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Fenton TR, Merlino Barr S, Elmrayed S, Alshaikh B. Expected and Desirable Preterm and Small Infant Growth Patterns. Adv Nutr 2024; 15:100220. [PMID: 38670164 PMCID: PMC11251411 DOI: 10.1016/j.advnut.2024.100220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024] Open
Abstract
Adequate nutrition is necessary for achieving optimal growth and neurodevelopment. Growth is a natural and expected process that happens concomitantly with rapid advancements in neurodevelopment. Serial weight, length, and head circumference growth measures are essential for monitoring development, although identifying pathological deviations from normal growth can pose challenges. Appropriate growth assessments require considerations that a range of sizes for length, head circumference, and weight are expected and appropriate. Because of genetic differences and morbidities, there is a considerable overlap between the growth of healthy infants and those with growth alterations. Parents tend to be over-concerned about children who plot low on growth charts and often need reassurance. Thus, the use of terms such as "poor" growth or growth "failure" are discouraged when growth is approximately parallel to growth chart curves even if their size is smaller than specific percentiles. No specific percentile should be set as a growth goal; individual variability should be expected. An infant's size at birth is important information that goes beyond the common use of prognostic predictions of appropriate compared with small or large for gestational age. The lower the birthweight, the lower the nutrient stores and the more important the need for nutrition support. Compared to term infants, preterm infants at term-equivalent age have a higher percentage of body fat, but this diminishes over the next months. Current research findings support expert recommendations that preterm infants should grow, after early postnatal weight loss, similar to the fetus and then term-born infants, which translates to growth approximately parallel to growth chart curves. There is no need for a trade-off between optimum cognition and optimum future health. Each high-risk infant needs individualized nutrition and growth assessments. This review aims to examine infant growth expectations and messaging for parents of preterm and term-born infants within the broader causal framework.
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Affiliation(s)
- Tanis R Fenton
- Community Health Sciences, O'Brien Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada.
| | | | - Seham Elmrayed
- Community Health Sciences, O'Brien Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada; Institute of Global Health and Human Ecology, American University in Cairo, Egypt
| | - Belal Alshaikh
- Community Health Sciences, O'Brien Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada; Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
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2
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Dhanireddy R, Scott PA, Barker B, Scott TA. Quality Initiative to Reduce Extrauterine Growth Restriction in Very Low Birth Weight Infants. Hosp Pediatr 2022; 12:173-181. [PMID: 35001101 DOI: 10.1542/hpeds.2021-006146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND We report a statewide quality improvement initiative aimed to decrease the incidence of extrauterine growth restriction among very low birth weight infants cared for in Tennessee NICUs. METHODS The cohort consisted of infants born appropriate for gestational age between May 2016 and December 2018 from 9 NICUs across Tennessee. The infants were 23 to 32 weeks gestation and 500 to 1499 g birth weight. The process measures were the hours of life (HOL) when parenteral protein and intravenous lipid emulsion were initiated, the number of days to first enteral feeding, and attainment of full enteral caloric intake (110-130 kcal/kg per day). The primary outcome was extrauterine growth restriction, defined as weight <10th percentile for weight at 36 weeks postmenstrual age. Statistical process control charts and the Shewhart control rules were used to find special cause variation. RESULTS Although special cause variation was not indicated in the primary outcome measure, it was indicated for the reduction in specific process measures: HOL when parenteral protein was initiated, HOL when intravenous lipid emulsion was initiated, and the number of days to attainment of full enteral caloric intake (among the hospitals considered regional perinatal centers). CONCLUSIONS A statewide quality improvement initiative led to earlier initiation of parenteral and enteral nutrition and improved awareness of the importance of postnatal nutrition.
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Affiliation(s)
- Ramasubbareddy Dhanireddy
- Division of Neonatology, Department of PediatricsUniversity of Tennessee Health Science Center Memphis Tennessee.,Tennessee Initiative for Perinatal Quality Care Nashville Tennessee
| | - Patricia A Scott
- Tennessee Initiative for Perinatal Quality Care Nashville Tennessee.,Vanderbilt University School of Nursing Nashville Tennessee; and
| | - Brenda Barker
- Tennessee Initiative for Perinatal Quality Care Nashville Tennessee.,Division of Neonatology, Vanderbilt University Medical Center Nashville Tennessee
| | - Theresa A Scott
- Tennessee Initiative for Perinatal Quality Care Nashville Tennessee.,Division of Neonatology, Vanderbilt University Medical Center Nashville Tennessee
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3
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Han JH, Yoon SJ, Lim JH, Shin JE, Eun HS, Park MS, Park KI, Lee SM. The impact of neonatal morbidities on child growth and developmental outcomes in very low birth weight infants: a nationwide cohort study. Eur J Pediatr 2022; 181:197-205. [PMID: 34236516 DOI: 10.1007/s00431-021-04177-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/11/2021] [Accepted: 06/22/2021] [Indexed: 11/26/2022]
Abstract
Growth in preterm infants has long-term implications for neurodevelopmental outcomes. We aimed to estimate the nationwide growth outcomes from birth to 5 years in infants born under 1500 g and to analyze the effects of major morbidities in preterm infants on growth. In total, 2961 children born in 2013 with a birth weight under 1500 g who underwent an infant health checkup between 2013 and 2018 according to the National Health Insurance Service database were included. Checkups were conducted at 4-6, 9-12, 18-24, 30-36, 42-48, and 54-60 months of age. Information was obtained from the International Classification of Diseases-10 codes or a questionnaire administered during the check-up. At 60 months of age, the mean percentiles of weight, height, and head circumference fell within only the 30-40th percentile of normal growth values. About 30% of infants had growth parameters below the 10th percentile and showed worse neurodevelopmental outcomes. Using multiple logistic regression, infants with bronchopulmonary dysplasia showed a significantly higher incidence of growth restriction in all three categories of weight (odds ratio [OR] 1.50), height (OR 1.33), and head circumference (OR 1.36) at 60 months. Sepsis was associated with growth restriction in weight (OR 1.43) and head circumference (OR 1.33). Periventricular leukomalacia infants had relatively small head circumferences (OR 1.91) and poor developmental screening results (OR 2.89).Conclusion: Catch-up growth remains a major issue in infants born under 1500 g, especially those with some morbidities from preterm birth. Regular checkups to monitor and early intervention to achieve normal growth are essential. What is Known: • Growth in preterm infants has long-term implications for neurodevelopmental and cardiometabolic outcomes. • Data are lacking on the time-serial effects of many preterm morbidities simultaneously on long-term growth outcomes. What is New: • All growth parameters of VLBW infants, including weight, height, and head circumference, fell within the 30-40th percentile of normal growth for infants at 60 months of age, indicating that catch-up growth for VLBW infants remains an issue. • VLBW infants with major preterm morbidities, including BPD, PVL, and sepsis, showed difficulties in achieving normal catch-up growth and neurodevelopment at 60 months of age.
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Affiliation(s)
- Jung Ho Han
- Department of Pediatrics, Yonsei University College of Medicine, 211 Eonjuro Gangnamgu, Seoul, 06273, Korea
| | - So Jin Yoon
- Department of Pediatrics, Yonsei University College of Medicine, 211 Eonjuro Gangnamgu, Seoul, 06273, Korea
| | - Joo Hee Lim
- Department of Pediatrics, Yonsei University College of Medicine, 211 Eonjuro Gangnamgu, Seoul, 06273, Korea
| | - Jeong Eun Shin
- Department of Pediatrics, Yonsei University College of Medicine, 211 Eonjuro Gangnamgu, Seoul, 06273, Korea
| | - Ho Seon Eun
- Department of Pediatrics, Yonsei University College of Medicine, 211 Eonjuro Gangnamgu, Seoul, 06273, Korea
| | - Min Soo Park
- Department of Pediatrics, Yonsei University College of Medicine, 211 Eonjuro Gangnamgu, Seoul, 06273, Korea
| | - Kook In Park
- Department of Pediatrics, Yonsei University College of Medicine, 211 Eonjuro Gangnamgu, Seoul, 06273, Korea
| | - Soon Min Lee
- Department of Pediatrics, Yonsei University College of Medicine, 211 Eonjuro Gangnamgu, Seoul, 06273, Korea.
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4
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Rao S, Esvaran M, Chen L, Keil AD, Gollow I, Simmer K, Wemheuer B, Conway P, Patole S. Probiotic supplementation in neonates with congenital gastrointestinal surgical conditions: a pilot randomised controlled trial. Pediatr Res 2022; 92:1122-1131. [PMID: 34980887 PMCID: PMC8722408 DOI: 10.1038/s41390-021-01884-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/09/2021] [Accepted: 11/18/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate whether probiotic supplementation attenuates gut-dysbiosis in neonates with congenital gastrointestinal surgical conditions (CGISC). METHODS Sixty-one neonates (≥35 weeks gestation) with CGISC were randomised to receive daily supplementation with a triple-strain bifidobacterial probiotic (n = 30) or placebo (n = 31) until discharge. Stool microbiota was analysed using 16S ribosomal RNA gene sequencing on samples collected before (T1), 1 week (T2), and 2 weeks (T3) after supplementation and before discharge (T4). The primary outcome was the sum of the relative abundance of potentially pathogenic families of Clostridiaceae, Enterobacteriaceae, Enterococcaceae, Pseudomonaceae, Staphylococcaeae, Streptococcaceae, and Yersiniaceae at T3. RESULTS The median gestational age [38 weeks (IQR: 37.1-38.9)] was similar in both groups. The probiotic group had lower rates of caesarean deliveries (40% versus 70%, p = 0.02). The relative abundance of potentially pathogenic families was lower in the probiotic group compared to placebo at T3 [(median: 50.4 (IQR: 26.6-67.6) versus 67.1 (IQR: 50.9-96.2); p = 0.04). Relative abundance of Bifidobacteriaceae was higher in the probiotic group at T3 [(median: 39.8 (IQR: 24.9-52.1) versus 0.03 (IQR 0.02-2.1); p < 0.001). Stratified analysis continued to show a higher abundance of Bifidobacteriaceae in the probiotic group, irrespective of the mode of delivery. CONCLUSIONS Probiotic supplementation attenuated gut dysbiosis in neonates with CGISC. TRIAL REGISTRATION http://www.anzctr.org.au (ACTRN12617001401347). IMPACT Probiotic supplementation attenuates gut dysbiosis and improves stool short-chain fatty acid levels in neonates with congenital gastrointestinal surgical conditions. This is the second pilot RCT of probiotic supplementation in neonates with congenital gastrointestinal conditions. These findings will pave the way for conducting multicentre RCTs in this area.
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Affiliation(s)
- Shripada Rao
- Neonatal Intensive Care Unit, Perth Children's Hospital, Perth, WA, Australia. .,Neonatal Intensive Care Unit, King Edward Memorial Hospital for Women, Perth, WA, Australia. .,School of Medicine, University of Western Australia, Crawley, WA, Australia.
| | - Meera Esvaran
- grid.1005.40000 0004 4902 0432Centre for Marine Science and Innovation at the University of New South Wales (UNSW), Sydney, NSW Australia
| | - Liwei Chen
- grid.59025.3b0000 0001 2224 0361School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore, Singapore
| | - Anthony D. Keil
- grid.2824.c0000 0004 0589 6117Department of Microbiology, PathWest Laboratory Medicine, Perth, WA Australia
| | - Ian Gollow
- grid.410667.20000 0004 0625 8600Department of Paediatric Surgery, Perth Children’s Hospital, Perth, WA Australia
| | - Karen Simmer
- grid.410667.20000 0004 0625 8600Neonatal Intensive Care Unit, Perth Children’s Hospital, Perth, WA Australia ,grid.415259.e0000 0004 0625 8678Neonatal Intensive Care Unit, King Edward Memorial Hospital for Women, Perth, WA Australia ,grid.1012.20000 0004 1936 7910School of Medicine, University of Western Australia, Crawley, WA Australia
| | - Bernd Wemheuer
- grid.1005.40000 0004 4902 0432Centre for Marine Science and Innovation at the University of New South Wales (UNSW), Sydney, NSW Australia ,grid.7450.60000 0001 2364 4210Department of Genomic and Applied Microbiology, University of Göttingen, Göttingen, Germany
| | - Patricia Conway
- grid.1005.40000 0004 4902 0432Centre for Marine Science and Innovation at the University of New South Wales (UNSW), Sydney, NSW Australia ,grid.59025.3b0000 0001 2224 0361School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore, Singapore
| | - Sanjay Patole
- grid.410667.20000 0004 0625 8600Neonatal Intensive Care Unit, Perth Children’s Hospital, Perth, WA Australia ,grid.415259.e0000 0004 0625 8678Neonatal Intensive Care Unit, King Edward Memorial Hospital for Women, Perth, WA Australia ,grid.1012.20000 0004 1936 7910School of Medicine, University of Western Australia, Crawley, WA Australia
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Yitayew M, Chahin N, Rustom S, Thacker LR, Hendricks-Muñoz KD. Fenton vs. Intergrowth-21st: Postnatal Growth Assessment and Prediction of Neurodevelopment in Preterm Infants. Nutrients 2021; 13:nu13082841. [PMID: 34445001 PMCID: PMC8400500 DOI: 10.3390/nu13082841] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/11/2021] [Accepted: 08/16/2021] [Indexed: 11/17/2022] Open
Abstract
Although the survival rate of preterm infants has improved over the years, growth failure and associated impaired neurodevelopmental outcome remains a significant morbidity. Optimal nutrition plays an important role in achieving adequate postnatal growth. Accurate growth monitoring of preterm infants is critical in guiding nutritional protocols. Currently, there is no consensus regarding which growth assessment tool is suitable for monitoring postnatal growth of preterm infants to foster optimal neurodevelopmental outcomes while avoiding future consequences of aggressive nutritional approaches including increased risk for cardiovascular disease and metabolic syndrome. A retrospective single center cohort study was conducted to compare the performance of two growth-assessment tools, Fenton and Intergrowth-21st (IG-21st) in the classification of size at birth, identification of impaired growth and predicting neurodevelopment. A total of 340 infants with mean gestational age of 30 weeks were included. Proportion of agreement between the two tools for identification of small for gestational age (SGA) was high 0.94 (0.87, 0.1) however, agreement for classification of postnatal growth failure at discharge was moderate 0.6 (0.52, 0.69). Growth failure at discharge was less prevalent using IG-21st. There was significant association between weight-based growth failure and poor neurodevelopmental outcomes at 12 and 24 months of age.
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Affiliation(s)
- Miheret Yitayew
- Department of Pediatrics, Children’s Hospital of Richmond, Virginia Commonwealth University, Richmond, VA 23298, USA; (N.C.); (K.D.H.-M.)
- Division of Neonatal Medicine, Department of Pediatrics, School of Medicine, Virginia Commonwealth University, Richmond, VA 23298, USA
- Correspondence:
| | - Nayef Chahin
- Department of Pediatrics, Children’s Hospital of Richmond, Virginia Commonwealth University, Richmond, VA 23298, USA; (N.C.); (K.D.H.-M.)
| | - Salem Rustom
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA 23298, USA; (S.R.); (L.R.T.)
| | - Leroy R. Thacker
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA 23298, USA; (S.R.); (L.R.T.)
| | - Karen D. Hendricks-Muñoz
- Department of Pediatrics, Children’s Hospital of Richmond, Virginia Commonwealth University, Richmond, VA 23298, USA; (N.C.); (K.D.H.-M.)
- Division of Neonatal Medicine, Department of Pediatrics, School of Medicine, Virginia Commonwealth University, Richmond, VA 23298, USA
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6
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Bagga N, Reddy KK, Mohamed A, Panigrahy N, Chirla DK. Quality improvement initiative to decrease extrauterine growth restriction in preterm neonates. Nutr Clin Pract 2021; 36:1296-1303. [PMID: 34245467 DOI: 10.1002/ncp.10735] [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: 11/09/2022] Open
Abstract
BACKGROUND Prevention of extrauterine growth restriction (EUGR) in preterm neonates is one of the biggest challenges to neonatologists. Lack of uniformity and inconsistency in nutrition practices are the most common causes. We started a quality improvement (QI) initiative with an intention to decrease the proportion of EUGR. METHODS We performed prospective nonrandomized QI from May 2018 to July 2019. Ninety-six neonates (born at <32 weeks and/or <1.2 kg) were compared with 111 historical controls. A continuous feedback loop was maintained, and changes were analyzed as plan-do-study-actcycle. RESULTS Although EUGR was lower after the intervention (93.7% vs 87.5%), this change was not statistically significant. However, other measures of in-hospital neonatal growth showed improvement, including median discharge weight percentile from 1% to 3% (P = .003). Median difference in the z-score for weight from birth to discharge also improved significantly from -1.84 to -1.65 (P = .04). Babies in the intervention group regained birth weight earlier (P = .005) and had better growth velocity (P = .0005). The feeding was started early (P < .0001), and these babies reached full feeds (P < .0001) earlier than the control cohort. CONCLUSION Although our QI initiative failed to achieve a significant reduction in EUGR, it did achieve a significant improvement in discharge weight percentile and difference in the z-score for weight at birth and during discharge from hospital. There was a significant improvement in growth velocity and an early regaining of birth weight. The implementation of written nutrition practice guidelines facilitated improved outcomes.
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Affiliation(s)
- Nitasha Bagga
- Neonatology, Rainbow Children's Hospital, Hyderabad, India
| | | | - Ashik Mohamed
- Ophthalmic Biophysics, L V Prasad Eye Institute, Hyderabad, India
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Flannery DD, Jensen EA, Tomlinson LA, Yu Y, Ying GS, Binenbaum G. Poor postnatal weight growth is a late finding after sepsis in very preterm infants. Arch Dis Child Fetal Neonatal Ed 2021; 106:298-304. [PMID: 33148685 PMCID: PMC8291375 DOI: 10.1136/archdischild-2020-320221] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/12/2020] [Accepted: 10/16/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To characterise the association between sepsis and postnatal weight growth when accounting for the degree of growth restriction present at birth. DESIGN Retrospective matched cohort study using data from the Postnatal Growth and Retinopathy of Prematurity study. Participants were born with birth weights of <1500 g or gestational ages of <32 weeks between 2006 and 2011 at 29 neonatal centres in the USA and Canada. Sepsis was defined as a culture-confirmed bacterial or fungal infection of the blood or cerebrospinal fluid before 36 weeks' postmenstrual age (PMA). Growth was assessed as the change in weight z-score between birth and 36 weeks' PMA. RESULTS Of 4785 eligible infants, 813 (17%) developed sepsis and 693 (85%) were matched 1:1 to controls. Sepsis was associated with a greater decline in weight z-score (mean difference -0.09, 95% CI -0.14 to -0.03). Postnatal weight growth failure (decline in weight z- score>1) was present in 237 (34%) infants with sepsis and 179 (26%) controls (adjusted OR 1.49, 95% CI 1.12 to 1.97). Longitudinal growth trajectories showed similar initial changes in weight z-scores between infants with and without sepsis. By 3 weeks after sepsis onset, there was a greater decline in weight z-scores relative to birth values in those with sepsis than without sepsis (delta z-score -0.89 vs -0.77; mean difference -0.12, 95% CI -0.18 to -0.05). This significant difference persisted until 36 weeks or discharge. CONCLUSION Infants with sepsis had similar early weight growth trajectories as infants without sepsis but developed significant deficits in weight that were not apparent until several weeks after the onset of sepsis.
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Affiliation(s)
- Dustin D. Flannery
- Division of Neonatology, Children’s Hospital of Philadelphia/University of Pennsylvania Perelman School of Medicine,Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia
| | - Erik A. Jensen
- Division of Neonatology, Children’s Hospital of Philadelphia/University of Pennsylvania Perelman School of Medicine,Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia
| | - Lauren A. Tomlinson
- Division of Ophthalmology, Children’s Hospital of Philadelphia/University of Pennsylvania Perelman School of Medicine
| | - Yinxi Yu
- Division of Ophthalmology, Children’s Hospital of Philadelphia/University of Pennsylvania Perelman School of Medicine,Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine
| | - Gui-shuang Ying
- Division of Ophthalmology, Children’s Hospital of Philadelphia/University of Pennsylvania Perelman School of Medicine,Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine,Department of Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine
| | - Gil Binenbaum
- Division of Ophthalmology, Children’s Hospital of Philadelphia/University of Pennsylvania Perelman School of Medicine
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McNelis K, Goddard G, Jenkins T, Poindexter A, Wessel J, Helmrath M, Poindexter B. Delay in achieving enteral autonomy and growth outcomes in very low birth weight infants with surgical necrotizing enterocolitis. J Perinatol 2021; 41:150-156. [PMID: 33268832 PMCID: PMC7710157 DOI: 10.1038/s41372-020-00880-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/26/2020] [Accepted: 11/13/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To understand the nutritional intake and growth outcomes of very low birth weight infants with surgical necrotizing enterocolitis (NEC). STUDY DESIGN In a retrospective cohort study, linear mixed models were used to compare growth outcomes from birth to 24 months corrected age for very low birth weight (VLBW) infants with surgical NEC to those with spontaneous intestinal perforation (SIP). Kaplan-Meier curves were developed to demonstrate the duration of parenteral nutrition (PN) use. RESULT Height differed by surgical NEC and SIP over time (interaction p = 0.03). Surviving infants with surgical NEC had lower head circumference z-scores at 24 months. Of infants surviving surgical NEC, 71% received PN for >60 days after diagnosis. CONCLUSION The majority of infants with surgical NEC have a delay in achieving enteral autonomy. There was a difference in linear catch-up growth over time between infants with SIP and surgical NEC at 24 months.
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Affiliation(s)
- Kera McNelis
- Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. .,University of Cincinnati, College of Medicine, Cincinnati, OH, USA.
| | - Gillian Goddard
- grid.239573.90000 0000 9025 8099Division of Pediatric and General and Thoracic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA ,grid.239424.a0000 0001 2183 6745Department of Surgery, Boston Medical Center, Boston, MA USA
| | - Todd Jenkins
- grid.239573.90000 0000 9025 8099Division of Pediatric and General and Thoracic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | - Anne Poindexter
- grid.24827.3b0000 0001 2179 9593University of Cincinnati, College of Medicine, Cincinnati, OH USA ,grid.239573.90000 0000 9025 8099Division of Pediatric and General and Thoracic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | - Jacqueline Wessel
- grid.239573.90000 0000 9025 8099Division of Pediatric and General and Thoracic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | - Michael Helmrath
- grid.24827.3b0000 0001 2179 9593University of Cincinnati, College of Medicine, Cincinnati, OH USA ,grid.239573.90000 0000 9025 8099Division of Pediatric and General and Thoracic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | - Brenda Poindexter
- grid.239573.90000 0000 9025 8099Division of Neonatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA ,grid.189967.80000 0001 0941 6502Department of Pediatrics, Emory University, Atlanta, GA USA
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9
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Fenton TR, Cormack B, Goldberg D, Nasser R, Alshaikh B, Eliasziw M, Hay WW, Hoyos A, Anderson D, Bloomfield F, Griffin I, Embleton N, Rochow N, Taylor S, Senterre T, Schanler RJ, Elmrayed S, Groh-Wargo S, Adamkin D, Shah PS. "Extrauterine growth restriction" and "postnatal growth failure" are misnomers for preterm infants. J Perinatol 2020; 40:704-714. [PMID: 32214217 DOI: 10.1038/s41372-020-0658-5] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 03/02/2020] [Accepted: 03/11/2020] [Indexed: 11/09/2022]
Abstract
Preterm infants are increasingly diagnosed as having "extrauterine growth restriction" (EUGR) or "postnatal growth failure" (PGF). Usually EUGR/PGF is diagnosed when weight is <10th percentile at either discharge or 36-40 weeks postmenstrual age. The reasons why the phrases EUGR/PGF are unhelpful include, they: (i) are not predictive of adverse outcome; (ii) are based only on weight without any consideration of head or length growth, proportionality, body composition, or genetic potential; (iii) ignore normal postnatal weight loss; (iv) are usually assessed prior to growth slowing of the reference fetus, around 36-40 weeks, and (v) are usually based on an arbitrary statistical growth percentile cut-off. Focus on EUGR/PGF prevalence may benefit with better attention to nutrition but may also harm with nutrition delivery above infants' actual needs. In this paper, we highlight challenges associated with such arbitrary cut-offs and opportunities for further refinement of understanding growth and nutritional needs of preterm neonates.
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Affiliation(s)
- Tanis R Fenton
- Community Health Sciences, Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Nutrition Services, Alberta Health Services, Calgary, AB, Canada.
| | - Barbara Cormack
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | - Roseann Nasser
- Saskatchewan Health Authority, Nutrition and Food Services, Regina, SK, Canada
| | - Belal Alshaikh
- Community Health Sciences, Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Misha Eliasziw
- Public Health and Community Medicine, Tufts University, Boston, MA, USA
| | | | - Angela Hoyos
- Clínica del Country, Universidad el Bosque, Bogotá, Colombia
| | - Diane Anderson
- Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Frank Bloomfield
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Ian Griffin
- Clinical and Translational Research, Biomedical research Institute of New Jersey, Cedar Knolls, NJ, USA
| | - Nicholas Embleton
- Newcastle Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Niels Rochow
- Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Sarah Taylor
- Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | | | - Richard J Schanler
- Neonatal Services, Cohen Children's Medical Center, Northwell Health, Zucker School of Medicine at Hofstra, New York, NY, USA
| | - Seham Elmrayed
- Community Health Sciences, Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sharon Groh-Wargo
- Pediatrics and Nutrition, Case Western Reserve University, Cleveland, OH, USA
| | - David Adamkin
- Pediatrics, University of Louisville, Louisville, KY, USA
| | - Prakesh S Shah
- Paediatrics and Institute of HPME, University of Toronto, Mount Sinai Hospital, Toronto, ON, Canada
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Cao M, Brunse A, Thymann T, Sangild PT. Physical Activity and Spatial Memory Are Minimally Affected by Moderate Growth Restriction in Preterm Piglets. Dev Neurosci 2020; 41:247-254. [PMID: 32015235 DOI: 10.1159/000505726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 01/02/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Preterm birth is associated with impaired brain functions, but it is unknown whether fetal growth restriction (GR) makes these deficits worse. Using piglets as a model for preterm infants, we hypothesized that moderate GR reduces growth rate, physical activity, and spatial memory in the first weeks after preterm birth. METHODS Preterm pigs were delivered by caesarean section and fed until 19 days (n = 830 from 55 pregnant sows) and received intensive clinical care. GR pigs were classified as animals with the lowest 5-20% percentile birth weight within each litter and were compared with litter-mate controls (21-100% percentile birth weight). Basic motor skill development, physical activity, and morbidities (e.g., necrotizing enterocolitis) were recorded within the first week. Weight of internal organs and data from a T-maze spatial memory test were noted until 19 days. RESULTS Moderate GR and control preterm pigs (birth weights 728 ± 140 and 1,019 ± 204 g, respectively) showed similar relative weights of internal organs (relative to body), except higher adrenal gland weights in GR pigs (+20-50%, p < 0.05). This was associated with a tendency to higher plasma cortisol (p < 0.05 on day 11). GR preterm pigs showed delayed ability to stand and walk (days 2-5, p < 0.01), but physical activity and proportion of correct choices in a T-maze test (70.3 vs. 71.6%) were similar. CONCLUSION Moderate GR has limited effect on motor function and spatial memory in the early postnatal period of preterm pigs, despite some initial delays in basic motor skills. In the postnatal period, moderately growth-restricted preterm infants may adapt well with regards to organ growth and neurodevelopment.
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Affiliation(s)
- Muqing Cao
- Department of Maternal and Child Health, Faculty of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Anders Brunse
- Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Thymann
- Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Per Torp Sangild
- Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark,
- Department of Neonatology, Rigshospitalet, Copenhagen, Denmark,
- Department of Pediatrics, Odense University Hospital, Odense, Denmark,
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11
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Yapicioglu Yildizdas H, Simsek H, Ece U, Ozlu F, Sertdemir Y, Narli N, Satar M. Effect of Short-Term Morbidities, Risk Factors and Rate of Growth Failure in Very Low Birth Weight Preterms at Discharge. J Trop Pediatr 2020; 66:95-102. [PMID: 31257429 DOI: 10.1093/tropej/fmz038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Very low birth weight (VLBW) infants often demonstrate postnatal growth failure (PGF). We aimed to analyze incidence and risk factors for PGF in surviving VLBW infants hospitalized more than 28 days. MATERIALS AND METHODS Fenton growth chart (2013) was used for Z-scores for birth weight (BW) and discharge weight. Infants with a decrease in their Z-scores at discharge >1 were considered as 'PGF group' and with a decrease >2 were considered as 'severe PGF group'. RESULTS One hundred and forty-one of 148 (95.3%) infants had PGF, 88 of 141 (62.4%) had severe PGF. There were significant differences in gestational age, birth and discharge weight, and days to regain BW, age of first and full enteral feeding, duration of parenteral nutrition, lipid emulsions, intubation and hospitalization between groups (p < 0.05). Vasopressor treatment, nosocomial infection, patent ductus arteriosus and bronchopulmonary dysplasia rates were significantly higher in severe PGF group (p < 0.05). CONCLUSION PGF remains a serious problem in our unit. All VLBW preterm infants should be followed for PGF.
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Affiliation(s)
- Hacer Yapicioglu Yildizdas
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Cukurova University, 01330 Adana, Turkey
| | - Huseyin Simsek
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Cukurova University, 01330 Adana, Turkey
| | - Umit Ece
- Private Adana Algomed Hospital, Adana, Turkey
| | - Ferda Ozlu
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Cukurova University, 01330 Adana, Turkey
| | - Yasar Sertdemir
- Department of Biostatistics, Faculty of Medicine, Cukurova University, 01330 Adana, Turkey
| | - Nejat Narli
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Cukurova University, 01330 Adana, Turkey
| | - Mehmet Satar
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Cukurova University, 01330 Adana, Turkey
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12
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Zhang M, Gazimbi MM, Chen Z, Zhang B, Chen Y, Yu Y, Tang J. Association between birth weight and neurodevelopment at age 1-6 months: results from the Wuhan Healthy Baby Cohort. BMJ Open 2020; 10:e031916. [PMID: 31900268 PMCID: PMC6955482 DOI: 10.1136/bmjopen-2019-031916] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The association between birth weight and infants' neurodevelopment is not well understood. We aimed to examine the impact of birth weight on neurodevelopment of infants at age 1-6 months using data from the Wuhan Healthy Baby Cohort (WHBC) study. SETTING AND PARTICIPANTS This is a prospective cohort study of 4026 infants from the WHBC study who were born at the Women and Children's Hospital of Wuhan, China between October 2012 and September 2013 and who had complete healthcare records within 6 months after birth. Participants were categorised into three groups according to their birth weight: low birth weight (LBW; birth weight <2500 g), normal birth weight (2500 g ≤ birth weight <4000 g) and macrosomia (birth weight ≥4000 g). MAIN OUTCOME MEASURES The main outcomes were development quotient (DQ) and clinical diagnosis of neurodevelopmental delay. Both adjusted regression coefficients and ORs were estimated for LBW and macrosomia. RESULTS Of the 4026 infants, 166 (4.12%) were of LBW and 237 (5.89%) were with macrosomia. Adjusted regression coefficients of LBW and macrosomia for gross motor DQ were -11.18 (95% CI -11.36 to 10.99) and 0.49 (95% CI 0.36 to 0.63), fine motor DQ -6.57 (95% CI -6.76 to -6.39) and -2.73 (95% CI -2.87 to -2.59), adaptability DQ -4.87 (95% CI -5.05 to -4.68) and -1.19 (95% CI -1.33 to -1.05), language DQ -6.23 (95% CI -6.42 to -6.05) and 0.43 (95% CI 0.29 to 0.57), and social behaviour DQ -6.82 (95% CI -7.01 to -6.64) and 1.10 (95% CI 0.96 to 1.24). Adjusted OR of LBW for clinical diagnosis of 'neurodevelopmental delay' in gross motor was 2.43 (95% CI 1.65 to 3.60), fine motor 1.49 (95% CI 1.01 to 2.19) and adaptability 1.56 (95% CI 1.06 to 2.31). LBW has no significant effects on 'neurodevelopmental delay' in language and social behaviour, and macrosomia has no significant effects on clinical diagnosis of 'neurodevelopmental delay' in all domains. CONCLUSION Both LBW and macrosomia are associated with infants' DQ, and LBW increases the risk of being diagnosed with 'neurodevelopmental delay' in gross motor, fine motor and adaptability among infants aged 1-6 months.
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Affiliation(s)
- Man Zhang
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, Guangdong, China
| | | | - Zhong Chen
- Department of Child Health Care, Wuhan Medical and Healthcare Center for Women and Children, Wuhan, China
| | - Bin Zhang
- Department of Child Health Care, Wuhan Medical and Healthcare Center for Women and Children, Wuhan, China
| | - Yanru Chen
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yizhen Yu
- Child and Women Health Care, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jie Tang
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, Guangdong, China
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13
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Meyers JM, Tan S, Bell EF, Duncan AF, Guillet R, Stoll BJ, Angio CTD. Neurodevelopmental outcomes among extremely premature infants with linear growth restriction. J Perinatol 2019; 39:193-202. [PMID: 30353080 PMCID: PMC6351156 DOI: 10.1038/s41372-018-0259-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/29/2018] [Accepted: 10/08/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare neurodevelopmental outcomes in linear growth-restricted (LGR) infants born <29 weeks with and without weight gain out of proportion to linear growth. STUDY DESIGN We compared 2-year neurodevelopmental outcomes between infants with and without LGR and between LGR infants with and without weight gain out of proportion to linear growth. The outcomes were Bayley-III cognitive, motor, and language scores, cerebral palsy, Gross Motor Function Classification System (GMFCS) level ≥ 2, and neurodevelopmental impairment. RESULT In total, 1227 infants were analyzed. LGR infants were smaller and less mature at birth, had higher BMI, and had lower Bayley-III language scores (82.3 vs. 85.0, p < 0.05). Among infants with LGR, infants with high BMI had lower language scores compared with those with low-to-normal BMI (80.8 vs. 83.3, p < 0.05), and were more likely to have GMFCS level ≥2 and neurodevelopmental impairment. CONCLUSION Among infants with LGR, weight gain out of proportion to linear growth was associated with poorer neurodevelopmental outcomes.
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Affiliation(s)
- JM Meyers
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - S Tan
- Statistics and Epidemiology Unit, RTI International, Research Triangle Park, NC, USA
| | - EF Bell
- Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - AF Duncan
- Department of Pediatrics, University of Texas Medical School at Houston, Houston, TX, USA
| | - R Guillet
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - BJ Stoll
- Department of Pediatrics, University of Texas Medical School at Houston, Houston, TX, USA,Emory University School of Medicine, Department of Pediatrics, Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - CT D Angio
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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14
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Underwood MA, Wedgwood S, Lakshminrusimha S, Steinhorn RH. Somatic growth and the risks of bronchopulmonary dysplasia and pulmonary hypertension: connecting epidemiology and physiology 1. Can J Physiol Pharmacol 2018; 97:197-205. [PMID: 30512966 DOI: 10.1139/cjpp-2018-0386] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In the premature infant, poor growth in utero (fetal growth restriction) and in the first weeks of life (postnatal growth restriction) are associated with increased risk for bronchopulmonary dysplasia and pulmonary hypertension. In this review, we summarize the epidemiologic data supporting these associations, present a novel rodent model of postnatal growth restriction, and review 5 promising mechanisms by which poor nutrition may affect the developing lung. These observations support the hypothesis that nutritional and (or) pharmacologic interventions early in life may be able to decrease risk of the pulmonary complications of extreme prematurity.
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Affiliation(s)
- Mark A Underwood
- a Department of Pediatrics, University of California Davis, Sacramento, CA 95817, USA
| | - Stephen Wedgwood
- a Department of Pediatrics, University of California Davis, Sacramento, CA 95817, USA
| | | | - Robin H Steinhorn
- b Department of Hospitalist Medicine, Children's National Health System, Washington, DC 20010, USA
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15
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Statewide Initiative to Reduce Postnatal Growth Restriction among Infants <31 Weeks of Gestation. J Pediatr 2018; 197:82-89.e2. [PMID: 29631770 DOI: 10.1016/j.jpeds.2018.01.074] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 01/13/2018] [Accepted: 01/27/2018] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To decrease the incidence of postnatal growth restriction, defined as discharge weight <10th percentile for postmenstrual age, among preterm infants cared for in New York State Regional Perinatal Centers. STUDY DESIGN The quality improvement cohort consisted of infants <31 weeks of gestation admitted to a New York State Regional Perinatal Center within 48 hours of birth who survived to hospital discharge. Using quality improvement principles from the Institute for Healthcare Improvement and experience derived from successfully reducing central line-associated blood stream infections statewide, the New York State Perinatal Quality Collaborative sought to improve neonatal growth by adopting better nutritional practices identified through literature review and collaborative learning. New York State Regional Perinatal Center neonatologists were surveyed to characterize practice changes during the project. The primary outcome-the incidence of postnatal growth restriction-was compared across the study period from baseline (2010) to the final (2013) years of the project. Secondary outcomes included differences in z-score between birth and discharge weights and head circumferences. RESULTS We achieved a 19% reduction, from 32.6% to 26.3%, in postnatal growth restriction before hospital discharge. Reductions in the difference in z-score between birth and discharge weights were significant, and differences in z-score between birth and discharge head circumference approached significance. In survey data, regional perinatal center neonatologists targeted change in initiation of feedings, earlier breast milk fortification, and evaluation of feeding tolerance. CONCLUSIONS Statewide collaborative quality improvement can achieve significant improvement in neonatal growth outcomes that, in other studies, have been associated with improved neurodevelopment in later infancy.
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16
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Huston RK, Markell AM, McCulley EA, Gardiner SK, Sweeney SL. Improving Growth for Infants ≤1250 Grams Receiving an Exclusive Human Milk Diet. Nutr Clin Pract 2018; 33:671-678. [PMID: 29451716 DOI: 10.1002/ncp.10054] [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] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND An exclusive human milk diet (EHM) fortified with human milk-based fortifier decreases necrotizing enterocolitis (NEC) compared to maternal milk supplemented with preterm formula and bovine fortifier (PTF). Growth has been less with EHM and also maternal milk supplemented with donor human milk and bovine fortifier (HMBF). The objective was to evaluate the effect of a standardized feeding protocol on the growth of infants ≤1250 g birth weight supported with EHM and HMBF. The effect on the incidence of NEC was also evaluated. DESIGN/METHODS A retrospective study of growth before and after implementation of a feeding protocol for infants who received either EHM or HMBF. Primary outcomes were weight, length, and head circumference gain velocities from birth to discharge. The incidence of NEC was also recorded. RESULTS Analysis of covariance for 379 total infants showed that earlier day of life for fortification to 24 Kcal/oz was associated with increased weight gain (p = 0.0166) and length gain (p = 0.0064). Implementation of the feeding protocol was associated with increased head circumference gain (p = 0.006). EHM was associated with decreased incidence of NEC (p = 0.0302). CONCLUSIONS Implementation of a standardized feeding protocol including earlier fortification of maternal milk was associated with improved growth for infants receiving human milk feedings. EHM significantly decreased NEC. Earlier fortification had no effect on NEC.
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Affiliation(s)
- Robert K Huston
- Division of Neonatology, Randall Children's Hospital at Legacy Emanuel, Portland, Oregon, USA.,Neonatologist, Northwest Newborn Specialists, PC and Peditatrix Medical Group Emanuel, Portland, Oregon, USA
| | - Andrea M Markell
- Department of Food and Nutrition Services, Randall Children's Hospital at Legacy Emanuel, Portland, Oregon, USA
| | - Elizabeth A McCulley
- Department of Food and Nutrition Services, Randall Children's Hospital at Legacy Emanuel, Portland, Oregon, USA
| | - Stuart K Gardiner
- Devers Eye Institute and Legacy Research Institute, Portland, Oregon, USA
| | - Sean L Sweeney
- Division of Neonatology, Randall Children's Hospital at Legacy Emanuel, Portland, Oregon, USA.,Neonatologist, Northwest Newborn Specialists, PC and Peditatrix Medical Group Emanuel, Portland, Oregon, USA
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17
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Towns M, Rosenbaum P, Palisano R, Wright FV. Should the Gross Motor Function Classification System be used for children who do not have cerebral palsy? Dev Med Child Neurol 2018; 60:147-154. [PMID: 29105760 DOI: 10.1111/dmcn.13602] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2017] [Indexed: 12/11/2022]
Abstract
UNLABELLED This literature review addressed four questions. (1) In which populations other than cerebral palsy (CP) has the Gross Motor Function Classification System (GMFCS) been applied? (2) In what types of study, and why was it used? (3) How was it modified to facilitate these applications? (4) What justifications and evidence of psychometric adequacy were used to support its application? A search of PubMed, MEDLINE, and Embase databases (January 1997 to April 2017) using the terms: 'GMFCS' OR 'Gross Motor Function Classification System' yielded 2499 articles. 118 met inclusion criteria and reported children/adults with 133 health conditions/clinical descriptions other than CP. Three broad GMFCS applications were observed: as a categorization tool, independent variable, or outcome measure. While the GMFCS is widely used for children with health conditions/clinical description other than CP, researchers rarely provided adequate justification for these uses. We offer recommendations for development/validation of other condition-specific classification systems and discuss the potential need for a generic gross motor function classification system. WHAT THIS PAPER ADDS The Gross Motor Function Classification System should not be used outside cerebral palsy or as an outcome measure. The authors provide recommendations for development and validation of condition-specific or generic classification systems.
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Affiliation(s)
- Megan Towns
- Bloorview Research Institute, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Peter Rosenbaum
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.,Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Robert Palisano
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.,Physical Therapy and Rehabilitation Science Department, Drexel University, Philadelphia, PA, USA
| | - F Virginia Wright
- Bloorview Research Institute, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
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18
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Bandyopadhyay A, Harmon H, Slaven JE, Daftary AS. Neurodevelopmental Outcomes at Two Years of Age for Premature Infants Diagnosed With Neonatal Obstructive Sleep Apnea. J Clin Sleep Med 2017; 13:1311-1317. [PMID: 29065963 PMCID: PMC5656480 DOI: 10.5664/jcsm.6804] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/18/2017] [Accepted: 08/11/2017] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Neurocognitive deficits have been shown in school-aged children with sleep apnea. The effect of obstructive sleep apnea (OSA) on the neurodevelopmental outcome of preterm infants is unknown. METHODS A retrospective chart review was performed for all preterm infants (< 37 weeks) who had neonatal polysomnography (PSG) and completed neurodevelopmental assessment with the Bayley Scales of Infant and Toddler Development, 3rd Edition, between 2006 to 2015 at Riley Hospital. Exclusion criteria included grade IV intraventricular hemorrhage, tracheostomy, cyanotic heart disease, severe retinopathy of prematurity, craniofacial anomalies, or central and mixed apnea on PSG. Sleep apnea was defined as an apnea-hypopnea index (AHI) > 1 event/h. Regression analyses were performed to find a relationship between PSG parameters and cognitive, language, and motor scores. RESULTS Fifteen patients (males: n = 10) were eligible for the study. Median postmenstrual age at the time of the PSG was 41 weeks (37-46). Median AHI for the cohort was 17.4 events/h (2.2-41.3). Median cognitive, language, and motor scores were 90 (65-125), 89 (65-121), and 91 (61-112), respectively. Mean end-tidal CO2 (median 47 mm Hg [25-60]) negatively correlated with cognitive scores (P = .01) but did not significantly correlate with language or motor scores. AHI was not associated with cognitive, language, or motor scores. CONCLUSIONS The median score for cognitive, language, and motor scores for preterm infants with neonatal OSA were within one standard deviation of the published norm. Mean end-tidal CO2, independent of AHI, may serve as a biomarker for predicting poor cognitive outcome in preterm infants with neonatal OSA. COMMENTARY A commentary on this article appears in this issue on page 1233.
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Affiliation(s)
- Anuja Bandyopadhyay
- Section of Pediatric Pulmonology, Allergy and Sleep Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Heidi Harmon
- Section of Neonatal-Perinatal Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - James E. Slaven
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Ameet S. Daftary
- Section of Pediatric Pulmonology, Allergy and Sleep Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
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