Catch up growth and pancreatic function in growth retarded neonates

Cystic Fibrosis is Associated with Adverse Neonatal Outcomes in Washington State, 1996-2013

OBJECTIVE

To determine whether cystic fibrosis (CF) is associated with adverse neonatal outcomes in a recent birth cohort in the US.

STUDY DESIGN

A retrospective matched cohort study of infants born in Washington State from 1996 to 2013 was identified through birth certificate data and linked to statewide hospital discharge data. Infants with CF were identified by hospitalization (through age 5 years) in which a CF-specific International Classification of Diseases, Ninth Revision code was recorded. "Unexposed" infants lacked CF-related International Classification of Diseases, Ninth Revision codes and were randomly selected among births, frequency-matched to "exposed" infants on birth year. Associations of CF with adverse neonatal outcomes (low birth weight [LBW], small for gestational age [SGA], preterm birth, and infant mortality) were estimated through Poisson regression. We performed extreme value imputation to address possible ascertainment bias.

RESULTS

We identified 170 infants with CF and 3400 unexposed infants. CF was associated with increased relative risk (95% CI) of 3.5 (2.5-4.9), 1.6 (1.1-2.4), 3.0 (2.2-4.0), and 6.8 (1.7-26.5) for LBW, SGA, preterm birth, and infant death, respectively. The estimated relative risks were similar among infants born from 2006 to 2013, except SGA was no longer associated with CF diagnosis. Results were robust to extreme value imputation and exclusion of infants with meconium ileus.

CONCLUSIONS

Observed associations of CF with LBW, preterm birth, and infant death are unlikely to be due to ascertainment bias. Further work is needed to determine how to prevent these adverse neonatal outcomes.

Intrauterine growth restriction, visceral blood flow velocity and exocrine pancreatic function

Background

Animal models and observations in human neonates suggest fetal exocrine pancreas vulnerability to reduced maternofetal blood flow. We investigated the relationship between superior mesenteric artery blood flow velocity (sma bfv) and exocrine pancreatic function, in a cohort of very low birth weight (VLBW) babies.

Group 1: 9 babies < 3rd percentile for birth weight. Antenatally, all had absent or reversed diastolic flow on Doppler ultrasound of the umbilical artery (UA).

Group2: 18 babies > 10th percentile for birth weight.

Findings

All had Doppler ultrasound scan of the superior mesenteric artery (sma), by same operator (RMN), on day 1 of life before commencement of enteral feeding. Stool samples assayed for faecal chymotrypsin and weekly serum samples assayed for amylase and lipase (kinetic colorimetric assay) from days 1 to 14 of life.

Growth restricted babies had significantly lower sma bfv values compared with appropriately grown preterm babies. Faecal chymotrypsin levels were also lower but this difference did not achieve statistical significance. Both groups had serum lipase levels detectable in adult concentrations. Serum amylase was undetectable in either group.

Conclusion

Babies with previous in-utero blood flow redistribution may exhibit altered gut ontogeny with re-setting of mesenteric blood flow velocities and altered exocrine pancreatic function.

The influence of feeding patterns on head circumference among Turkish infants during the first 6 months of life

The influence of various feeding patterns on physical growth and mental development of the infant, particularly during the first 6 months of life, is an important subject. Head circumference values of 172 healthy new-born infants were included in the study; 62 were exclusively breast-fed (BF), 58 were mixed-fed (MF) and 52 were formula-fed (FF). No significant differences were found in head circumference values between the groups at birth (BF 35.2+/-0.1, MF 35.1+/-0.1, FF 35.0+/-0.1 cm for boys and BF 35.0+/-0.1, MF 34.9+/-0.1, FF 34.8+/-0.1 cm for girls). At the end of the first month, the infants in the BF group (38.3+/-0.1 cm and 37.9+/-0.1 cm for boys and girls, respectively) had strikingly greater head circumference measurements than the others (MF 36.7+/-0.1, FF 36.6+/-0.1 cm for boys and MF 36.5+/-0.1, FF 36.4+/-0.1 cm for girls) (P < 0.05). However, in the subsequent 4-month period, the values detected in each group were almost the same. At the sixth month, head circumference-for-age values of infants in MF (42.6+/-0.1 cm for boys, 41.4+/-0.1 cm for girls) and FF (42.5+/-0.1 cm for boys, 41.5+/-0.1 cm for girls) were well below those of BF group (43.7+/-0.1 cm and 42.9+/-0.1 cm for boys and girls, respectively) and the standard curve (P < 0.05). These results suggest that exclusive breast feeding is sufficient during the first 6 months, the most important period of life.

Faecal chymotrypsin in small for gestational age infants: effects of nucleotides and breast feeding

The effect of diet on pancreatic exocrine function, measured by faecal chymotrypsin activity (FCA), was studied longitudinally in three groups of small for gestational age (SGA) infants in the first six months of life. The three groups comprised breastfed infants (group B), those randomly allocated to receive a standard infant formula (group S), or the same formula supplemented with nucleotides (group N). The three groups did not differ in their birthweight or gestational age. Nucleotide supplementation of infant formula improves catchup growth in SGA infants but whether this is due to effects on the gastrointestinal mucosa or the exocrine pancreas is not known. There were no differences in FCA at study entry but by one month group B had significantly lower values than the other groups, and this was maintained at 2, 4, and 6 months. Groups N and S did not differ significantly at any time point. Nucleotide supplementation of infant formula does not influence pancreatic exocrine function and its effect on growth is unlikely, therefore, to be mediated through the pancreas. This study shows that breast feeding is associated with lower FCA which may be related to the lower protein content of human milk. Reliable interpretation of FCA in young infants requires information about their diet.