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Gilbreath D, Hagood D, Larson-Prior L. A Systematic Review over the Effect of Early Infant Diet on Neurodevelopment: Insights from Neuroimaging. Nutrients 2024; 16:1703. [PMID: 38892636 PMCID: PMC11174660 DOI: 10.3390/nu16111703] [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: 03/20/2024] [Revised: 04/29/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
The optimization of infant neuronal development through nutrition is an increasingly studied area. While human milk consumption during infancy is thought to give a slight cognitive advantage throughout early childhood in comparison to commercial formula, the biological underpinnings of this process are less well-known and debated in the literature. This systematic review seeks to quantitatively analyze whether early diet affects infant neurodevelopment as measured by various neuroimaging modalities and techniques. Results presented suggest that human milk does have a slight positive impact on the structural development of the infant brain-and that this impact is larger in preterm infants. Other diets with distinct macronutrient compositions were also considered, although these had more conflicting results.
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Affiliation(s)
- Dylan Gilbreath
- Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Science, Little Rock, AR 72207, USA;
- Arkansas Children’s Nutrition Center, Little Rock, AR 72202, USA;
| | - Darcy Hagood
- Arkansas Children’s Nutrition Center, Little Rock, AR 72202, USA;
| | - Linda Larson-Prior
- Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Science, Little Rock, AR 72207, USA;
- Arkansas Children’s Nutrition Center, Little Rock, AR 72202, USA;
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2
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Davidson JR, Omran K, Chong CKL, Eaton S, Edwards AD, Yardley IE. Exploring Growth Failure in Neonates With Enterostomy. J Pediatr Surg 2024; 59:211-215. [PMID: 37940463 DOI: 10.1016/j.jpedsurg.2023.10.010] [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: 09/27/2023] [Accepted: 10/07/2023] [Indexed: 11/10/2023]
Abstract
AIM OF THE STUDY Neonatal enterostomy is a known risk for growth failure. We hypothesized that episodes of inflammation may drive a catabolic state, exploring this by assessing serum biochemistry alongside growth trajectory in enterostomy patients. METHODS A retrospective analysis of infants with histologically confirmed NEC from 01/2012-07/2021 in a tertiary neonatal surgical centre was performed. Change in weight-for-age Z-score (ΔZ) between stoma formation and closure was calculated. Serum CRP (C-reactive protein), urea, and creatinine levels were recorded and duration of elevated levels calculated as Area Under Curve (AUC). We examined for trends of serum levels rising together using intersecting moving averages. Spearman's correlation analysis was performed, while multivariable linear regression examined factors associated with ΔZ. RESULTS 79 neonates were included. At stoma formation, median Z-score was -1.42 [range -4.73, +1.3]. Sixty-two patients (78 %) had a fall in Z-score during their time with a stoma, 16 (20 %) had a ΔZ less than -2. Urea AUC was significantly univariably correlated with ΔZ and remained statistically significant in a multivariable model (Exp(B) x 100 = -0.57[-1, -0.09]; p = 0.022). The number of biomarker peaks correlated significantly with ΔZ for urea (r = -0.25; p = 0.025) and CRP (r = -0.35; p = 0.0017) but not Creatinine (r = -0.21; p = 0.066). Analysing the number of peaks of any combination of variables coinciding was consistently significantly correlated negatively with ΔZ (r = -0.29 to -0.27; p ≤ 0.016 for all). CONCLUSION Our data shows that infants who were more severely affected by growth failure had more frequent and severe uremia while they had a stoma (suggesting a catabolic state). Disturbances in urea were commonly associated with CRP, suggesting that inflammation is a significant factor in growth failure in these infants. These findings promote aggressive management of sepsis in these infants, as well as suggesting an earlier closure of stoma to minimise their "at-risk"' period.
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Affiliation(s)
- Joseph R Davidson
- Department of Paediatric Surgery, Evelina London Children's Hospital, London, UK; Stem Cells and Regenerative Medicine Section, GOS-UCL Institute of Child Health, London, UK; Prenatal Cell and Gene Therapy, Elizabeth Garrett Anderson UCL Institute for Women's Health, London, UK
| | - Kareem Omran
- Department of Neonatology, Evelina London Children's Hospital, London, UK
| | - Clara K L Chong
- Department of Paediatric Surgery, Evelina London Children's Hospital, London, UK
| | - Simon Eaton
- Stem Cells and Regenerative Medicine Section, GOS-UCL Institute of Child Health, London, UK
| | - A David Edwards
- Department of Neonatology, Evelina London Children's Hospital, London, UK; Centre for the Developing Brain, King's College London, London, UK
| | - Iain E Yardley
- Department of Paediatric Surgery, Evelina London Children's Hospital, London, UK; Department of Neonatology, Evelina London Children's Hospital, London, UK.
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Moliner-Calderón E, Verd S, Leiva A, Ginovart G, Moll-McCarthy P, Figueras-Aloy J. The role of human milk feeds on inotrope use in newborn infants with sepsis. Front Pediatr 2023; 11:1172799. [PMID: 37138570 PMCID: PMC10150957 DOI: 10.3389/fped.2023.1172799] [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: 02/23/2023] [Accepted: 03/16/2023] [Indexed: 05/05/2023] Open
Abstract
Background Regarding neonatal hypotension, there is no certainty as to whether inotrope properties are beneficial or whether they may be harmful. However, given that the antioxidant content of human milk plays a compensatory role in neonatal sepsis and that human milk feeding has direct effects in modulating the cardiovascular function of sick neonates, this research hypothesized that human milk feeds might predict lower requirements of vasopressors in the management of neonatal septic shock. Method Between January 2002 and December 2017, all late preterm and full-term infants attending a neonatal intensive care unit, with clinical and laboratory findings of bacterial or viral sepsis, were identified in a retrospective study. During their first month of life, data on feeding type and early clinical characteristics were collected. A multivariable logistic regression model was constructed to determine the impact of human milk on the use of vasoactive drugs in septic newborns. Results 322 newborn infants were eligible to participate in this analysis. Exclusively formula-fed infants were more likely to be delivered via C-section, to have a lower birth weight and a lower 1-minute Apgar score than their counterparts. Human milk-fed newborns had 77% (adjusted OR = 0.231; 95% CI: 0.07-0.75) lower odds of receiving vasopressors than exclusively formula-fed newborns. Conclusion We report that any human milk feeding is associated with a decrease in the need for vasoactive medications in sepsis-affected newborns. This observation encourages us to undertake further research to determine whether human milk feeds mitigate the use of vasopressors in neonates with sepsis.
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Affiliation(s)
| | - Sergio Verd
- Pediatric Unit, La Vileta Surgery, Department of Primary Care, Palma de Mallorca, Spain
- Group of Cell Therapy and Tissue Engineering, Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, Spain
- Correspondence: Sergio Verd
| | - Alfonso Leiva
- Research Unit, Department of Primary Care, Palma de Mallorca, Spain
| | - Gemma Ginovart
- Neonatal Unit, Department of Paediatrics, Germans Trias I Pujol Hospital, Badalona, Spain
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Romberg J, Wilke M, Allgaier C, Nägele T, Engel C, Poets CF, Franz A. MRI-based brain volumes of preterm infants at term: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2022; 107:520-526. [PMID: 35078779 PMCID: PMC9411894 DOI: 10.1136/archdischild-2021-322846] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/30/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND MRI allows a detailed assessment of brain structures in preterm infants, outperforming cranial ultrasound. Neonatal MR-based brain volumes of preterm infants could serve as objective, quantitative and reproducible surrogate parameters of early brain development. To date, there are no reference values for preterm infants' brain volumes at term-equivalent age. OBJECTIVE Systematic review of the literature to determine reference ranges for MRI-based brain volumes of very preterm infants at term-equivalent age. METHODS PubMed Database was searched on 6 April 2020 for studies reporting MR-based brain volumes on representative unselected populations of very preterm and/or very low birthweight infants examined at term equivalent age (defined as 37-42 weeks mean postmenstrual age at MRI). Analyses were limited to volumetric parameters reported in >3 studies. Weighted mean volumes and SD were both calculated and simulated for each parameter. RESULTS An initial 367 publications were identified. Following application of exclusion criteria, 13 studies from eight countries were included for analysis, yielding four parameters. Weighted mean total brain volume was 379 mL (SD 72 mL; based on n=756). Cerebellar volume was 21 mL (6 mL; n=791), cortical grey matter volume 140 mL (47 mL; n=572) and weighted mean volume of unmyelinated white matter was 195 mL (38 mL; n=499). CONCLUSION This meta-analysis reports pooled data on several brain and cerebellar volumes which can serve as reference for future studies assessing MR-based volumetric parameters as a surrogate outcome for neurodevelopment and for the interpretation of individual or cohort MRI-based volumetric findings.
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Affiliation(s)
- Julia Romberg
- Department of Pediatrics, University Hospital Tuebingen, Tuebingen, Germany
| | - Marko Wilke
- Pediatric Neurology & Developmental Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | - Christoph Allgaier
- Department of Pediatrics, Center for Pediatric Clinical Studies, University Hospital Tuebingen, Tuebingen, Germany
| | - Thomas Nägele
- Department of Neuroradiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Corinna Engel
- Department of Pediatrics, Center for Pediatric Clinical Studies, University Hospital Tuebingen, Tuebingen, Germany
| | - Christian F Poets
- Department of Neonatology, University Hospital Tuebingen, Tuebingen, Germany
| | - Axel Franz
- Department of Neonatology, University Hospital Tuebingen, Tuebingen, Germany
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Associations of Macronutrient Intake Determined by Point-of-Care Human Milk Analysis with Brain Development among very Preterm Infants. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9070969. [PMID: 35883953 PMCID: PMC9320519 DOI: 10.3390/children9070969] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/06/2022] [Accepted: 06/28/2022] [Indexed: 11/26/2022]
Abstract
Point-of-care human milk analysis is now feasible in the neonatal intensive care unit (NICU) and allows accurate measurement of macronutrient delivery. Higher macronutrient intakes over this period may promote brain growth and development. In a prospective, observational study of 55 infants born at <32 weeks’ gestation, we used a mid-infrared spectroscopy-based human milk analyzer to measure the macronutrient content in repeated samples of human milk over the NICU hospitalization. We calculated daily nutrient intakes from unfortified milk and assigned infants to quintiles based on median intakes over the hospitalization. Infants underwent brain magnetic resonance imaging at term equivalent age to quantify total and regional brain volumes and fractional anisotropy of white matter tracts. Infants in the highest quintile of energy intake from milk, as compared with the lower four quintiles, had larger total brain volume (31 cc, 95% confidence interval [CI]: 5, 56), cortical gray matter (15 cc, 95%CI: 1, 30), and white matter volume (23 cc, 95%CI: 12, 33). Higher protein intake was associated with larger total brain (36 cc, 95%CI: 7, 65), cortical gray matter (22 cc, 95%CI: 6, 38) and deep gray matter (1 cc, 95%CI: 0.1, 3) volumes. These findings suggest innovative strategies to close nutrient delivery gaps in the NICU may promote brain growth for preterm infants.
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Belfort MB, Inder TE. Human Milk and Preterm Infant Brain Development: A Narrative Review. Clin Ther 2022; 44:612-621. [PMID: 35307209 PMCID: PMC9133155 DOI: 10.1016/j.clinthera.2022.02.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/07/2022] [Accepted: 02/23/2022] [Indexed: 12/18/2022]
Abstract
PURPOSE To review and synthesize the literature on human milk and structural brain development and injury in preterm infants, focusing on the application of quantitative brain magnetic resonance imaging (MRI) in this field. METHODS For this narrative review, we searched PubMed for articles published from 1990 to 2021 that reported observational or interventional studies of maternal milk or donor milk in relation to brain development and/or injury in preterm infants assessed with quantitative MRI at term equivalent age. Studies were characterized with respect to key aspects of study design, milk exposure definition, and MRI outcomes. FINDINGS We identified 7 relevant studies, all of which were observational in design and published between 2013 and 2021. Included preterm infants were born at or below 33 weeks' gestation. Sample sizes ranged from 22 to 377 infants. Exposure to human milk included both maternal and donor milk. No study included a full-term comparison group. Main MRI outcome domains were white matter integrity (assessed with diffusion tensor imaging, resting state functional connectivity, or semiautomated segmentation of white matter abnormality) and total and regional brain volumes. Studies revealed that greater exposure to human milk versus formula was associated with favorable outcomes, including more mature and connected cerebral white matter with less injury and larger regional brain volumes, notably in the deep nuclear gray matter, amygdala-hippocampus, and cerebellum. No consistent signature effect of human milk exposure was found; instead, the beneficial associations were regional and tissue-specific neuroprotective effects on the areas of known vulnerability in the preterm infant. IMPLICATIONS Evidence to date suggests that human milk may protect the preterm infant from the white matter injury and dysmaturation to which this population is vulnerable. Brain MRI at term equivalent age is emerging as a useful tool to investigate the effects of human milk on the preterm brain. When grounded in neurobiological knowledge about preterm brain injury and development, this approach holds promise for allowing further insight into the mechanisms and pathways underlying beneficial associations of human milk with neurodevelopmental outcomes in this population and in the investigation of specific milk bioactive components with neuroprotective or neurorestorative potential.
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Binder C, Buchmayer J, Thajer A, Giordano V, Schmidbauer V, Harreiter K, Klebermass-Schrehof K, Berger A, Goeral K. Association between Fat-Free Mass and Brain Size in Extremely Preterm Infants. Nutrients 2021; 13:nu13124205. [PMID: 34959757 PMCID: PMC8708955 DOI: 10.3390/nu13124205] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/20/2021] [Accepted: 11/22/2021] [Indexed: 11/16/2022] Open
Abstract
Postnatal growth restriction and deficits in fat-free mass are associated with impaired neurodevelopment. The optimal body composition to support normal brain growth and development remains unclear. This study investigated the association between body composition and brain size in preterm infants. We included 118 infants born <28 weeks of gestation between 2017–2021, who underwent body composition (fat-free mass (FFM) and fat mass (FM)) and cerebral magnetic resonance imaging to quantify brain size (cerebral biparietal diameter (cBPD), bone biparietal diameter (bBPD), interhemispheric distance (IHD), transverse cerebellar diameter (tCD)) at term-equivalent age. FFM Z-Score significantly correlated with higher cBPD Z-Score (rs = 0.69; p < 0.001), bBPD Z-Score (rs = 0.48; p < 0.001) and tCD Z-Score (rs = 0.30; p = 0.002); FM Z-Score significantly correlated with lower brain size (cBPD Z-Score (rs = −0.32; p < 0.001) and bBPD Z-Score (rs = −0.42; p < 0.001). In contrast weight (rs = 0.08), length (rs = −0.01) and head circumference Z-Score (rs = 0.14) did not. Linear regression model adjusted for important neonatal variables revealed that FFM Z-Score was independently and significantly associated with higher cBPD Z-Score (median 0.50, 95% CI: 0.59, 0.43; p < 0.001) and bBPD Z-Score (median 0.31, 95% CI: 0.42, 0.19; p < 0.001); FM Z-Score was independently and significantly associated with lower cBPD Z-Score (median −0.27, 95% CI: −0.42, −0.11; p < 0.001) and bBPD Z-Score (median −0.32, 95% CI: −0.45, −0.18; p < 0.001). Higher FFM Z-Score and lower FM Z-scores were significantly associated with larger brain size at term-equivalent age. These results indicate that early body composition might be a useful tool to evaluate and eventually optimize brain growth and neurodevelopment.
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Affiliation(s)
- Christoph Binder
- Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Intensive Care and Neuropediatrics, Medical University of Vienna, 1090 Vienna, Austria; (J.B.); (A.T.); (V.G.); (K.H.); (K.K.-S.); (A.B.); (K.G.)
- Correspondence: ; Tel.: +43-1-40400-67400
| | - Julia Buchmayer
- Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Intensive Care and Neuropediatrics, Medical University of Vienna, 1090 Vienna, Austria; (J.B.); (A.T.); (V.G.); (K.H.); (K.K.-S.); (A.B.); (K.G.)
| | - Alexandra Thajer
- Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Intensive Care and Neuropediatrics, Medical University of Vienna, 1090 Vienna, Austria; (J.B.); (A.T.); (V.G.); (K.H.); (K.K.-S.); (A.B.); (K.G.)
| | - Vito Giordano
- Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Intensive Care and Neuropediatrics, Medical University of Vienna, 1090 Vienna, Austria; (J.B.); (A.T.); (V.G.); (K.H.); (K.K.-S.); (A.B.); (K.G.)
| | - Victor Schmidbauer
- Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Karin Harreiter
- Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Intensive Care and Neuropediatrics, Medical University of Vienna, 1090 Vienna, Austria; (J.B.); (A.T.); (V.G.); (K.H.); (K.K.-S.); (A.B.); (K.G.)
| | - Katrin Klebermass-Schrehof
- Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Intensive Care and Neuropediatrics, Medical University of Vienna, 1090 Vienna, Austria; (J.B.); (A.T.); (V.G.); (K.H.); (K.K.-S.); (A.B.); (K.G.)
| | - Angelika Berger
- Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Intensive Care and Neuropediatrics, Medical University of Vienna, 1090 Vienna, Austria; (J.B.); (A.T.); (V.G.); (K.H.); (K.K.-S.); (A.B.); (K.G.)
| | - Katharina Goeral
- Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Intensive Care and Neuropediatrics, Medical University of Vienna, 1090 Vienna, Austria; (J.B.); (A.T.); (V.G.); (K.H.); (K.K.-S.); (A.B.); (K.G.)
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Rozé JC, Morel B, Lapillonne A, Marret S, Guellec I, Darmaun D, Bednarek N, Moyon T, Marchand-Martin L, Benhammou V, Pierrat V, Flamant C, Gascoin G, Mitanchez D, Cambonie G, Storme L, Tosello B, Biran V, Claris O, Picaud JC, Favrais G, Beuchée A, Loron G, Gire C, Durrmeyer X, Gressens P, Saliba E, Ancel PY. Association Between Early Amino Acid Intake and Full-Scale IQ at Age 5 Years Among Infants Born at Less Than 30 Weeks' Gestation. JAMA Netw Open 2021; 4:e2135452. [PMID: 34846527 PMCID: PMC8634058 DOI: 10.1001/jamanetworkopen.2021.35452] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
IMPORTANCE An international expert committee recently revised its recommendations on amino acid intake for very preterm infants, suggesting that more than 3.50 g/kg/d should be administered only to preterm infants in clinical trials. However, the optimal amino acid intake during the first week after birth in these infants is unknown. OBJECTIVE To evaluate the association between early amino acid intake and cognitive outcomes at age 5 years. DESIGN, SETTING, AND PARTICIPANTS Using the EPIPAGE-2 (Epidemiologic Study on Small-for-Gestational-Age Children-Follow-up at Five and a Half Years) cohort, a nationwide prospective population-based cohort study conducted at 63 neonatal intensive care units in France, a propensity score-matched analysis was performed comparing infants born at less than 30 weeks' gestation who had high amino acid intake (3.51-4.50 g/kg/d) at 7 days after birth with infants who did not. Participants were recruited between April 1 and December 31, 2011, and followed up from September 1, 2016, to December 31, 2017. Full-scale IQ (FSIQ) was assessed at age 5 years. A confirmatory analysis used neonatal intensive care unit preference for high early amino acid intake as an instrumental variable to account for unmeasured confounding. Statistical analysis was performed from January 15 to May 15, 2021. EXPOSURES Amino acid intake at 7 days after birth. MAIN OUTCOMES AND MEASURES The primary outcome was an FSIQ score greater than -1 SD (ie, ≥93 points) at age 5 years. A complementary analysis was performed to explore the association between amino acid intake at day 7 as a continuous variable and FSIQ score at age 5 years. Data from cerebral magnetic resonance imaging at term were available for a subgroup of preterm infants who participated in the EPIRMEX (Cerebral Abnormalities Detected by MRI, Realized at the Age of Term and the Emergence of Executive Functions) ancillary study. RESULTS Among 1789 preterm infants (929 boys [51.9%]; mean [SD] gestational age, 27.17 [1.50] weeks) with data available to determine exposure to amino acid intake of 3.51 to 4.50 g/kg/d at 7 days after birth, 938 infants were exposed, and 851 infants were not; 717 infants from each group could be paired. The primary outcome was known in 396 of 646 exposed infants and 379 of 644 nonexposed infants who were alive at age 5 years and was observed more frequently among exposed vs nonexposed infants (243 infants [61.4%] vs 206 infants [54.4%], respectively; odds ratio [OR], 1.33 [95% CI, 1.00-1.71]; absolute risk increase in events [ie, the likelihood of having an FSIQ score >-1 SD at age 5 years] per 100 infants, 7.01 [95% CI, 0.06-13.87]; P = .048). In the matched cohort, correlation was found between amino acid intake per 1.00 g/kg/d at day 7 and FSIQ score at age 5 years (n = 775; β = 2.43 per 1-point increase in FSIQ; 95% CI, 0.27-4.59; P = .03), white matter area (n = 134; β = 144 per mm2; 95% CI, 3-285 per mm2; P = .045), anisotropy of the corpus callosum (n = 50; β = 0.018; 95% CI, 0.016-0.021; P < .001), left superior longitudinal fasciculus (n = 42; β = 0.018; 95% CI, 0.010-0.025; P < .001), and right superior longitudinal fasciculus (n = 42; β = 0.014 [95% CI, 0.005-0.024; P = .003) based on magnetic resonance imaging at term. Confirmatory and sensitivity analyses confirmed these results. For example, the adjusted OR for the association between the exposure and the primary outcome was 1.30 (95% CI, 1.16-1.46) using the instrumental variable approach among 978 participants in the overall cohort, and the adjusted OR was 1.35 (95% CI, 1.05-1.75) using multiple imputations among 1290 participants in the matched cohort. CONCLUSIONS AND RELEVANCE In this cohort study, high amino acid intake at 7 days after birth was associated with an increased likelihood of an FSIQ score greater than -1 SD at age 5 years. Well-designed randomized studies with long-term follow-up are needed to confirm the benefit of this nutritional approach.
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Affiliation(s)
- Jean-Christophe Rozé
- Department of Neonatal Medicine, Nantes University Hospital, Nantes, France
- Epidémiologie Clinique, Centre d’Investigation Clinique, Nantes University Hospital, Institut National de la Santé et de la Recherche Médicale (INSERM), Nantes, France
- Unité Mixte de Recherche (UMR) 1280, Physiologie des Adaptations Nutritionnelles, Nantes University, Institut National de la Recherche Agronomique (INRAE), Nantes, France
| | - Baptiste Morel
- UMR 1253, iBrain, Tours University, INSERM, Tours, France
| | - Alexandre Lapillonne
- Department of Neonatal Medicine, Assistance Publique Hopitaux de Paris, Necker Enfants Malades Hospital, Paris, France
| | - Stéphane Marret
- Department of Neonatal Medicine, Rouen University Hospital, Rouen, France
| | - Isabelle Guellec
- Department of Neonatal Medicine, Assistance Publique Hopitaux de Paris, Trousseau Hospital, Paris, France
| | - Dominique Darmaun
- Unité Mixte de Recherche (UMR) 1280, Physiologie des Adaptations Nutritionnelles, Nantes University, Institut National de la Recherche Agronomique (INRAE), Nantes, France
| | - Nathalie Bednarek
- EA 3804, Department of Neonatal Medicine, Reims University Hospital, Champagne-Ardennes University, Reims, France
| | - Thomas Moyon
- Unité Mixte de Recherche (UMR) 1280, Physiologie des Adaptations Nutritionnelles, Nantes University, Institut National de la Recherche Agronomique (INRAE), Nantes, France
| | - Laetitia Marchand-Martin
- Obstetrical Perinatal and Pediatric Epidemiology Research Team, U1153 Epidemiology and Biostatistics Sorbonne, University of Paris, INSERM, Paris, France
| | - Valérie Benhammou
- Obstetrical Perinatal and Pediatric Epidemiology Research Team, U1153 Epidemiology and Biostatistics Sorbonne, University of Paris, INSERM, Paris, France
| | - Véronique Pierrat
- Obstetrical Perinatal and Pediatric Epidemiology Research Team, U1153 Epidemiology and Biostatistics Sorbonne, University of Paris, INSERM, Paris, France
- Department of Neonatal Medicine, Jeanne de Flandre Hospital, Lille University Hospital, Lille, France
| | - Cyril Flamant
- Department of Neonatal Medicine, Nantes University Hospital, Nantes, France
- Epidémiologie Clinique, Centre d’Investigation Clinique, Nantes University Hospital, Institut National de la Santé et de la Recherche Médicale (INSERM), Nantes, France
| | - Géraldine Gascoin
- Department of Neonatal Medicine, Angers University Hospital, Angers, France
| | - Delphine Mitanchez
- Department of Neonatal Medicine, Tours University Hospital, Tours, France
| | - Gilles Cambonie
- Department of Neonatal Medicine, Montpellier University Hospital, Montpellier, France
| | - Laurent Storme
- Department of Neonatal Medicine, Jeanne de Flandre Hospital, Lille University Hospital, Lille, France
| | - Bathélémie Tosello
- Department of Neonatology, Assistance Publique Hopitaux de Marseille, Aix-Marseille Universite, Marseille, France
| | - Valérie Biran
- Department of Neonatology, University of Paris, Robert-Debre Hospital, Assistance Publique Hopitaux de Paris, Paris, France
| | - Olivier Claris
- Department of Neonatology, Hospices Civils de Lyon, Lyon, France
| | | | | | - Alain Beuchée
- Department of Neonatology, Rennes University Hospital, Rennes, France
| | - Gauthier Loron
- EA 3804, Department of Neonatal Medicine, Reims University Hospital, Champagne-Ardennes University, Reims, France
| | - Catherine Gire
- Department of Neonatal Medicine, Montpellier University Hospital, Montpellier, France
| | - Xavier Durrmeyer
- Department of Neonatology, Centre Inter-Communal de Créteil, Créteil, France
| | - Pierre Gressens
- NeuroDiderot, Robert-Debré Hospital, University of Paris, INSERM, Paris, France
| | - Elie Saliba
- UMR 1253, iBrain, Tours University, INSERM, Tours, France
| | - Pierre-Yves Ancel
- Obstetrical Perinatal and Pediatric Epidemiology Research Team, U1153 Epidemiology and Biostatistics Sorbonne, University of Paris, INSERM, Paris, France
- Clinical Investigation Centre P1419, Assistance Publique-Hôpitaux de Paris, Paris, France
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El-Khuffash A, Lewandowski AJ, Jain A, Hamvas A, Singh GK, Levy PT. Cardiac Performance in the First Year of Age Among Preterm Infants Fed Maternal Breast Milk. JAMA Netw Open 2021; 4:e2121206. [PMID: 34448867 PMCID: PMC8397926 DOI: 10.1001/jamanetworkopen.2021.21206] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE There is a beneficial association between human breast milk exposure in the neonatal period and cardiac mechanics in adults who were born preterm. It is unknown whether this benefit is apparent in infants in the first year of age. OBJECTIVE To test the hypothesis that higher consumption of mother's own milk in preterm infants is associated with enhanced cardiac performance during the first year of age. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study of cardiac and nutritional data at an academic medical center included 80 individuals born preterm and 100 individuals in the control group born full-term. All births were between 2011 and 2013. Two-dimensional echocardiograms were performed at 32 weeks' and 36 weeks' postmenstrual age and at 1 year's corrected age in individuals born preterm and at 1 month and 1 year of age in individuals born full-term. Statistical analysis was performed from January to May 2021. EXPOSURES Consumption of mother's own milk. MAIN OUTCOMES AND MEASURES Main study outcomes included echocardiography measures of right and left ventricle longitudinal strain (function), left ventricle mass index and right ventricular areas (morphology), and pulmonary vascular resistance (pulmonary hemodynamics) at age 1 year. RESULTS Of 180 infants included in the study, 97 (54%) were Black infants and 89 (49%) were female infants. Among the 80 infants born in the preterm cohort, 43 (54%) were female infants and 43 (54%) were Black infants. The median gestational age at birth of the preterm infants was 27.0 weeks (interquartile range, 26.0-28.0 weeks) and the median birth weight was 960 g (interquartile range, 800-1138). For each week of exposure to mother's own milk, preterm infants had greater magnitudes of right ventricular strain (eg, right longitudinal strain: β, 0.021; 95% CI, 0.002-0.041; P < .001) and left ventricular strain (eg, left longitudinal strain: β, 0.065; 95% CI, 0.049-0.080; P = .01), larger right ventricle areas (eg, systolic area: β, 0.026; 95% CI, 0.011-0.042; P = .009), larger left ventricle mass index (β, 0.045; 95% CI, 0.024-0.073; P = .003), and decreased pulmonary vascular resistance (eg, pulmonary artery acceleration time: β, 0.041; 95% CI, 0.018-0.063; P < .001) at 1 year's corrected age, even after accounting for gestational age and common neonatal morbidities. Cardiac values approached those seen in controls born full-term with increased mother's own milk exposure. There were no differences in any of the cardiac indices at 32 weeks' postmenstrual age, but with each week of exposure, right ventricle function (eg, right longitudinal strain: β, 0.016; 95% CI, 0.002-0.031; P < .001) was greater and pulmonary pressured (eg, pulmonary artery acceleration time: β, 0.0032; 95% CI, 0.0013-0.0062; P < .001). CONCLUSIONS AND RELEVANCE This study found that preterm infants with higher consumption of mother's own milk had enhanced cardiac performance at age 1 year, suggesting that mother's own milk consumption may play a dynamic modulator role on cardiac mechanics in preterm-born infants and help in normalization of the preterm cardiac phenotype.
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Affiliation(s)
- Afif El-Khuffash
- Department of Neonatology, The Rotunda Hospital and School of Medicine (Pediatrics), Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Adam J Lewandowski
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe, Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Amish Jain
- Department of Paediatrics, University of Toronto and Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Aaron Hamvas
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Gautam K Singh
- Department of Pediatrics, Washington University School of Medicine, Saint Louis, Missouri
- Department of Pediatrics, Central Michigan University School of Medicine, Children's Hospital of Michigan, Detroit
| | - Philip T Levy
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts
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10
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Ottolini KM, Andescavage N, Limperopoulos C. Lipid Intake and Neurodevelopment in Preterm Infants. Neoreviews 2021; 22:e370-e381. [PMID: 34074642 DOI: 10.1542/neo.22-6-e370] [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: 01/05/2023]
Abstract
Preterm infants are born before the critical period of lipid accretion and brain development that occurs during the third trimester of pregnancy. Dietary lipids serve as an important source of energy and are involved in complex processes that are essential for normal central nervous system development. In addition to traditional neurodevelopmental testing, novel quantitative magnetic resonance imaging (MRI) techniques are now available to evaluate the impact of nutritional interventions on early preterm brain development. Trials of long-chain polyunsaturated fatty acid supplementation have yielded inconsistent effects on neurodevelopmental outcomes and quantitative MRI findings. Recent studies using quantitative MRI suggest a positive impact of early lipid intake on brain volumes and white matter microstructural organization by term-equivalent age.
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Affiliation(s)
- Katherine M Ottolini
- Department of Pediatrics, Division of Neonatology, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Nickie Andescavage
- Department of Neonatology and.,Developing Brain Research Laboratory, Children's National Hospital, Washington, DC
| | - Catherine Limperopoulos
- Developing Brain Research Laboratory, Children's National Hospital, Washington, DC.,Departments of Pediatrics and Radiology, George Washington University School of Medicine, Washington, DC
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11
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Paviotti G, De Cunto A, Travan L, Bua J, Miron T, Cont G, Demarini S. Change in body composition of premature infants from parenteral nutrition discontinuation to term equivalent age. Early Hum Dev 2020; 151:105163. [PMID: 32905898 DOI: 10.1016/j.earlhumdev.2020.105163] [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: 05/07/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 10/23/2022]
Abstract
AIM To compare body composition (BC) of premature infants at parenteral nutrition (PN) suspension and at term equivalent age (TEA). METHODS Body weight, fat mass (FM), fat free mass (FFM) and FM as % of body weight were measured in infants born at <32 gestational weeks by air-displacement plethysmography at PN suspension and at TEA in a tertiary level hospital. Z-scores were calculated for BC and anthropometric measurements. Nutritional and clinical data were obtained during hospital stay. BC, weight and length were measured at birth in a sample of infants born at term for comparison. RESULTS Thirty premature infants with birth weight of 1198 ± 270 g and gestational age of 29.8 ± 1.8 weeks were included. At PN suspension, at 32.6 ± 1.6 postconceptional weeks, FFM z-score was similar to FFM z-score measured at TEA, at 39.8 ± 0.7 postconceptional weeks (-1.43 ± 1.27 vs -1.78 ± 1.64, p = 0.26), while FM z-score and %FM z-score at PN suspension were lower than those measured at TEA (FM z-score: 0.23 ± 0.62 versus 2.04 ± 1.00, p < 0.0001 and %FM z-score: 0.66 ± 0.76 versus 2.08 ± 1.07, p < 0.0001). At TEA, weight and length of premature infants were similar to those of term-born infants (3130 ± 340 g vs 3350 ± 340 g; 49.2 ± 2.4 cm vs 50.2 ± 2.5 cm, respectively), but %FM was higher (21.3 ± 4.2% vs 9.2 ± 4.4%, p < 0.001); higher exclusive enteral caloric and protein intakes were associated with a decrease in FM z-scores from PN suspension to TEA. CONCLUSION In our sample of premature infants, fat free mass z-score was similar, while fat mass and % fat mass z-scores increased substantially from parenteral nutrition suspension to term-equivalent age. Nutritional intakes during exclusive enteral nutrition did not seem to contribute to such increase.
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Affiliation(s)
- Giulia Paviotti
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy.
| | - Angela De Cunto
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Laura Travan
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Jenny Bua
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Tatiana Miron
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Gabriele Cont
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Sergio Demarini
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
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12
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Ottolini KM, Andescavage N, Keller S, Limperopoulos C. Nutrition and the developing brain: the road to optimizing early neurodevelopment: a systematic review. Pediatr Res 2020; 87:194-201. [PMID: 31349359 PMCID: PMC7374795 DOI: 10.1038/s41390-019-0508-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/02/2019] [Accepted: 07/08/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Neonatal intensive care practices have resulted in marked improvements in the survival of premature infants; however, they remain at significant risk for adverse neurodevelopmental outcomes. The impact of current nutritional practices on brain development following early extra-uterine exposure in premature infants is not well known. METHODS We performed a systematic review to investigate nutritional effects on postnatal brain development in healthy term and prematurely born infants utilizing advanced magnetic resonance imaging tools. RESULTS Systematic screen yielded 595 studies for appraisal. Of these, 22 total studies were selected for inclusion in the review, with findings summarized in a qualitative, descriptive fashion. CONCLUSION Fat and energy intake are associated with improved brain volume and development in premature infants. While breast milk intake and long-chain polyunsaturated fatty acid supplementation has been proven beneficial in term infants, the impact in preterm infants is less well understood.
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Affiliation(s)
- Katherine M. Ottolini
- Department of Neonatology, 18th Medical Operations Squadron, Kadena AB, Okinawa, Japan
| | - Nickie Andescavage
- Division of Neonatology, Children’s National Health System, 111 Michigan Avenue NW, Washington, DC 20010, USA,Department of Pediatrics, George Washington University School of Medicine, 2300 Eye Street NW, Washington, DC 20037, USA
| | - Susan Keller
- Department of Nursing Science Professional Practice and Quality, Children’s National Health System, 111 Michigan Avenue NW, Washington, DC 20010, USA
| | - Catherine Limperopoulos
- Department of Pediatrics, George Washington University School of Medicine, 2300 Eye Street NW, Washington, DC, 20037, USA. .,Division of Diagnostic Imaging and Radiology, Children's National Health System, 111 Michigan Avenue NW, Washington, DC, 20010, USA. .,Department of Radiology, George Washington University School of Medicine, 2300 Eye Street NW, Washington, DC, 20037, USA.
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13
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Valentine CJ. Nutrition and the developing brain. Pediatr Res 2020; 87:190-191. [PMID: 31673115 DOI: 10.1038/s41390-019-0650-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Christina J Valentine
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Medical Sciences Building, Room 4407 231 Albert Sabin Way, Cincinnati, OH, 45267 0526, USA.
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14
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Bell KA, Matthews LG, Cherkerzian S, Palmer C, Drouin K, Pepin HL, Ellard D, Inder TE, Ramel SE, Belfort MB. Associations of Growth and Body Composition with Brain Size in Preterm Infants. J Pediatr 2019; 214:20-26.e2. [PMID: 31377040 PMCID: PMC9131302 DOI: 10.1016/j.jpeds.2019.06.062] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/08/2019] [Accepted: 06/25/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To assess the association of very preterm infants' brain size at term-equivalent age with physical growth from birth to term and body composition at term. STUDY DESIGN We studied 62 infants born at <33 weeks of gestation. At birth and term, we measured weight and length and calculated body mass index. At term, infants underwent air displacement plethysmography to determine body composition (fat and fat-free mass) and magnetic resonance imaging to quantify brain size (bifrontal diameter, biparietal diameter, transverse cerebellar distance). We estimated associations of physical growth (Z-score change from birth to term) and body composition with brain size, adjusting for potential confounders using generalized estimating equations. RESULTS The median gestational age was 29 weeks (range, 24.0-32.9 weeks). Positive gains in weight and body mass index Z-score were associated with increased brain size. Each additional 100 g of fat-free mass at term was associated with larger bifrontal diameter (0.6 mm; 95% CI, 0.2-1.0 mm), biparietal diameter (0.7 mm; 95% CI, 0.3-1.1 mm), and transverse cerebellar distance (0.3 mm; 95% CI, 0.003-0.5 mm). Associations between fat mass and brain metrics were not statistically significant. CONCLUSIONS Weight and body mass index gain from birth to term, and lean mass-but not fat-at term, were associated with larger brain size. Factors that promote lean mass accrual among preterm infants may also promote brain growth.
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Affiliation(s)
- Katherine A Bell
- Department of Pediatric Newborn Medicine, Brigham & Women's Hospital, Boston, MA.
| | - Lillian G Matthews
- Department of Pediatric Newborn Medicine, Brigham & Women's Hospital, Boston, MA
| | - Sara Cherkerzian
- Department of Pediatric Newborn Medicine, Brigham & Women's Hospital, Boston, MA
| | - Caroline Palmer
- Department of Pediatric Newborn Medicine, Brigham & Women's Hospital, Boston, MA
| | - Kaitlin Drouin
- Department of Pediatric Newborn Medicine, Brigham & Women's Hospital, Boston, MA
| | - Hunter L Pepin
- Department of Nutrition, Brigham & Women's Hospital, Boston, MA
| | - Deirdre Ellard
- Department of Nutrition, Brigham & Women's Hospital, Boston, MA
| | - Terrie E Inder
- Department of Pediatric Newborn Medicine, Brigham & Women's Hospital, Boston, MA
| | - Sara E Ramel
- Division of Neonatology, School of Medicine, University of Minnesota, Minneapolis, MN
| | - Mandy B Belfort
- Department of Pediatric Newborn Medicine, Brigham & Women's Hospital, Boston, MA
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15
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Cormack BE, Harding JE, Miller SP, Bloomfield FH. The Influence of Early Nutrition on Brain Growth and Neurodevelopment in Extremely Preterm Babies: A Narrative Review. Nutrients 2019; 11:E2029. [PMID: 31480225 PMCID: PMC6770288 DOI: 10.3390/nu11092029] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 08/22/2019] [Accepted: 08/27/2019] [Indexed: 12/29/2022] Open
Abstract
Extremely preterm babies are at increased risk of less than optimal neurodevelopment compared with their term-born counterparts. Optimising nutrition is a promising avenue to mitigate the adverse neurodevelopmental consequences of preterm birth. In this narrative review, we summarize current knowledge on how nutrition, and in particular, protein intake, affects neurodevelopment in extremely preterm babies. Observational studies consistently report that higher intravenous and enteral protein intakes are associated with improved growth and possibly neurodevelopment, but differences in methodologies and combinations of intravenous and enteral nutrition strategies make it difficult to determine the effects of each intervention. Unfortunately, there are few randomized controlled trials of nutrition in this population conducted to determine neurodevelopmental outcomes. Substantial variation in reporting of trials, both of nutritional intakes and of outcomes, limits conclusions from meta-analyses. Future studies to determine the effects of nutritional intakes in extremely preterm babies need to be adequately powered to assess neurodevelopmental outcomes separately in boys and girls, and designed to address the many potential confounders which may have clouded research findings to date. The development of minimal reporting sets and core outcome sets for nutrition research will aid future meta-analyses.
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Affiliation(s)
- Barbara E Cormack
- Starship Child Health, Auckland City Hospital, Auckland 1023, New Zealand
- Liggins Institute, University of Auckland, Auckland 1142, New Zealand
| | - Jane E Harding
- Liggins Institute, University of Auckland, Auckland 1142, New Zealand
| | - Steven P Miller
- Department of Paediatrics, Hospital for Sick Children, Toronto, ON M5G, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON M5S, Canada
| | - Frank H Bloomfield
- Starship Child Health, Auckland City Hospital, Auckland 1023, New Zealand.
- Liggins Institute, University of Auckland, Auckland 1142, New Zealand.
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16
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Measuring body composition in the preterm infant: Evidence base and practicalities. Clin Nutr 2019; 38:2521-2530. [PMID: 30737045 DOI: 10.1016/j.clnu.2018.12.033] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/08/2018] [Accepted: 12/28/2018] [Indexed: 12/15/2022]
Abstract
Preterm birth and body composition have demonstrable effects on growth and later health outcomes. Preterm infants reach term equivalent age with a lower proportion of lean mass and higher body fat percentage than their term equivalent counterparts. Weight and length do not give an accurate assessment of body composition. Tracking body composition rather than just weight is a fundamental part of improving nutritional outcomes. This is important given the ongoing controversies regarding the nutritional needs of preterm infants, as well as establishing suitable targets for their growth. In this review we describe current methodologies used in the measurement of body composition of the preterm infant and the review the recent published evidence for their accuracy and utility. Current measurement techniques employed include air displacement plethysmography, bioelectrical impedance analysis, isotope dilution techniques, MRI and a combination of manual measurements including skinfold thickness, body mass index and mid upper arm/mid-thigh circumference. These measures allow for the estimation of fat mass, fat-free mass and regional assessment of adiposity. Some methods, such as dual-energy X-ray absorptiometry and air displacement plethysmography do allow for comparison of change in body composition over time in cohorts of preterm infants that may be studied over a longer period of time and into adult life. However, none of the currently described methods give an accurate and practically achievable method of obtaining body composition measures in preterm infants in day to day routine clinical practise, although this remains a key priority when decisions are being made about how best to feed.
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17
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Williamson W, Lewandowski AJ, Forkert ND, Griffanti L, Okell TW, Betts J, Boardman H, Siepmann T, McKean D, Huckstep O, Francis JM, Neubauer S, Phellan R, Jenkinson M, Doherty A, Dawes H, Frangou E, Malamateniou C, Foster C, Leeson P. Association of Cardiovascular Risk Factors With MRI Indices of Cerebrovascular Structure and Function and White Matter Hyperintensities in Young Adults. JAMA 2018; 320:665-673. [PMID: 30140877 PMCID: PMC6142949 DOI: 10.1001/jama.2018.11498] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 07/22/2018] [Indexed: 12/28/2022]
Abstract
Importance Risk of stroke and brain atrophy in later life relate to levels of cardiovascular risk in early adulthood. However, it is unknown whether cerebrovascular changes are present in young adults. Objective To examine relationships between modifiable cardiovascular risk factors and cerebrovascular structure, function, and white matter integrity in young adults. Design, Setting, and Participants A cross-sectional observational study of 125 young adults (aged 18-40 years) without clinical evidence of cerebrovascular disease. Data collection was completed between August 2014 and May 2016 at the University of Oxford, United Kingdom. Final data collection was completed on May 31, 2016. Exposures The number of modifiable cardiovascular risk factors at recommended levels, based on the following criteria: body mass index (BMI) <25; highest tertile of cardiovascular fitness and/or physical activity; alcohol consumption <8 drinks/week; nonsmoker for >6 months; blood pressure on awake ambulatory monitoring <130/80 mm Hg; a nonhypertensive diastolic response to exercise (peak diastolic blood pressure <90 mm Hg); total cholesterol <200 mg/dL; and fasting glucose <100mg/dL. Each risk factor at the recommended level was assigned a value of 1, and participants were categorized from 0-8, according to the number of risk factors at recommended levels, with higher numbers indicating healthier risk categories. Main Outcomes and Measures Cerebral vessel density, caliber and tortuosity, brain white matter hyperintensity lesion count. In a subgroup (n = 52), brain blood arrival time and cerebral blood flow assessed by brain magnetic resonance imaging (MRI). Results A total of 125 participants, mean (SD) age 25 (5) years, 49% women, with a mean (SD) score of 6.0 (1.4) modifiable cardiovascular risk factors at recommended levels, completed the cardiovascular risk assessment and brain MRI protocol. Cardiovascular risk factors were correlated with cerebrovascular morphology and white matter hyperintensity count in multivariable models. For each additional modifiable risk factor categorized as healthy, vessel density was greater by 0.3 vessels/cm3 (95% CI, 0.1-0.5; P = .003), vessel caliber was greater by 8 μm (95% CI, 3-13; P = .01), and white matter hyperintensity lesions were fewer by 1.6 lesions (95% CI, -3.0 to -0.5; P = .006). Among the 52 participants with available data, cerebral blood flow varied with vessel density and was 2.5 mL/100 g/min higher for each healthier category of a modifiable risk factor (95% CI, 0.16-4.89; P = .03). Conclusions and Relevance In this preliminary study involving young adults without clinical evidence of cerebrovascular disease, a greater number of modifiable cardiovascular risk factors at recommended levels was associated with higher cerebral vessel density and caliber, higher cerebral blood flow, and fewer white matter hyperintensities. Further research is needed to verify these findings and determine their clinical importance.
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Affiliation(s)
- Wilby Williamson
- Oxford Cardiovascular Clinical Research Facility, University of Oxford, Oxford, United Kingdom
| | - Adam J. Lewandowski
- Oxford Cardiovascular Clinical Research Facility, University of Oxford, Oxford, United Kingdom
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Nils D. Forkert
- Department of Radiology and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Ludovica Griffanti
- Wellcome Centre for Integrative Neuroimaging, FMRIB Division, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Thomas W. Okell
- Wellcome Centre for Integrative Neuroimaging, FMRIB Division, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Jill Betts
- Oxford Cardiovascular Clinical Research Facility, University of Oxford, Oxford, United Kingdom
| | - Henry Boardman
- Oxford Cardiovascular Clinical Research Facility, University of Oxford, Oxford, United Kingdom
| | - Timo Siepmann
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - David McKean
- Department of Radiology, Stoke Mandeville Hospital, Buckinghamshire NHS Trust, Buckinghamshire, England, United Kingdom
| | - Odaro Huckstep
- Oxford Cardiovascular Clinical Research Facility, University of Oxford, Oxford, United Kingdom
| | - Jane M. Francis
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Renzo Phellan
- Department of Radiology and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Mark Jenkinson
- Wellcome Centre for Integrative Neuroimaging, FMRIB Division, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Aiden Doherty
- Nuffield Department of Population Health, BHF Centre of Research Excellence and Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
| | - Helen Dawes
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, Oxford, United Kingdom
| | - Eleni Frangou
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Christina Malamateniou
- School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom
- Department of Family Care and Mental Health, University of Greenwich, London, United Kingdom
| | - Charlie Foster
- School of Policy Studies, University of Bristol, Bristol, United Kingdom
| | - Paul Leeson
- Oxford Cardiovascular Clinical Research Facility, University of Oxford, Oxford, United Kingdom
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18
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Watanabe Y, Itabashi K, Taki M, Miyazawa T, Nakano Y, Murase M. Body length and occipitofrontal circumference may be good indicators of neurodevelopment in very low birthweight infants - secondary publication. Acta Paediatr 2018; 107:975-980. [PMID: 29385636 DOI: 10.1111/apa.14250] [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: 09/19/2017] [Revised: 11/01/2017] [Accepted: 01/25/2018] [Indexed: 01/29/2023]
Abstract
AIM The aim of this study was to predict the neurological prognosis of very low birthweight (VLBW) infants. We examined the relationship between nutritional status, brain volume measured by magnetic resonance imaging (MRI) and anthropometric measurements of VLBW infants at term-equivalent age (TEA). METHODS We evaluated 27 VLBW infants, born at Showa University Hospital in Japan between April 2012 and August 2013, who underwent brain MRI at TEA. Based on their clinical data, we analysed their protein and energy intake. RESULTS Median values for the 27 VLBW infants were as follows: gestational age, 29.7 weeks; birthweight 1117 g; protein intake 2.7 g/kg/day and energy intake 97.9 kcal/kg/day. At TEA, the standard deviation scores (SDSs) of body weight, body length and the occipitofrontal circumference (OFC) were -0.8, -1.4 and 0.7, respectively. Multiple regression analysis revealed that the SDSs of body length and the OFC at TEA were significant determinants of white matter volume, but that the SDS of body weight at TEA was not. CONCLUSION Our findings suggest that the SDSs of body length and the OFC at TEA may be better indicators than body weight for predicting the development of the central nervous system in VLBW infants receiving nutritional management.
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Affiliation(s)
- Yoshitaka Watanabe
- Department of Pediatrics; Showa University School of Medicine; Tokyo Japan
| | - Kazuo Itabashi
- Department of Pediatrics; Showa University School of Medicine; Tokyo Japan
| | - Motohiro Taki
- Department of Pediatrics; Tokyo Metropolitan Health and Medical Treatment Corporation Ebara Hospital; Tokyo Japan
| | - Tokuo Miyazawa
- Department of Pediatrics; Showa University School of Medicine; Tokyo Japan
| | - Yuya Nakano
- Department of Pediatrics; Showa University School of Medicine; Tokyo Japan
| | - Masahiko Murase
- Department of Pediatrics; Showa University School of Medicine; Tokyo Japan
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Barbeito-Andrés J, Gleiser PM, Bernal V, Hallgrímsson B, Gonzalez PN. Brain Structural Networks in Mouse Exposed to Chronic Maternal Undernutrition. Neuroscience 2018; 380:14-26. [DOI: 10.1016/j.neuroscience.2018.03.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 11/27/2022]
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20
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Schneider J, Fischer Fumeaux CJ, Duerden EG, Guo T, Foong J, Graz MB, Hagmann P, Chakravarty MM, Hüppi PS, Beauport L, Truttmann AC, Miller SP. Nutrient Intake in the First Two Weeks of Life and Brain Growth in Preterm Neonates. Pediatrics 2018; 141:peds.2017-2169. [PMID: 29440285 DOI: 10.1542/peds.2017-2169] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Optimizing early nutritional intake in preterm neonates may promote brain health and neurodevelopment through enhanced brain maturation. Our objectives were (1) to determine the association of energy and macronutrient intake in the first 2 weeks of life with regional and total brain growth and white matter (WM) maturation, assessed by 3 serial MRI scans in preterm neonates; (2) to examine how critical illness modifies this association; and (3) to investigate the relationship with neurodevelopmental outcomes. METHODS Forty-nine preterm neonates (21 boys, median [interquartile range] gestational age: 27.6 [2.3] weeks) were scanned serially at the following median postmenstrual weeks: 29.4, 31.7, and 41. The total brain, basal nuclei, and cerebellum were semiautomatically segmented. Fractional anisotropy was extracted from diffusion tensor imaging data. Nutritional intake from day of life 1 to 14 was monitored and clinical factors were collected. RESULTS Greater energy and lipid intake predicted increased total brain and basal nuclei volumes over the course of neonatal care to term-equivalent age. Similarly, energy and lipid intake were significantly associated with fractional anisotropy values in selected WM tracts. The association of ventilation duration with smaller brain volumes was attenuated by higher energy intake. Brain growth predicted psychomotor outcome at 18 months' corrected age. CONCLUSIONS In preterm neonates, greater energy and enteral feeding during the first 2 weeks of life predicted more robust brain growth and accelerated WM maturation. The long-lasting effect of early nutrition on neurodevelopment may be mediated by enhanced brain growth. Optimizing nutrition in preterm neonates may represent a potential avenue to mitigate the adverse brain health consequences of critical illness.
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Affiliation(s)
- Juliane Schneider
- Department of Paediatrics, University of Toronto and The Hospital for Sick Children, Toronto, Canada.,Department of Woman-Mother-Child, Clinic of Neonatology and
| | | | - Emma G Duerden
- Department of Paediatrics, University of Toronto and The Hospital for Sick Children, Toronto, Canada
| | - Ting Guo
- Department of Paediatrics, University of Toronto and The Hospital for Sick Children, Toronto, Canada
| | - Justin Foong
- Department of Paediatrics, University of Toronto and The Hospital for Sick Children, Toronto, Canada
| | | | - Patric Hagmann
- Department of Radiology, Clinic of Neuroradiology, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - M Mallar Chakravarty
- Douglas Mental Health University Institute, Montreal, Canada.,Departments of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal, Canada; and
| | - Petra S Hüppi
- Division of Development and Growth, Department of Paediatrics, University Hospital of Geneva, Geneva, Switzerland
| | - Lydie Beauport
- Department of Woman-Mother-Child, Clinic of Neonatology and
| | | | - Steven P Miller
- Department of Paediatrics, University of Toronto and The Hospital for Sick Children, Toronto, Canada;
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21
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Paviotti G, De Cunto A, Zennaro F, Boz G, Travan L, Cont G, Bua J, Demarini S. Higher growth, fat and fat-free masses correlate with larger cerebellar volumes in preterm infants at term. Acta Paediatr 2017; 106:918-925. [PMID: 28295577 DOI: 10.1111/apa.13829] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 01/15/2017] [Accepted: 03/07/2017] [Indexed: 12/12/2022]
Abstract
AIM Smaller cerebellar volumes in very low-birthweight (VLBW) infants at term have been related to adverse cognitive outcomes, and this study evaluated whether these volumes were associated with a growth in body composition during hospital stays. METHODS We prospectively recruited 42 VLBW infants from an Italian neonatal unit between January 2013 and August 2015. Cerebellar volumes and body composition were measured by magnetic resonance imaging (MRI) and air-displacement plethysmography, respectively, at 40 weeks of gestational age and anthropometric and nutritional data were collected. We also included 20 term-born controls. RESULTS The mean gestational age and birthweight of the VLBW infants were 29.4 (±1.9) weeks and 1120 (±290) g. There was a positive correlation between cerebellar volumes and daily weight gain from birth to term (R2 = 0.26, p = 0.001), weight (R2 = 0.25, p = 0.001), length (R2 = 0.16, p = 0.01), fat mass (R2 = 0.15, p = 0.01) and fat-free mass at term (R2 = 0.20, p = 0.003). In multiple regression analysis, daily weight gain, mechanical ventilation and postconceptional age at MRI were independently associated with cerebellar volumes. Anthropometric data and cerebellar volumes were similar between VLBW and control infants. CONCLUSION Higher growth, higher fat mass and fat-free mass were associated with larger cerebellar volumes in VLBW infants at term.
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Affiliation(s)
- Giulia Paviotti
- Division of Neonatology; Institute for Maternal and Child Health - IRCCS Burlo Garofolo; Trieste Italy
| | - Angela De Cunto
- Division of Neonatology; Institute for Maternal and Child Health - IRCCS Burlo Garofolo; Trieste Italy
| | - Floriana Zennaro
- Pediatric Radiology; Institute for Maternal and Child Health - IRCCS Burlo Garofolo; Trieste Italy
| | - Giulia Boz
- Division of Neonatology; Institute for Maternal and Child Health - IRCCS Burlo Garofolo; Trieste Italy
| | - Laura Travan
- Division of Neonatology; Institute for Maternal and Child Health - IRCCS Burlo Garofolo; Trieste Italy
| | - Gabriele Cont
- Division of Neonatology; Institute for Maternal and Child Health - IRCCS Burlo Garofolo; Trieste Italy
| | - Jenny Bua
- Division of Neonatology; Institute for Maternal and Child Health - IRCCS Burlo Garofolo; Trieste Italy
| | - Sergio Demarini
- Division of Neonatology; Institute for Maternal and Child Health - IRCCS Burlo Garofolo; Trieste Italy
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22
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Beauport L, Schneider J, Faouzi M, Hagmann P, Hüppi PS, Tolsa JF, Truttmann AC, Fischer Fumeaux CJ. Impact of Early Nutritional Intake on Preterm Brain: A Magnetic Resonance Imaging Study. J Pediatr 2017; 181:29-36.e1. [PMID: 27837953 DOI: 10.1016/j.jpeds.2016.09.073] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 07/14/2016] [Accepted: 09/29/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate the association between early nutritional intake and brain development assessed by magnetic resonance imaging (MRI). STUDY DESIGN A cohort of neonates born at ≤30 weeks gestational age underwent MRI at term equivalent age. Brain maturation and injury were assessed using the Kidokoro score. Two groups were defined by severity of the scores. The associations between macronutrients intake during the first 2 weeks of life, clinical factors, and imaging scores were analyzed using logistic regression. RESULTS MRI scores from group 1 patients (n = 27) were normal to mildly abnormal (0-5). Group 2 (n = 15) had more abnormal scores (6-12). The median gestational ages (IQR) were 27.4 (1.9) weeks in group 1 and 27.0 (2.9) weeks in group 2, with birth weights of 900 (318) g (group 1) and 844 (293) g (group 2). In group 2, energy, lipid, and carbohydrate intake were significantly lower than in group 1. Group 2 also showed higher rates of sepsis and clinical risk scores than group 1. After adjustments in bivariate models, higher energy and lipid intake remained significantly associated with improved scores on MRI. This association was stronger for the gray matter component of the score. CONCLUSIONS Higher energy and lipid intake during the first 2 weeks after birth was associated with a lower incidence of brain lesions and dysmaturation at term equivalent age in preterm neonates.
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Affiliation(s)
- Lydie Beauport
- Clinic of Neonatology, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland; Division of Neonatology, Department of Pediatrics, Centre Hospitalier Chrétien, Site St-Vincent, Rocourt, Belgium
| | - Juliane Schneider
- Clinic of Neonatology, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland; Division of Neurology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Mohamed Faouzi
- Biostatitics, Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Patric Hagmann
- Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Petra S Hüppi
- Division of Development and Growth, Department of Pediatrics, University Hospital of Geneva, Geneva, Switzerland
| | - Jean-François Tolsa
- Clinic of Neonatology, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Anita C Truttmann
- Clinic of Neonatology, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Céline J Fischer Fumeaux
- Clinic of Neonatology, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland.
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23
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Lewandowski AJ, Lamata P, Francis JM, Piechnik SK, Ferreira VM, Boardman H, Neubauer S, Singhal A, Leeson P, Lucas A. Breast Milk Consumption in Preterm Neonates and Cardiac Shape in Adulthood. Pediatrics 2016; 138:peds.2016-0050. [PMID: 27302980 PMCID: PMC6198929 DOI: 10.1542/peds.2016-0050] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Preterm birth relates to long-term alterations in cardiac morphology and function. Understanding whether preterm postnatal life is a tractable period of cardiovascular development that can be positively altered by nutrition is relevant to long-term outcomes. We hypothesized that being fed human breast milk during early postnatal life is beneficial to long-term cardiac structure and function in preterm-born individuals compared with infant formulas. METHODS A total of 926 preterm-born infants originally took part in a randomized controlled trial of postnatal milk-feeding regimens between 1982 and 1985 across 5 different UK centers. Preterm-born individuals were randomly assigned to either breast milk donated by unrelated lactating women or nutrient-enriched formulas. We followed 102 individuals from this cohort: 30 of whom had been randomized to being fed exclusively human milk and 16 to being fed exclusively formula. As a comparison group, we recruited an additional 102 individuals born term to uncomplicated pregnancies. Cardiac morphology and function were assessed by MRI. RESULTS Preterm-born individuals fed exclusively human milk as infants had increased left and right ventricular end-diastolic volume index (+9.73%, P = .04 and +18.2%, P < .001) and stroke volume index (+9.79%, P = .05 and +22.1%, P = .01) compared with preterm-born individuals who were exclusively formula fed as infants. CONCLUSIONS This study provides the first evidence of a beneficial association between breast milk and cardiac morphology and function in adult life in those born preterm and supports promotion of human milk for the care of preterm infants to reduce long-term cardiovascular risk.
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Affiliation(s)
- Adam J. Lewandowski
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom,Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Pablo Lamata
- Department of Biomedical Engineering, King’s College London, London, United Kingdom
| | - Jane M. Francis
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Stefan K. Piechnik
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Vanessa M. Ferreira
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Henry Boardman
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom,Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Atul Singhal
- MRC Childhood Nutrition Research Centre, Institute of Child Health, University College London, London, United Kingdom
| | - Paul Leeson
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom,Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Alan Lucas
- MRC Childhood Nutrition Research Centre, Institute of Child Health, University College London, London, United Kingdom
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24
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Uthaya S, Liu X, Babalis D, Doré CJ, Warwick J, Bell J, Thomas L, Ashby D, Durighel G, Ederies A, Yanez-Lopez M, Modi N. Nutritional Evaluation and Optimisation in Neonates: a randomized, double-blind controlled trial of amino acid regimen and intravenous lipid composition in preterm parenteral nutrition. Am J Clin Nutr 2016; 103:1443-52. [PMID: 27099248 PMCID: PMC4880995 DOI: 10.3945/ajcn.115.125138] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 03/24/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Parenteral nutrition is central to the care of very immature infants. Current international recommendations favor higher amino acid intakes and fish oil-containing lipid emulsions. OBJECTIVE The aim of this trial was to compare 1) the effects of high [immediate recommended daily intake (Imm-RDI)] and low [incremental introduction of amino acids (Inc-AAs)] parenteral amino acid delivery within 24 h of birth on body composition and 2) the effect of a multicomponent lipid emulsion containing 30% soybean oil, 30% medium-chain triglycerides, 25% olive oil, and 15% fish oil (SMOF) with that of soybean oil (SO)-based lipid emulsion on intrahepatocellular lipid (IHCL) content. DESIGN We conducted a 2-by-2 factorial, double-blind, multicenter randomized controlled trial. RESULTS We randomly assigned 168 infants born at <31 wk of gestation. We evaluated outcomes at term in 133 infants. There were no significant differences between Imm-RDI and Inc-AA groups for nonadipose mass [adjusted mean difference: 1.0 g (95% CI: -108, 111 g; P = 0.98)] or between SMOF and SO groups for IHCL [adjusted mean SMOF:SO ratio: 1.1 (95% CI: 0.8, 1.6; P = 0.58]. SMOF does not affect IHCL content. There was a significant interaction (P = 0.05) between the 2 interventions for nonadipose mass. There were no significant interactions between group differences for either primary outcome measure after adjusting for additional confounders. Imm-RDI infants were more likely than Inc-AA infants to have blood urea nitrogen concentrations >7 mmol/L or >10 mmol/L, respectively (75% compared with 49%, P < 0.01; 49% compared with 18%, P < 0.01). Head circumference at term was smaller in the Imm-RDI group [mean difference: -0.8 cm (95% CI: -1.5, -0.1 cm; P = 0.02)]. There were no significant differences in any prespecified secondary outcomes, including adiposity, liver function tests, incidence of conjugated hyperbilirubinemia, weight, length, mortality, and brain volumes. CONCLUSION Imm-RDI of parenteral amino acids does not benefit body composition or growth to term and may be harmful. This trial was registered at www.isrctn.com as ISRCTN29665319 and at eudract.ema.europa.eu as EudraCT 2009-016731-34.
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Affiliation(s)
- Sabita Uthaya
- Chelsea and Westminster National Health Service Foundation Trust, London, United Kingdom; Section of Neonatal Medicine, Department of Medicine, Imperial College London,
| | - Xinxue Liu
- Imperial Clinical Trials Unit, School of Public Health, and
| | - Daphne Babalis
- Imperial Clinical Trials Unit, School of Public Health, and Clinical Trials and Evaluation Unit, Royal Brompton and Harefield National Health Service Foundation Trust, London, United Kingdom
| | - Caroline J Doré
- Comprehensive Clinical Trials Unit, University College London, London, United Kingdom
| | - Jane Warwick
- Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom; and
| | - Jimmy Bell
- Institute of Clinical Sciences, Imperial College London and Medical Research Council Clinical Sciences Centre, Hammersmith Hospital, London, United Kingdom; Department of Life Sciences, University of Westminster, London, United Kingdom
| | - Louise Thomas
- Institute of Clinical Sciences, Imperial College London and Medical Research Council Clinical Sciences Centre, Hammersmith Hospital, London, United Kingdom; Department of Life Sciences, University of Westminster, London, United Kingdom
| | - Deborah Ashby
- Imperial Clinical Trials Unit, School of Public Health, and
| | - Giuliana Durighel
- Institute of Clinical Sciences, Imperial College London and Medical Research Council Clinical Sciences Centre, Hammersmith Hospital, London, United Kingdom
| | - Ash Ederies
- Institute of Clinical Sciences, Imperial College London and Medical Research Council Clinical Sciences Centre, Hammersmith Hospital, London, United Kingdom
| | - Monica Yanez-Lopez
- Institute of Clinical Sciences, Imperial College London and Medical Research Council Clinical Sciences Centre, Hammersmith Hospital, London, United Kingdom
| | - Neena Modi
- Chelsea and Westminster National Health Service Foundation Trust, London, United Kingdom; Section of Neonatal Medicine, Department of Medicine, Imperial College London
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25
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Uthaya S, Modi N. Practical preterm parenteral nutrition: systematic literature review and recommendations for practice. Early Hum Dev 2014; 90:747-53. [PMID: 25263586 DOI: 10.1016/j.earlhumdev.2014.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Current practice in relation to the prescribing, compounding and administration of parenteral nutrition for extremely preterm infants is inconsistent and based on largely historical evidence. Increasingly there are calls for more 'aggressive' nutritional interventions to prevent 'postnatal growth failure'. However the evidence base for these recommendations is weak, and there are no long-term studies examining the impact of such practices. Here we summarise the evidence for preterm parenteral nutrition interventions. We suggest principles to guide practice based on evidence from a systematic search and review of evidence to date, and recommend actions necessary to advance the understanding of this important aspect of preterm care.
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Affiliation(s)
- S Uthaya
- Imperial College London, UK; Chelsea Westminster Hospital NHS Foundation Trust, London, UK.
| | - N Modi
- Imperial College London, UK; Chelsea Westminster Hospital NHS Foundation Trust, London, UK.
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