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Brinkis R, Albertsson-Wikland K, Šmigelskas K, Vanckavičienė A, Aldakauskienė I, Tamelienė R, Verkauskienė R. Impact of Nutrient Intake on Body Composition in Very Low-Birth Weight Infants Following Early Progressive Enteral Feeding. Nutrients 2024; 16:1462. [PMID: 38794701 PMCID: PMC11124094 DOI: 10.3390/nu16101462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/07/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
Preterm infants have increased body adiposity at term-equivalent age and risk of adverse metabolic outcomes. The aim of the study was to define how nutrient intake may impact body composition (BC) of very low-birth weight infants fed with early progressive enteral feeding and standard fortification. Eighty-six infants with <1500 g birth weight were included in the BC study and stratified into extremely preterm (EP) and very preterm (VP) groups. Nutrient intake was calculated during the first 28 days and BC assessed by dual X-ray absorptiometry at discharge and by skinfold thickness at 12 months of corrected age (CA). Total nutrient intake did not differ between the groups. EP infants had a higher fat mass percentage at discharge than VP infants (24.8% vs. 19.4%, p < 0.001); lean mass did not differ. None of the nutrients had any impact on BC of EP infants. Protein intake did not result in a higher lean mass in either group; fat intake was a significant predictor of increased fat mass percentage in VP infants at discharge (p = 0.007) and body adiposity at 12 months of CA (p = 0.021). Nutritional needs may depend on gestational age and routine fortification should be used with caution in more mature infants.
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Affiliation(s)
- Rasa Brinkis
- Department of Neonatology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (I.A.); (R.T.)
| | - Kerstin Albertsson-Wikland
- Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden;
| | - Kastytis Šmigelskas
- Health Research Institute, Faculty of Public Health, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania;
| | - Aurika Vanckavičienė
- Department of Nursing, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania;
| | - Ilona Aldakauskienė
- Department of Neonatology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (I.A.); (R.T.)
| | - Rasa Tamelienė
- Department of Neonatology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (I.A.); (R.T.)
| | - Rasa Verkauskienė
- Institute of Endocrinology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania;
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Lin YC, Chu CH, Lin YK, Chen CC, Chen LW, Huang CC. Association of Neonatal Antibiotic Exposure with Long-Term Growth Trajectory Faltering in Preterm-Birth Children. Neonatology 2024; 121:396-405. [PMID: 38286129 PMCID: PMC11126203 DOI: 10.1159/000535946] [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: 06/17/2023] [Accepted: 12/14/2023] [Indexed: 01/31/2024]
Abstract
INTRODUCTION Preterm neonates often receive a variety of duration of antibiotic exposure during admission. The aim of the study was to evaluate whether neonatal antibiotic exposure is relevant with longitudinal growth problems in preterm-birth children. METHODS This prospective study enrolled 481 infants who were born <32 weeks of gestation, discharged, and longitudinally followed from corrected age (CA) 6-60 months. After excluding 153 infants with blood culture-confirmed bacteremia, necrotizing enterocolitis, severe cerebral palsy, intestinal ostomy, and congenital anomaly, 328 infants were included for analysis. Covariates included perinatal demographics, neonatal morbidities, extrauterine growth restriction, and antibiotic exposure accumulated by term equivalent age. The primary outcome was the anthropometric trajectories in z-score of bodyweight (zBW), body height (zBH), and body mass index (zBMI) from CA 6-60 months. RESULTS Antibiotic exposure duration was significantly negatively associated with zBW and zBH at CA 6, 12, and 60 months, and zBMI at CA 60 months. Multivariate generalized estimating equation analyses showed antibiotic exposure duration had significantly faltering z-score increment from CA 6 to 60 months in zBW and zBH (adjusted mean [95% CI]; ΔzBW: -0.021 [-0.041 to -0.001], p = 0.042; ΔzBH: -0.019 [-0.035 to -0.002], p = 0.027) after adjustment. Children with neonatal antibiotic exposure duration >15 days were significantly lower in the mean anthropometric zBW, zBH, and zBMI at CA 6, 12, 24, and 60 months compared with children with neonatal antibiotic exposure ≤15 days (all p < 0.01). CONCLUSIONS Growth increments were negatively associated with antibiotic exposure duration in preterm neonates implicating that antibiotic stewardship and growth follow-up for preterm neonates are thus warranted.
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Affiliation(s)
- Yung-Chieh Lin
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan,
| | - Chi-Hsiang Chu
- Institute of Statistics, National University of Kaohsiung, Kaohsiung, Taiwan
- Department of Statistics, Tunghai University, Taichung, Taiwan
| | - Yen-Kuang Lin
- Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University, Taoyuan, Taiwan
| | - Chih-Chia Chen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Li-Wen Chen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chao-Ching Huang
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Pediatrics, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Perrone M, Casirati A, Stagi S, Amato O, Piemontese P, Liotto N, Orsi A, Menis C, Pesenti N, Tabasso C, Roggero P, Mosca F. Don't Forget the Bones: Incidence and Risk Factors of Metabolic Bone Disease in a Cohort of Preterm Infants. Int J Mol Sci 2022; 23:10666. [PMID: 36142579 PMCID: PMC9506409 DOI: 10.3390/ijms231810666] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/02/2022] [Accepted: 09/10/2022] [Indexed: 11/16/2022] Open
Abstract
Metabolic bone disease of prematurity (MBD) is a condition of reduced bone mineral content (BMC) compared to that expected for gestational age (GA). Preterm birth interrupts the physiological process of calcium (Ca) and phosphorus (P) deposition that occurs mostly in the third trimester of pregnancy, leading to an inadequate bone mineralization during intrauterine life (IUL). After birth, an insufficient intake of Ca and P carries on this alteration, resulting in overt disease. If MBD is often a self-limited condition, in some cases it could hesitate the permanent alteration of bone structures with growth faltering and failure to wean off mechanical ventilation due to excessive chest wall compliance. Despite advances in neonatal intensive care, MBD is still frequent in preterm infants, with an incidence of 16−23% in very-low-birth-weight (VLBW, birth weight <1500 g) and 40−60% in extremely low-birth-weight (ELBW, birth weight <1000 g) infants. Several risk factors are associated with MBD (e.g., malabsorption syndrome, parenteral nutrition (PN), pulmonary bronchodysplasia (BPD), necrotizing enterocolitis (NEC), and some chronic medications). The aim of this study was to evaluate the rate of MBD in a cohort of VLBWI and the role of some risk factors. We enrolled 238 VLBWIs (107 male). 52 subjects were classified as increased risk (G1) and 186 as standard risk (G2) according to serum alkaline phosphatase (ALP) and phosphorus (P) levels. G1 subjects have lower GA (p < 0.01) and BW (p < 0.001). Moreover, they need longer PN support (p < 0.05) and invasive ventilation (p < 0.01). G1 presented a higher rate of BPD (p = 0.026). At linear regression analysis, BW and PN resulted as independent predictor of increased risk (p = 0.001, p = 0.040, respectively). Preventive strategies are fundamental to prevent chronic alteration in bone structures and to reduce the risk of short stature. Screening for MBD based on serum ALP could be helpful in clinical practice to identify subjects at increased risk.
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Affiliation(s)
- Michela Perrone
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Amanda Casirati
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Ca'Granda Policlinico San Matteo, 27100 Pavia, Italy
| | - Stefano Stagi
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, 50139 Florence, Italy
| | - Orsola Amato
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Pasqua Piemontese
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Nadia Liotto
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Anna Orsi
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Camilla Menis
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Nicola Pesenti
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology, and Public Health, University of Milano-Bicocca, 20126 Milan, Italy
| | - Chiara Tabasso
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Paola Roggero
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Via Francesco Sforza 35, 20122 Milan, Italy
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Nutrient Intake with Early Progressive Enteral Feeding and Growth of Very Low-Birth-Weight Newborns. Nutrients 2022; 14:nu14061181. [PMID: 35334838 PMCID: PMC8955398 DOI: 10.3390/nu14061181] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 02/24/2022] [Accepted: 03/08/2022] [Indexed: 12/22/2022] Open
Abstract
Early nutrition is one of the most modifiable factors influencing postnatal growth. Optimal nutrient intakes for very preterm infants remain unknown, and poor postnatal growth is common in this population. The aim of this study was to assess nutrient intake during the first 4 weeks of life with early progressive enteral feeding and its impact on the in-hospital growth of very low-birth-weight (VLBW) infants. In total, 120 infants with birth weights below 1500 g and gestational ages below 35 weeks were included in the study. Nutrient intakes were assessed daily for the first 28 days. Growth was measured weekly until discharge. Median time of parenteral nutrition support was 6 days. Target enteral nutrient and energy intake were reached at day 10 of life, and remained stable until day 28, with slowly declining protein intake. Median z-scores at discharge were −0.73, −0.49, and −0.31 for weight, length, and head circumference, respectively. Extrauterine growth restriction was observed in 30.3% of the whole cohort. Protein, carbohydrates, and energy intakes correlated positively with weight gain and head circumference growth. Early progressive enteral feeding with human milk is well tolerated in VLBW infants. Target enteral nutrient intake may be reached early and improve in-hospital growth.
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Weight gain speed and z-score behavior in large prematures for gestational age. NUTR HOSP 2022; 39:1220-1227. [DOI: 10.20960/nh.04124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Energy Expenditure, Protein Oxidation and Body Composition in a Cohort of Very Low Birth Weight Infants. Nutrients 2021; 13:nu13113962. [PMID: 34836218 PMCID: PMC8620881 DOI: 10.3390/nu13113962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/19/2021] [Accepted: 11/03/2021] [Indexed: 11/24/2022] Open
Abstract
The nutritional management of preterm infants is a critical point of care, especially because of the increased risk of developing extrauterine growth restriction (EUGR), which is associated with worsened health outcomes. Energy requirements in preterm infants are simply estimated, so the measurement of resting energy expenditure (REE) should be a key point in the nutritional evaluation of preterm infants. Although predictive formulae are available, it is well known that they are imprecise. The aim of our study was the evaluation of REE and protein oxidation (Ox) in very low birth weight infants (VLBWI) and the association with the mode of feeding and with body composition at term corrected age. Methods: Indirect calorimetry and body composition were performed at term corrected age in stable very low birth weight infants. Urinary nitrogen was measured in spot urine samples to calculate Ox. Infants were categorized as prevalent human milk (HMF) or prevalent formula diet (PFF). Results: Fifty VLBWI (HMF: 23, PFF: 27) were evaluated at 36.48 ± 0.85 post-conceptional weeks. No significant differences were found in basic characteristics or nutritional intake in the groups at birth and at the assessment. No differences were found in the REE of HMF vs. PFF (59.69 ± 9.8 kcal/kg/day vs. 59.27 ± 13.15 kcal/kg/day, respectively). We found statistical differences in the protein-Ox of HMF vs. PFF (1.7 ± 0.92 g/kg/day vs. 2.8 ± 1.65 g/kg/day, respectively, p < 0.01), and HMF infants had a higher fat-free mass (kg) than PFF infants (2.05 ± 0.26 kg vs. 1.82 ± 0.35 kg, respectively, p < 0.01), measured with air displacement plethysmography. Conclusion: REE is similar in infants with a prevalent human milk diet and in infants fed with formula. The HMF infants showed a lower oxidation rate of proteins for energy purposes and a better quality of growth. A greater amount of protein in HMF is probably used for anabolism and fat-free mass deposition. Further studies are needed to confirm our hypothesis.
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Gounaris A, Sokou R, Theodoraki M, Gounari E, Panagiotounakou P, Antonogeorgos G, Ioakeimidis G, Parastatidou S, Konstantinidi A, Grivea IN. "Aggressive" Feeding of Very Preterm Neonates and Body Mass Index at School Age. Nutrients 2021; 13:nu13061901. [PMID: 34205860 PMCID: PMC8227043 DOI: 10.3390/nu13061901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/17/2021] [Accepted: 05/27/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The effects of "aggressive" neonatal feeding policies of very preterm neonates (VPN) and the risk of metabolic syndrome later in life remain questionable. We aimed to evaluate the effect of our "aggressive" nutrition policies of VPN during hospitalisation on body mass index (BMI) at ages 2 and 8 years. MATERIALS AND METHODS Eighty four VPN, who received "aggressive" nutrition during hospitalisation in an effort to minimise postnatal growth restriction (PGR) (group A), and 62 term neonates, as controls (group B), were enrolled in the study. Group A was further divided in four subgroups depending on the type (A1: fortified expressed breast milk and preterm formula; A2: exclusively preterm formula) and quantity of milk received (A3: maximum feeds 180-210 mL/kg/day; A4: maximum feeds 210 and up to 260 mL/kg/day). BMI was calculated at ages 2 and 8 years and plotted on the centile charts. RESULTS There was no significant difference in BMI between groups A and B at 2 and 8 years, respectively, in both absolute BMI values and their centile chart distribution. There was no significant difference in BMI at 2 and 8 years either between subgroups A1 and A2 or between subgroups A3 and A4. CONCLUSIONS "Aggressive" and individualised feeding policy for VPN did not affect the BMI and obesity rates at ages of 2 and 8 years in our study population. The type and quantity of milk feeds had no impact on their BMI at school age. Further larger studies are needed to confirm our results.
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Affiliation(s)
- Antonios Gounaris
- Neonatal Clinic-NICU, University General Hospital, 41222 Larissa, Greece;
- Correspondence: ; Tel.: +30-6944-887-522
| | - Rozeta Sokou
- Neonatal Clinic-NICU, General Hospital “Agios Panteleimon”, 18454 Piraeus, Greece; (R.S.); (M.T.); (P.P.); (G.A.); (G.I.); (S.P.); (A.K.)
| | - Martha Theodoraki
- Neonatal Clinic-NICU, General Hospital “Agios Panteleimon”, 18454 Piraeus, Greece; (R.S.); (M.T.); (P.P.); (G.A.); (G.I.); (S.P.); (A.K.)
| | - Eleni Gounari
- Royal Alexandra Children’s Hospital Brighton, Eastern Road, Brighton BN2 5BE, East Sussex, UK;
| | - Polytimi Panagiotounakou
- Neonatal Clinic-NICU, General Hospital “Agios Panteleimon”, 18454 Piraeus, Greece; (R.S.); (M.T.); (P.P.); (G.A.); (G.I.); (S.P.); (A.K.)
| | - George Antonogeorgos
- Neonatal Clinic-NICU, General Hospital “Agios Panteleimon”, 18454 Piraeus, Greece; (R.S.); (M.T.); (P.P.); (G.A.); (G.I.); (S.P.); (A.K.)
| | - Georgios Ioakeimidis
- Neonatal Clinic-NICU, General Hospital “Agios Panteleimon”, 18454 Piraeus, Greece; (R.S.); (M.T.); (P.P.); (G.A.); (G.I.); (S.P.); (A.K.)
| | - Stavroula Parastatidou
- Neonatal Clinic-NICU, General Hospital “Agios Panteleimon”, 18454 Piraeus, Greece; (R.S.); (M.T.); (P.P.); (G.A.); (G.I.); (S.P.); (A.K.)
| | - Aikaterini Konstantinidi
- Neonatal Clinic-NICU, General Hospital “Agios Panteleimon”, 18454 Piraeus, Greece; (R.S.); (M.T.); (P.P.); (G.A.); (G.I.); (S.P.); (A.K.)
| | - Ioanna N. Grivea
- Neonatal Clinic-NICU, University General Hospital, 41222 Larissa, Greece;
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Lebrão CW, Suano-Souza FI, Sarni ROS. Is the Intrauterine INTERGROWTH-21 Growth Curve Better Than Fenton's for the Classification at Birth and Prediction of Postnatal Growth in Preterm Infants? Matern Child Health J 2021; 24:1446-1453. [PMID: 32740751 DOI: 10.1007/s10995-020-02988-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To compare the classification of the adequacy of birth weight for gestational age applying INTERGROWTH-21 (IG-21) and Fenton growth curves in preterm infants, and to relate this classification to the nutritional status at 12 months corrected age. METHODS This is a retrospective study with 173 preterm infants aged between 26 and 33 weeks. Data was collected on maternal health conditions, birth and gestational age anthropometric information, and anthropometry (weight, height, and head circumference) at 12 months corrected age. RESULTS The mean birth weight and gestational age were 1151.4 ± 227.2 g and 30.2 ± 2.4 weeks, respectively. Using percentiles of IG-21 and Fenton curves, the proportion of SGA and LGA preterm infants was 39.2% vs. 35.2%, and 3.5% vs. 3.5%, respectively (p = 0.520). At 12 months corrected age, short stature, overweight, and thinness were observed in 33.5%, 9.9%, and 11% of preterm infants, respectively. The ROC curve evidenced that the IG-21 was slightly better than Fenton to predict short stature (AUC = 0.626, 95% CI 0.537-0.715 and AUC = 0.600, 95% CI 0.506-0.694) and overweight (AUC = 0.648, 95% CI 0.527-0.769 and AUC = 0.618, 95% CI 0.486-0.750) at 12 months corrected age. In contrast, the ROC curve did not show an association of IG-21 and Fenton percentiles with thinness. CONCLUSIONS FOR PRACTICE This study showed that IG-21 and Fenton were similar for the classification of birth weight for gestational age in preterm infants. IG-21 was slightly better than Fenton to predict overweight and short stature in preterm infants at 12 months corrected age.
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Affiliation(s)
- Cibele Wolf Lebrão
- Neonatology Service of Hospital Municipal de São Bernardo Do Campo, São Bernardo Do Campo, Brazil
| | - Fabíola Isabel Suano-Souza
- Pediatric Department of Centro Universitário ABC - Faculdade de Medicina do ABC, Pediatric Department of Universidade Federal de São Paulo-UNIFESP-EPM, Avenida Principe de Gales, 821, Santo André, São Paulo, 09061-650, Brazil.
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Lamb RL, Haszard JJ, Little HMJ, Franks AF, Meeks MG. Macronutrient Composition of Donated Human Milk in a New Zealand Population. J Hum Lact 2021; 37:114-121. [PMID: 33030996 DOI: 10.1177/0890334420963666] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND A primary role of human donor milk banks is to provide pasteurized human milk for the sick and preterm infant populations and to support the mothers of these infants as they establish their own milk supply. The results of human milk pasteurization continue to be studied to provide information that enables optimal nutrition in this sick and preterm population. RESEARCH AIMS The aims of our study were to determine macronutrient characteristics (fat, protein, carbohydrate) and energy content of human milk donated to the Christchurch Women's Hospital Human Milk Bank in New Zealand, and the influence of Holder pasteurization on this macronutrient composition. METHODS This was a retrospective, pre/post pasteurization observational design to describe the macronutrient content within two groups of donors, mature preterm PDM (n = 13; 21%) and mature term PDM (n = 50; 79%). Sixty three samples of human milk donated to the human milk bank by 27 registered participants (mothers of preterm and term infants) were analyzed. This analysis took place July-September 2018 using a human milk analyzer before and after Holder pasteurization (62.5 °C for 30 min). RESULTS Preterm milk contained on average 76 kcal/100 ml energy, 4.0 g/100 ml fat, 1.1 g/100 ml protein and 8.2 g/100 ml total carbohydrate; and mature term milk contained 68 kcal/100 ml energy, 3.5 g/100 ml fat, 0.8 g/100 ml protein and 7.9 g/100 ml total carbohydrate. Wide variation between single, donor-pooled samples was demonstrated and there was no major result of pasteurization. CONCLUSION This research adds to the evidence regarding the macronutrient content of preterm and term milk and that these values are unaffected by Holder pasteurization. The variance in individual pooled donor human milk indicates the importance of determining the nutrient composition of donated milk to inform fortification procedures.
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Affiliation(s)
| | - Jillian J Haszard
- 2495 Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Helen M J Little
- 299516 Nutrition and Dietetics, Christchurch Hospital, Christchurch, New Zealand
| | - Anthea F Franks
- 299516 Human Milk Bank, Neonatal Intensive Care Unit, Christchurch Women's Hospital, Christchurch, New Zealand
| | - Maggie G Meeks
- 299516 Neonatal Intensive Care Unit, Christchurch Women's Hospital, Christchurch, New Zealand
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Salas AA, Jerome ML, Chandler-Laney P, Ambalavanan N, Carlo WA. Serial assessment of fat and fat-free mass accretion in very preterm infants: a randomized trial. Pediatr Res 2020; 88:733-738. [PMID: 32634820 PMCID: PMC7581604 DOI: 10.1038/s41390-020-1052-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/26/2020] [Accepted: 06/26/2020] [Indexed: 12/03/2022]
Abstract
BACKGROUND Clinicians could modify dietary interventions during early infancy by monitoring fat and fat-free mass accretion in very preterm infants. METHODS Preterm infants were randomly assigned to either having reports on infant body composition available to the clinicians caring for them (intervention group) or not having reports available (control group). All infants underwent serial assessments of body composition by air-displacement plethysmography before 32 weeks of postmenstrual age (PMA) and at 36 weeks PMA. The primary outcome was percent body fat (%BF) at 3 months of corrected age (CA). RESULTS Fifty infants were randomized (median gestational age: 30 weeks; mean ± SD birth weight: 1387 ± 283 g). The mean %BF increased from 7 ± 4 before 32 weeks PMA to 20 ± 5 at 3 months CA. The differences in mean %BF between the intervention group and the control group were not statistically significant at 36 weeks PMA (14.5 vs. 13.6) or 3 months CA (20.8 vs. 19.4). Feeding practices and anthropometric measurements during hospitalization did not differ between groups. CONCLUSIONS Serial assessments of body composition in both intervention and control groups showed consistent increments in %BF. However, providing this information to clinicians did not influence nutritional practices or growth. IMPACT Serial assessments of body composition in preterm infants at 32 and 36 weeks postmenstrual age show consistent increments in % body fat up to 3 months of corrected age. However, providing this information to the clinician did not influence nutritional practices or growth.
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Affiliation(s)
- Ariel A Salas
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, 35249, USA.
| | - Maggie L Jerome
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, 35249, USA
| | - Paula Chandler-Laney
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, 35249, USA
| | | | - Waldemar A Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, 35249, USA
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Fu Y, Gou W, Hu W, Mao Y, Tian Y, Liang X, Guan Y, Huang T, Li K, Guo X, Liu H, Li D, Zheng JS. Integration of an interpretable machine learning algorithm to identify early life risk factors of childhood obesity among preterm infants: a prospective birth cohort. BMC Med 2020; 18:184. [PMID: 32646442 PMCID: PMC7350615 DOI: 10.1186/s12916-020-01642-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 05/19/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The early life risk factors of childhood obesity among preterm infants are unclear and little is known about the influence of the feeding practices. We aimed to identify early life risk factors for childhood overweight/obesity among preterm infants and to determine feeding practices that could modify the identified risk factors. METHODS A total of 338,413 mother-child pairs were enrolled in the Jiaxing Birth Cohort (1999 to 2013), and 2125 eligible singleton preterm born children were included for analyses. We obtained data on health examination, anthropometric measurement, lifestyle, and dietary habits of each participant at their visits to clinics. An interpretable machine learning-based analytic framework was used to identify early life predictors for childhood overweight/obesity, and Poisson regression was used to examine the associations between feeding practices and the identified leading predictor. RESULTS Of the eligible 2125 preterm infants (863 [40.6%] girls), 274 (12.9%) developed overweight/obesity at age 4-7 years. We summarized early life variables into 25 features and identified two most important features as predictors for childhood overweight/obesity: trajectory of infant BMI (body mass index) Z-score change during the first year of corrected age and maternal BMI at enrollment. According to the impacts of different BMI Z-score trajectories on the outcome, we classified this feature into the favored and unfavored trajectories. Compared with early introduction of solid foods (≤ 3 months of corrected age), introducing solid foods after 6 months of corrected age was significantly associated with 11% lower risk (risk ratio, 0.89; 95% CI, 0.82 to 0.97) of being in the unfavored trajectory. CONCLUSIONS The trajectory of BMI Z-score change within the first year of life is the most important predictor for childhood overweight/obesity among preterm infants. Introducing solid foods after 6 months of corrected age is a recommended feeding practice for mitigating the risk of being in the unfavored trajectory.
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Affiliation(s)
- Yuanqing Fu
- Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, School of Life Sciences, Westlake University, 18 Shilongshan Rd, Cloud Town, Hangzhou, 310024, China.,China-Canada Joint Lab of Food Nutrition and Health, Beijing Technology and Business University, Beijing, China
| | - Wanglong Gou
- Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, School of Life Sciences, Westlake University, 18 Shilongshan Rd, Cloud Town, Hangzhou, 310024, China
| | - Wensheng Hu
- Department of Obstetrics and Gynecology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou, China
| | - Yingying Mao
- Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yunyi Tian
- Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, School of Life Sciences, Westlake University, 18 Shilongshan Rd, Cloud Town, Hangzhou, 310024, China
| | - Xinxiu Liang
- Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, School of Life Sciences, Westlake University, 18 Shilongshan Rd, Cloud Town, Hangzhou, 310024, China
| | - Yuhong Guan
- Jiaxing University Affiliated Women and Children Hospital, Jiaxing, China
| | - Tao Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Kelei Li
- Institute of Nutrition and Health, Qingdao University, 308 Ningxia Road, Qingdao, China
| | - Xiaofei Guo
- Institute of Nutrition and Health, Qingdao University, 308 Ningxia Road, Qingdao, China
| | - Huijuan Liu
- Jiaxing University Affiliated Women and Children Hospital, Jiaxing, China.
| | - Duo Li
- Institute of Nutrition and Health, Qingdao University, 308 Ningxia Road, Qingdao, China.
| | - Ju-Sheng Zheng
- Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, School of Life Sciences, Westlake University, 18 Shilongshan Rd, Cloud Town, Hangzhou, 310024, China. .,Institute of Nutrition and Health, Qingdao University, 308 Ningxia Road, Qingdao, China.
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12
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Ceratto S, Savino F, Vannelli S, De Sanctis L, Giuliani F. Growth Assessment in Preterm Children from Birth to Preschool Age. Nutrients 2020; 12:nu12071941. [PMID: 32629786 PMCID: PMC7400378 DOI: 10.3390/nu12071941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/25/2020] [Accepted: 06/28/2020] [Indexed: 11/17/2022] Open
Abstract
Preterm infant growth is a major health indicator and needs to be monitored with an appropriate growth curve to achieve the best developmental and growth potential while avoiding excessive caloric intake that is linked to metabolic syndrome and hypertension later in life. New international standards for size at birth and postnatal growth for preterm infants are available and need implementation in clinical practice. A prospective, single center observational study was conducted to evaluate the in-hospital and long-term growth of 80 preterm infants with a mean gestational age of 33.3 ± 2.2 weeks, 57% males. Size at birth and at discharge were assessed using the INTERGROWTH-21ST standards, at preschool age with World Health Organization (WHO) child growth standards. The employment of INTERGROWTH-21ST Preterm Postnatal longitudinal standards during the in-hospital follow-up significantly reduced the diagnosis of short term extrauterine growth restriction when compared to commonly used cross sectional neonatal charts, with significant lower loss of percentiles between birth and term corrected age (p < 0.0001). The implementation of a package of standards at birth, preterm postnatal growth standards and WHO child growth standards proved to be consistent, with correlation between centile at birth and at follow-up, and therefore effective in monitoring growth in a moderate and late preterm infant cohort without chronic or major morbidities. Infants identified as small for gestational age at birth showed significantly more frequently a need for auxological referral.
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Affiliation(s)
- Simone Ceratto
- Postgraduate School of Pediatrics, University of Torino, 10126 Turin, Italy;
- Division of Pediatrics and Neonatology, Department of Maternal Medicine, Nuovo Ospedale degli Infermi, 13875 Ponderano (Biella), Italy
| | - Francesco Savino
- Early Infancy Special Care Unit, Regina Margherita Children Hospital, A.O.U. Città della Salute e della Scienza di Torino, 10126 Torino, Italy;
| | - Silvia Vannelli
- Pediatric Endocrinology and Diabetology Unit, Regina Margherita Children Hospital, AOU Città della Salute e della Scienza di Torino, 10126 Torino, Italy; (S.V.); (L.D.S.)
| | - Luisa De Sanctis
- Pediatric Endocrinology and Diabetology Unit, Regina Margherita Children Hospital, AOU Città della Salute e della Scienza di Torino, 10126 Torino, Italy; (S.V.); (L.D.S.)
- Pediatric Endocrinology, Department of Public Health and Pediatric Sciences, University of Torino, 10124 Torino, Italy
| | - Francesca Giuliani
- Early Infancy Special Care Unit, Regina Margherita Children Hospital, A.O.U. Città della Salute e della Scienza di Torino, 10126 Torino, Italy;
- Correspondence:
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13
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Tewari VV, Kumar A, Singhal A, Prakash A, Pillai N, Varghese J. Proportionate Postnatal Growth in Preterm Neonates on Expressed Breast Milk Feeding With Selected Fortification. Nutr Clin Pract 2020; 35:715-723. [PMID: 32383218 DOI: 10.1002/ncp.10494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Preterm neonates not fed an exclusive human-milk diet in the neonatal intensive care unit (NICU) show disproportionate postnatal growth. There are scant data on postnatal growth in neonates from India fed an exclusive expressed breast milk (EBM) diet. This study describes the postnatal changes in weight, length, and head circumference in preterm neonates given EBM with selected fortification. METHODS The study had a prospective observational design. Exclusive EBM feeding, early initiation, and standardized progression of feeds was followed. Fortification of breast milk with human milk fortifier (HMF) or liquid calcium phosphate and multivitamins (CALVIT) or hindmilk (HM) was done based on the gestational age. Monitoring for weight, length, and head circumference was done from admission to discharge. RESULTS Ninety-three preterm neonates were included in the study, of which 34 (36.6%) were small for gestational age. Thirty-two (34.3%) neonates received EBM with HMF, 35 (35.7%) received EBM fortified with CALVIT and 26 (28%) neonates received HM fortification. There was a significant difference in the change in z-scores from birth to discharge for the weight, length, and head circumference (P = .001). The mean increase in daily weight ranged from 8.8 to 9.5 g/d, whereas weekly change in length was 0.8-0.9 cm/wk, and head circumference was 0.7 cm/wk. CONCLUSION Postnatal growth of preterm neonates during NICU admission on exclusive EBM feeding with selected fortification resulted in a proportionate increase in weight, length, and head circumference.
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Affiliation(s)
| | | | - Amit Singhal
- Army Hospital (Referral and Research), New Delhi, India
| | - Arya Prakash
- Army Hospital (Referral and Research), New Delhi, India
| | - Nayana Pillai
- Army Hospital (Referral and Research), New Delhi, India
| | - Jaya Varghese
- Army Hospital (Referral and Research), New Delhi, India
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14
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Wang J, Shen S, Price MJ, Lu J, Sumilo D, Kuang Y, Manolopoulos K, Xia H, Qiu X, Cheng KK, Nirantharakumar K. Glucose, Insulin, and Lipids in Cord Blood of Neonates and Their Association with Birthweight: Differential Metabolic Risk of Large for Gestational Age and Small for Gestational Age Babies. J Pediatr 2020; 220:64-72.e2. [PMID: 32093929 DOI: 10.1016/j.jpeds.2020.01.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 12/02/2019] [Accepted: 01/06/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To investigate the association of birthweight percentile with cord blood glucose, lipids, and insulin levels. STUDY DESIGN Data obtained from 1522 newborns were included in the Born in Guangzhou Cohort study. The generalized additive model and multivariable linear regression model were used to explore the nonlinear and linear relationships between birthweight and cord blood metabolic measures, and to evaluate the differences of metabolic measures Z-scores among small for gestational age, appropriate for gestational age, and large for gestational age babies. RESULTS Birthweight Z-score was linearly associated with increased cord blood insulin Z-score (adjusted β = 0.30; 95% CI, 0.22-0.37). Compared with appropriate for gestational age babies, neonates born small for gestational age had significantly higher cord blood triglycerides Z-score (adjusted mean difference [MDadj], 0.60; 95% CI, 0.40-0.79) and lower cord blood insulin (MDadj, -0.37; 95% CI, -0.57 to -0.16), high-density lipoprotein cholesterol (MDadj, -0.34; 95% CI, -0.55 to -0.13), total cholesterol (MDadj, -0.26; 95% CI, -0.47 to -0.05), and low-density lipoprotein (MDadj, -0.23; 95% CI, -0.43 to -0.02) Z-scores, and neonates born large for gestational age had higher cord blood insulin Z-score (MDadj, 0.31; 95% CI, 0.09 to 0.52). CONCLUSIONS Our findings support the hypothesis that babies born small for gestational age and large for gestational age are exposed to different intrauterine environments, which may contribute to altered fat accumulation patterns with implications for the risk of metabolic dysfunction later in life. There is a need to consider the development of tailored intervention strategies to prevent metabolic dysfunction in adult life for these babies.
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Affiliation(s)
- Jingya Wang
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China; Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Songying Shen
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Malcolm James Price
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Jinhua Lu
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Dana Sumilo
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Yashu Kuang
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | | | - Huimin Xia
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xiu Qiu
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
| | - Kar Keung Cheng
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
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15
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Cordova EG, Belfort MB. Updates on Assessment and Monitoring of the Postnatal Growth of Preterm Infants. Neoreviews 2020; 21:e98-e108. [PMID: 32005720 DOI: 10.1542/neo.21-2-e98] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Assessing and monitoring the physical growth of preterm infants is fundamental to NICU care. The goals of nutritional care are to approximate the growth and body composition of the healthy fetus and to support optimal brain development while minimizing future cardiometabolic risk. Both poor and excessive growth predict adverse long-term health outcomes. Growth curves are clinical tools used to assess the preterm infant's growth status. Several growth curves for preterm infants were developed in the past decade. To use them effectively, clinicians need to understand how each growth curve was developed; the underlying reference population; intended use; and strengths and limitations. Intrauterine growth curves are references that use size at birth to represent healthy fetal growth. These curves serve 2 purposes-to assign size classifications at birth and to monitor postnatal growth. The INTERGROWTH-21 st preterm postnatal growth standards were developed to compare the postnatal growth of preterm infants to that of healthy preterm infants rather than the fetus. Individualized weight growth curves account for the water weight loss that frequently occurs after birth. In addition, body mass index (BMI) curves are now available. In this review, we discuss the main characteristics of growth curves used for preterm infants as well as the use of percentiles, z scores, and their change over time to evaluate size and growth status. We also review the differences in body composition between preterm infants at term-equivalent age and term-born infants and the potential role of monitoring proportionality of growth using BMI curves.
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Affiliation(s)
- Erika G Cordova
- Department of Medicine, Boston Children's Hospital, Boston, MA
| | - Mandy Brown Belfort
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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16
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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. Applying Methods for Postnatal Growth Assessment in the Clinical Setting: Evaluation in a Longitudinal Cohort of Very Preterm Infants. Nutrients 2019; 11:nu11112772. [PMID: 31739632 PMCID: PMC6893690 DOI: 10.3390/nu11112772] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/11/2019] [Accepted: 11/12/2019] [Indexed: 12/25/2022] Open
Abstract
AIM To analyze different methods to assess postnatal growth in a cohort of very premature infants (VPI) in a clinical setting and identify potential early markers of growth failure. METHODS Study of growth determinants in VPI (≤32 weeks) during hospital stay. Nutritional intakes and clinical evolution were recorded. Growth velocity (GV: g/kg/day), extrauterine growth restriction (%) (EUGR: weight < 10th centile, z-score < -1.28) and postnatal growth failure (PGF: fall in z-score > 1.34) at 36 weeks postmenstrual age (PMA) were calculated. Associations between growth and clinical or nutritional variables were explored (linear and logistic regression). RESULTS Sample: 197 VPI. GV in IUGR patients was higher than in non-IUGRs (28 days of life and discharge). At 36 weeks PMA 66.0% of VPIs, including all but one of the IUGR patients, were EUGR. Prevalence of PGF at the same time was 67.4% (IUGR patients: 48.1%; non-IUGRs: 70.5% (p = 0.022)). Variables related to PGF at 36 weeks PMA were initial weight loss (%), need for oxygen and lower parenteral lipids in the first week. CONCLUSIONS The analysis of z-scores was better suited to identify postnatal growth faltering. PGF could be reduced by minimising initial weight loss and assuring adequate nutrition in patients at risk.
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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.)
- Correspondence: ; Tel.: +34-9328-04000 (ext. 72564)
| | - 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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17
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Menon G, Davidson AL, Drake AJ, Embleton ND. Is preterm nutrition a trade-off between head and heart? Arch Dis Child Fetal Neonatal Ed 2019; 104:F232-F234. [PMID: 30314974 DOI: 10.1136/archdischild-2018-315672] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 09/24/2018] [Accepted: 09/25/2018] [Indexed: 02/05/2023]
Affiliation(s)
- Gopi Menon
- Neonatal Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Amanda Jane Drake
- University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Nicholas D Embleton
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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