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Avendaño-Vásquez CJ, Villamizar-Osorio ML, Peñaranda CJN, Olaya JM, Gamba NCR. Feeding practices and anthropometric classification of nutritional status in low-birth-weight infants at term. A prospective cohort study. Early Hum Dev 2024; 192:106005. [PMID: 38579519 DOI: 10.1016/j.earlhumdev.2024.106005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND About 50 % of LBW occurs in term newborns, which is associated with higher infant mortality rates compared to infants of average birth weight. Analysis of feeding practices in at-risk groups is essential to address malnutrition and stunting in infancy. AIM To identify feeding practices and anthropometric classification of nutritional status in a cohort of low-birth-weight term infants. METHODS Methods: Cohort study. A prospective follow-up of 73 term newborns with low birth weight up to six months of age was performed. Feeding practices and anthropometric classification of nutritional were analysed. Data were processed by univariate analysis and multivariate linear regression. RESULTS The most common feeding practice was exclusive breastfeeding. Breast milk substitutes are frequent in this population group. The risk of undernutrition ranged from 2.7 % to 19.2 % and of overweight from 4.1 % to 11.0 % during the first six months of life. Low height-for-age risk was the most frequent anthropometric classification during the follow-up period. Average head circumference was consistent in infants with low birth weight. Gestational risk classification, breastfeeding during the first hour of life, and sex of the newborn were predictors of variations in anthropometric indicators. CONCLUSIONS Exclusive breastfeeding is the most common feeding practice in the population group studied, but using breast milk substitutes is also prevalent. Low height-for-age is the most frequent anthropometric classification. The weight growth rate seems reasonable, but further studies are needed based on gender differences, analysis of the composition of breast milk, and socio-environmental factors involved in growth.
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Choobdar F, Mazouri A, Firuzian F, Ghasemzadeh M, Vahedi Z. The Effect of High Glucose Intake on Weight Gain in Very Low Birth Weight Neonates: A Randomized Controlled Trial. Clin Pediatr (Phila) 2021; 60:577-585. [PMID: 34806452 DOI: 10.1177/00099228211054665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aims at evaluating the effect of high glucose intake as a component of total parenteral nutrition on birth weight (BW) regain in very low birth weight neonates. Ninety newborns with BW <1500 g were randomized to control or experimental groups. Both groups received the same total parenteral nutrition regimens except glucose intake provided by dextrose water (DW) serum: 7 to 15 g/kg/d (10% DW) in the former versus 8.75 to 18.75 g/kg/d (12.5% DW) in the latter. Body weight as the primary outcome was monitored until the BW was regained. Results revealed that neonates who received 12.5% DW regained BW significantly faster (10.98 ± 2.46 vs 13.24 ± 4.03 days, P = .024) and needed lesser duration of respiratory support (5.34 ± 2.11 vs 7.17 ± 3.19 days, P = .003). As the proposed intervention can reduce neonatal intensive care unit admission duration, it mitigates risks of health care-associated infections, while favorably affecting the health economy.
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Affiliation(s)
| | - Ali Mazouri
- Akbarabadi Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Maral Ghasemzadeh
- Firuzgar General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Vahedi
- Iran University of Medical Sciences, Tehran, Iran
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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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Kumar P, Perino J, Bowers L, Welch B, Albert V, Drenckpohl D, Wolfe D. Cumulative impact of multiple evidence based strategies on postnatal growth of extremely-low-birth-weight infants. Clin Nutr 2021; 40:3908-3913. [PMID: 34134008 DOI: 10.1016/j.clnu.2021.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/06/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Postnatal growth failure is common in very preterm infants and is associated with worse neurodevelopmental outcome. OBJECTIVE To evaluate the cumulative impact of multiple evidence based strategies on the postnatal growth of extremely-low-birth-weight (ELBW) infants. METHODS We conducted a prospective observational study. Based on current literature, changes were implemented to provide optimal parenteral and enteral nutrition. Daily intakes of calories, protein, lipids and carbohydrates were calculated. The average growth velocity (GV) was calculated using 2-point exponential model and is reported as grams/kg/day. The length and head circumference gains are reported as centimeters/week. RESULTS The mean gestational age and birth weight for 38 ELBW survivors were 27.0 ± 2.1 weeks and 752 ± 147 g respectively. The GV was 13.2 ± 2.2 g/kg/day (range 8.8-17.4) and gains in length and head circumference were 0.88 ± 0.9 (range 0.15-1.42) and 0.71 ± 0.5 (range 0.22-0.96) centimeters/week respectively. Twenty nine (76.3%) infants were small-for-gestational-age (SGA) at discharge and 23 of these (60.5% of all infants) had weight below 3rd percentile. All 11 infants who were SGA at birth were SGA at discharge as well. Of 25 appropriate-for-gestational-age (AGA) infants at birth, 16 (64%) were SGA at discharge. The number of infants with length and head circumference below 10th percentile at birth and discharge were 11 (28.9%) and 29 (76.3%) for length and 20 (52.6%) and 27 (71.1%) for head circumference. Infants with multiple morbidities and more hospital days with no enteral feeds had lower GV. CONCLUSION All infants born SGA at birth and majority of ELBW survivors born AGA at birth had weight, length and head circumference below 10th percentile at discharge despite aggressive nutrition supplementation.
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Affiliation(s)
- Praveen Kumar
- Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, IL, United States.
| | - Jeanne Perino
- Nursing, OSF Saint Francis Medical Center, Peoria, IL, United States
| | - Laura Bowers
- Nursing, OSF Saint Francis Medical Center, Peoria, IL, United States
| | - Brittany Welch
- Nursing, OSF Saint Francis Medical Center, Peoria, IL, United States
| | - Viola Albert
- Nursing, OSF Saint Francis Medical Center, Peoria, IL, United States
| | - Douglas Drenckpohl
- Food & Nutrition, Food & Nutrition, OSF Saint Francis Medical Center, Peoria, IL, United States
| | - David Wolfe
- Biostatistics, OSF Saint Francis Medical Center, Peoria, IL, United States
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Bapistella S, Hamprecht K, Thomas W, Speer CP, Dietz K, Maschmann J, Poets CF, Goelz R. Short-term Pasteurization of Breast Milk to Prevent Postnatal Cytomegalovirus Transmission in Very Preterm Infants. Clin Infect Dis 2020; 69:438-444. [PMID: 30407512 DOI: 10.1093/cid/ciy945] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 11/06/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Postnatally acquired cytomegalovirus (pCMV) infection through breast milk (BM) may cause severe illness and even death, yet BM is advantageous for preterm infants. Therefore, effective methods to prevent CMV transmission are needed. METHODS To assess the effectiveness of short-term pasteurization (62°C for 5 seconds) in preventing CMV transmission via BM in preterm infants. Design: Prospective interventional bicentric cohort study with infant enrollment between 6/2010 and 1/2012. A cohort from the Tuebingen neonatal intensive care unit (NICU) from 1995-1998 served as historical controls. Differences in CMV transmission were compared with reference to the cumulative time at risk for CMV transmission. Setting: Two German level-3 NICUs. Eighty-seven preterm infants of 69 CMV immunoglobulin G-positive mothers with birth weight <1500 g or gestational age <32 weeks and 83 historical controls were included. Intervention: BM samples were short-term pasteurized from postnatal day 4 to discharge. Primary endpoint: CMV status at discharge, evaluated by polymerase chain reaction and short-term microculture from urine. RESULTS Two of 87 (2.3%) study infants had a pCMV transmission. This compared to 17 of 83 (20.5%) controls. Total time under risk for infection was 9.6 years vs 10.0 years in controls, yielding an incidence of 0.21/year (95% confidence interval [CI], 0.03 to 0.75/year) vs 1.70/year (95% CI, 0.99 to 2.72/year), respectively. The risk ratio controls vs study infants was 8.3 (95% CI, 2.4 to 52.4) according to Cox proportional hazard model (P = .0003). CONCLUSIONS Short-term pasteurization significantly reduces the incidence of pCMV infection through BM in the NICU. CLINICAL TRIALS REGISTRATION NCT01178905.
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Affiliation(s)
| | - Klaus Hamprecht
- Institute of Medical Virology and Epidemiology of Viral Diseases, University Hospital of Tuebingen
| | - Wolfgang Thomas
- Department of Pediatrics, Klinikum Mutterhaus der Borromaeerinnen, Trier
| | | | - Klaus Dietz
- Department of Medical Biometry, University of Tuebingen
| | | | | | - Rangmar Goelz
- Department of Neonatology, University Children's Hospital Tuebingen
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6
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Böckmann KA, von Stumpff A, Bernhard W, Shunova A, Minarski M, Frische B, Warmann S, Schleicher E, Poets CF, Franz AR. Fatty acid composition of adipose tissue at term indicates deficiency of arachidonic and docosahexaenoic acid and excessive linoleic acid supply in preterm infants. Eur J Nutr 2020; 60:861-872. [PMID: 32476053 PMCID: PMC7900037 DOI: 10.1007/s00394-020-02293-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 05/21/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Arachidonic (ARA) and docosahexaenoic acid (DHA) are constitutive to membrane phospholipids, and essential for brain and overall development. ARA/DHA pools in term infants (TI) are built during the third trimester, stored as adipose tissue triglycerides and predominantly distributed via plasma phosphatidylcholine (PC). In preterm infants (PTI), placental ARA/DHA supply is replaced by linoleic-acid (LA)-enriched nutrition. This study aimed to investigate the impact of PTI nutrition, compared to placental supply, on fatty acid composition in adipose tissue and blood. METHODS Prospective observational study (4/2017-3/2019) in 12 PTI and 3 PTI with enterostomy (PTI/E) (gestational age (GA) < 32 weeks) with surgical intervention at term (± 6 weeks) and 14 TI (GA ≥ 34 weeks, surgical intervention < 2 weeks postnatally). PTI/E were analyzed descriptively only. PC and triglyceride fatty acids were analyzed with tandem mass spectrometry and gas chromatography, respectively. Results were compared between TI and PTI with Wilcoxon Test and shown as median [25th percentile-75th percentile] mol%. RESULTS PTI had less ARA in adipose tissue TG (0.77[0.67-0.87]% vs. 1.04[0.95-1.14]%, p = 0.0003) and plasma PC (20.7[18.7-22.8]% vs. 28.3[22.7-33.5]%, p = 0.011) than TI. PTI also had less DHA in adipose tissue TG (0.6[0.4-0.8]% vs. 1.1[0.8-1.4]%, p = 0.006) and plasma PC (6.4[5.6-7.1]% vs. 8.4[7.8-13.1]%, p = 0.002). LA was increased in PTI's adipose tissue TG (10.0[8.8-12.3]% vs. 3.0[2.5-3.6]%, p < 0.0001) and plasma PC (48.4[44.6-49.6]% vs. 30.6[24.9-35.6]%, p = 0.0002). Similar differences were observed in erythrocyte PC. CONCLUSION In PTI, LA is increased and ARA/DHA decreased in adipose tissue, plasma and erythrocyte lipids as proxies for other tissues, likely caused by PTI nutrition. This may contribute to impaired PTI development.
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Affiliation(s)
- K A Böckmann
- Department of Neonatology, Faculty of Medicine, Eberhard-Karls-University, Calwer Straße 7, 72076, Tübingen, Germany.
| | - A von Stumpff
- Department of Neonatology, Faculty of Medicine, Eberhard-Karls-University, Calwer Straße 7, 72076, Tübingen, Germany
| | - W Bernhard
- Department of Neonatology, Faculty of Medicine, Eberhard-Karls-University, Calwer Straße 7, 72076, Tübingen, Germany
| | - A Shunova
- Department of Neonatology, Faculty of Medicine, Eberhard-Karls-University, Calwer Straße 7, 72076, Tübingen, Germany
| | - M Minarski
- Department of Neonatology, Faculty of Medicine, Eberhard-Karls-University, Calwer Straße 7, 72076, Tübingen, Germany
| | - B Frische
- Department of Neonatology, Faculty of Medicine, Eberhard-Karls-University, Calwer Straße 7, 72076, Tübingen, Germany
| | - S Warmann
- Department of Pediatric Surgery and Child Urology, Faculty of Medicine, Eberhard-Karls-University, Tübingen, Germany
| | - E Schleicher
- Department of Internal Medicine IV, Faculty of Medicine, Eberhard-Karls-University, Tübingen, Germany
| | - C F Poets
- Department of Neonatology, Faculty of Medicine, Eberhard-Karls-University, Calwer Straße 7, 72076, Tübingen, Germany
| | - A R Franz
- Department of Neonatology, Faculty of Medicine, Eberhard-Karls-University, Calwer Straße 7, 72076, Tübingen, Germany
- Center for Pediatric Clinical Studies, Faculty of Medicine, Eberhard-Karls-University, Tübingen, Germany
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7
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Wittwer A, Hascoët JM. Impact of introducing a standardized nutrition protocol on very premature infants' growth and morbidity. PLoS One 2020; 15:e0232659. [PMID: 32437423 PMCID: PMC7241817 DOI: 10.1371/journal.pone.0232659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/19/2020] [Indexed: 12/16/2022] Open
Abstract
Background Inappropriate nutritional intake in premature infants may be responsible for postnatal growth restriction (PGR) and adverse long-term outcomes. Objective We evaluated the impact of an updated nutrition protocol on very premature infants’ longitudinal growth and morbidity, and secondly the compliance to this new protocol. Design All infants born between 26–32 weeks gestation (GA) were studied retrospectively during two 6-month periods before (group 1) and after (group 2) the introduction of an optimized nutrition protocol, in a longitudinal comparative analysis. Results 158 infants were included; 72 before and 86 after the introduction of the protocol (Group 1: (mean±SD) birthweight (BW) 1154±276 g, GA 29.0±1.4 weeks; Group 2: BW 1215±332 g, GA 28.9±1.7 weeks). We observed growth improvement in Group 2 more pronounced in males (weight z-score) at D42 (−1.688±0.758 vs. −1.370±0.762, p = 0.045), D49 (−1.696±0.776 vs. −1.370±0.718, p = 0.051), D56 (−1.748±0.855 vs. −1.392±0.737, p = 0.072), D63 (−1.885±0.832 vs. −1.336±0.779 p = 0.016), and D70 (−2.001±0.747 vs. −1.228±0.765 p = 0.004). There was no difference in females or in morbidities between the groups. We observed low compliance to the protocol in both groups: similar energy intake but higher lipid intake in Group 1 and higher protein intake in Group 2. Conclusion The quality of nutritional care with a strictly-defined protocol may significantly improve weight gain for very preterm infants. As compliance remained low, an educational reinforcement is needed to prevent PGR. Clinical trial registration This retrospective study was registered by ClinicalTrials.gov under number NCT03217045, and by the CNIL (Commission Nationale de l’Informatique et des Libertés) under study number R2015-1 for the Maternity of the CHRU of Nancy.
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Affiliation(s)
- Apolline Wittwer
- Department of Neonatology, Maternité Régionale, CHRU NANCY, DevAH University of Lorraine, France
- * E-mail:
| | - Jean-Michel Hascoët
- Department of Neonatology, Maternité Régionale, CHRU NANCY, DevAH University of Lorraine, France
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Izquierdo Renau M, Aldecoa-Bilbao V, Balcells Esponera C, del Rey Hurtado de Mendoza B, Iriondo Sanz M, Iglesias-Platas I. Reply: "It is Time for a Universal Nutrition Policy in Very Preterm Neonates during the Neonatal Period? Comment on: Applying Methods for Postnatal Growth Assessment in the Clinical Setting: Evaluation in a Longitudinal Cohort of Very Preterm Infants Nutrients 2019, 11, 2772". Nutrients 2020; 12:E983. [PMID: 32252477 PMCID: PMC7230857 DOI: 10.3390/nu12040983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/04/2020] [Indexed: 11/17/2022] Open
Abstract
We would like to thank Gounaris et al [...].
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Affiliation(s)
- Montserrat Izquierdo Renau
- Neonatology Department, Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Universidad de Barcelona, BCNatal, Esplugues de Llobregat, 08950 Barcelona, Spain; (C.B.E.); (B.d.R.H.d.M.); (M.I.S.); (I.I.-P.)
| | - Victoria Aldecoa-Bilbao
- Neonatology Department, Hospital Clinic, Universidad de Barcelona, BCNatal, 08028 Barcelona, Spain;
| | - Carla Balcells Esponera
- Neonatology Department, Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Universidad de Barcelona, BCNatal, Esplugues de Llobregat, 08950 Barcelona, Spain; (C.B.E.); (B.d.R.H.d.M.); (M.I.S.); (I.I.-P.)
| | - Beatriz del Rey Hurtado de Mendoza
- Neonatology Department, Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Universidad de Barcelona, BCNatal, Esplugues de Llobregat, 08950 Barcelona, Spain; (C.B.E.); (B.d.R.H.d.M.); (M.I.S.); (I.I.-P.)
| | - Martin Iriondo Sanz
- Neonatology Department, Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Universidad de Barcelona, BCNatal, Esplugues de Llobregat, 08950 Barcelona, Spain; (C.B.E.); (B.d.R.H.d.M.); (M.I.S.); (I.I.-P.)
| | - Isabel Iglesias-Platas
- Neonatology Department, Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Universidad de Barcelona, BCNatal, Esplugues de Llobregat, 08950 Barcelona, Spain; (C.B.E.); (B.d.R.H.d.M.); (M.I.S.); (I.I.-P.)
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Setruk H, Nogué E, Desenfants A, Prodhomme O, Filleron A, Nagot N, Cambonie G. Reference Values for Abdominal Circumference in Premature Infants. Front Pediatr 2020; 8:37. [PMID: 32117842 PMCID: PMC7033386 DOI: 10.3389/fped.2020.00037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 01/24/2020] [Indexed: 11/18/2022] Open
Abstract
Objectives: Abdominal distention is a common indicator of feeding intolerance in premature newborns. In the absence of a precise definition, abdominal distention and its degree are highly subjective. The aim of this study was to construct references and smoothed percentiles for abdominal circumference (AC) and AC to head circumference (HC) ratio (AC/HC) in infants born between 24 weeks and 34 weeks of gestational age. Methods: ACs and HCs were collected weekly in eutrophic premature infants without congenital abdominal or cerebral malformation. AC and HC charts were modeled using the LMS method, excluding measures associated with abdominal distention at clinical examination or intracranial abnormality at cerebral ultrasounds. Changes in AC and AC/HC over time were studied by repeated-measures analysis using mixed-effects linear models. Results: A total of 1,605 measurements were made in 373 newborns with a mean gestational age of 31 [29-33] weeks and mean birth weight of 1,540 [1,160-1,968] g. Of these measurements, 1,220 were performed in normal conditions. Gestational age, postnatal age, singleton status, and respiratory support were significantly associated with AC and AC/HC. LMS curves were generated according to gestational age groups and postnatal age, with coherent profiles. AC/HC was 0.91 [0.86-0.95] in absence of abdominal distention. It was higher in cases of abdominal distention (0.95 [0.89-1.00], p < 0.001) and necrotizing enterocolitis (0.98 [0.93-1.07], p < 0.001). Conclusions: References constructed for AC and AC/HC might be used to assess feeding tolerance in premature infants. AC/HC was more relevant than AC to rationalize the diagnosis of abdominal distention.
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Affiliation(s)
- Héléna Setruk
- Department of Neonatal Medicine, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France
| | - Erika Nogué
- Department of Medical Information, Montpellier University Hospital Center, Montpellier, France
| | - Aurélie Desenfants
- Department of Pediatrics, Carémeau Hospital, Nîmes University Hospital Center, Nîmes, France
| | - Olivier Prodhomme
- Department of Pediatric Radiology, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France
| | - Anne Filleron
- Department of Pediatrics, Carémeau Hospital, Nîmes University Hospital Center, Nîmes, France
| | - Nicolas Nagot
- Department of Medical Information, Montpellier University Hospital Center, Montpellier, France
| | - Gilles Cambonie
- Department of Neonatal Medicine, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France
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Kohler JA, Fowler JO, Moore RT, Higginson JD. Improved Use of Human Milk, Growth, and Central Line Utilization With Standard Feeding Roadmap in an Academic NICU. Nutr Clin Pract 2019; 35:703-707. [PMID: 31840305 DOI: 10.1002/ncp.10441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Before the initiation of a standardized feeding roadmap in our regional, level IV academic neonatal intensive care unit, utilization of central lines was high, and initiation of enteral feeds delayed in the very low-birth-weight population (<1500 g). Given our review of the literature, it appeared that the standardization of feeding advancement would likely result in improved performance in both issues. METHODS This was a retrospective cohort comparison of very low-birth-weight patients before initiation of any feeding roadmap with a second cohort following completion of the final roadmap. Infants were examined retrospectively in 2 historical cohorts: Phase 1, infants fed before roadmap development and rollout, October 1, 2012-March 31, 2013; and Phase 2, following promulgation of the final feeding roadmap, January 1, 2017-June 30, 2017. RESULTS During Phase 2, we observed a significant reduction in median (interquartile range) days to first feed (3 [1] vs 1 [1] [P < 0.0001]) and utilization of a second central line (35% vs 12% [P < 0.01]). Weight gain was significantly improved from before roadmap implementation to final, mean (SD) (g/d, 21 [5] vs 24 [4]; [P < .0001]). Percentage of first enteral feedings that were human milk also increased significantly from 71% to 91% (P = 0.0007). CONCLUSION Implementation of a standardized feeding roadmap was associated with a reduction in days to first enteral feeds, an increase in the primary use of human milk for initiation of enteral feeds, and a decrease in the utilization of central lines while improving weight gain in very low-birth-weight infants.
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Affiliation(s)
- John A Kohler
- Department of Pediatrics, East Carolina University, Greenville, North Carolina, USA
| | - Jennifer O Fowler
- Department of Clinical Nutrition, Vidant Medical Center, Greenville, North Carolina, USA
| | - Ryan T Moore
- Department of Pediatrics, East Carolina University, Greenville, North Carolina, USA
| | - Jason D Higginson
- Department of Pediatrics, East Carolina University, Greenville, North Carolina, USA
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11
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Nascimento J, Santos IMMD, Silva LJD. CARE GIVEN TO NEWBORNS FED BY GASTRIC TUBE: CONCEPTS AND PRACTICES. TEXTO & CONTEXTO ENFERMAGEM 2019. [DOI: 10.1590/1980-265x-tce-2017-0242] [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] Open
Abstract
ABSTRACT Objective: to describe the conduct related to feeding care through gastric tube in neonates hospitalized in the Neonatal Intensive Care Unit, from scientific articles published in the last five years. Method: an integrative literature review was developed in the databases: MEDLINE, LILACS, SciELO, CINAHL and BDENF. The search for the studies was carried out in August 2016, in English, Spanish and Portuguese. Results: 33 articles were analyzed. The level of evidence was classified as level IV (30%), level VI (27%), level II (15%), level III (18%), level I, V and VII with 3% each. The analytical categories were: Gastric tubes, their materials and their use in the Neonatal Intensive Care Unit, Nursing care for enteral nutrition through gastric tube in the Neonatal Intensive Care Unit, From the tube the oral route. The time to reach total enteral nutrition is lower, as is the decrease in length of hospital stay. The largest losses of milk fat are during gastroclysis at the expense of gavage. The relationship of food tolerance to dietary dosage form and volumes is not yet conclusive. Nursing stands out: in favor of the bond with the family, in the physical examination and evaluation, in the positioning, in the non-nutritive suction during the diet, in the oral stimulus, in the observation and conduct regarding the gastric residue. Conclusion: due to the heterogeneity of the data, more randomized and qualitative clinical trials are required to better support the conduct and improvement of nursing care.
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Aydemir O, Cakık Saglık A, Sekili Z, Tekin AN. Employing a Nutrition Nurse in Neonatal Intensive Care Unit Improved Nutrition and Growth Outcomes in Preterm Neonates. Nutr Clin Pract 2018; 34:616-622. [DOI: 10.1002/ncp.10216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ozge Aydemir
- Department of Neonatology; Eskişehir Osmangazi University Faculty of Medicine; Eskişehir Turkey
| | - Adviye Cakık Saglık
- Department of Neonatology; Eskişehir Osmangazi University Faculty of Medicine; Eskişehir Turkey
| | - Zekiye Sekili
- Department of Neonatology; Eskişehir Osmangazi University Faculty of Medicine; Eskişehir Turkey
| | - Ayşe Neslihan Tekin
- Department of Neonatology; Eskişehir Osmangazi University Faculty of Medicine; Eskişehir Turkey
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13
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Ziegler JO, Maas C, Bernhard W, Arand J, Poets CF, Franz AR. Retrospective cohort analysis on pancreatic enzyme substitution in very low birthweight infants with postnatal growth failure. Arch Dis Child Fetal Neonatal Ed 2018; 103:F485-F489. [PMID: 29122829 DOI: 10.1136/archdischild-2017-313278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 10/03/2017] [Accepted: 10/17/2017] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To evaluate the effects of pancreatic enzyme substitution (PES) in selected very low birthweight (VLBW) infants with poor postnatal growth despite intensified nutritional support. DESIGN Retrospective historic cohort study with matched controls. SETTING Single level III neonatal intensive care unit. PATIENTS Infants with a gestational age at birth <32 weeks and birth weight <1500 g born between 1 January 2005 and 31 December 2014 (n=26) who received PES for restricted postnatal growth despite intensified enteral nutritional support in comparison with infants matched for birth weight, birth year, gestational and postnatal age (n=52). INTERVENTIONS PES 15-93 mg/g fat with enteral feeds. MAIN OUTCOME MEASURES The difference in SD score (SDS) differences for weight during the 7 days before and after onset of PES and weight gain in g/kg/d. Data are presented as median (P10-P90). RESULTS Gestational age was 26.6 (24.4-29.9) weeks in enzyme substituted versus 26.4 (24.7-29.9) weeks in matched controls, and birth weight was 648(420-950)g versus 685(453-949)g. SDS differences for weight improved after onset of PES by 0.18(-0.12 to 0.53) in PES infants versus -0.04(-0.31 to 0.44) in controls. Weight gain increased in the PES group from 13.6 (4.2-22.9) g/kg/day in the week before to 19.0 (10.9-29.1) g/kg/day in the week after the onset of PES. There was no difference in weight gain in substituted subgroups receiving formula/pasteurised human milk versus unpasteurised human breast milk or who had pancreatic-specific elastase-1 concentrations in stool >200 µg/g versus≤200 µg/g. No adverse effects were noted. CONCLUSIONS PES in selected VLBW infants with growth failure despite intensified enteral nutritional support was associated with a significant increase in weight gain in the first 7 days of PES.k.
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Affiliation(s)
- Julian O Ziegler
- Department of Neonatology, Center for Pediatric Clinical Studies, University Children's Hospital, Tuebingen, Germany
| | - Christoph Maas
- Department of Neonatology, Center for Pediatric Clinical Studies, University Children's Hospital, Tuebingen, Germany
| | - Wolfgang Bernhard
- Department of Neonatology, Center for Pediatric Clinical Studies, University Children's Hospital, Tuebingen, Germany
| | - Joerg Arand
- Department of Neonatology, Center for Pediatric Clinical Studies, University Children's Hospital, Tuebingen, Germany
| | - Christian F Poets
- Department of Neonatology, Center for Pediatric Clinical Studies, University Children's Hospital, Tuebingen, Germany
| | - Axel R Franz
- Department of Neonatology, Center for Pediatric Clinical Studies, University Children's Hospital, Tuebingen, Germany
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14
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Reducing time to initiation and advancement of enteral feeding in an all-referral neonatal intensive care unit. J Perinatol 2018; 38:936-943. [PMID: 29740193 DOI: 10.1038/s41372-018-0110-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 03/08/2018] [Accepted: 03/14/2018] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Decrease time to enteral feeding initiation and advancement. STUDY DESIGN In our all-referral neonatal intensive care unit, we developed an evidence-based guideline addressing feeding initiation and advancement. During 6 months before and 7 months after guideline implementation, we measured time to initiate feeding, time to 100 ml/kg/day of feeding, gastric residual measurement frequency, and incidence of necrotizing enterocolitis (balancing measure). RESULT Two hundred twenty-three infants were studied. Time from admission to feeding initiation was shorter after guideline implementation (mean 0.5 days [95% CI: 0.4-0.7] vs. 1.1 days [95% CI: 0.7-1.5], p = 0.01). Time from admission to 100 ml/kg/day feeding was also shorter (3.6 days [95% CI: 2.8-4.4] vs. 6.2 days [95% CI: 4.4-8.1], p = 0.01). After guideline implementation, routine gastric residual measurements were discontinued. CONCLUSION After implementation of an enteral feeding guideline, which included discontinuation of routine gastric residual assessment, we observed a faster initiation of enteral feeding and shorter time to reach 100 ml/kg/day.
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15
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Dako J, Buzzard J, Jain M, Pandey R, Groh-Wargo S, Shekhawat P. Slow enteral feeding decreases risk of transfusion associated necrotizing enterocolitis. J Neonatal Perinatal Med 2018; 11:231-239. [PMID: 29843272 DOI: 10.3233/npm-181773] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Necrotizing Enterocolitis (NEC) is a multifactorial condition where PRBC transfusion is associated with necrotizing enterocolitis (TANEC) in about a third of all cases of NEC. We have investigated the role of feeding practices in incidence of TANEC. We sought to compare infants diagnosed with TANEC versus infants diagnosed with classic NEC and investigated the effects of a standardized slow enteral feeding (SSEF) protocol on TANEC incidence as well as the effects of SSEF on growth of infants with NEC. METHODS We conducted a retrospective cohort study, where medical records of infants born in a tertiary care neonatal intensive care unit (level IIIb) from January 1997 to May 2014 with birth weight < 1500 grams and gestational age≤34 weeks with NEC stage IIa or greater according to the modified Bell's staging were reviewed. RESULTS During the study period, 111 infants developed NEC, and 41/111 (37%) were diagnosed with TANEC. Infants with TANEC were smaller, more premature, had higher SNAPPE scores and were more anemic prior to transfusion compared with infants with 'classic NEC'. The severity of NEC did not differ between the two groups, however, infants with TANEC had worse outcomes and longer NICU stays. Introduction of SSEF protocol, led to a significant decrease in TANEC. There was no difference in weight and head circumference of infants in the two groups at 2 years corrected age. CONCLUSION SSEF led to a significant reduction in the incidence of TANEC without impairing growth at 2 years corrected age.
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MESH Headings
- Blood Transfusion/methods
- Enteral Nutrition/methods
- Enterocolitis, Necrotizing/etiology
- Enterocolitis, Necrotizing/physiopathology
- Enterocolitis, Necrotizing/therapy
- Female
- Gestational Age
- Humans
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/physiopathology
- Infant, Premature, Diseases/therapy
- Infant, Very Low Birth Weight
- Male
- Retrospective Studies
- Risk Factors
- Transfusion Reaction
- Treatment Outcome
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Affiliation(s)
- J Dako
- Department of Pediatrics, Division of Neonatology, Metro Health Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - J Buzzard
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - M Jain
- Department of Pediatrics, Division of Neonatology, Metro Health Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - R Pandey
- Department of Pediatrics, Division of Neonatology, University of Texas Health Science Center at Houston, TX, USA
| | - S Groh-Wargo
- Department of Pediatrics, Division of Neonatology, Metro Health Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - P Shekhawat
- Department of Pediatrics, Division of Neonatology, Metro Health Medical Center, Case Western Reserve University, Cleveland, OH, USA
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16
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Moreno Algarra MC, Fernández Romero V, Sánchez Tamayo T, Espinosa Fernández MG, Salguero García E. Variabilidad en las prácticas sobre alimentación enteral del prematuro entre hospitales españoles de la red SEN-1500. An Pediatr (Barc) 2017; 87:245-252. [DOI: 10.1016/j.anpedi.2016.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 09/19/2016] [Accepted: 09/26/2016] [Indexed: 12/20/2022] Open
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17
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Moreno Algarra MC, Fernández Romero V, Sánchez Tamayo T, Espinosa Fernández MG, Salguero García E. Variability in enteral feeding practices of preterm infants among hospitals in the SEN1500 Spanish neonatal network. An Pediatr (Barc) 2017. [DOI: 10.1016/j.anpede.2016.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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18
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Genoni G, Binotti M, Monzani A, Bernascone E, Stasi I, Bona G, Ferrero F. Nonrandomised interventional study showed that early aggressive nutrition was effective in reducing postnatal growth restriction in preterm infants. Acta Paediatr 2017. [PMID: 28632972 DOI: 10.1111/apa.13958] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This study evaluated whether an early aggressive nutrition (EAN) strategy could limit extrauterine growth restriction (EUGR) in a cohort of preterm infants. METHODS This prospective nonrandomised interventional study was carried out in the neonatal intensive care unit of an Italian hospital from January 2013 to December 2015. The prevalence of EUGR was assessed in 100 infants with a gestational age of ≤34 weeks, 50 after the introduction of an EAN regimen in October 2014 and 50 before. RESULTS The prevalence of EUGR at discharge was significantly lower after the introduction of EAN than before for weight (34% vs. 66%), head circumference (22% vs. 42%) and length at discharge (20% vs. 48%). The Z-scores for all measurements were significantly higher after the introduction of EAN. In the EAN group, weight velocity was significantly higher and maximum weight loss and negative changes in the Z-scores from birth to discharge for weight were lower than in the pre-intervention controls. In extremely low birthweight subjects, the weight Z-score and weight velocity were significantly higher in the EAN group than the control group. CONCLUSION The use of EAN at a very early age reduced EUGR and improved auxological outcomes in preterm infants.
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Affiliation(s)
- Giulia Genoni
- Division of Pediatrics; Department of Health Sciences; University of Piemonte Orientale; Novara Italy
| | - Marco Binotti
- Neonatal and Pediatric Intensive Care Unit; Maggiore della Carità Hospital; Novara Italy
| | - Alice Monzani
- Division of Pediatrics; Department of Health Sciences; University of Piemonte Orientale; Novara Italy
| | - Elena Bernascone
- Division of Pediatrics; Department of Health Sciences; University of Piemonte Orientale; Novara Italy
| | - Ilaria Stasi
- Neonatal and Pediatric Intensive Care Unit; Maggiore della Carità Hospital; Novara Italy
| | - Gianni Bona
- Division of Pediatrics; Department of Health Sciences; University of Piemonte Orientale; Novara Italy
| | - Federica Ferrero
- Neonatal and Pediatric Intensive Care Unit; Maggiore della Carità Hospital; Novara Italy
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19
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Poets CF, Maas C, Buchenau W, Arand J, Vierzig A, Braumann B, Müller-Hagedorn S. Multicenter study on the effectiveness of the pre-epiglottic baton plate for airway obstruction and feeding problems in Robin sequence. Orphanet J Rare Dis 2017; 12:46. [PMID: 28274235 PMCID: PMC5343539 DOI: 10.1186/s13023-017-0602-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 02/27/2017] [Indexed: 12/03/2022] Open
Abstract
Background Treatment of Robin sequence is often either invasive or of unproven effectiveness. The pre-epiglottic baton plate (PEBP) is a well-studied alternative, yet is not widely applied internationally. We report on a prospective 3-center cohort study investigating this treatment. Based on an agreed protocol, parents of infants with Robin sequence referred to participating centers were offered enrollment, which involved taking a maxillary cast followed by endoscopy to fit the plate and sleep studies to monitor its effectiveness. Recordings were centrally analyzed by sleep specialists blinded to timing and center. Primary outcome was the mixed-obstructive apnea index, defined as the number of such apneas/h of sleep; secondary outcomes included the desaturation index to <80% pulse oximeter saturation and weight gain. Results Of 75 infants referred, 49 could be included; 1 center failed to perform appropriate sleep studies. Within a mean hospitalization of 3 weeks, the mixed-obstructive apnea index decreased (median; interquartile range) from 15.9 (6.3–31.5) to 2.3 (1.2–5.4); it decreased further to 0.7 (0.1–2.4) in the 32 infants who had a successful 3-month follow-up sleep study performed. The desaturation index normalized (from 0.38 (0–2.7) to 0.0 (0–0.1)). Mean standard deviation score for weight remained unchanged between admission and follow-up, while the proportion of tube-fed infants decreased from 74 to 14%. Conclusions This prospective multi-center cohort study confirms retrospective audits on the effectiveness of PEBP treatment in improving upper airway obstruction and feeding problems, the main clinical problems of infants with Robin sequence. International collaboration is required to compare this with other treatment approaches. Trial registration Number NCT02266043, Registered 30/09/2014; registered partially retrospectively.
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Affiliation(s)
- Christian F Poets
- Interdisciplinary Center for Craniofacial Malformations, Tuebingen University Hospital, Tuebingen, Germany. .,Department of Neonatology, Tuebingen University Hospital, Calwerstrasse 7, Tuebingen, 72076, Germany.
| | - Christoph Maas
- Interdisciplinary Center for Craniofacial Malformations, Tuebingen University Hospital, Tuebingen, Germany.,Department of Neonatology, Tuebingen University Hospital, Calwerstrasse 7, Tuebingen, 72076, Germany
| | - Wolfgang Buchenau
- Interdisciplinary Center for Craniofacial Malformations, Tuebingen University Hospital, Tuebingen, Germany.,Department of Neonatology, Tuebingen University Hospital, Calwerstrasse 7, Tuebingen, 72076, Germany
| | - Joerg Arand
- Interdisciplinary Center for Craniofacial Malformations, Tuebingen University Hospital, Tuebingen, Germany
| | - Anne Vierzig
- Department of Pediatrics, Cologne University Hospital, Cologne, Germany
| | - Bert Braumann
- Department of Orthodontics, Cologne University Hospital, Cologne, Germany
| | - Silvia Müller-Hagedorn
- Interdisciplinary Center for Craniofacial Malformations, Tuebingen University Hospital, Tuebingen, Germany.,Department of Orthodontics, Tuebingen University Hospital, Tuebingen, Germany
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20
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Worthington P, Balint J, Bechtold M, Bingham A, Chan LN, Durfee S, Jevenn AK, Malone A, Mascarenhas M, Robinson DT, Holcombe B. When Is Parenteral Nutrition Appropriate? JPEN J Parenter Enteral Nutr 2017; 41:324-377. [PMID: 28333597 DOI: 10.1177/0148607117695251] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Parenteral nutrition (PN) represents one of the most notable achievements of modern medicine, serving as a therapeutic modality for all age groups across the healthcare continuum. PN offers a life-sustaining option when intestinal failure prevents adequate oral or enteral nutrition. However, providing nutrients by vein is an expensive form of nutrition support, and serious adverse events can occur. In an effort to provide clinical guidance regarding PN therapy, the Board of Directors of the American Society for Parenteral and Enteral Nutrition (ASPEN) convened a task force to develop consensus recommendations regarding appropriate PN use. The recommendations contained in this document aim to delineate appropriate PN use and promote clinical benefits while minimizing the risks associated with the therapy. These consensus recommendations build on previous ASPEN clinical guidelines and consensus recommendations for PN safety. They are intended to guide evidence-based decisions regarding appropriate PN use for organizations and individual professionals, including physicians, nurses, dietitians, pharmacists, and other clinicians involved in providing PN. They not only support decisions related to initiating and managing PN but also serve as a guide for developing quality monitoring tools for PN and for identifying areas for further research. Finally, the recommendations contained within the document are also designed to inform decisions made by additional stakeholders, such as policy makers and third-party payers, by providing current perspectives regarding the use of PN in a variety of healthcare settings.
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Affiliation(s)
| | - Jane Balint
- 2 Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | | | - Angela Bingham
- 4 University of the Sciences, Philadelphia, Pennsylvania, USA
| | | | - Sharon Durfee
- 6 Central Admixture Pharmacy Services, Inc, Denver, Colorado, USA
| | | | | | - Maria Mascarenhas
- 9 The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel T Robinson
- 10 Ann & Robert H. Lurie Children's Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Beverly Holcombe
- 11 American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
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21
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Sánchez-Tamayo T, Espinosa Fernández MG, Affumicato L, González López M, Fernández Romero V, Moreno Algarra MC, Salguero García E. Reduction in necrotising enterocolitis after implementing an evidence-based enteral nutrition protocol in very low birth weight newborns. An Pediatr (Barc) 2016. [DOI: 10.1016/j.anpede.2016.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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22
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Blakstad EW, Moltu SJ, Nakstad B, Veierød MB, Strømmen K, Júlíusson PB, Almaas AN, Rønnestad AE, Brække K, Drevon CA, Iversen PO. Enhanced nutrition improves growth and increases blood adiponectin concentrations in very low birth weight infants. Food Nutr Res 2016; 60:33171. [PMID: 27914187 PMCID: PMC5136127 DOI: 10.3402/fnr.v60.33171] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 10/12/2016] [Accepted: 11/04/2016] [Indexed: 12/27/2022] Open
Abstract
Background Adequate nutrient supply is essential for optimal postnatal growth in very low birth weight (VLBW, birth weight<1,500 g) infants. Early growth may influence the risk of metabolic syndrome later in life. Objective To evaluate growth and blood metabolic markers (adiponectin, leptin, and insulin-like growth factor-1 (IGF-1)) in VLBW infants participating in a randomized nutritional intervention study. Design Fifty VLBW infants were randomized to an enhanced nutrient supply or a standard nutrient supply. Thirty-seven infants were evaluated with growth measurements until 2 years corrected age (CA). Metabolic markers were measured at birth and 5 months CA. Results Weight gain and head growth were different in the two groups from birth to 2 years CA (weight gain: pinteraction=0.006; head growth: pinteraction=0.002). The intervention group improved their growth z-scores after birth, whereas the control group had a pronounced decline, followed by an increase and caught up with the intervention group after discharge. At 5 months CA, adiponectin concentrations were higher in the intervention group and correlated with weight gain before term (r=0.35) and nutrient supply (0.35≤r≤0.45). Leptin concentrations correlated with weight gain after term and IGF-1 concentrations with length growth before and after term and head growth after term (0.36≤r≤0.53). Conclusion Enhanced nutrient supply improved early postnatal growth and may have prevented rapid catch-up growth later in infancy. Adiponectin concentration at 5 months CA was higher in the intervention group and correlated positively with early weight gain and nutrient supply. Early nutrition and growth may affect metabolic markers in infancy. Clinical Trial Registration (ClinicalTrials.gov) no.: NCT01103219
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Affiliation(s)
- Elin W Blakstad
- Department of Pediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway.,Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway;
| | - Sissel J Moltu
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Neonatal Intensive Care, Women and Children's Division, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Britt Nakstad
- Department of Pediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway
| | - Marit B Veierød
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway.,Oslo Centre of Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kenneth Strømmen
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Neonatal Intensive Care, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Pétur B Júlíusson
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Astrid N Almaas
- Department of Pediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway.,Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Arild E Rønnestad
- Department of Neonatal Intensive Care, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Kristin Brække
- Department of Neonatal Intensive Care, Women and Children's Division, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Christian A Drevon
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Per O Iversen
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
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23
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Jeong E, Jung YH, Shin SH, Kim MJ, Bae HJ, Cho YS, Kim KS, Kim HS, Moon JS, Kim EK, Kim HS, Ko JS. The successful accomplishment of nutritional and clinical outcomes via the implementation of a multidisciplinary nutrition support team in the neonatal intensive care unit. BMC Pediatr 2016; 16:113. [PMID: 27465214 PMCID: PMC4963950 DOI: 10.1186/s12887-016-0648-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 07/15/2016] [Indexed: 11/25/2022] Open
Abstract
Background Nutritional support is critical for preterm infants in the neonatal intensive care unit (NICU). A multidisciplinary nutritional support team (NST) that focuses on providing optimal and individualized nutrition care could be helpful. We conducted a thorough evaluation of clinical and nutritional outcomes in a tertiary NICU following the implementation of an NST. Methods This study used a retrospective approach with historical comparisons. Preterm neonates < 30 weeks gestational age or weighing < 1250 g were enrolled. Clinical and nutritional outcomes were compared before and after the establishment of the NST. Medical records were reviewed, and clinical and nutritional outcomes were compared between the two groups. Results In total, 107 patients from the pre-NST period and 122 patients from the post-NST period were included. The cumulative energy delivery during the first week of life improved during the post-NST period (350.17 vs. 408.62 kcal/kg, p < 0.001). The cumulative protein and lipid deliveries also significantly increased. The time required to reach full enteric feedings decreased during the post-NST period (6.4 ± 5.8 vs. 4.7 ± 5.1 days, p = 0.016). Changes of Z-score in weight from admission to discharge exhibited more favorable results in the post-NST period (−1.13 ± 0.99 vs.−0.91 ± 0.74, p = 0.055), and the length of ICU stay significantly decreased in the post-NST period (81.7 ± 36.6 vs. 72.2 ± 32.9 days, p = 0.040). Conclusions NST intervention in the NICU resulted in significant improvements in the provision of nutrition to preterm infants in the first week of life. There were also favorable clinical outcomes, such as increased weight gain and reduced length of ICU stay. Evaluable data remain sparse in the NICU setting with premature neonatal populations; therefore, the successful outcomes identified in this study may provide support for NST practices. Electronic supplementary material The online version of this article (doi:10.1186/s12887-016-0648-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eurim Jeong
- Department of Pharmacy, Seoul National University Hospital, Seoul, South Korea
| | - Young Hwa Jung
- Department of Pediatrics, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-769, South Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-769, South Korea.
| | - Moon Jin Kim
- Department of Pharmacy, Seoul National University Hospital, Seoul, South Korea
| | - Hye Jung Bae
- Department of Pharmacy, Seoul National University Hospital, Seoul, South Korea
| | - Yoon Sook Cho
- Department of Pharmacy, Seoul National University Hospital, Seoul, South Korea
| | - Kwi Suk Kim
- Department of Pharmacy, Seoul National University Hospital, Seoul, South Korea
| | - Hyang Sook Kim
- Department of Pharmacy, Seoul National University Hospital, Seoul, South Korea
| | - Jin Soo Moon
- Department of Pediatrics, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-769, South Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-769, South Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-769, South Korea
| | - Jae Sung Ko
- Department of Pediatrics, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-769, South Korea
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24
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Sánchez-Tamayo T, Espinosa Fernández MG, Affumicato L, González López M, Fernández Romero V, Moreno Algarra MC, Salguero García E. [Reduction in necrotising enterocolitis after implementing an evidence-based enteral nutrition protocol in very low birth weight newborns]. An Pediatr (Barc) 2016; 85:291-299. [PMID: 27443828 DOI: 10.1016/j.anpedi.2016.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 06/05/2016] [Accepted: 06/09/2016] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION An unexpected increase in the incidence of necrotising enterocolitis (NEC) cases was observed in our hospital. Just in case, our feeding policy could be responsible, it was decided to conduct a systematic review and develop a clinical guideline regarding enteral nutrition of very low birth weight infants (VLBW). OBJECTIVE To assess the impact of the new feeding protocol in the incidence of NEC. METHOD A "before" (2011) and "after" (May 2012 - April 2013) study was performed on the new feeding protocol. This included initiation of enteral feeding in the absence of haemodynamic problems, a trophic feeding period of 5-7 days, and subsequent increments of 20-30ml/kg/day, of breast milk/donor human milk from the beginning. Probiotics were not administered. PRIMARY OUTCOME incidence of NEC II 2 Bell's stage. SECONDARY OUTCOMES focal intestinal perforation, overall mortality and mortality due to NEC, nosocomial sepsis; weight at 28 days and 36 weeks; % of infants with weight <p10 at discharge; and length of stay. RESULTS Of the 270 VLBW infants, 155 were included in the "before" group, and 115 in the "after" group. NEC significantly decreased (12/155 vs 1/115, P=.008). A decrease in mortality rate was also observed (17.4% vs 7.8%, P=.02). In four cases NEC was part of the sequence of events that led to death in the first cohort, with none in the second. There was no difference in the incidence of focal intestinal perforation or of the other secondary variables analysed. CONCLUSIONS Implementation of an evidence-based enteral feeding protocol leads to a decrease in incidence of NEC, without increasing hospital stay or the incidence of sepsis.
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Affiliation(s)
- Tomás Sánchez-Tamayo
- Grupo multidisciplinario de investigación pediátrica, Unidad de Gestión Clínica de Neonatología, Hospital Regional Universitario de Málaga. Facultad de Medicina, Universidad de Málaga, Málaga, España.
| | - María Gracia Espinosa Fernández
- Grupo multidisciplinario de investigación pediátrica, Unidad de Gestión Clínica de Neonatología, Hospital Regional Universitario de Málaga. Facultad de Medicina, Universidad de Málaga, Málaga, España
| | - Laura Affumicato
- Grupo multidisciplinario de investigación pediátrica, Unidad de Gestión Clínica de Neonatología, Hospital Regional Universitario de Málaga. Facultad de Medicina, Universidad de Málaga, Málaga, España
| | - María González López
- Grupo multidisciplinario de investigación pediátrica, Unidad de Gestión Clínica de Neonatología, Hospital Regional Universitario de Málaga. Facultad de Medicina, Universidad de Málaga, Málaga, España
| | - Verónica Fernández Romero
- Grupo multidisciplinario de investigación pediátrica, Unidad de Gestión Clínica de Neonatología, Hospital Regional Universitario de Málaga. Facultad de Medicina, Universidad de Málaga, Málaga, España
| | - María Concepción Moreno Algarra
- Grupo multidisciplinario de investigación pediátrica, Unidad de Gestión Clínica de Neonatología, Hospital Regional Universitario de Málaga. Facultad de Medicina, Universidad de Málaga, Málaga, España
| | - Enrique Salguero García
- Grupo multidisciplinario de investigación pediátrica, Unidad de Gestión Clínica de Neonatología, Hospital Regional Universitario de Málaga. Facultad de Medicina, Universidad de Málaga, Málaga, España
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Mena P, Milad M, Vernal P, Escalante MJ. [Nutrition in the preterm hospitalized newborn. Recommendations of the Chilean Neonatology Branch, Chilean Pediatric Society]. ACTA ACUST UNITED AC 2016; 87:305-21. [PMID: 27156140 DOI: 10.1016/j.rchipe.2016.03.007] [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: 03/24/2016] [Accepted: 03/29/2016] [Indexed: 11/27/2022]
Abstract
Recommendations based on current publications are presented for postnatal preterm nutrition, depending on birth weight: less 1000g, between 1000 and 1500g, and above 1500g, as well for the development periods: adaptation, stabilisation, and growth. A review is also presented on the nutritional management of morbidities that affect or may affect nutrition, such as: osteopenia, bronchopulmonary dysplasia, patent ductus arteriosus, red cell transfusion, and short bowel syndrome.
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Affiliation(s)
- Patricia Mena
- Departamento de Neonatología, Facultad de Medicina, Pontificia Universidad Católica de Chile y Servicio de Recién Nacidos Hospital Dr. Sótero del Río, Santiago, Chile.
| | - Marcela Milad
- Servicio de Neonatología, Clínica Santa María, Santiago, Chile
| | - Patricia Vernal
- Servicio de Recién Nacidos, Hospital San José, Santiago, Chile
| | - M José Escalante
- Departamento de Neonatología, Facultad de Medicina, Pontificia Universidad Católica de Chile y Servicio de Recién Nacidos Hospital Dr. Sótero del Río, Santiago, Chile
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Proaño A, Aragón RE, Rivera F, Zegarra J. Nutritional intake and weight z-scores in very low birth weight infants in Peru. Medwave 2016; 16:e6414. [PMID: 27043997 DOI: 10.5867/medwave.2016.02.6414] [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: 12/17/2015] [Accepted: 03/15/2016] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To determine the actual nutritional intake of very low birth weight infants and their growth outcome during the first month of life. Additionally, we identified factors that account for a negative neonatal outcome in this population. METHODS A case-series study was conducted in a tertiary hospital in Lima, Peru between 2011 and 2012 and the data was obtained from medical records. No feeding protocol was used during this study. Daily fluids, energy and protein intakes were documented and weekly weight z-scores were calculated. A logistic regression analysis was used to identify factors for an adverse outcome, defined as neonatal mortality or extra-uterine growth restriction, during the first 28 days of life. RESULTS After applying selection criteria, 76 participants were included. The nutritional intakes were similar to standard values seen in the literature, but protein intakes were suboptimal in all of the four weeks. Birth weight z-score was associated with an adverse outcome (p=0.035). It was determined that having a birth weight z-score under -1.09 predicted a negative outcome with an area under the curve of 96.8% [93.5%, 100%] with a 95% confidence interval. CONCLUSION Protein intakes are widely deficient in the population of this study. Nevertheless, an adverse outcome during the neonatal period is more associated with a poor birth weight z-score than nutrition-related factors.
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Affiliation(s)
- Alvaro Proaño
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Perú. Address: Avenida El Polo 740, Edificio C, Oficina 313, Santiago de Surco, Lima, Peru.
| | - Romina Elena Aragón
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Perú
| | | | - Jaime Zegarra
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Perú; Unidad de Neonatología, Clínica San Felipe, Lima, Perú; Unidad de Cuidados Intensivos Neonatología, Hospital Nacional Cayetano Heredia, Lima, Perú
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Lapointe M, Barrington KJ, Savaria M, Janvier A. Preventing postnatal growth restriction in infants with birthweight less than 1300 g. Acta Paediatr 2016; 105:e54-9. [PMID: 26452335 DOI: 10.1111/apa.13237] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 09/28/2015] [Accepted: 10/05/2015] [Indexed: 11/27/2022]
Abstract
AIM To examine nutritional and growth outcomes in very preterm infants with a birthweight (BW) of ≤1300 g before and after the introduction of enhanced enteral and parenteral nutrition protocols. METHODS A comparison of two historical cohorts. RESULTS There were 153 infants in cohort 1 and 118 in cohort 2. A total of 19% were growth restricted at birth in both cohorts. Feeds advanced more quickly in cohort 2, with decreased duration of central lines and TPN; breastmilk fortification occurred sooner. Calorie and protein intakes were increased during all of the first 14 days of life. Adverse clinical outcomes were unchanged, including NEC. The proportion of infants discharged <10th percentile of expected weight, decreased from 23% to 9%. In cohort 2, the z-score for body weight decreased by 0.39, compared to an average 1.03 in cohort 1 (p < 0.001). Head circumference and body weight were also significantly improved at discharge (p < 0.01), but length was improved to a lesser degree. CONCLUSION Early and enhanced postnatal intravenous and enteral feeding can provide good postnatal growth among very immature infants without adverse effects. Calorie and particularly protein intake in early life could probably be further optimised.
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Affiliation(s)
- M Lapointe
- Division of Neonatology; Sainte-Justine Hospital; Montreal QC Canada
| | - KJ Barrington
- Division of Neonatology; Sainte-Justine Hospital; Montreal QC Canada
- Department of Pediatrics; Sainte-Justine Hospital Research Center; University of Montreal; Montréal QC Canada
| | - M Savaria
- Division of Neonatology; Sainte-Justine Hospital; Montreal QC Canada
| | - A Janvier
- Division of Neonatology; Sainte-Justine Hospital; Montreal QC Canada
- Department of Pediatrics; Sainte-Justine Hospital Research Center; University of Montreal; Montréal QC Canada
- Clinical Ethics University of Montreal and Hôpital Sainte-Justine; Montréal QC Canada
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Electrolyte and Mineral Homeostasis After Optimizing Early Macronutrient Intakes in VLBW Infants on Parenteral Nutrition. J Pediatr Gastroenterol Nutr 2015; 61:491-8. [PMID: 25988555 DOI: 10.1097/mpg.0000000000000854] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The aim of the present study was to evaluate electrolyte and mineral homeostasis in very-low-birth-weight (VLBW) infants who received high protein and energy intakes with a unique standardized parenteral nutrition solution containing electrolytes and minerals from birth onward. METHODS Prospective cohort study in 102 infants with birth weight <1250 g. The evolution of plasma biochemical parameters was described during the first 2 weeks of life. RESULTS During the first 3 days of life, mean parenteral intakes were 51 ± 8 kcal · kg · day with 2.7 ± 0.4 g · kg · day of protein, 1.1 ± 0.2 mmol · kg · day of sodium and potassium, and 1.3 ± 0.2 mmol · kg · day of calcium and phosphorus. Afterwards, most nutritional intakes (parenteral and enteral) met growth requirements. No infant developed a hyperkalemia >7 mmol/L, and a hypernatremia >150 mmol/L occurred only in 15.7% of the infants. In contrast, hyponatremia <130 mmol/L and hypokalemia <3 mmol/L occurred in 30.4% and 8.8% of the infants, respectively. The initial neonatal metabolic acidosis rapidly resolved in most infants and only 2.0% developed a base deficit >10 mmol/L after day 3 of life. Early hypocalcemia <1.8 mmol/L occurred in 13.7% of the infants. In contrast, hypophosphatemia <1.6 mmol/L occurred in 37.3% and hypercalcemia >2.8 mmol/L occurred in 12.7% of the infants. CONCLUSIONS Increasing early protein and energy intakes in VLBW infants in the first week of life improves electrolyte homeostasis. It also increases the phosphorus requirements with a calcium-to-phosphorus ratio ≤1.0 (mmol/mmol) and the potassium and sodium requirements to avoid the development of a refeeding-like syndrome. These data suggest that the parenteral nutrition guidelines for VLBW infants for the first week of life need to be revised.
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Lin Z, Green RS, Chen S, Wu H, Liu T, Li J, Wei J, Lin J. Quantification of EUGR as a Measure of the Quality of Nutritional Care of Premature Infants. PLoS One 2015; 10:e0132584. [PMID: 26193640 PMCID: PMC4508031 DOI: 10.1371/journal.pone.0132584] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 06/16/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To develop an index of the quality of nutritional care of premature infants based on the change in weight Z score from birth to discharge and to illustrate the use of this index in comparing the performance of different NICUs. METHODS Retrospective data analysis was performed to compare the growth of premature infants born in three perinatal centers. Infants with gestational age ≤ 32 weeks who survived to discharge from 2006 to 2010 were included. Weight Z scores at birth and discharge were calculated by the method of Fenton. Using data from one NICU as the reference, a multivariable linear regression model of change in weight Z score from birth to discharge was developed. Employing this model, a benchmark value of change in weight Z score was calculated for each baby. The difference between this calculated benchmark value and the baby's observed change in weight Z score was defined as the performance gap for that infant. The average value of the performance gaps in a NICU serves as its quality care index. RESULTS 1,714 infants were included for analysis. Change in weight Z score is influenced by birth weight Z score and completed weeks of gestation; thus the model for calculating the benchmark change in weight Z score was adjusted for these two variables. We found statistically significant differences in the average performance gaps for the three units. CONCLUSIONS A quality care index was developed based on change in weight Z score from birth to discharge adjusted for two initial risk factors. This objective, easily calculated index may be used as a measurement of the quality of nutritional care to rank the performance of different NICUs.
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Affiliation(s)
- Zhenlang Lin
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou, China, 325027
| | - Robert S. Green
- Kravis Children’s Hospital and Department of Pediatrics, The Icahn School of Medicine at Mount Sinai, New York, NY, 10029, United States of America
| | - Shangqin Chen
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou, China, 325027
| | - Hui Wu
- Department of Neonatology, The First Hospital of Jilin University, Changchun, China, 130021
| | - Tiantian Liu
- Department of Neonatology, The First Hospital of Jilin University, Changchun, China, 130021
| | - Jingyang Li
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou, China, 325027
| | - Jia Wei
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou, China, 325027
| | - Jing Lin
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou, China, 325027
- Kravis Children’s Hospital and Department of Pediatrics, The Icahn School of Medicine at Mount Sinai, New York, NY, 10029, United States of America
- * E-mail:
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Horbar JD, Ehrenkranz RA, Badger GJ, Edwards EM, Morrow KA, Soll RF, Buzas JS, Bertino E, Gagliardi L, Bellù R. Weight Growth Velocity and Postnatal Growth Failure in Infants 501 to 1500 Grams: 2000-2013. Pediatrics 2015; 136:e84-92. [PMID: 26101360 DOI: 10.1542/peds.2015-0129] [Citation(s) in RCA: 212] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Very low birth weight infants often gain weight poorly and demonstrate growth failure during the initial hospitalization. Although many of the major morbidities experienced by these infants during their initial NICU stays have decreased in recent years, it is unclear whether growth has improved. METHODS We studied 362 833 infants weighing 501 to 1500 g without major birth defects born from 2000 to 2013 and who were hospitalized for 15 to 175 days at 736 North American hospitals in the Vermont Oxford Network. Average growth velocity (GV; g/kg per day) was computed by using a 2-point exponential model on the basis of birth weight and discharge weight. Postnatal growth failure and severe postnatal growth failure were defined as a discharge weight less than the 10th and third percentiles for postmenstrual age, respectively. RESULTS From 2000 to 2013, average GV increased from 11.8 to 12.9 g/kg per day. Postnatal growth failure decreased from 64.5% to 50.3% and severe postnatal growth failure from 39.8% to 27.5%. The interquartile ranges for the hospitals participating in 2013 were as follows: GV, 12.3 to 13.4 g/kg per day; postnatal growth failure, 41.1% to 61.7%; and severe postnatal growth failure, 19.4% to 36.0%. Adjusted and unadjusted estimates were nearly identical. CONCLUSIONS For infants weighing 501 to 1500 g at birth, average GV increased and the percentage with postnatal growth failure decreased. However, in 2013, half of these infants still demonstrated postnatal growth failure and one-quarter demonstrated severe postnatal growth failure.
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Affiliation(s)
- Jeffrey D Horbar
- Vermont Oxford Network, Burlington, Vermont; Department of Pediatrics
| | | | | | - Erika M Edwards
- Vermont Oxford Network, Burlington, Vermont; Department of Mathematics and Statistics, University of Vermont, Burlington, Vermont;
| | | | - Roger F Soll
- Vermont Oxford Network, Burlington, Vermont; Department of Pediatrics
| | - Jeffrey S Buzas
- Vermont Oxford Network, Burlington, Vermont; Department of Mathematics and Statistics, University of Vermont, Burlington, Vermont
| | - Enrico Bertino
- Italian Neonatal Network, Lecco, Lido di Camaiore, and Turin, Italy
| | - Luigi Gagliardi
- Italian Neonatal Network, Lecco, Lido di Camaiore, and Turin, Italy
| | - Roberto Bellù
- Italian Neonatal Network, Lecco, Lido di Camaiore, and Turin, Italy
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Length and weight of very low birth weight infants in Germany at 2 years of age: does it matter at what age they start complementary food? Eur J Clin Nutr 2015; 69:662-7. [PMID: 25872910 DOI: 10.1038/ejcn.2015.54] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 02/19/2015] [Accepted: 03/09/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND/OBJECTIVES We analysed at what age parents start complementary food in very low birth weight infants, determined risk factors for early introduction of complementary food (post-term age) and analysed whether the age at introduction of complementary food influences height or weight at 2 years of age. SUBJECTS/METHODS Parents of premature infants born in 2009-2011 answered questionnaires regarding introduction of complementary food in the first year of life (N=2262) and were followed up at a post-term age of 2 years (N=981). Length and weight were compared with full-term infants from the KiGGs study. Logistic and linear regression analyses were conducted to study predictors for early introduction of complementary food and the influence of age at introduction of complementary food on later height and weight. RESULTS Average age at introduction of complementary food was 3.5 months post-term age. The lower the gestational age at birth, the earlier (post-term age) vegetables and meat were introduced. Age at introduction of complementary food was influenced by intrauterine growth restriction, gestational age at birth, maternal education and a developmental delay perceived by the parents. Length and weight at a post-term age of 2 years was not negatively influenced by early introduction of complementary food. CONCLUSIONS VLBW infants are introduced to complementary food on average before a post-term age of 4 months. There was no negative effect of early introduction of complementary food on height and weight at 2 years of age.
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