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Cagliari PZ, Hoeller VRF, Kanzler ÉLR, Carraro MCM, Corrêa ZGD, Blazius G, Marghetti PG, Lenz GB, Mastroeni SSDBS, Mastroeni MF. Oral DHA supplementation and retinopathy of prematurity: the Joinville DHA Clinical Trial. Br J Nutr 2024; 132:341-350. [PMID: 38826072 DOI: 10.1017/s0007114524001120] [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] [Indexed: 06/04/2024]
Abstract
Retinopathy of prematurity (ROP) is a leading cause of blindness in premature infants. The condition is associated with DHA deficiency. This study aimed to investigate the effect of DHA supplementation on the occurrence of ROP in infants receiving oral oil drops. It is part of the Joinville DHA study, a non-parallel-group cohort study conducted from March 2020 to January 2023 at a public maternity hospital in Brazil. Infants born before 33 weeks of gestational age or with a birth weight ≤ 1500 g were recruited. Among 155 infants, 81 did not receive and 74 received DHA supplementation until complete vascularisation of the peripheral retina. There was a higher incidence of infants with ROP in the unsupplemented group (58·6 %) compared with the DHA group (41·4 %), but this difference was NS (P = 0·22). Unadjusted logistic regression analysis showed that patent ductus arteriosus and neonatal corticosteroids were significantly (P < 0·05) associated with ROP in both groups. In the DHA group, surfactant use was also associated with ROP (P = 0·003). After adjusting for important covariates, patent ductus arteriosus and neonatal corticosteroids continued to be significant for infants in the unsupplemented group (OR = 3·99; P = 0·022 and OR = 5·64; P = 0·019, respectively). In the DHA group, only surfactant use continued to be associated with ROP (OR = 4·84; P = 0·015). In summary, DHA supplementation was not associated with ROP. Further studies are necessary to better understand the relationship between DHA supplementation, ROP and associated comorbidities.
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Affiliation(s)
- Patrícia Zanotelli Cagliari
- Postgraduate Program in Health and Environment, University of Joinville Region - UNIVILLE, Joinville, SC89.219-710, Brazil
- Darcy Vargas Maternity Hospital, Joinville, SC89.202-190, Brazil
- Medicine Department, University of Joinville Region - UNIVILLE, Joinville, SC89.219-710, Brazil
| | | | | | | | | | - Gleici Blazius
- Nursing Department, University of Joinville Region - UNIVILLE, Joinville, SC89.219-710, Brazil
| | | | - Gabriela Bruns Lenz
- Medicine Department, University of Joinville Region - UNIVILLE, Joinville, SC89.219-710, Brazil
| | - Silmara Salete de Barros Silva Mastroeni
- Postgraduate Program in Health and Environment, University of Joinville Region - UNIVILLE, Joinville, SC89.219-710, Brazil
- Medicine Department, University of Joinville Region - UNIVILLE, Joinville, SC89.219-710, Brazil
- Nursing Department, University of Joinville Region - UNIVILLE, Joinville, SC89.219-710, Brazil
- Nutrition Department, University of Joinville Region - UNIVILLE, Joinville, SC89.219-710, Brazil
| | - Marco Fabio Mastroeni
- Postgraduate Program in Health and Environment, University of Joinville Region - UNIVILLE, Joinville, SC89.219-710, Brazil
- Medicine Department, University of Joinville Region - UNIVILLE, Joinville, SC89.219-710, Brazil
- Nursing Department, University of Joinville Region - UNIVILLE, Joinville, SC89.219-710, Brazil
- Nutrition Department, University of Joinville Region - UNIVILLE, Joinville, SC89.219-710, Brazil
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Gao L, Shen W, Wu F, Mao J, Liu L, Chang YM, Zhang R, Ye XZ, Qiu YP, Ma L, Cheng R, Wu H, Chen DM, Chen L, Xu P, Mei H, Wang SN, Xu FL, Ju R, Zheng Z, Lin XZ, Tong XM. Effect of early initiation of enteral nutrition on short-term clinical outcomes of very premature infants: A national multicenter cohort study in China. Nutrition 2023; 107:111912. [PMID: 36577163 DOI: 10.1016/j.nut.2022.111912] [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: 08/08/2022] [Revised: 10/28/2022] [Accepted: 11/06/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The management of enteral nutrition in very preterm infants (VPIs) is still controversial, and there is no consensus on the optimal time point after birth at which enteral nutrition can be started. The aim of this study was to investigate the effect of early initiation of enteral nutrition on the short-term clinical outcomes of VPIs. METHODS Data of infants (n = 2514) born before 32 wk of gestation were collected from 28 hospitals located in seven different regions of China. Based on whether enteral feeding was initiated within or after 24 h since birth, the infants were divided into an early initiation of enteral feeding (EIEF) group and a delayed initiation of enteral feeding (DIEF) group. RESULTS Compared with the DIEF group, the EIEF group was more likely to tolerate enteral nutrition and had less need for parenteral nutrition (all P < 0.05). The EIEF group was associated with lower incidence rates of feeding intolerance, extrauterine growth restriction (EUGR), and late-onset sepsis (LOS) (all P < 0.05). There was no significant difference in the incidence of necrotizing enterocolitis (NEC) (Bell stage ≥2) between the two groups (P = 0.118). The multivariate logistic regression analysis revealed that EIEF was a protective factor against EUGR (odds ratio [OR], 0.621; 95% confidence interval [CI], 0.544-0.735; P < 0.001), feeding intolerance (OR, 0.658; 95% CI, 0.554-0.782; P < 0.001), and LOS (OR, 0.706; 95% CI, 0.550-0.906; P = 0.006). CONCLUSIONS Early initiation of enteral feeding was associated with less frequency of feeding intolerance, EUGR, and LOS, and it may shorten the time to reach total enteral feeding without increasing the risk of NEC.
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Affiliation(s)
- Liang Gao
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Wei Shen
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Fan Wu
- Department of Neonatology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jian Mao
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ling Liu
- Department of Neonatology, Guiyang Maternal and Child Health Hospital and Guiyang Children's Hospital, Guiyang, China
| | - Yan-Mei Chang
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Rong Zhang
- Department of Neonatology, Pediatric Hospital of Fudan University, Shanghai, China
| | - Xiu-Zhen Ye
- Department of Neonatology, Guangdong Province Maternal and Children's Hospital, Guangzhou, China
| | - Yin-Ping Qiu
- Department of Neonatology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Li Ma
- Department of Neonatology, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Rui Cheng
- Department of Neonatology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Hui Wu
- Department of Neonatology, The First Hospital of Jilin University, Changchun, China
| | - Dong-Mei Chen
- Department of Neonatology, Quanzhou Maternity and Children's Hospital, Quanzhou, China
| | - Ling Chen
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ping Xu
- Department of Neonatology, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Hua Mei
- Department of Neonatology, the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - San-Nan Wang
- Department of Neonatology, Suzhou Municipal Hospital, Suzhou, Jiangsu, China
| | - Fa-Lin Xu
- Department of Neonatology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Rong Ju
- Department of Neonatology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Zhi Zheng
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Xin-Zhu Lin
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China.
| | - Xiao-Mei Tong
- Department of Pediatrics, Peking University Third Hospital, Beijing, China.
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3
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Kebede DA, Tafere Y, Eshete T, Abebaw E, Adimasu M, Endalew B. The time to initiate trophic feeding and its predictors among preterm neonate admitted to neonatal intensive care unit, Multicenter study, Northwest Ethiopia. PLoS One 2022; 17:e0272571. [PMID: 35951594 PMCID: PMC9371352 DOI: 10.1371/journal.pone.0272571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 07/21/2022] [Indexed: 11/29/2022] Open
Abstract
Background Trophic feeding is a small volume, hypo-caloric feeding, gut priming or minimal enteral feeding acclimate the immature gut of enteral fasting preterm neonates. Delayed starting of trophic feeding had resulted in short and long-term physical and neurological sequels. The current study aimed to estimate the time to initiate trophic feeding and its predictors among preterm neonates admitted in the neonatal intensive care unit of Debre Markos, Felege Hiwot, and Tibebe Ghion comprehensive specialized hospitals. Methods An institutional-based prospective follow-up study was conducted among 210 neonates. The data were collected with interview and chart review, entered into Epi data 3.1 and exported to Stata 14.1 for analysis. Multivariable Cox regression models were fitted to identify predictors of time to initiate trophic feeding. Result A total of 210 neonates were followed for 10136 person-hours of risk time and 191 (90.95%) of neonates were started trophic feeding. The overall incidence of starting trophic feeding was 2 per 100 (95% CI: 2, 2.2) person-hours observations. The median survival time was 42 hours (95% CI: 36, 48). APGAR- score at first minute <7 (AHR: 0.6, 95% CI: 0.44, 0.82), gestational age of <34 weeks (AHR: 0.69, 95% CI: 0.5, 0.94), presence of respiratory distress syndrome (AHR: 0.5, 95% CI: 0.36, 0.68), presence of hemodynamic instability (AHR: 0.37, 95% CI: 0.24, 0.57), presence of perinatal asphyxia (AHR: 0.63, 95% CI: 0.44, 0.89), cesarean section delivery (AHR: 0.63, 95% CI: 0.44, 89) and being delivered within the study hospitals (AHR: 0.54, 95% CI: 0.39, 0.74) were found to be statistically significant predictors of time to initiate trophic feeding. Conclusion There was a significant delay to initiate trophic feeding in the studied hospitals. Gestational age of below 34 weeks, APGAR-score of less than seven, out-born delivery, cesarean delivery, presence of respiratory distress syndrome; perinatal asphyxia, and hemodynamic instability were predictors of delay in starting of trophic feeding. Standardized feeding guideline has to be implemented to overcome delays in enteral feeding initiation.
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Affiliation(s)
| | - Yilikal Tafere
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Tewodros Eshete
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Ermias Abebaw
- School of Medicine, Debre Markos University, Debre Markos, Ethiopia
- * E-mail:
| | - Mekonen Adimasu
- Department of Nursing, School of Nursing and Midwifery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bekalu Endalew
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Yang R, Ding H, Shan J, Li X, Zhang J, Liu G, Zheng H, Su Y, Yao H, Qi K. Association of fish oil containing lipid emulsions with retinopathy of prematurity: a retrospective observational study. BMC Pediatr 2022; 22:113. [PMID: 35236316 PMCID: PMC8889774 DOI: 10.1186/s12887-022-03174-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 02/21/2022] [Indexed: 11/28/2022] Open
Abstract
Background Retinopathy of prematurity (ROP) remains a leading cause of childhood blindness worldwide. This study aimed to investigate whether supplementation of n-3 polyunsaturated fatty acids (n-3 PUFAs) in parenteral nutrition may have beneficial effects on ROP in preterm infants. Methods A total of 89 preterm infants, admitted to Neonatal Intensive Care Unit (NICU) in Anhui Provincial Children’s Hospital from September 2017 to August 2020, were recruited in the study. Based on the medical documents, the subjects were categorised into two groups: administration of the fish oil emulsion (n=43) containing soy oil, medium-chain-triglycerides (MCT), olive oil and fish oil (6g/dL, 6g/dL, 5g/dL and 3g/dL respectively), and the soy oil emulsion (n=46) containing 10g/dL of soy oil and MCT each. At 4 weeks of hospitalization, ROP was screened and diagnosed. Fatty acids in erythrocytes were determined using gas chromatography. Results The averaged birth weight and gestational age were 1594±296 g and 31.9±2.3 wk, 1596±263 g and 31.6±2.3 wk respectively for preterm infants in the fish oil group and soy oil group. After 4 to 6 weeks of hospitalization, among all the preterm infants, 52 developed ROP (all stages) indicating an incidence of ROP at 58.43%. Although the incidence of ROP with any stages showed no differences between the two groups, the severe ROP incidence in the group with fish oil emulsions (2.33%) was significantly lower than that in the group with soy oil emulsions (23.91%) (P<0.05). After 14 days of nutrition support, the preterm infants administered fish oil emulsions had an increase in erythrocyte DHA content, with a reduction in ratio of arachidonic acid (AA) to DHA and an increase of n-3 index. Conclusion Supplementation of n-3 PUFAs through parenteral fish oil containing lipid emulsions resulted in an increase in erythrocyte DHA, and this might have beneficial effects on prevention of severe ROP in preterm infants.
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Affiliation(s)
- Rongqiang Yang
- Department of Clinical Nutrition, Anhui Provincial Children's Hospital, Wangjiang East Road 39, Hefei, 23000, Anhui, China.
| | - Hao Ding
- Department of Clinical Nutrition, Anhui Provincial Children's Hospital, Wangjiang East Road 39, Hefei, 23000, Anhui, China
| | - Jing Shan
- Department of Clinical Nutrition, Anhui Provincial Children's Hospital, Wangjiang East Road 39, Hefei, 23000, Anhui, China
| | - Xiaole Li
- Department of Clinical Nutrition, Anhui Provincial Children's Hospital, Wangjiang East Road 39, Hefei, 23000, Anhui, China
| | - Jian Zhang
- Department of Clinical Nutrition, Anhui Provincial Children's Hospital, Wangjiang East Road 39, Hefei, 23000, Anhui, China
| | - Guanghui Liu
- Department of Clinical Nutrition, Anhui Provincial Children's Hospital, Wangjiang East Road 39, Hefei, 23000, Anhui, China
| | - Hong Zheng
- Department of Clinical Nutrition, Anhui Provincial Children's Hospital, Wangjiang East Road 39, Hefei, 23000, Anhui, China
| | - Yu Su
- Department of Clinical Nutrition, Anhui Provincial Children's Hospital, Wangjiang East Road 39, Hefei, 23000, Anhui, China
| | - Hongyang Yao
- Beijing Paediatric Research Institute, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, Beijing, 100045, China
| | - Kemin Qi
- Beijing Paediatric Research Institute, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, Beijing, 100045, China.
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5
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Rakshasbhuvankar AA, Simmer K, Patole SK, Stoecklin B, Nathan EA, Clarke MW, Pillow JJ. Enteral Vitamin A for Reducing Severity of Bronchopulmonary Dysplasia: A Randomized Trial. Pediatrics 2021; 147:peds.2020-009985. [PMID: 33386338 DOI: 10.1542/peds.2020-009985] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Evidence suggests that intramuscular vitamin A reduces the risk of bronchopulmonary dysplasia (BPD) in preterm infants. Our objective was to compare enteral water-soluble vitamin A with placebo supplementation to reduce the severity of BPD in extremely preterm infants. METHODS We conducted a double-blind randomized controlled trial in infants <28 weeks' gestation who were to receive either enteral water-soluble vitamin A (5000 IU per day) or a placebo. Supplementation was started within 24 hours of introduction of feeds and continued until 34 weeks' postmenstrual age (PMA). The primary outcome was the severity of BPD, assessed by using the right shift of the pulse oximeter saturation versus the inspired oxygen pressure curve. RESULTS A total of 188 infants were randomly assigned. The mean ± SD birth weight (852 ± 201 vs 852 ± 211 g) and gestation (25.8 ± 1.49 vs 26.0 ± 1.39 weeks) were comparable between the vitamin A and placebo groups. There was no difference in the right shift (median [25th-75th percentiles]) of the pulse oximeter saturation versus inspired oxygen pressure curve (in kilopascals) between the vitamin A (11.1 [9.5-13.7]) and placebo groups (10.7 [9.5-13.1]) (P = .73). Enteral vitamin A did not affect diagnosis of BPD or other clinical outcomes. Plasma retinol levels were significantly higher in the vitamin A group versus the placebo group on day 28 and at 34 weeks' PMA. CONCLUSIONS Enteral water-soluble vitamin A supplementation improves plasma retinol levels in extremely preterm infants but does not reduce the severity of BPD.
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Affiliation(s)
- Abhijeet A Rakshasbhuvankar
- Neonatal Clinical Care Unit and .,Neonatal Clinical Care Unit, Perth Children's Hospital, Perth, Western Australia, Australia.,Centre for Child Health Research, Medical School, The University of Western Australia and Telethon Kids Institute, Perth, Western Australia, Australia.,Division of Anatomy and Human Biology, School of Human Sciences, Faculty of Science, The University of Western Australia, Perth, Western Australia, Australia; and
| | - Karen Simmer
- Neonatal Clinical Care Unit and.,Neonatal Clinical Care Unit, Perth Children's Hospital, Perth, Western Australia, Australia.,Centre for Child Health Research, Medical School, The University of Western Australia and Telethon Kids Institute, Perth, Western Australia, Australia
| | - Sanjay K Patole
- Neonatal Clinical Care Unit and.,Neonatal Clinical Care Unit, Perth Children's Hospital, Perth, Western Australia, Australia.,Centre for Child Health Research, Medical School, The University of Western Australia and Telethon Kids Institute, Perth, Western Australia, Australia
| | - Benjamin Stoecklin
- Neonatal Clinical Care Unit and.,Centre for Child Health Research, Medical School, The University of Western Australia and Telethon Kids Institute, Perth, Western Australia, Australia.,Division of Anatomy and Human Biology, School of Human Sciences, Faculty of Science, The University of Western Australia, Perth, Western Australia, Australia; and.,Department of Neonatology, University Children's Hospital Basel, Basel, Switzerland
| | - Elizabeth A Nathan
- Women and Infants Research Foundation, King Edward Memorial Hospital, Subiaco, Western Australia, Australia.,Division of Obstetrics and Gynaecology, Faculty of Health and Medical Sciences
| | - Michael W Clarke
- Metabolomics Australia, Centre for Microscopy, Characterization, and Analysis.,School of Biomedical Sciences, Faculty of Health and Medical Sciences, and
| | - J Jane Pillow
- Centre for Child Health Research, Medical School, The University of Western Australia and Telethon Kids Institute, Perth, Western Australia, Australia.,Division of Anatomy and Human Biology, School of Human Sciences, Faculty of Science, The University of Western Australia, Perth, Western Australia, Australia; and
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6
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Gupta S, Patwardhan G, Parikh T, Kadam S, Vaidya U, Pandit A. Which long line do we use in very low birth weight neonates; umbilical venous catheter or peripherally inserted central catheter? J Neonatal Perinatal Med 2020; 14:229-235. [PMID: 33104045 DOI: 10.3233/npm-190379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Umbilical venous catheters (UVC) and peripherally inserted central catheters (PICC) are commonly used in preterms. UVC is cheap, easy to insert but has shorter dwell time. UVC is replaced after 7 days due to the risk of complications. This is associated with increased cost, work, and risk of nosocomial infections. The aim of this study was to determine the antenatal and postnatal factors that predict the need for a central line for more than 7 days, thus helping select between UVC or PICC on day 1 of life in babies ≤1500 grams. METHODS We retrospectively collected antenatal and postnatal data of VLBW neonates over a period of 1 year who needed CL during their NICU stay. We then divided them into two cohorts. Group 1: CL ≤7 days. Group 2: CL > 7 days. RESULTS Sepsis and catheter complications were lower with use of a single CL or duration being ≤7 days. Birth weight, incomplete/no antenatal steroids, need for resuscitation, low Apgar's, RDS, hs-PDA, and initiation of feeds beyond 24 hours of birth were significant. The score was devised based on factors found significant that had an acceptable AUC of 0.767 on ROC analysis with a score of 1 or above having 74.8% sensitivity and 67.7% specificity for prediction of need for CL > 7 days. CONCLUSIONS Birth weight ≤1000 grams, incomplete steroids and need for resuscitation at birth were predictive of the need of CL beyond seven days, on day one of life.
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Affiliation(s)
- S Gupta
- Department of Pediatrics, KEM Hospital, Rasta Peth, Pune Maharashtra, India
| | - G Patwardhan
- Department of Pediatrics, KEM Hospital, Rasta Peth, Pune Maharashtra, India
| | - T Parikh
- Department of Pediatrics, KEM Hospital, Rasta Peth, Pune Maharashtra, India
| | - S Kadam
- Department of Pediatrics, KEM Hospital, Rasta Peth, Pune Maharashtra, India
| | - U Vaidya
- Department of Pediatrics, KEM Hospital, Rasta Peth, Pune Maharashtra, India
| | - A Pandit
- Department of Pediatrics, KEM Hospital, Rasta Peth, Pune Maharashtra, India
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Abstract
Late preterm infants comprise the majority of preterm infants, yet there are few data to support best nutritional practice for these infants. Breastmilk is considered the best choice of enteral feeding for late preterm infants. However, supplementation of breastmilk may be indicated to promote optimal growth. Preterm formulas can be used for supplementation of breastmilk or as a breastmilk substitute but there is little evidence for their use in the late preterm infant. Feeding difficulties are common and some infants require intravenous nutritional support soon after birth. Others require tube feeding until full sucking feeds are established. Future research should focus on whether nutritional support of late preterm babies pending exclusive breastfeeding influences growth, body composition and long-term outcomes of late preterm infants and, if so, how nutritional interventions can optimise these outcomes.
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Affiliation(s)
- Sharin Asadi
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | - Jane E Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand.
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Henderickx JGE, Zwittink RD, van Lingen RA, Knol J, Belzer C. The Preterm Gut Microbiota: An Inconspicuous Challenge in Nutritional Neonatal Care. Front Cell Infect Microbiol 2019; 9:85. [PMID: 31001489 PMCID: PMC6454191 DOI: 10.3389/fcimb.2019.00085] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/12/2019] [Indexed: 12/16/2022] Open
Abstract
The nutritional requirements of preterm infants are unique and challenging to meet in neonatal care, yet crucial for their growth, development and health. Normally, the gut microbiota has distinct metabolic capacities, making their role in metabolism of dietary components indispensable. In preterm infants, variation in microbiota composition is introduced while facing a unique set of environmental conditions. However, the effect of such variation on the microbiota's metabolic capacity and on the preterm infant's growth and development remains unresolved. In this review, we will provide a holistic overview on the development of the preterm gut microbiota and the unique environmental conditions contributing to this, in addition to maturation of the gastrointestinal tract and immune system in preterm infants. The role of prematurity, as well as the role of human milk, in the developmental processes is emphasized. Current research stresses the early life gut microbiota as cornerstone for simultaneous development of the gastrointestinal tract and immune system. Besides that, literature provides clues that prematurity affects growth and development. As such, this review is concluded with our hypothesis that prematurity of the gut microbiota may be an inconspicuous clinical challenge in achieving optimal feeding besides traditional challenges, such as preterm breast milk composition, high nutritional requirements and immaturity of the gastrointestinal tract and immune system. A better understanding of the metabolic capacity of the gut microbiota and its impact on gut and immune maturation in preterm infants could complement current feeding regimens in future neonatal care and thereby facilitate growth, development and health in preterm infants.
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Affiliation(s)
- Jannie G E Henderickx
- Laboratory of Microbiology, Wageningen University and Research, Wageningen, Netherlands
| | - Romy D Zwittink
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, Netherlands
| | - Richard A van Lingen
- Department of Neonatology, Isala Women and Children's Hospital, Zwolle, Netherlands
| | - Jan Knol
- Laboratory of Microbiology, Wageningen University and Research, Wageningen, Netherlands.,Danone Nutricia Research, Utrecht, Netherlands
| | - Clara Belzer
- Laboratory of Microbiology, Wageningen University and Research, Wageningen, Netherlands
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9
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Algorithm for Calculating the Protein Intake in Enteral and Parenteral Nutrition in Premature Infants. CURRENT HEALTH SCIENCES JOURNAL 2019; 44:157-165. [PMID: 30746164 PMCID: PMC6320467 DOI: 10.12865/chsj.44.02.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 03/27/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Calculating the exact nutritional balance especially for the premature infant has always been a challenge for the daily practice of the clinician. PURPOSE we intend to establish a simplified formula and mathematical algorithms to calculate the necessary amino acids and proteins for the nutrition of the premature newborn, covering most of the international recommendations and also to give to the neonatal intensive care physician the opportunity of their rapid customization for each case. METHODS following an extensive literature revision we have established the protein intake recommendations, indications and contraindications for enteral and parenteral nutrition in premature infants, by age of gestation, birth weight and postnatal age. Then, these recommendations were translated into simplified mathematical equations and we have proceeded to develop logical algorithms to enable the rapid choice of the best equation that fits each individual case with all its peculiarities, at a defined time. RESULTS for all three premature categories, we have identified intervals for enteral and parenteral nutrition, which were translated into mathematical formulas and management regulations and then transposed into logic algorithms. CONCLUSIONS although mathematically one can use a simplified calculation, for a rapid appreciation, the clinician is still required to go through these algorithms daily and sometimes several times a day. Moreover, to optimize protein intake, we have to calculate the protein / energy ratio and the non-protein calories / gram of protein ratio. This involves extending the calculation for the carbohydrates, fats and calories-practically the entire nutrition.
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10
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Choline and choline-related nutrients in regular and preterm infant growth. Eur J Nutr 2018; 58:931-945. [PMID: 30298207 DOI: 10.1007/s00394-018-1834-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 09/22/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Choline is an essential nutrient, with increased requirements during development. It forms the headgroup of phosphatidylcholine and sphingomyelin in all membranes and many secretions. Phosphatidylcholine is linked to cell signaling as a phosphocholine donor to synthesize sphingomyelin from ceramide, a trigger of apoptosis, and is the major carrier of arachidonic and docosahexaenoic acid in plasma. Acetylcholine is important for neurodevelopment and the placental storage form for fetal choline supply. Betaine, a choline metabolite, functions as osmolyte and methyl donor. Their concentrations are all tightly regulated in tissues. CLINCAL IMPACT During the fetal growth spurt at 24-34-week postmenstrual age, plasma choline is higher than beyond 34 weeks, and threefold higher than in pregnant women [45 (36-60) µmol/L vs. 14 (10-17) µmol/L]. The rapid decrease in plasma choline after premature birth suggests an untimely reduction in choline supply, as cellular uptake is proportional to plasma concentration. Supply via breast milk, with phosphocholine and α-glycerophosphocholine as its major choline components, does not prevent such postnatal decrease. Moreover, high amounts of liver PC are secreted via bile, causing rapid hepatic choline turnover via the enterohepatic cycle, and deficiency in case of pancreatic phospholipase A2 deficiency or intestinal resection. Choline deficiency causes hepatic damage and choline accretion at the expense of the lungs and other tissues. CONCLUSION Choline deficiency may contribute to the impaired lean body mass growth and pulmonary and neurocognitive development of preterm infants despite adequate macronutrient supply and weight gain. In this context, a reconsideration of current recommendations for choline supply to preterm infants is required.
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HOLZBACH LC, MOREIRA RADM, PEREIRA RJ. Protein-energy adequacy and nutritional evolution of preterm infants in neonatal intensive care unit. REV NUTR 2018. [DOI: 10.1590/1678-98652018000200002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Objective To evaluate the prescription of protein-calorie nutrition and its adequacy to the requirements of preterm newborns. Methods Prospective study with 30 preterm infants from a neonate intensive unit care. Anthropometric and nutritional therapy data were collected daily. Nutritional demands were defined according to the national guidelines. Protein-calorie nutritional support was considered adequate when it reached 70% of the calculated demand. The evolution of nutritional status was evaluated according to the growth curves of preterm infants. Statistical analyses were performed with the Statistical Package for Social Sciences 20.0, at a 5% significance level. Results The means of demand, prescription and infusion significantly differed from each other. The values of calories and proteins prescribed and infused were inadequate according to the calculated ones. There was no significant difference between the volume of prescribed and administered nutrition (p>0.05). At birth, 30% of the children were small, 66.7% were adequate, and 3.3% were large for gestational age. At discharge, the percentages were 33.3%; 63.3%; 3.3%, respectively. The values at birth significantly differed from those at discharge (p<0.01). Conclusion In the Unit of Neonatal Care studied, inadequate nutrient prescription and support is a factor that can compromise the nutritional status of the newborns at hospital discharge.
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Bulbul A, Bulbul L, Uslu S, Zubarioglu U. Nutritional support in preterm infants. Pediatr Neonatol 2017; 58:562. [PMID: 28888880 DOI: 10.1016/j.pedneo.2017.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 08/22/2017] [Indexed: 11/18/2022] Open
Affiliation(s)
- Ali Bulbul
- Department of Pediatrics, Division of Neonatology, Sisli Hamidiye Etfal Educational and Research Hospital, Istanbul, Turkey.
| | - Lida Bulbul
- Department of Pediatrics, Bakırköy Dr. Sadi Konuk Educational and Research Hospital, Istanbul, Turkey.
| | - Sinan Uslu
- Department of Pediatrics, Division of Neonatology, Sisli Hamidiye Etfal Educational and Research Hospital, Istanbul, Turkey.
| | - Umut Zubarioglu
- Department of Pediatrics, Division of Neonatology, Sisli Hamidiye Etfal Educational and Research Hospital, Istanbul, Turkey.
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Sámano R, Martínez-Rojano H, Hernández RM, Ramírez C, Flores Quijano ME, Espíndola-Polis JM, Veruete D. Retinol and α-Tocopherol in the Breast Milk of Women after a High-Risk Pregnancy. Nutrients 2017; 9:E14. [PMID: 28045436 PMCID: PMC5295058 DOI: 10.3390/nu9010014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 11/20/2016] [Accepted: 12/21/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There is scant information about whether, after a high-risk pregnancy, breast milk provides enough vitamins for assuring satisfactory bodily reserves in newborns. OBJECTIVE To comparatively evaluate, in women with high-risk and normal pregnancy, the concentration of retinol and α-tocopherol in breast milk. METHODS This cross-sectional, analytical study was evaluated with reverse-phase high-performance liquid chromatography (HPLC). Informed consent was signed by 95 mothers with a high-risk pregnancy and 32 mothers with a normal pregnancy. From the mothers with a high-risk pregnancy were obtained: 23 samples of colostrum, 24 of transitional milk, and 48 of mature milk. From the normal pregnancy group, 32 mature milk samples were collected. Pregestational Body Mass Index (BMI) and the gestational weight gain were noted. Models of logistic regression were constructed to identify the variables related to a low concentration of either retinol or α-tocopherol in breast milk. RESULTS The concentration of retinol and α-tocopherol in mature milk was 60 (interquartile range (IQR), 41-90) and 276 (103-450) μg/dL, respectively, for the high-risk pregnancy group, and 76 (65-91) and 673 (454-866) µg/dL, respectively, for the normal pregnancy group (p = 0.001). The concentration of retinol and α-tocopherol was similar in the subgroups of mothers with different disorders during gestation. A clear correlation was found between a greater pregestational weight and a lower concentration of retinol (Rho = -0.280, p = 0.006), and between α-tocopherol and retinol in all cases (Rho = 0.463, p = 0.001). Among women having a high-risk pregnancy, those delivering prematurely rather than carrying their pregnancy to term had a reduced concentration of retinol (54 (37-78) vs. 70 (49-106) µg/dL; p = 0.002) and a tendency to a lower concentration of α-tocopherol in breast milk (185 (75-410) vs. 339 (160-500) µg/dL; p = 0.053). Compared to mothers with a normal pregnancy, those with a high-risk pregnancy (whether carried to term or ending in preterm delivery) exhibited a reduced concentration of retinol in mature milk (p = 0.003), as well as a tendency to a lower concentration of α-tocopherol (p = 0.054). CONCLUSION Even though the women in the high-risk pregnancy group showed a deficiency of vitamins A and E in their breast milk, the unique biological benefits of this milk justify the promotion of breast feeding as the optimal method of nourishing neonates and infants. In these cases, it should be recommended that the woman increase her consumption of certain nutrients during pregnancy. Additionally, after childbirth mothers should consider the use of supplements to produce milk of adequate quality and thus meet the needs of the baby and prevent any deficiency in micronutrients.
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Affiliation(s)
- Reyna Sámano
- Departamento de Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Secretaría de Salud Montes Urales 800, Miguel Hidalgo, Lomas Virreyes, Ciudad de México CP. 11000, Mexico.
| | - Hugo Martínez-Rojano
- Departamento de Posgrado e Investigación, Escuela Superior de Medicina del Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón s/n, Colonia Casco de Santo Tomas, Delegación Miguel Hidalgo, Ciudad de México CP. 11340, Mexico.
- Coordinación de Medicina Laboral, Instituto de Diagnóstico y Referencia Epidemiológicos (InDRE) "Dr. Manuel Martínez Báez", Secretaría de Salud Francisco de P. Miranda 177, Lomas de Plateros, Ciudad de México CP. 01480, Mexico.
| | - Rosa M Hernández
- Departamento de Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Secretaría de Salud Montes Urales 800, Miguel Hidalgo, Lomas Virreyes, Ciudad de México CP. 11000, Mexico.
| | - Cristina Ramírez
- Departamento de Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Secretaría de Salud Montes Urales 800, Miguel Hidalgo, Lomas Virreyes, Ciudad de México CP. 11000, Mexico.
| | - María E Flores Quijano
- Departamento de Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Secretaría de Salud Montes Urales 800, Miguel Hidalgo, Lomas Virreyes, Ciudad de México CP. 11000, Mexico.
| | - José M Espíndola-Polis
- Departamento de Nutrición Humana, Universidad del Altiplano, Mirasol 1, Tlacomulco, Tlaxcala de Xicohténcatl CP. 90102, Mexico.
| | - Daniela Veruete
- Universidad del Valle de México, campus Chapultepec Av. Constituyentes No. 151, Miguel Hidalgo, San Miguel Chapultepec I Secc, Ciudad de México CP. 11850, Mexico.
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