Research Foundation, Athens, Greece
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Villalain C, Quezada M, Gómez-Arriaga P, Simón E, Gómez-Montes E, Galindo A, Herraiz I. Prognostic Factors of Successful Cervical Ripening and Labor Induction in Late-Onset Fetal Growth Restriction. Fetal Diagn Ther 2019; 47:536-544. [DOI: 10.1159/000503390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 09/15/2019] [Indexed: 11/19/2022]
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Postnatal management of growth failure in children born small for gestational age. J Pediatr (Rio J) 2019; 95 Suppl 1:23-29. [PMID: 30550759 DOI: 10.1016/j.jped.2018.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 10/05/2018] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To discuss the etiology and growth consequences of small size at birth and the indications, effects, and safety of biosynthetic growth hormone therapy in children born small for gestational age. SOURCE OF DATA A comprehensive and non-systematic search was carried out in the PubMed, LILACS, and SciELO databases from 1980 to the present day, using the terms "small for gestational age," "intrauterine growth restriction," and "growth hormone". The publications were critically selected by the authors. DATA SYNTHESIS Although the majority of children born small for gestational age show spontaneous catch-up growth during the first two years of life, some of them remain with short stature during childhood, with high risk of short stature in adult life. Treatment with growth hormone might be indicated, preferably after 2-4 years of age, in those small for gestational age children who remain short, without catch-up growth. Treatment aims to increase growth velocity and to reach a normal height during childhood and an adult height within target height. Response to growth hormone treatment is variable, with better growth response during the pre-pubertal period. CONCLUSIONS Treatment with growth hormone in short children born small for gestational age is safe and effective to improve adult height. Efforts should be done to identify the etiology of small size at birth before treatment.
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Cardoso‐Demartini AA, Boguszewski MC, Alves CA. Postnatal management of growth failure in children born small for gestational age. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2018.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Campisi SC, Carbone SE, Zlotkin S. Catch-Up Growth in Full-Term Small for Gestational Age Infants: A Systematic Review. Adv Nutr 2019; 10:104-111. [PMID: 30649167 PMCID: PMC6370265 DOI: 10.1093/advances/nmy091] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 10/04/2018] [Accepted: 10/11/2018] [Indexed: 11/12/2022] Open
Abstract
This is the first systematic review to examine the global prevalence of catch-up growth (CUG) in small for gestational age (SGA) infants who were born at full term (FT). Size at birth and subsequent growth is an important indicator of neonatal and adult health. Globally, 16% of infants are SGA at birth, ranging from 7% in industrialized countries to 41.5% in South Asia. SGA infants are at increased risk for negative developmental and adult health outcomes. Some achieve CUG but others do not. CUG has immediate and late health implications especially in low- and middle-income countries. This systematic review sought to determine the global prevalence of CUG among FT-SGA infants. We performed a literature search of MEDLINE, Pubmed, Embase, Web of Science, and Scopus, as well as grey literature databases, and identified 3137 studies. The final analysis included 11 studies. The median prevalence of CUG was 87.4% across all definitions of SGA and CUG. However, multiple definitions were used to classify SGA and CUG. Nine unique reference populations were used to classify SGA, and 6 to approximate CUG. Due to this heterogeneity, a meta-analysis could not be conducted. Program implementation for this vulnerable group of infants is dependent on proper classification. Given the wide range of definitions and reference standards used in the past, it is not possible to determine the global need for programs to address CUG for FT-SGA infants or to rationally plan any such programs. We highlight the need and propose standard definitions and references for SGA and CUG.
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Affiliation(s)
- Susan C Campisi
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Sarah E Carbone
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Stanley Zlotkin
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Munk School of Public Affairs and Public Policy, University of Toronto, Toronto, Canada
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
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Sánchez-Illana Á, Parra-Llorca A, Escuder-Vieco D, Pallás-Alonso CR, Cernada M, Gormaz M, Vento M, Kuligowski J. Biomarkers of oxidative stress derived damage to proteins and DNA in human breast milk. Anal Chim Acta 2018. [DOI: 10.1016/j.aca.2018.01.054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Goldberg DL, Becker PJ, Brigham K, Carlson S, Fleck L, Gollins L, Sandrock M, Fullmer M, Van Poots HA. Identifying Malnutrition in Preterm and Neonatal Populations: Recommended Indicators. J Acad Nutr Diet 2018; 118:1571-1582. [PMID: 29398569 DOI: 10.1016/j.jand.2017.10.006] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Indexed: 01/04/2023]
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Lee LY, Muhardi L, Cheah FC, Supapannachart S, Teller IC, Bindels J, van Der Beek EM, van Elburg RM. Health-care professionals' approach in feeding term small-for-gestational age infants and its potential implications to later growth outcomes. J Paediatr Child Health 2018; 54:370-376. [PMID: 29205630 DOI: 10.1111/jpc.13775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 08/24/2017] [Accepted: 09/03/2017] [Indexed: 11/28/2022]
Abstract
AIM To understand feeding practices, nutrition management and postnatal growth monitoring of term small-for-gestational age (tSGA) infants in Southeast Asia. METHODS Anonymous questionnaires to assess practices on feeding, nutrition management and post-natal growth monitoring of tSGA infants were distributed among health-care professionals (HCPs) participating in regional/local perinatology symposia in Malaysia, Thailand and Singapore. RESULTS Three hundred seventy-seven respondents from Malaysia (37%), Thailand (27%), Singapore (18%) and other Asian countries (19%) participated in the survey. Respondents were neonatologists (35%), paediatricians (25%) and other HCPs (40%) including nurses and midwives. Exclusive human milk feeding was reported the most preferred feeding option for tSGA infants, followed by fortified human milk feeding (60% and 20%, respectively). This was consistent among the different countries. The perceived nutrient requirements of tSGA infants varied between countries. Most respondents from Malaysia and Singapore reported requirements to be similar to preterm infants, while the majority from Thailand reported that it was less than those of preterm infants. The World Health Organization Growth Chart of 2006 and Fenton Growth Charts of 2013 were the most frequently used charts for growth monitoring in the hospital and after discharge. CONCLUSIONS Nutrition management and perceived nutrient requirements for tSGA infants among practising HCPs in Southeast Asia showed considerable variation. The impetus to form standardised and evidence based feeding regimens is important as adequate nutritional management and growth monitoring particularly in this population of infants will have long term impact on population health.
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Affiliation(s)
- Le Ye Lee
- Department of Neonatology, National University Hospital, Singapore
| | - Leilani Muhardi
- Danone Nutricia Early Life Nutrition, Danone Nutricia Research Singapore, Singapore
| | - Fook-Choe Cheah
- Department of Paediatrics, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | | | - Inga C Teller
- Danone Nutricia Early Life Nutrition, Danone Nutricia Research, Utrecht, Netherlands
| | - Jacques Bindels
- Danone Nutricia Early Life Nutrition, Danone Nutricia Research, Utrecht, Netherlands
| | - Eline M van Der Beek
- Danone Nutricia Early Life Nutrition, Danone Nutricia Research, Utrecht, Netherlands.,Department of Pediatrics, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ruurd M van Elburg
- Danone Nutricia Early Life Nutrition, Danone Nutricia Research, Utrecht, Netherlands.,Emma Children's Hospital, Amsterdam, Netherlands
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Carducci B, Bhutta ZA. Care of the growth-restricted newborn. Best Pract Res Clin Obstet Gynaecol 2018; 49:103-116. [PMID: 29571821 DOI: 10.1016/j.bpobgyn.2018.02.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 02/15/2018] [Indexed: 12/23/2022]
Abstract
With the first 1,000 days of life proving to be a critical window of opportunity for physical and cognitive growth and development, an optimal intrauterine environment is vital. If fetus needs are compromised prenatally, there is an increased risk of intrauterine growth restriction (IUGR), and infants being born premature, low birth weight (LBW), or small-for-gestational age (SGA). Specialized care of these high-risk infants is necessary in terms of preconception interventions, resuscitation, thermoregulation, nutritional support and kangaroo mother care. Significant evidence supports exclusive breastfeeding as the standard of care for feeding SGA, preterm, LBW and very low birth weight infants. Expressed milk or donor milk may also require fortification, to meet higher nutrient needs of these newborns. Future research should address the gap in the literature on specific care of term and preterm IUGR and or SGA infants, and strengthening evidence for human milk bank models and emollient care.
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Affiliation(s)
- Bianca Carducci
- Peter Gilgan Centre for Research and Learning (PGCRL), 686 Bay Street, 11th Floor, Suite 11.9805, Toronto, ON, M5G 0A4, Canada.
| | - Zulfiqar A Bhutta
- Peter Gilgan Centre for Research and Learning (PGCRL), 686 Bay Street, 11th Floor, Suite 11.9805, Toronto, ON, M5G 0A4, Canada.
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Brown LD, Hay WW. Impact of placental insufficiency on fetal skeletal muscle growth. Mol Cell Endocrinol 2016; 435:69-77. [PMID: 26994511 PMCID: PMC5014698 DOI: 10.1016/j.mce.2016.03.017] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 03/03/2016] [Accepted: 03/14/2016] [Indexed: 02/07/2023]
Abstract
Intrauterine growth restriction (IUGR) caused by placental insufficiency is one of the most common and complex problems in perinatology, with no known cure. In pregnancies affected by placental insufficiency, a poorly functioning placenta restricts nutrient supply to the fetus and prevents normal fetal growth. Among other significant deficits in organ development, the IUGR fetus characteristically has less lean body and skeletal muscle mass than their appropriately-grown counterparts. Reduced skeletal muscle growth is not fully compensated after birth, as individuals who were born small for gestational age (SGA) from IUGR have persistent reductions in muscle mass and strength into adulthood. The consequences of restricted muscle growth and accelerated postnatal "catch-up" growth in the form of adiposity may contribute to the increased later life risk for visceral adiposity, peripheral insulin resistance, diabetes, and cardiovascular disease in individuals who were formerly IUGR. This review will discuss how an insufficient placenta results in impaired fetal skeletal muscle growth and how lifelong reductions in muscle mass might contribute to increased metabolic disease risk in this vulnerable population.
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Affiliation(s)
- Laura D Brown
- Department of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Campus F441, Perinatal Research Center, 13243 East 23rd Avenue, Aurora, CO 80045, United States.
| | - William W Hay
- Department of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Campus F441, Perinatal Research Center, 13243 East 23rd Avenue, Aurora, CO 80045, United States.
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Taine M, Stengel B, Forhan A, Carles S, Botton J, Charles MA, Heude B. Rapid Early Growth May Modulate the Association Between Birth Weight and Blood Pressure at 5 Years in the EDEN Cohort Study. Hypertension 2016; 68:859-65. [PMID: 27550918 DOI: 10.1161/hypertensionaha.116.07529] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 07/27/2016] [Indexed: 12/30/2022]
Abstract
Physiological evidence suggests that birth weight (BW) and postnatal growth affect blood pressure (BP) level, independently or in interaction. Their respective roles are difficult to disentangle in epidemiological studies, however, especially when adjusting for final weight. We assessed the portion of the effect of BW on BP at 5 years that was not attributable to postnatal growth and investigated potential interactions between BW and postnatal growth velocity at different time points in the EDEN mother-child study. Collecting a median of 19 weight measurements for each of the 1119 children who completed follow-up enabled us to model instantaneous growth velocity at any age. After computing a BP SD-score at 5 years, adjusted for age, sex, current body mass index, and height, we used multiple linear regression to study its association with age- and sex-specific BW z score, adjusting for several maternal and pregnancy risk factors. We tested interactions between BW categories (small-, appropriate-, and large-for-gestational-age) and weight growth velocities at different ages. The BW z score was negatively and significantly correlated with the systolic BP SD-score at the age of 5 years (r=-0.07, P=0.02). Interactions were found between BW categories and weight growth velocities from 1 to 4 months (P from 0.002 to 0.08) but not at older ages; specifically, children born small for gestational age with a fast weight growth velocity in their first few months of life had the highest absolute systolic BP and SD score values at 5 years. They may need monitoring for cardiovascular risks.
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Affiliation(s)
- Marion Taine
- From the Inserm UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Early Determinants of Children's Health and Development Team (ORCHAD), Villejuif, France (M.T., A.F., S.C., J.B., M.-A.C., B.H.); Paris Descartes University, Paris, France (M.T., A.F., S.C., M.-A.C., B.H.); Inserm UMRS 1018, Center for Research in Epidemiology and Population Health (CESP), Paris-Sud University, Versailles-Saint-Quentin en Yvelines University, Paris-Saclay University, Villejuif, France (B.S.); Paris Sud University, Villejuif, France (S.C.); and Paris Sud University, Paris-Saclay University, Faculty of Pharmacy, Châtenay-Malabry, France (J.B.).
| | - Bénédicte Stengel
- From the Inserm UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Early Determinants of Children's Health and Development Team (ORCHAD), Villejuif, France (M.T., A.F., S.C., J.B., M.-A.C., B.H.); Paris Descartes University, Paris, France (M.T., A.F., S.C., M.-A.C., B.H.); Inserm UMRS 1018, Center for Research in Epidemiology and Population Health (CESP), Paris-Sud University, Versailles-Saint-Quentin en Yvelines University, Paris-Saclay University, Villejuif, France (B.S.); Paris Sud University, Villejuif, France (S.C.); and Paris Sud University, Paris-Saclay University, Faculty of Pharmacy, Châtenay-Malabry, France (J.B.)
| | - Anne Forhan
- From the Inserm UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Early Determinants of Children's Health and Development Team (ORCHAD), Villejuif, France (M.T., A.F., S.C., J.B., M.-A.C., B.H.); Paris Descartes University, Paris, France (M.T., A.F., S.C., M.-A.C., B.H.); Inserm UMRS 1018, Center for Research in Epidemiology and Population Health (CESP), Paris-Sud University, Versailles-Saint-Quentin en Yvelines University, Paris-Saclay University, Villejuif, France (B.S.); Paris Sud University, Villejuif, France (S.C.); and Paris Sud University, Paris-Saclay University, Faculty of Pharmacy, Châtenay-Malabry, France (J.B.)
| | - Sophie Carles
- From the Inserm UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Early Determinants of Children's Health and Development Team (ORCHAD), Villejuif, France (M.T., A.F., S.C., J.B., M.-A.C., B.H.); Paris Descartes University, Paris, France (M.T., A.F., S.C., M.-A.C., B.H.); Inserm UMRS 1018, Center for Research in Epidemiology and Population Health (CESP), Paris-Sud University, Versailles-Saint-Quentin en Yvelines University, Paris-Saclay University, Villejuif, France (B.S.); Paris Sud University, Villejuif, France (S.C.); and Paris Sud University, Paris-Saclay University, Faculty of Pharmacy, Châtenay-Malabry, France (J.B.)
| | - Jérémie Botton
- From the Inserm UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Early Determinants of Children's Health and Development Team (ORCHAD), Villejuif, France (M.T., A.F., S.C., J.B., M.-A.C., B.H.); Paris Descartes University, Paris, France (M.T., A.F., S.C., M.-A.C., B.H.); Inserm UMRS 1018, Center for Research in Epidemiology and Population Health (CESP), Paris-Sud University, Versailles-Saint-Quentin en Yvelines University, Paris-Saclay University, Villejuif, France (B.S.); Paris Sud University, Villejuif, France (S.C.); and Paris Sud University, Paris-Saclay University, Faculty of Pharmacy, Châtenay-Malabry, France (J.B.)
| | - Marie-Aline Charles
- From the Inserm UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Early Determinants of Children's Health and Development Team (ORCHAD), Villejuif, France (M.T., A.F., S.C., J.B., M.-A.C., B.H.); Paris Descartes University, Paris, France (M.T., A.F., S.C., M.-A.C., B.H.); Inserm UMRS 1018, Center for Research in Epidemiology and Population Health (CESP), Paris-Sud University, Versailles-Saint-Quentin en Yvelines University, Paris-Saclay University, Villejuif, France (B.S.); Paris Sud University, Villejuif, France (S.C.); and Paris Sud University, Paris-Saclay University, Faculty of Pharmacy, Châtenay-Malabry, France (J.B.)
| | - Barbara Heude
- From the Inserm UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Early Determinants of Children's Health and Development Team (ORCHAD), Villejuif, France (M.T., A.F., S.C., J.B., M.-A.C., B.H.); Paris Descartes University, Paris, France (M.T., A.F., S.C., M.-A.C., B.H.); Inserm UMRS 1018, Center for Research in Epidemiology and Population Health (CESP), Paris-Sud University, Versailles-Saint-Quentin en Yvelines University, Paris-Saclay University, Villejuif, France (B.S.); Paris Sud University, Villejuif, France (S.C.); and Paris Sud University, Paris-Saclay University, Faculty of Pharmacy, Châtenay-Malabry, France (J.B.)
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Deter RL, Levytska K, Melamed N, Lee W, Kingdom JCP. Classifying neonatal growth outcomes: use of birth weight, placental evaluation and individualized growth assessment. J Matern Fetal Neonatal Med 2016; 29:3939-49. [DOI: 10.3109/14767058.2016.1157576] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Russell L. Deter
- Department of Obstetrics and Gynecology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA and
| | - Khrystyna Levytska
- Division of Maternal-Fetal Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Nir Melamed
- Division of Maternal-Fetal Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Wesley Lee
- Department of Obstetrics and Gynecology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA and
| | - John C. P. Kingdom
- Division of Maternal-Fetal Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
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Stunting at birth: recognition of early-life linear growth failure in the western highlands of Guatemala. Public Health Nutr 2016; 18:1737-45. [PMID: 26017476 DOI: 10.1017/s136898001400264x] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Measurements of length at birth, or in the neonatal period, are challenging to obtain and often discounted for lack of validity. Hence, classical 'under-5' stunting rates have been derived from surveys on children from 6 to 59 months of age. Guatemala has a high prevalence of stunting (49.8%), but the age of onset of growth failure is not clearly defined. The objective of the study was to assess length-for-age within the first 1.5 months of life among Guatemalan infants. DESIGN As part of a cross-sectional observational study, supine length was measured in young infants. Mothers' height was measured. Length-for-age Z-scores (HAZ) were generated and stunting was defined as HAZ <-2 using WHO growth standards. SETTING Eight rural, indigenous Mam-Mayan villages (n 200, 100% of Mayan indigenous origin) and an urban clinic of Quetzaltenango (n 106, 27% of Mayan indigenous origin), Guatemala. SUBJECTS Three hundred and six newborns with a median age of 19 d. RESULTS The median rural HAZ was -1.56 and prevalence of stunting was 38%; the respective urban values were -1.41 and 25%. Linear regression revealed no relationship between infant age and HAZ (r = 0.101, r(2) = 0.010, P = 0.077). Maternal height explained 3% of the variability in HAZ (r = 0.171, r(2) = 0.029, P = 0.003). CONCLUSIONS Stunting must be carried over from in utero growth retardation in short-stature Guatemalan mothers. As linear growth failure in this setting begins in utero, its prevention must be linked to maternal care strategies during gestation, or even before. A focus on maternal nutrition and health in an intergenerational dimension is needed to reduce its prevalence.
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Raiten DJ, Steiber AL, Carlson SE, Griffin I, Anderson D, Hay WW, Robins S, Neu J, Georgieff MK, Groh-Wargo S, Fenton TR. Working group reports: evaluation of the evidence to support practice guidelines for nutritional care of preterm infants-the Pre-B Project. Am J Clin Nutr 2016; 103:648S-78S. [PMID: 26791182 PMCID: PMC6459074 DOI: 10.3945/ajcn.115.117309] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The "Evaluation of the Evidence to Support Practice Guidelines for the Nutritional Care of Preterm Infants: The Pre-B Project" is the first phase in a process to present the current state of knowledge and to support the development of evidence-informed guidance for the nutritional care of preterm and high-risk newborn infants. The future systematic reviews that will ultimately provide the underpinning for guideline development will be conducted by the Academy of Nutrition and Dietetics' Evidence Analysis Library (EAL). To accomplish the objectives of this first phase, the Pre-B Project organizers established 4 working groups (WGs) to address the following themes: 1) nutrient specifications for preterm infants, 2) clinical and practical issues in enteral feeding of preterm infants, 3) gastrointestinal and surgical issues, and 4) current standards of infant feeding. Each WG was asked to 1) develop a series of topics relevant to their respective themes, 2) identify questions for which there is sufficient evidence to support a systematic review process conducted by the EAL, and 3) develop a research agenda to address priority gaps in our understanding of the role of nutrition in health and development of preterm/neonatal intensive care unit infants. This article is a summary of the reports from the 4 Pre-B WGs.
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Affiliation(s)
- Daniel J Raiten
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD;
| | | | | | | | | | | | - Sandra Robins
- Fairfax Neonatal Associates at Inova Children's Hospital, Fairfax, VA
| | - Josef Neu
- University of Florida, Gainesville, FL
| | | | - Sharon Groh-Wargo
- Case Western Reserve University-School of Medicine, Cleveland, OH; and
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Application effect of extensively hydrolyzed milk protein formula and follow-up in preterm children with a gestational age of less than 34 weeks: study protocol for a randomized controlled trial. Trials 2015; 16:498. [PMID: 26537897 PMCID: PMC4632355 DOI: 10.1186/s13063-015-1030-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 10/23/2015] [Indexed: 12/17/2022] Open
Abstract
Background The average incidence of preterm birth in the world is up to 11.1 %, and deaths of preterm children account for more than 50 % of neonatal deaths. Gastrointestinal function of preterm children with a gestational age less than 34 weeks is immaturely developed. For preterm children who can only be fed with formula due to their mothers’ sickness, choosing a suitable formula can not only meet the high nutritional needs of preterm children, but also solve their low gastrointestinal tolerability, and is thus very important. Methods/Design The study is a prospective, randomized, single-blind and controlled clinical trial. Preterm children with a gestational age less than 34 weeks meeting the inclusion criteria who cannot be breastfed will be included. To demonstrate the application effect of extensively hydrolyzed milk protein formula on the target population, preterm children will be randomized into two groups, 185 subjects in each group. The observation group will be fed with extensively hydrolyzed milk protein (100 % whey protein) formula, while the control group will be fed with preterm children’s formula until the children are discharged from the neonatal intensive care unit (NICU). All the formula involved in this study will be from Dumex. After discharge, both groups will be uniformly fed with formula for 0 to 6-month-old infants. For statistical analysis, a chi-square test and Student’s t test will be applied using SAS 9.4. Discussion This will be the first randomized controlled clinical study with long-term observation of the growth and development of preterm children during the NICU stay and at 3-month follow-up after discharge from the NICU. Results from this study will be used to determine whether the extensively hydrolyzed formula is more suitable for the low gastrointestinal tolerability of preterm children, and also whether feeding preterm children who are fed with such formula during the NICU stay with ordinary infant formula after discharge from the NICU would affect the normal growth and development of preterm children in the early stage of their lives. Trial registration This study was registered with the Chinese Clinical Trial Registry (http://www.chictr.org.cn/) with number ChiCTR-IOR-14005696, on December 22, 2014.
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Williams TC, Drake AJ. What a general paediatrician needs to know about early life programming. Arch Dis Child 2015; 100:1058-63. [PMID: 25990501 DOI: 10.1136/archdischild-2014-307958] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 04/28/2015] [Indexed: 01/13/2023]
Abstract
The process whereby early exposure to an adverse environment has an influence on later life outcomes has been called 'early life programming'. While epidemiological evidence for this has been available for decades, only in recent years have the mechanisms, in particular epigenetic modifications, for this process begun to be elucidated. We discuss the evidence for early life programming, the possible mechanisms, how effects may be transmitted across generations, and conclude by looking at some examples relevant to general paediatrics.
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Affiliation(s)
- Thomas C Williams
- Neonatal Unit, Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Amanda J Drake
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, The Queen's Medical Research Institute, Edinburgh, UK
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M Kidder G, Winterhager E. Physiological roles of connexins in labour and lactation. Reproduction 2015; 150:R129-36. [PMID: 26150552 DOI: 10.1530/rep-15-0134] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 07/06/2015] [Indexed: 01/08/2023]
Abstract
The connexin family of proteins are best known as oligomerizing to form intercellular membrane channels (gap junctions) that metabolically and ionically couple cells to allow for coordinated cellular function. Nowhere in the body is this role better illustrated than in the uterine smooth muscle during parturition, where gap junctions conduct the contraction wave throughout the tissue to deliver the baby. Parturition is followed by the onset of lactation with connexins contributing to both the dramatic reorganization of mammary gland tissue leading up to lactation and the smooth muscle contraction of the myoepithelial cells which extrudes the milk. This review summarizes what is known about the expression and roles of individual connexin family members in the uterus during labour and in the mammary glands during development and lactation. Connexin loss or malfunction in mammary glands and the uterus can have serious implications for the health of both the mother and the newborn baby.
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Affiliation(s)
- Gerald M Kidder
- Department of Physiology and PharmacologySchulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario N6A 5C1, CanadaInstitute of Molecular BiologyUniversity of Duisburg-Essen, University Clinics, 45211 Essen, Germany
| | - Elke Winterhager
- Department of Physiology and PharmacologySchulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario N6A 5C1, CanadaInstitute of Molecular BiologyUniversity of Duisburg-Essen, University Clinics, 45211 Essen, Germany
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Domany KA, Mandel D, Kedem MH, Lubetzky R. Breast milk fat content of mothers to small-for-gestational-age infants. J Perinatol 2015; 35:444-6. [PMID: 25375840 DOI: 10.1038/jp.2014.200] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Revised: 09/26/2014] [Accepted: 09/29/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Little is known about the composition of human milk (HM) expressed by mothers of asymmetrically growth-restricted infants. To test the null hypothesis that lactating mothers of small-for-gestational-age (SGA) infants produce milk with fat content similar to that of lactating mothers of infants whose growth is appropriate for gestational age (AGA). STUDY DESIGN Fifty-six lactating mothers of newborns (26 SGA and 30 AGA) were recruited within the first 3 days of delivery. Creamatocrit (CMT) levels in HM were measured at 72 h, 7 days and 14 days postdelivery in capillary tubes after centrifugation at 9000 r.p.m. for 5 min. RESULT The groups did not differ in terms of maternal age, body mass index, gestational age (GA), pregnancy weight gain and parity. They differed significantly in terms of infant's birth weight by design. The mean CMT levels at the three time points were similar for the two groups. This remained true when timing of the sample (colostrum, transitional, mature milk) was introduced as a confounder in the analysis of variance (general linear model). CONCLUSION Fat content of HM is not affected by fetal growth status. We suggest that mothers of SGA infants may be reassured that their milk contains adequate amount of fat that is appropriate for the growth of their infants.
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Affiliation(s)
- K Armoni Domany
- 1] Department of Neonatology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel [2] Department of Pediatrics, Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - D Mandel
- 1] Department of Neonatology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel [2] The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Hausman Kedem
- 1] Department of Neonatology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel [2] Department of Pediatrics, Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - R Lubetzky
- 1] Department of Pediatrics, Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel [2] The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Zecca E, Costa S, Barone G, Giordano L, Zecca C, Maggio L. Proactive enteral nutrition in moderately preterm small for gestational age infants: a randomized clinical trial. J Pediatr 2014; 165:1135-1139.e1. [PMID: 25304922 DOI: 10.1016/j.jpeds.2014.08.065] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 07/23/2014] [Accepted: 08/27/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the efficacy of a proactive feeding regimen (PFR) in reducing hospital length of stay in a population of moderately preterm small for gestational age (SGA) infants. STUDY DESIGN SGA infants (z-score <-1.28) of gestational age (GA) 32-36 weeks and birth weight (BW) >1499 g were allocated at random to receive either a PFR, starting with 100 mL/kg/day and gradually increasing to 200 mL/kg/day by day 4, or a standard feeding regimen, starting with 60 mL/kg/day and gradually increasing to 170 mL/kg/day by day 9. All infants received human milk. RESULTS A total of 72 infants were randomized to the 2 groups, 36 to the PFR group (mean GA, 35.1 ± 0.7 weeks; mean BW, 1761 ± 177 g) and 36 to the standard feeding regimen group (mean GA, 35.5 ± 1.2 weeks; mean BW, 1754 ± 212 g). Infants in the PFR group were discharged significantly earlier (mean, 9.8 ± 3.1 days vs 11.9 ± 4.7 days; P = .029). The need for intravenous fluids (2.8% vs 33.3%; P = .0013) and the incidence of hypoglycemia (0 vs 33.3%; P = .00016) were significantly lower in the PFR group. Feeding intolerance and fecal calprotectin levels did not differ between the 2 groups. CONCLUSION A PFR in moderately preterm SGA infants is well tolerated and significantly reduces both the length of stay and the risk of neonatal hypoglycemia.
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Affiliation(s)
- Enrico Zecca
- Division of Neonatology, Department of Pediatrics, Catholic University of the Sacred Heart, Rome, Italy
| | - Simonetta Costa
- Division of Neonatology, Department of Pediatrics, Catholic University of the Sacred Heart, Rome, Italy.
| | - Giovanni Barone
- Division of Neonatology, Department of Pediatrics, Catholic University of the Sacred Heart, Rome, Italy
| | - Lucia Giordano
- Division of Neonatology, Department of Pediatrics, Catholic University of the Sacred Heart, Rome, Italy
| | - Chiara Zecca
- Division of Neonatology, Department of Pediatrics, Catholic University of the Sacred Heart, Rome, Italy
| | - Luca Maggio
- Division of Neonatology, Department of Pediatrics, Catholic University of the Sacred Heart, Rome, Italy
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Ramel SE, Brown LD, Georgieff MK. The Impact of Neonatal Illness on Nutritional Requirements-One Size Does Not Fit All. CURRENT PEDIATRICS REPORTS 2014; 2:248-254. [PMID: 25722954 PMCID: PMC4337785 DOI: 10.1007/s40124-014-0059-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Sick neonates are at high risk for growth failure and poorer neurodevelopment than their healthy counterparts. The etiology of postnatal growth failure in sick infants is likely multi-factorial and includes undernutrition due to the difficulty of feeding them during their illness and instability. Illness also itself induces fundamental changes in cellular metabolism that appear to significantly alter nutritional demand and nutrient handling. Inflammation and physiologic stress play a large role in inducing the catabolic state characteristic of the critically ill newborn infant. Inflammatory and stress responses are critical short-term adaptations to promote survival, but are not conducive to promoting long-term growth and development. Conditions such as sepsis, surgery, necrotizing enterocolitis, chronic lung disease and intrauterine growth restriction and their treatments are characterized by altered energy, protein and micronutrient metabolism that result in nutritional requirements that are different from those of the healthy, growing term or preterm infant.
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Affiliation(s)
- Sara E. Ramel
- Assistant Professor of Pediatrics, University of Minnesota
Children’s Hospital, 2450 Riverside Avenue; MB630 East Building,
Minneapolis, MN 55454, Ph: 612-626-0644; Fax: 612-624-8176
| | - Laura D. Brown
- Associate Professor of Pediatrics, University of Colorado School of
Medicine, Aurora, CO, Ph: 303-724-0106 Fax: 303-724-0898
| | - Michael K. Georgieff
- Professor of Pediatrics and Child Psychology, University of
Minnesota Children’s Hospital, 2450 Riverside Avenue; MB630 East
Building, Minneapolis, MN 55454, Ph: 612-626-0644; Fax: 612-624-8176
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Choudhri AF, Sable HJ, Chizhikov VV, Buddington KK, Buddington RK. Parenteral nutrition compromises neurodevelopment of preterm pigs. J Nutr 2014; 144:1920-7. [PMID: 25342697 DOI: 10.3945/jn.114.197145] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Despite advances in nutritional support and intensive care, preterm infants are at higher risk of compromised neurodevelopment. OBJECTIVE This study evaluated the contribution of total parenteral nutrition (PN) to compromised neurodevelopment after preterm birth. METHODS Preterm pigs were provided PN or enteral nutrition (EN) for 10 d. Neurodevelopment was assessed by observations of motor activity and evaluation of sensory/motor reflexes, brain weight, MRI, and cerebellar histology. RESULTS Despite similar gains in body weight, PN pigs had smaller brains (32 ± 0.4 vs. 35 ± 0.6 g; P = 0.0002) including the cerebellum, as well as reduced motor activity (P = 0.005), which corresponded to underdeveloped myelination (P = 0.004) measured by diffusion tensor imaging. PN resulted in lower serum triglycerides (17 ± 5.9 vs. 27 ± 3.1 mg/dL; P = 0.05), total cholesterol (31 ± 9.6 vs. 85 ± 8.1 mg/dL; P = 0.04), VLDL cholesterol (3.7 ± 1.2 vs. 5.7 ± 0.7 mg/dL; P = 0.04), and HDL cholesterol (16 ± 4.6 vs. 57 ± 7.3 mg/dL; P = 0.03) and nonsignificantly lower LDL cholesterol (10.7 ± 4.4 vs. 22.7 ± 2.9 mg/dL; P = 0.09). CONCLUSIONS The compromised neurodevelopment caused by total PN is a novel finding, was independent of confounding variables (disease, inconsistent gestational ages, diverse genetics, extrauterine growth retardation, and inconsistent neonatal intensive care unit protocols), and highlights a need to improve current PN solutions. The preterm pig is a translational animal model for improving nutrition support to enhance neurodevelopment of preterm infants requiring PN.
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Affiliation(s)
- Asim F Choudhri
- Departments of Radiology and Le Bonheur Children's Hospital, Memphis, TN; and
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50
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Gidrewicz DA, Fenton TR. A systematic review and meta-analysis of the nutrient content of preterm and term breast milk. BMC Pediatr 2014; 14:216. [PMID: 25174435 PMCID: PMC4236651 DOI: 10.1186/1471-2431-14-216] [Citation(s) in RCA: 320] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 08/22/2014] [Indexed: 12/22/2022] Open
Abstract
Background Breast milk nutrient content varies with prematurity and postnatal age. Our aims were to conduct a meta-analysis of preterm and term breast milk nutrient content (energy, protein, lactose, oligosaccharides, fat, calcium, and phosphorus); and to assess the influence of gestational and postnatal age. Additionally we assessed for differences by laboratory methods for: energy (measured vs. calculated estimates) and protein (true protein measurement vs. the total nitrogen estimates). Methods Systematic review results were summarized graphically to illustrate the changes in composition over time for term and preterm milk. Since breast milk fat content varies within feeds and diurnally, to obtain accurate estimates we limited the meta-analyses for fat and energy to 24-hour breast milk collections. Results Forty-one studies met the inclusion criteria: 26 (843 mothers) preterm studies and 30 (2299 mothers) term studies of breast milk composition. Preterm milk was higher in true protein than term milk, with differences up to 35% (0.7 g/dL) in colostrum, however, after postnatal day 3, most of the differences in true protein between preterm and term milk were within 0.2 g/dL, and the week 10–12 estimates suggested that term milk may be the same as preterm milk by that age. Colostrum was higher than mature milk for protein, and lower than mature milk for energy, fat and lactose for both preterm and term milk. Breast milk composition was relatively stable between 2 and 12 weeks. With milk maturation, there was a narrowing of the protein variance. Energy estimates differed whether measured or calculated, from −9 to 13%; true protein measurement vs. the total nitrogen estimates differed by 1 to 37%. Conclusions Although breast milk is highly variable between individuals, postnatal age and gestational stage (preterm versus term) were found to be important predictors of breast milk content. Energy content of breast milk calculated from the macronutrients provides poor estimates of measured energy, and protein estimated from the nitrogen over-estimates the protein milk content. When breast milk energy, macronutrient and mineral content cannot be directly measured the average values from these meta-analyses may provide useful estimates of mother’s milk energy and nutrient content.
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Affiliation(s)
- Dominica A Gidrewicz
- Department of Pediatrics, University of Calgary, 2888 Shaganappi Trail NW, Calgary, AB T3B 6A8, Canada.
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