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Morris M, Bennett S, Drake L, Hetherton MC, Clifton-Koeppel R, Schroeder H, Breault C, Larson K. Multidisciplinary evidence-based tools for improving consistency of care and neonatal nutrition. J Perinatol 2024; 44:751-759. [PMID: 38615125 DOI: 10.1038/s41372-024-01963-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/27/2024] [Accepted: 04/04/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Extrauterine growth restriction from inadequate nutrition remains a significant morbidity in very low birth weight infants. Participants in the California Perinatal Quality Care Collaborative Quality Improvement Collaborative, Grow, Babies, Grow! developed or refined tools to improve nutrition and reduce practice variation. METHOD Five Neonatal Intensive Care Units describe the development and implementation of nutrition tools. Tools include Parenteral Nutrition Guidelines, Automated Feeding Protocol, electronic medical record Order Set, Nutrition Time-Out Rounding Tool, and a Discharge Nutrition Recommendations. 15 of 22 participant sites completed a survey regarding tool value and implementation. RESULTS Reduced growth failure at discharge was observed in four of five NICUs, 11-32% improvement. Tools assisted with earlier TPN initiation (8 h) and reaching full feeds (2-5 days). TPN support decreased by 5 days. 80% of survey respondents rated the tools as valuable. CONCLUSION Evidence and consensus-based nutrition tools help promote standardization, leading to improved and sustainable outcomes.
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Affiliation(s)
- Mindy Morris
- California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA, USA.
| | | | - Liz Drake
- Children's Hospital Orange County Mission Hospital, Mission Viejo, CA, USA
| | | | | | - Holly Schroeder
- Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA, USA
| | - Courtney Breault
- California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA, USA
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Ifran EKB, Hegar B, Rohsiswatmo R, Indriatmi W, Yuniarti T, Advani N, Santoso DIS, Masui M, Hikmahrachim HG, Huysentruyt K, Vandenplas Y. Feeding intolerance scoring system in very preterm and very low birth weight infants using clinical and ultrasound findings. Front Pediatr 2024; 12:1370361. [PMID: 38725983 PMCID: PMC11079181 DOI: 10.3389/fped.2024.1370361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 04/01/2024] [Indexed: 05/12/2024] Open
Abstract
Very preterm infants are at a high risk of developing feeding intolerance; however, there are no widely accepted definitions of feeding intolerance. This study aimed to develop a scoring system for feeding intolerance in very preterm infants by combining clinical symptoms and ultrasonography (US) findings. This prospective cohort study included very preterm and/or very low birth weight infants. We defined feeding intolerance as the inability to achieve full feeding (150 ml/kg/day) by 14 days of life. The clinical findings included vomiting, abdominal distention, and gastric fluid color. US findings included intestinal peristaltic frequency, gastric residual volume, peak systolic velocity, and the resistive index of the superior mesenteric artery. We conducted multivariate analyses to evaluate the potential predictors and developed a scoring system to predict feeding intolerance. A total of 156 infants fulfilled the eligibility criteria; however, 16 dropped out due to death. The proportion of patients with feeding intolerance was 60 (42.8%). Based on the predictive ability, predictors of feeding intolerance were determined using data from the US at 5-7 days of age. According to multivariate analysis, the final model consisted of 5 predictors: abdominal distention (score 1), hemorrhagic gastric fluid (score 2), intestinal peristaltic movement ≤18x/2 min (score 2), gastric fluid residue >25% (score 2), and resistive index >0.785 (score 2). A score equal to or above 5 indicated an increased risk of feeding intolerance with a positive predictive value of 84.4% (95% confidence interval:73.9-95.0) and a negative predictive value of 76.8% (95% confidence interval:68.4-85.3). The scoring system had good discrimination (area under the receiver operating characteristic curve:0.90) and calibration (p = 0.530) abilities. This study developed an objective, accurate, easy, and safe scoring system for predicting feeding intolerance based on clinical findings, 2D US, and color Doppler US.
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Affiliation(s)
- Evita Karianni Bermanshah Ifran
- Department of Child Health, Faculty of Medicine Universitas Indonesia—Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia
| | - Badriul Hegar
- Department of Child Health, Faculty of Medicine Universitas Indonesia—Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia
| | - Rinawati Rohsiswatmo
- Department of Child Health, Faculty of Medicine Universitas Indonesia—Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia
| | - Wresti Indriatmi
- Department of Dermatology and Venereology, Faculty of Medicine Universitas Indonesia—Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia
| | - Tetty Yuniarti
- Department of Child Health, Faculty of Medicine Universitas Padjajaran—Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Najib Advani
- Department of Child Health, Faculty of Medicine Universitas Indonesia—Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia
| | | | - Marshita Masui
- Department of Child Health, Faculty of Medicine Universitas Indonesia—Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia
| | - Hardya Gustada Hikmahrachim
- Department of Child Health, Faculty of Medicine Universitas Indonesia—Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia
| | - Koen Huysentruyt
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Brussels, Belgium
| | - Yvan Vandenplas
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Brussels, Belgium
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Shen RL, Ritz C, Li Y, Sangild PT, Jiang PP. Early parenteral nutrition is associated with improved growth in very low birth weight infants: a retrospective study. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2023-325829. [PMID: 38212106 DOI: 10.1136/archdischild-2023-325829] [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] [Received: 05/16/2023] [Accepted: 12/15/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVE To assess the association between early initiation of parenteral nutrition (PN) and body growth in preterm infants with very low birth weight (VLBW). DESIGN Causal inference analysis with confounders preselected by causal diagram based on the NeoNutriNet cohort containing data of infants born between 2011 and 2014 from 13 hospitals from 5 continents. PATIENTS Neonates with birth weight ≤1500 g. INTERVENTIONS PN initiated within the first day of life (early PN) versus within day 2-5 (delayed PN). MAIN OUTCOME MEASURES The primary outcome was body weight z-scores at postmenstrual age (PMA) 36 weeks or early discharge or death, whichever comes first (WT z-score END). Secondary outcomes included WT z-scores at week 1 and 4 of life (WT z-scores CA1 and CA4), corresponding growth velocities (GVs), mortality and incidence of necrotising enterocolitis (NEC), and duration and episodes of antibiotic treatment. RESULTS In total, 2151 infants were included in this study and 2008 infants were in the primary outcome analysis. Significant associations of early PN were found with WT z-score END (adjusted mean difference, 0.14 (95% CI 0.05 to 0.23)), CA4 (β, 0.09 (0.04 to 0.14)) and CA1 (0.04 (0.01 to 0.08)), and GV PMA 36 weeks (1.02 (0.46 to 1.58)) and CA4 (1.03 (0.56 to 1.49), all p<0.001), but not with GV CA1 (p>0.05). No significant associations with mortality, incidence of NEC or antibiotic use was found (all p>0.05). CONCLUSIONS For VLBW infants, PN initiated within the first day of life is associated with improved in-hospital growth.
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Affiliation(s)
- René Liang Shen
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Christian Ritz
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Yanqi Li
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark
- NBCD A/S, Søborg, Denmark
| | - Per Torp Sangild
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Paediatrics, Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Ping-Ping Jiang
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark
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Bauer-Rusek S, Shalit S, Yakobson D, Levkovitz O, Ghetti C, Gold C, Stordal AS, Arnon S. Music therapy and weight gain in preterm infants: Secondary analysis of the randomized controlled LongSTEP trial. J Pediatr Gastroenterol Nutr 2024; 78:113-121. [PMID: 38291685 DOI: 10.1002/jpn3.12061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/14/2023] [Accepted: 09/20/2023] [Indexed: 02/01/2024]
Abstract
OBJECTIVES This study assessed the association between MT and weight gain among preterm infants hospitalized in Neonatal Intensive Care Units. METHODS Data collected during the international, randomized, Longitudinal Study of Music Therapy's Effectiveness for Premature Infants and their Caregivers (LongSTEP) study were compared between the MT group and the standard care (SC) group. Weights were recorded at birth, enrollment, and discharge. Weight percentiles, Z-scores, weight gain velocity, and extrauterine growth restriction (EUGR) were calculated. RESULTS Among 201 preterm infants included, no significant differences in weight parameters (weight, weight percentiles, weight Z-scores; all p ≥ 0.23) were found between the MT group (n = 104) and the SC (n = 97) group at birth, enrollment, or discharge. No statistical differences in EUGR represented by change in Z-scores from birth to discharge were recorded between MT and SC (0.8 vs. 0.7). Among perinatal parameters, younger gestational age (p = 0.005) and male sex (p = 0.012) were associated with increased risk of EUGR at discharge. Antenatal steroid treatment, systemic infection, bronchopulmonary dysplasia, neurological morbidities, retinopathy of prematurity, necrotizing enterocolitis, parental factors (amount of skin-to-skin care, bonding, anxiety, and depression questionnaire scores), and type of enteral nutrition did not significantly influence weight gain parameters (all p > 0.05). CONCLUSIONS In the LongSTEP study, MT for preterm infants and families was not associated with better weight parameters compared to the SC group. The degree of prematurity remains the main risk factor for unfavorable weight parameters.
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Affiliation(s)
- Sofia Bauer-Rusek
- Department of Neonatology, Meir Medical Center, Kfar Saba, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shachar Shalit
- Department of Neonatology, Meir Medical Center, Kfar Saba, Israel
- Department of Nutrition and Dietetics, Meir Medical Center, Kfar Saba, Israel
| | - Dana Yakobson
- Department of Neonatology, Meir Medical Center, Kfar Saba, Israel
- Department of Music Therapy, Aalborg University, Aalborg, Denmark
| | - Orly Levkovitz
- Department of Neonatology, Meir Medical Center, Kfar Saba, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Claire Ghetti
- The Grieg Academy Music Therapy Research Center, University of Bergen, Bergen, Norway
| | - Christian Gold
- The Grieg Academy Music Therapy Research Center, University of Bergen, Bergen, Norway
- Norwegian Research Centre AS, University of Bergen, Bergen, Norway
| | | | - Shmuel Arnon
- Department of Neonatology, Meir Medical Center, Kfar Saba, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Ehrhardt H, Aubert AM, Ådén U, Draper ES, Gudmundsdottir A, Varendi H, Weber T, Zemlin M, Maier RF, Zeitlin J. Apgar Score and Neurodevelopmental Outcomes at Age 5 Years in Infants Born Extremely Preterm. JAMA Netw Open 2023; 6:e2332413. [PMID: 37672271 PMCID: PMC10483322 DOI: 10.1001/jamanetworkopen.2023.32413] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/29/2023] [Indexed: 09/07/2023] Open
Abstract
Importance The Apgar score is used worldwide as an assessment tool to estimate the vitality of newborns in their first minutes of life. Its applicability to estimate neurodevelopmental outcomes in infants born extremely preterm (EPT; <28 weeks' gestation) is not well established. Objective To investigate the association between the Apgar score and neurodevelopmental outcomes in infants born EPT. Design, Setting, and Participants This cohort study was conducted using data from the Effective Perinatal Intensive Care in Europe-Screening to Improve Health in Very Preterm Infants in Europe (EPICE-SHIPS) study, a population-based cohort in 19 regions of 11 European countries in 2011 to 2012. Clinical assessments of cognition and motor function at age 5 years were performed in infants born EPT and analyzed in January to July 2023. Exposures Apgar score at 5 minutes of life categorized into 4 groups (0-3, 4-6, 7-8, and 9-10 points). Main Outcomes and Measures Cognitive and motor outcomes were assessed using the Wechsler Preschool and Primary Scale of Intelligence test of IQ derived from locally normed versions by country and the Movement Assessment Battery for Children-Second Edition. Parents additionally provided information on communication and problem-solving skills using the Ages and Stages Questionnaire, third edition (ASQ-3). All outcomes were measured as continuous variables. Results From the total cohort of 4395 infants born EPT, 2522 infants were live born, 1654 infants survived to age 5 years, and 996 infants (478 females [48.0%]) followed up had at least 1 of 3 outcome measures. After adjusting for sociodemographic variables, perinatal factors, and severe neonatal morbidities, there was no association of Apgar score with IQ, even for scores of 3 or less (β = -3.3; 95% CI, -10.5 to 3.8) compared with the score 9 to 10 category. Similarly, no association was found for ASQ-3 (β = -2.1; 95% CI, -24.6 to 20.4). Congruent results for Apgar scores of 3 or less were obtained for motor function scores for all children (β = -4.0; 95% CI, -20.1 to 12.1) and excluding children with a diagnosis of cerebral palsy (β = 0.8, 95% CI -11.7 to 13.3). Conclusions and Relevance This study found that low Apgar scores were not associated with longer-term outcomes in infants born EPT. This finding may be associated with high interobserver variability in Apgar scoring, reduced vitality signs and poorer responses to resuscitation after birth among infants born EPT, and the association of more deleterious exposures in the neonatal intensive care unit or of socioeconomic factors with greater changes in outcomes during the first 5 years of life.
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Affiliation(s)
- Harald Ehrhardt
- Division of Neonatology and Pediatric Intensive Care Medicine, Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Adrien M. Aubert
- Université Paris Cité, Inserm, National Research Institute for Agriculture, Food and the Environment, Centre for Research in Epidemiology and Statistics, Obstetrical Perinatal and Pediatric Epidemiology Research Team, Paris, France
| | - Ulrika Ådén
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Elizabeth S. Draper
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Anna Gudmundsdottir
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Heili Varendi
- University of Tartu, Tartu University Hospital, Tartu, Estonia
| | - Tom Weber
- University of Copenhagen, Copenhagen, Denmark
| | - Michael Zemlin
- Saarland University Medical Center, Hospital for General Pediatrics and Neonatology, Homburg, Germany
| | - Rolf F. Maier
- Children’s Hospital, University Hospital, Philipps University Marburg, Marburg, Germany
| | - Jennifer Zeitlin
- Université Paris Cité, Inserm, National Research Institute for Agriculture, Food and the Environment, Centre for Research in Epidemiology and Statistics, Obstetrical Perinatal and Pediatric Epidemiology Research Team, Paris, France
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6
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Cuestas E, Hillman M, Galetto S, Gaido MI, Sobh V, Damico LT, Rizzotti A. Inflammation induces stunting by lowering bone mass via GH/IGF-1 inhibition in very preterm infants. Pediatr Res 2023; 94:1136-1144. [PMID: 36941338 DOI: 10.1038/s41390-023-02559-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/13/2023] [Accepted: 02/22/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Sustained systemic inflammatory response (SIR) was associated with poor postnatal growth in very preterm infants (VPI). We hypothesize that VPI with sustained SIR will exhibit linear growth retardation related to lower bone mass accrual mediated by GH/IGF-1 axis inhibition at term corrected age (CA). METHODS C-reactive protein (CRP), procalcitonin (PCT), growth hormone (GH), insulin-like growth factor 1 (IGF-1), calcium, phosphorus, alkaline phosphatase, anthropometric, nutritional, neonatal and maternal data were collected prospectively in 23 infants <32 weeks gestational age. Body composition using dual-energy X-ray absorptiometry was performed at term CA. Analysis was undertaken with multiple linear regression models. RESULTS At term CA 11 infants with sustained SIR compared with 12 infants without sustained SIR present significantly lower IGF-1, length z-score (LZS), bone mineral content (BMC) and lean mass (LM), and higher GH and fat mass (FM). LZS was associated significantly with PCT, BMC with IGF-1, FM and LM with CRP, GH with bronchopulmonary dysplasia and CRP, and IGF-1 with invasive mechanical ventilation, CRP and PCT. CONCLUSIONS In addition to the known effect on linear growth failure, sustained SIR induces lower bone mass accrual related to higher GH and lower IGF-1 levels in VPI. IMPACT Very preterm infants (VPI) with sustained systemic inflammatory response (SIR) compared with VPI without SIR present stunting, lower bone mass, higher GH and lower IGF-1 levels at term corrected age. SIR may help to explain the influence of non-nutritional factors on growth and body composition in VPI. SIR induces postnatal stunting related to lower bone mass accrual via GH/IGF-1 axis inhibition in VPI. VPI with SIR need special attention to minimize inflammatory stress, which could result in improved postnatal growth. Research on inflammatory-endocrine interactions involved in the pathophysiology of postnatal stunting is needed as a basis for new interventional approaches.
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Affiliation(s)
- Eduardo Cuestas
- Department of Pediatrics and Neonatology, Hospital Privado Universitario de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina.
| | - Macarena Hillman
- Department of Pediatrics and Neonatology, Hospital Privado Universitario de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina
| | - Silvia Galetto
- Department of Pediatrics and Neonatology, Hospital Privado Universitario de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina
| | - María Isabel Gaido
- Department of Clinical Biochemistry, Hospital Privado Universitario de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina
| | - Viviana Sobh
- Department of Radiology, Instituto Conci-Carpinella, Córdoba, Argentina
| | | | - Alina Rizzotti
- Department of Pediatrics and Neonatology, Hospital Privado Universitario de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina
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Using machine learning to impact on long-term clinical care: principles, challenges, and practicalities. Pediatr Res 2023; 93:324-333. [PMID: 35906306 PMCID: PMC9937918 DOI: 10.1038/s41390-022-02194-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/10/2022] [Accepted: 06/22/2022] [Indexed: 11/08/2022]
Abstract
The rise of machine learning in healthcare has significant implications for paediatrics. Long-term conditions with significant disease heterogeneity comprise large portions of the routine work performed by paediatricians. Improving outcomes through discovery of disease and treatment prediction models, alongside novel subgroup clustering of patients, are some of the areas in which machine learning holds significant promise. While artificial intelligence has percolated into routine use in our day to day lives through advertising algorithms, song or movie selections and sifting of spam emails, the ability of machine learning to utilise highly complex and dimensional data has not yet reached its full potential in healthcare. In this review article, we discuss some of the foundations of machine learning, including some of the basic algorithms. We emphasise the importance of correct utilisation of machine learning, including adequate data preparation and external validation. Using nutrition in preterm infants and paediatric inflammatory bowel disease as examples, we discuss the evidence and potential utility of machine learning in paediatrics. Finally, we review some of the future applications, alongside challenges and ethical considerations related to application of artificial intelligence. IMPACT: Machine learning is a widely used term; however, understanding of the process and application to healthcare is lacking. This article uses clinical examples to explore complex machine learning terms and algorithms. We discuss limitations and potential future applications within paediatrics and neonatal medicine.
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O'Shea TM, Register HM, Yi JX, Jensen ET, Joseph RM, Kuban KCK, Frazier JA, Washburn L, Belfort M, South AM, Santos HP, Shenberger J, Perrin EM, Thompson AL, Singh R, Rollins J, Gogcu S, Sanderson K, Wood C, Fry RC. Growth During Infancy After Extremely Preterm Birth: Associations with Later Neurodevelopmental and Health Outcomes. J Pediatr 2023; 252:40-47.e5. [PMID: 35987367 PMCID: PMC10242541 DOI: 10.1016/j.jpeds.2022.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 07/12/2022] [Accepted: 08/11/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate associations between changes in weight, length, and weight/length ratio during infancy and outcomes later in life among individuals born extremely preterm. STUDY DESIGN Among participants in the Extremely Low Gestational Age Newborn (ELGAN) study, we measured weight and length at discharge from the neonatal intensive care unit (NICU) and at age 2 years and evaluated neurocognitive, psychiatric, and health outcomes at age 10 years and 15 years. Using multivariable logistic regression, we estimated associations between gains in weight, length, and weight/length ratio z-scores between discharge and 2 years and outcomes at 10 and 15 years. High gain was defined as the top quintile of change; low gain, as the bottom quintile of change. RESULTS High gains in weight and weight/length were associated with greater odds of obesity at 10 years, but not at 15 years. These associations were found only for females. High gain in length z-score was associated with lower odds of obesity at 15 years. The only association found between high gains in growth measures and more favorable neurocognitive or psychiatric outcomes was between high gain in weight/length and lower odds of cognitive impairment at age 10 years. CONCLUSIONS During the 2 years after NICU discharge, females born extremely preterm with high gains in weight/length or weight have greater odds of obesity at 10 years, but not at 15 years. Infants with high growth gains in the 2 years after NICU discharge have neurocognitive and psychiatric outcomes in middle childhood and adolescence similar to those of infants with lower gains in weight and weight/length.
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Affiliation(s)
- T Michael O'Shea
- Department of Pediatrics, The University of North Carolina, Chapel Hill, NC
| | - Hannah M Register
- Department of Pediatrics, The University of North Carolina, Chapel Hill, NC
| | - Joe X Yi
- Frank Porter Graham Child Development Institute, The University of North Carolina, Chapel Hill, NC
| | - Elizabeth T Jensen
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Robert M Joseph
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA
| | - Karl C K Kuban
- Department of Pediatrics and Neurology, Boston Medical Center, Boston, MA
| | - Jean A Frazier
- Eunice Kennedy Shriver Center and Department of Psychiatry, University of Massachusetts Chan Medical Center, Worcester, MA
| | - Lisa Washburn
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Mandy Belfort
- Department of Pediatric Newborn Medicine, Harvard Medical School, Boston, MA
| | - Andrew M South
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Hudson P Santos
- School of Nursing & Health Studies, University of Miami, Coral Gables, FL
| | - Jeffrey Shenberger
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Eliana M Perrin
- Department of Pediatrics, Johns Hopkins University School of Medicine and Nursing, Baltimore, MD
| | - Amanda L Thompson
- Department of Anthropology, The University of North Carolina, Chapel Hill, NC
| | - Rachana Singh
- Department of Pediatrics, Tufts Children's Hospital, Tufts University School of Medicine, Boston, MA
| | - Julie Rollins
- Department of Pediatrics, The University of North Carolina, Chapel Hill, NC
| | - Semsa Gogcu
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Keia Sanderson
- Department of Internal Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Charles Wood
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Rebecca C Fry
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, NC
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9
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Marino LV, Paulson S, Ashton JJ, Weeks C, Young A, Pappachan JV, Swann J, Johnson MJ, Beattie RM. A Scoping Review: Urinary Markers of Metabolic Maturation in Preterm Infants and Future Interventions to Improve Growth. Nutrients 2022; 14:nu14193957. [PMID: 36235609 PMCID: PMC9571892 DOI: 10.3390/nu14193957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/10/2022] [Accepted: 09/20/2022] [Indexed: 11/21/2022] Open
Abstract
Background: Growth failure in infants born preterm is a significant issue, increasing the risk of poorer neurodevelopmental outcomes and metabolic syndrome later in life. During the first 1000 days of life biological systems mature rapidly involving developmental programming, cellular senescence, and metabolic maturation, regulating normal growth and development. However, little is known about metabolic maturation in infants born preterm and the relationship with growth. Objective: To examine the available evidence on urinary markers of metabolic maturation and their relationship with growth in infants born preterm. Eligibility criteria: Studies including in this scoping review using qualitative or quantitative methods to describe urinary markers of metabolic maturation and the relationship with growth in infants born preterm. Results: After a screening process 15 titles were included in this review, from 1998–2021 drawing from China (n = 1), Italy (n = 3), Germany (n = 3), Greece (n = 1), Japan (n = 2), Norway (n = 1), Portugal (n = 1), Spain (n = 2) and USA (n = 1). The included studies examined urinary metabolites in 1131 infants. A content analysis identified 4 overarching themes relating to; (i) metabolic maturation relative to gestational age, (ii) metabolic signature and changes in urinary metabolites over time, (iii) nutrition and (iv) growth. Conclusion: The results of this scoping review suggest there are considerable gaps in our knowledge relating to factors associated with metabolic instability, what constitutes normal maturation of preterm infants, and how the development of reference phenome age z scores for metabolites of interest could improve nutritional and growth outcomes.
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Affiliation(s)
- Luise V. Marino
- Paediatric Intensive Care Unit, Southampton Children’s Hospital, NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton S016 6YD, UK
- Faculty of Health Science, University of Southampton, Southampton SO17 1BJ, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation, Southampton S016 6YD, UK
- Correspondence: ; Tel.: +44-(0)-23-8079-6000
| | - Simone Paulson
- Paediatric Intensive Care Unit, Southampton Children’s Hospital, NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton S016 6YD, UK
| | - James J. Ashton
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation, Southampton S016 6YD, UK
- Paediatric Gastroenterology, Southampton Children’s Hospital, NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton S016 6YD, UK
- Human Genetics and Genomic Medicine, University of Southampton, Southampton SO17 1BJ, UK
| | - Charlotte Weeks
- Paediatric Intensive Care Unit, Southampton Children’s Hospital, NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton S016 6YD, UK
| | - Aneurin Young
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation, Southampton S016 6YD, UK
- Human Genetics and Genomic Medicine, University of Southampton, Southampton SO17 1BJ, UK
- Department of Neonatal Medicine, Southampton Children’s Hospital, University Hospital Southampton, NHS Foundation Trust, Southampton S016 6YD, UK
| | - John V. Pappachan
- Paediatric Intensive Care Unit, Southampton Children’s Hospital, NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton S016 6YD, UK
- Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK
| | - Jonathan Swann
- Biomolecular Medicine, School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK
| | - Mark J. Johnson
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation, Southampton S016 6YD, UK
- Department of Neonatal Medicine, Southampton Children’s Hospital, University Hospital Southampton, NHS Foundation Trust, Southampton S016 6YD, UK
- Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK
| | - Robert Mark Beattie
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation, Southampton S016 6YD, UK
- Paediatric Gastroenterology, Southampton Children’s Hospital, NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton S016 6YD, UK
- Human Genetics and Genomic Medicine, University of Southampton, Southampton SO17 1BJ, UK
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Biomarker und Neuromonitoring zur Entwicklungsprognose nach perinataler Hirnschädigung. Monatsschr Kinderheilkd 2022; 170:688-703. [PMID: 35909417 PMCID: PMC9309449 DOI: 10.1007/s00112-022-01542-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 11/02/2022]
Abstract
Das sich entwickelnde Gehirn ist in der Perinatalperiode besonders empfindlich für eine Vielzahl von Insulten, wie z. B. Extremfrühgeburtlichkeit und perinatale Asphyxie. Ihre Komplikationen können zu lebenslangen neurokognitiven, sensorischen und psychosozialen Einschränkungen führen; deren Vorhersage bleibt eine Herausforderung. Eine Schlüsselfunktion kommt der möglichst exakten Identifikation von Hirnläsionen und funktionellen Störungen zu. Die Prädiktion stützt sich auf frühe diagnostische Verfahren und die klinische Erfassung der Meilensteine der Entwicklung. Zur klinischen Diagnostik und zum Neuromonitoring in der Neonatal- und frühen Säuglingsperiode stehen bildgebende Verfahren zur Verfügung. Hierzu zählen zerebrale Sonographie, MRT am errechneten Termin, amplitudenintegriertes (a)EEG und/oder klassisches EEG, Nah-Infrarot-Spektroskopie, General Movements Assessment und die frühe klinische Nachuntersuchung z. B. mithilfe der Hammersmith Neonatal/Infant Neurological Examination. Innovative Biomarker und -muster (Omics) sowie (epi)genetische Prädispositionen sind Gegenstand wissenschaftlicher Untersuchungen. Neben der Erfassung klinischer Risiken kommt psychosozialen Faktoren im Umfeld des Kindes eine entscheidende Rolle zu. Eine möglichst akkurate Prognose ist mit hohem Aufwand verbunden, jedoch zur gezielten Beratung der Familien und der Einleitung von frühen Interventionen, insbesondere vor dem Hintergrund der hohen Plastizität des sich entwickelnden Gehirns, von großer Bedeutung. Diese Übersichtsarbeit fokussiert die Charakterisierung der oben genannten Verfahren und ihrer Kombinationsmöglichkeiten. Zudem wird ein Ausblick gegeben, wie innovative Techniken in Zukunft die Prädiktion der Entwicklung und Nachsorge dieser Kinder vereinfachen können.
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