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Olsen IE, Granger M, Masoud W, Clark RH, Ferguson AN. Defining Body Mass Index Using Weight and Length for Gestational Age in the Growth Assessment of Preterm Infants at Birth. Am J Perinatol 2024; 41:e2735-e2743. [PMID: 37683671 DOI: 10.1055/s-0043-1774316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
OBJECTIVE The objectives of this study were to describe (1) body mass indexes (BMIs) using weight and length for gestational age (GA) classifications, and (2) the additional information BMI, as a measure of body proportionality, provides for preterm infant growth assessment and care plans at birth. STUDY DESIGN Birth weight, length, and BMI of 188,646 preterm infants (24-36 weeks gestation) admitted to U.S. neonatal intensive care units (Pediatrix Clinical Data Warehouse, 2013-2018) were classified (Olsen curves) as small, appropriate, or large for GA (SGA < 10th, AGA 10-90th, LGA > 90th percentile for GA, respectively). The distribution for the 27 weight-length-BMI combinations was described. RESULTS At birth, most infants were appropriate for weight (80.0%), length (82.2%), head circumference (82.9%), and BMI (79.9%) for GA. Birth weight for GA identified approximately 20% of infants as SGA or LGA. Infants born SGA (or LGA) for both weight and length ("proportionate" in size) were usually appropriate for BMI (59.0% and 75.6%). BMI distinguished disproportionate weight for length in infants with SGA or LGA weight at birth (58.3%, 49.9%). BMI also identified 11.4% of AGA weight infants as small or large for BMI ("disproportionate" in size) at birth; only using weight for GA missed these underweight/overweight for length infants. CONCLUSION The unique, additional information provided by birth BMI further informs individualized preterm infant growth assessment by providing an assessment of an infant's body proportionality (weight relative to its length) in addition to the routine assessment of weight, length, and head circumference for GA and may better inform care plans and impact outcomes. KEY POINTS · Most preterm infants were born AGA for all growth measures.. · AGA weight infants may be under- or overweight for length.. · BMI distinguished body disproportionality in SGA/LGA infants.. · Recommend BMI assessed along with weight, length and head.. · Further research on BMI in preterm infants is needed..
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Affiliation(s)
- Irene E Olsen
- Department of Nutrition Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania
| | - Marion Granger
- School of Data Science and Analytics, Kennesaw State University, Kennesaw, Georgia
| | - Waleed Masoud
- School of Data Science and Analytics, Kennesaw State University, Kennesaw, Georgia
| | - Reese H Clark
- The Pediatrix Center for Research, Education, Quality, and Safety (CREQS), Pediatrix Medical Group, Inc., Sunrise, Florida
| | - A Nicole Ferguson
- School of Data Science and Analytics, Kennesaw State University, Kennesaw, Georgia
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2
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Sato J, Vandewouw MM, Safar K, Ng DVY, Bando N, O’Connor DL, Unger SL, Pang E, Taylor MJ. Social-Cognitive Network Connectivity in Preterm Children and Relations With Early Nutrition and Developmental Outcomes. Front Syst Neurosci 2022; 16:812111. [PMID: 35465192 PMCID: PMC9022474 DOI: 10.3389/fnsys.2022.812111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/18/2022] [Indexed: 11/13/2022] Open
Abstract
Infants born very low birth weight (VLBW, < 1,500 g) are at a heightened risk for structural brain abnormalities and social-cognitive deficits, which can impair behavioural functioning. Resting-state fMRI, reflecting a baseline level of brain activity and underlying social-cognitive processes, has also been reported to be altered in children born VLBW. Yet very little is known about the functional networks underlying social cognition using magnetoencephalography (MEG) and how it relates to neonatal factors and developmental outcomes. Thus, we investigated functional connectivity at rest in VLBW children and the associations with early nutrition and IQ and behavioural problems. We collected resting-state MEG recordings and measures of IQ and social-cognitive behaviour, as well as macronutrient/energy intakes during initial hospitalisation in 5-year-old children born VLBW (n = 37) compared to full-term (FT; n = 27) controls. We examined resting-state network differences controlling for sex and age at scan. Functional connectivity was estimated using the weighted phase lag index. Associations between functional connectivity with outcome measures and postnatal nutrition were also assessed using regression analyses. We found increased resting-state functional connectivity in VLBW compared to FT children in the gamma frequency band (65–80 Hz). This hyper-connected network was primarily anchored in frontal regions known to underlie social-cognitive functions such as emotional processing. In VLBW children, increased functional connectivity was related to higher IQ scores, while reduced connectivity was related to increased behavioural problems at 5 years of age. These within-group associations were found in the slower frequency bands of theta (4–7 Hz) and alpha (8–12 Hz), frequently linked to higher-order cognitive functions. We also found significant associations between macronutrient (protein and lipid) and energy intakes during the first postnatal month with functional connectivity at preschool-age, highlighting the long-term impacts of postnatal nutrition on preterm brain development. Our findings demonstrate that at preschool-age, VLBW children show altered resting-state connectivity despite IQ and behaviour being in the average range, possibly reflecting functional reorganisation of networks to support social-cognitive and behavioural functioning. Further, our results highlight an important role of early postnatal nutrition in the development of resting-state networks, which in turn may improve neurodevelopmental outcomes in this vulnerable population.
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Affiliation(s)
- Julie Sato
- Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychology, University of Toronto, Toronto, ON, Canada
- Division of Neurosciences and Mental Health, Hospital for Sick Children, Toronto, ON, Canada
- *Correspondence: Julie Sato,
| | - Marlee M. Vandewouw
- Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada
- Division of Neurosciences and Mental Health, Hospital for Sick Children, Toronto, ON, Canada
- Autism Research Centre, Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Kristina Safar
- Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada
- Division of Neurosciences and Mental Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Dawn V. Y. Ng
- Division of Translational Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Nicole Bando
- Division of Translational Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Deborah L. O’Connor
- Division of Translational Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
- Department of Paediatrics, Sinai Health, Toronto, ON, Canada
| | - Sharon L. Unger
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
- Department of Paediatrics, Sinai Health, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Division of Neonatology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Elizabeth Pang
- Division of Neurosciences and Mental Health, Hospital for Sick Children, Toronto, ON, Canada
- Division of Neurology, Hospital for Sick Children, Toronto, ON, Canada
| | - Margot J. Taylor
- Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychology, University of Toronto, Toronto, ON, Canada
- Division of Neurosciences and Mental Health, Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
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3
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Skinner AM, Narchi H. Preterm nutrition and neurodevelopmental outcomes. World J Methodol 2021; 11:278-293. [PMID: 34888181 PMCID: PMC8613713 DOI: 10.5662/wjm.v11.i6.278] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/13/2021] [Accepted: 09/27/2021] [Indexed: 02/06/2023] Open
Abstract
Survival of preterm infants has been steadily improving in recent years because of many recent advances in perinatal and neonatal medicine. Despite these advances, the growth of survivors does not reach the ideal target level of the normal fetus of the same gestational age. Postnatal weight gain is often not achieved because extrauterine growth has higher energy requirements than intrauterine growth, due to the intensive care environment, illness and inadequate nutrition. Although many other factors influence infant brain development, including family socioeconomic and educational background, the role of nutrition is considerable and fortunately, amenable to intervention. In the preterm neonate, the brain is the most metabolically demanding organ, consuming the largest proportions of energy and nutrient intake for its function and programmed growth and maturation. Weight gain, linear and head circumference growth are all markers of nutritional status and are independently associated with long-term neurodevelopment. Brain development is not only the result of nutrients intake, but in addition, of the interaction with growth factors which depend on adequate nutrient supply and overall health status. This explains why conditions such as sepsis, necrotizing enterocolitis and chronic lung disease alter the distribution and accretion of nutrients thereby suppressing growth factor synthesis. In this review, we will focus on the direct role of nutrition on neurodevelopment, emphasizing why it should be started without delay. The nutritional requirements of the preterm infant will be discussed, followed by the effects of general nutritional interventions and specific nutrients, as well as the role of nutritional supplements on neurodevelopment. The primordial role of human breast milk, breast milk fortifiers and human milk oligosaccharides will be discussed in detail. We will also examine the role of nutrition in preventing neonatal complications which can affect neurodevelopment in their own right.
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Affiliation(s)
- Alyson Margaret Skinner
- Department of Paediatrics, Manor Hospital, Walsall Healthcare NHS Trust, Walsall WS2 9PS, West Midlands, United Kingdom
- Department of Paediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain PO Box 17666, United Arab Emirates
| | - Hassib Narchi
- Department of Paediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain PO Box 17666, United Arab Emirates
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Alja'nini Z, Merlino-Barr S, Brumfiel A, McNelis K, Viswanathan S, Collin M, Groh-Wargo S. Effect of parenteral nutrition duration on patterns of growth and body composition in very low-birth-weight premature infants. JPEN J Parenter Enteral Nutr 2021; 45:1673-1682. [PMID: 34638161 DOI: 10.1002/jpen.2278] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Parenteral nutrition (PN) is essential to support premature infants' growth and varies with enteral nutrition (EN) advancement rates. Data on PN duration's impact on premature infants' growth are limited. The aim of this multicenter observational study was to determine the effect of early PN duration on body composition at term corrected gestational age (CGA) in very low-birth-weight (VLBW) premature infants. METHODS VLBW infants exposed to PN in the first week of life and exposed to significantly different EN regimens were divided into two groups on the basis of early PN duration. Infants with a birth weight (BW) <1000 g and PN duration <28 days and infants with a BW 1000-1500 g and PN duration <14 days were assigned to the "short-PN" group. Infants receiving PN for longer durations were assigned to the "long-PN" group. Body composition was assessed via air displacement plethysmography at term CGA or before discharge. RESULTS Sixty-two and 53 infants were assigned to the short-PN and long-PN groups, respectively. The two groups were significantly different in BW and GA, so a nested case-control study was conducted after matching 36 infant pairs. Infants in the long-PN group had significantly lower fat-free mass (FFM) z-scores, but both groups had comparable fat mass (FM) z-scores. Long PN was a significant negative predictor of FFM z-score in the multivariate regression analysis. CONCLUSION In VLBW premature infants, PN duration is negatively associated with FFM z-scores at term CGA without affecting FM z-scores.
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Affiliation(s)
- Zaineh Alja'nini
- Department of Pediatrics, MetroHealth Medical Center affiliated with Case Western Reserve University, Cleveland, Ohio, USA
| | - Stephanie Merlino-Barr
- Department of Pediatrics, MetroHealth Medical Center affiliated with Case Western Reserve University, Cleveland, Ohio, USA
| | - Alexa Brumfiel
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Kera McNelis
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Sreekanth Viswanathan
- Division of Neonatology, Department of Pediatrics, Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Marc Collin
- Department of Pediatrics, MetroHealth Medical Center affiliated with Case Western Reserve University, Cleveland, Ohio, USA
| | - Sharon Groh-Wargo
- Department of Pediatrics, MetroHealth Medical Center affiliated with Case Western Reserve University, Cleveland, Ohio, USA
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5
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Hopperton KE, Pitino MA, Chouinard-Watkins R, Shama S, Sammut N, Bando N, Williams BA, Walton K, Kiss A, Unger SL, Bazinet RP, O'Connor DL. Determinants of fatty acid content and composition of human milk fed to infants born weighing <1250 g. Am J Clin Nutr 2021; 114:1523-1534. [PMID: 34254983 PMCID: PMC8488876 DOI: 10.1093/ajcn/nqab222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 06/10/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Infants born at very low birth weight (VLBW) are vulnerable to deficits in fatty acids (FAs) but little is known of factors that influence the intakes or composition of their human milk feeds. OBJECTIVES We aimed to identify sources of variability in the fat composition of human milk fed to VLBW infants and examine the impact of milk source (mother's own or donor) on fat and FA intakes. METHODS Serial samples of mother's milk (n = 476) and donor milk (n = 53) fed to infants born weighing <1250 g (n = 114 infants from 100 mothers) were collected [Optimizing Mothers' Milk for Preterm Infants (OptiMoM) randomized clinical trial]. Fat and FA were analyzed using a mid-infrared human milk analyzer and GC with flame ionization detection. RESULTS At full enteral feeding, donor milk is estimated to provide 1.3 g · kg-1 · d-1 less total fat than mature mother's milk (recommended intake: 4.8 g · kg-1 · d-1), and 5-9 mg · kg-1 · d-1 less DHA (22:6n-3) and arachidonic acid (20:4n-6) (estimated average requirement: 55-60 and 35-45 mg · kg-1 · d-1, respectively) than colostrum or transitional milk. Similar deficits were observed in measured intakes of a subset of OptiMoM infants. In multivariable-adjusted models, maternal ethnicity had medium to large [≥0.5 SD score (SDS)] effects on DHA, SFAs, and MUFAs. Mothers with prepregnancy BMI in overweight and obese categories had higher milk total fat (β: 0.35; 95% CI: 0.10, 0.61 and β: 0.46; 95% CI: 0.16, 0.77 SDS, respectively). Those with BMI ≥30 in addition had higher proportions of SFAs (β: 0.61; 95% CI: 0.33, 0.89 SDS) and lower DHA (β: -0.54; 95% CI: -0.89, -0.20 SDS). Other factors, such as gestational age and income, were also associated with FA composition. CONCLUSIONS The fat and FA content of human milk fed to VLBW infants is variable. Care must be taken to ensure fat and FA intakes meet recommendations, particularly when feeding a high proportion of donor milk.This trial was registered at clinicaltrials.gov as NCT02137473.
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Affiliation(s)
- Kathryn E Hopperton
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael A Pitino
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | | | - Sara Shama
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Natasha Sammut
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Nicole Bando
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Brock A Williams
- Department of Food, Nutrition and Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kathryn Walton
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alex Kiss
- Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,Evaluative and Clinical Sciences, Sunnybrook Research Institute and the Institute of Health Policy, Toronto, Ontario, Canada
| | - Sharon L Unger
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada,Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada,Department of Paediatrics, Sinai Health System, Toronto, Ontario, Canada
| | - Richard P Bazinet
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
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6
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Wang N, Cui L, Liu Z, Wang Y, Zhang Y, Shi C, Cheng Y. Optimizing parenteral nutrition to achieve an adequate weight gain according to the current guidelines in preterm infants with birth weight less than 1500 g: a prospective observational study. BMC Pediatr 2021; 21:303. [PMID: 34233641 PMCID: PMC8260575 DOI: 10.1186/s12887-021-02782-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/10/2021] [Indexed: 11/12/2022] Open
Abstract
Aim European Society for Clinical Nutrition and Metabolism released the guidelines on pediatric parenteral nutrition in 2018. We aimed to compare the parenteral nutrition (PN) regimen with the current guidelines, evaluate weight gain and explore the correlation of parenteral macronutrient and energy intakes with weight gain outcome in preterm infants with birth weight less than 1500 g. Methods A prospective observational study was conducted. Parenteral macronutrients and energy intakes were described. Weight gain during PN was assessed. Nutritional factors associated with weight gain outcome after PN were identified using a cox proportional hazards model. Results A total of 163 infants were included in this study, in which 41 were extremely low birth weight (ELBW) infants and 122 were very low birth weight (VLBW) infants. Average glucose, amino acid, lipid, and energy during the first postnatal week were 7.5 g/kg/d, 2.4 g/kg/d, 0.8 g/kg/d, 48 kcal/kg/d. Median maximum glucose, amino acid, lipid, and energy were 11.1 g/kg/d, 3.5 g/kg/d, 3 g/kg/d, 78 kcal/kg/d. Median days to maximum glucose, amino acid, lipid, and energy were 10, 9, 12, 11 days. The proportion of appropriate for gestational age (AGA) infants was 76.9%. The ratio of infants without poor weight gain outcome after PN was 38%. With every 0.1 g/kg/d decrease of maximum amino acid and average lipid during the first postnatal week, the probability of appropriate weight gain outcome decreased by 77.6 and 74.4% respectively. With each additional day to maximum glucose and energy, the probability of appropriate weight gain outcome decreased by 5.6 and 6.1% respectively. Conclusions Most preterm infants with birth weight less than 1500 g remain below the latest recommended nutrition goals. The poor weight gain outcome of these infants after PN is related to insufficient parenteral macronutrient and energy intakes. PN strategies should be improved according to the latest evidence-based recommendations. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02782-1.
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Affiliation(s)
- Nan Wang
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, 7 Wei Wu Road, Zhengzhou, 450003, Henan, China
| | - Lianlian Cui
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, 7 Wei Wu Road, Zhengzhou, 450003, Henan, China
| | - Zhen Liu
- Department of Neonatology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, 450003, Henan, China
| | - Yan Wang
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, 7 Wei Wu Road, Zhengzhou, 450003, Henan, China
| | - Yuhua Zhang
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, 7 Wei Wu Road, Zhengzhou, 450003, Henan, China
| | - Changsong Shi
- Department of Pediatric Intensive Care Unit, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, 450003, Henan, China
| | - Yanbo Cheng
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, 7 Wei Wu Road, Zhengzhou, 450003, Henan, China.
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Al-Jebawi Y, Agarwal N, Groh Wargo S, Shekhawat P, Mhanna MJ. Low caloric intake and high fluid intake during the first week of life are associated with the severity of bronchopulmonary dysplasia in extremely low birth weight infants. J Neonatal Perinatal Med 2021; 13:207-214. [PMID: 31771083 DOI: 10.3233/npm-190267] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To study whether there is an association between nutritional intake during the first week of life and severity of bronchopulmonary dysplasia (BPD) in extremely low birth weight (ELBW) infants. METHODS In a retrospective cohort study, medical records of all ELBW infants admitted to our Neonatal Intensive Care Unit (2010-2017) were reviewed for infants' demographics, clinical characteristics, nutritional intake during their first week of life, and BPD risk factors. RESULTS During the study period 226 infants were identified of whom 67% (151/226) had moderate-severe BPD and the rest served as controls. Overall infants with moderate-severe BPD were younger, smaller, and spent more time on mechanical ventilation than their controls [(mean±standard deviation) 24.7±1.7 vs. 26.8±2.0 weeks gestational age (p < 0.001); 678±154 vs. 837±129 grams (p < 0.001); and 37.9±23.6 vs. 13.7±15.3 days (p < 0.001) respectively]. During the first week of life, the average caloric, carbohydrate, protein and lipid intakes were significantly lower, and the average fluid intake was significantly higher in the moderate-severe BPD than the control group. After adjustment for confounders, fluid intake, and days on mechanical ventilation were significantly associated with moderate-severe BPD with an odds ratio [OR (95% confidence interval)] of 1.03 (1.01-1.04), and 1.05 (1.03-1.07) respectively. Daily caloric intake was associated with an increased risk for moderate-severe BPD [OR: 0.94 (0.91-0.97)]. CONCLUSION Low caloric intake, and high fluid intake during the first week of life are associated with the severity of BPD in ELBW infants.
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Affiliation(s)
- Y Al-Jebawi
- Department of Pediatrics, Division of Neonatology, Case Western Reserve University, at MetroHealth Medical Center, Cleveland, OH, USA
| | - N Agarwal
- Department of Pediatrics, Division of Neonatology, Case Western Reserve University, at MetroHealth Medical Center, Cleveland, OH, USA
| | - S Groh Wargo
- Department of Pediatrics, Division of Neonatology, Case Western Reserve University, at MetroHealth Medical Center, Cleveland, OH, USA
| | - P Shekhawat
- Department of Pediatrics, Division of Neonatology, Case Western Reserve University, at MetroHealth Medical Center, Cleveland, OH, USA
| | - M J Mhanna
- Department of Pediatrics, Division of Neonatology, Case Western Reserve University, at MetroHealth Medical Center, Cleveland, OH, USA
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8
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Sato J, Vandewouw MM, Bando N, Ng DVY, Branson HM, O’Connor DL, Unger SL, Taylor MJ. Early nutrition and white matter microstructure in children born very low birth weight. Brain Commun 2021; 3:fcab066. [PMID: 33977266 PMCID: PMC8100003 DOI: 10.1093/braincomms/fcab066] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 02/17/2021] [Accepted: 02/23/2021] [Indexed: 12/31/2022] Open
Abstract
Infants born at very low birth weight (<1500 g) are vulnerable to nutritional deficits during their first postnatal month, which are associated with poor neurodevelopmental outcomes. Despite this knowledge, the impact of early postnatal nutrition on white matter microstructure in children born with very low birth weight has not been investigated. In this prospective cohort study, we employed a whole-brain approach to investigate associations between precise estimates of nutrient intake within the first postnatal month with white matter microstructure at 5 years of age. Detailed information about breastmilk, macronutrient and energy intakes during this period were prospectively recorded for all participants. Multi-shell diffusion and T1-weighted MRIs were acquired in 41 children (21 males; mean scan age: 5.75 ± 0.22 years; mean birth weight: 1028.6 ± 256.8 g). The diffusion tensor imaging and neurite orientation dispersion and density imaging models were used to obtain maps of fractional anisotropy, radial diffusivity, orientation dispersion and neurite density indices. Tract-based spatial statistics was used to test associations between metrics of white matter microstructure with breastmilk, macronutrient (protein, lipids and carbohydrate) and energy intake. Associations between white matter microstructure and cognitive outcomes were also examined. Compared to children who did not meet enteral feeding recommendations, those who achieved enteral protein, lipid and energy recommendations during the first postnatal month showed improved white matter maturation at 5 years. Among the macronutrients, greater protein intake contributed most to the beneficial effect of nutrition, showing widespread increases in fractional anisotropy and reductions in radial diffusivity. No significant associations were found between white matter metrics with breastmilk or carbohydrate intake. Voxel-wise analyses with cognitive outcomes revealed significant associations between higher fractional anisotropy and neurite density index with higher processing speed scores. Lower radial diffusivity and orientation dispersion index were also associated with improved processing speed. Our findings support the long-term impacts of early nutrition on white matter microstructure, which in turn is related to cognitive outcomes. These results provide strong support for early postnatal nutritional intervention as a promising strategy to improve long-term cognitive outcomes of infants born at very low birth weight.
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Affiliation(s)
- Julie Sato
- Diagnostic Imaging, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Psychology, University of Toronto, Toronto, ON, Canada
- Neurosciences & Mental Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Marlee M Vandewouw
- Diagnostic Imaging, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Neurosciences & Mental Health, Hospital for Sick Children, Toronto, ON, Canada
- Autism Research Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Nicole Bando
- Translational Medicine, SickKids Research Institute, Toronto, ON, Canada
| | - Dawn V Y Ng
- Translational Medicine, SickKids Research Institute, Toronto, ON, Canada
- Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Helen M Branson
- Diagnostic Imaging, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Medical Imaging, University of Toronto, ON, Canada
| | - Deborah L O’Connor
- Translational Medicine, SickKids Research Institute, Toronto, ON, Canada
- Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Sharon L Unger
- Nutritional Sciences, University of Toronto, Toronto, ON, Canada
- Paediatrics, University of Toronto, Toronto, ON, Canada
- Paediatrics, Mount Sinai Health, Toronto, ON, Canada
- Division of Neonatology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Margot J Taylor
- Diagnostic Imaging, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Psychology, University of Toronto, Toronto, ON, Canada
- Neurosciences & Mental Health, Hospital for Sick Children, Toronto, ON, Canada
- Medical Imaging, University of Toronto, ON, Canada
- Paediatrics, University of Toronto, Toronto, ON, Canada
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9
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Hay WW. Intravenous Lipid for Preterm Infants: The Right Amount, at the Right Time, of the Right Kind. J Pediatr 2021; 228:8-10. [PMID: 32889011 DOI: 10.1016/j.jpeds.2020.08.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 08/28/2020] [Indexed: 11/26/2022]
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10
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Perioperative nutrition in extremely preterm infants undergoing surgery for patent ductus arteriosus. CLINICAL NUTRITION EXPERIMENTAL 2020. [DOI: 10.1016/j.yclnex.2020.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Immeli L, Mäkelä PM, Leskinen M, Rinta‐Koski O, Sund R, Andersson S, Luukkainen P. A triple-chamber parenteral nutrition solution was associated with improved protein intake in very low birthweight infants. Acta Paediatr 2020; 109:1588-1594. [PMID: 31955472 DOI: 10.1111/apa.15179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/08/2019] [Accepted: 01/15/2020] [Indexed: 12/01/2022]
Abstract
AIM We evaluated the nutrient intakes of very low birthweight (VLBW) infants weighing less than 1500 g and tested the hypothesis that using a triple-chamber parenteral nutrition (PN) solution, containing lipids, glucose and amino acids, would improve protein intake. METHODS This retrospective cohort study comprised 953 VLBW infants born in 2005-2013 at a gestational age of less than 32 + 0/7 weeks and admitted to the neonatal care unit at Helsinki Children's Hospital, Finland. The infants were divided into four groups according their birth year and PN regime. Nutrient intakes were obtained from computerised medication administration records. RESULTS In 2012-2013, when a triple-chamber PN solution was used, infants were more likely to reach the target parenteral protein intake of 3.5 g/kg/d, and reach it 3-7 days earlier, compared with infants who received individual PN or standard two-in-one PN solutions in 2005-2011. In addition, infants in the triple-chamber group had the highest median energy intake (90 kcal/kg/d) during the first week. They also had higher median protein intakes in weeks one, two and three (3.1, 3.4 and 3.7 g/kg/d) than infants born in 2005-2011 (P < .05). CONCLUSION Using a triple-chamber PN solution was associated with improved protein intake, and the protein target was more likely to be achieved.
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Affiliation(s)
- Lotta Immeli
- Children's Hospital Pediatric Research Center University of Helsinki Helsinki University Hospital Helsinki Finland
| | - Pauliina M. Mäkelä
- Children's Hospital Pediatric Research Center University of Helsinki Helsinki University Hospital Helsinki Finland
| | - Markus Leskinen
- Children's Hospital Pediatric Research Center University of Helsinki Helsinki University Hospital Helsinki Finland
| | | | - Reijo Sund
- Faculty of Health Sciences School of Medicine Institute of Clinical Medicine University of Eastern Finland Kuopio Finland
| | - Sture Andersson
- Children's Hospital Pediatric Research Center University of Helsinki Helsinki University Hospital Helsinki Finland
| | - Päivi Luukkainen
- Children's Hospital Pediatric Research Center University of Helsinki Helsinki University Hospital Helsinki Finland
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12
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Ottolini KM, Andescavage N, Kapse K, Jacobs M, Murnick J, VanderVeer R, Basu S, Said M, Limperopoulos C. Early Lipid Intake Improves Cerebellar Growth in Very Low-Birth-Weight Preterm Infants. JPEN J Parenter Enteral Nutr 2020; 45:587-595. [PMID: 32384168 DOI: 10.1002/jpen.1868] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/29/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Despite recent advances in nutrition practice in the neonatal intensive care unit, infants remain at high risk for growth restriction following preterm birth. Additionally, optimal values for macronutrient administration, especially lipid intake, have yet to be established for preterm infants in the extrauterine environment. METHODS We studied preterm infants born at very low-birth weight (VLBW, <1500 g) and ≤32 weeks' gestation. Cumulative macronutrient (carbohydrate, lipid, protein, energy) intake in the first 2 and 4 weeks of life was compared with total and regional brain volumes on magnetic resonance imaging (MRI) obtained at term-equivalent age. Preterm infants had no structural brain injury on conventional MRI. RESULTS In a cohort of 67 VLBW infants, cumulative lipid intake in the first 2 weeks of life was positively associated with significantly greater cerebellar volume (β = 95.8; P = .01) after adjusting for weight gain, gestational age at birth, and postmenstrual age at MRI. Cumulative lipid (β = 36.1, P = .01) and energy (β = 3.1; P = .02) intake in the first 4 weeks of life were both significantly associated with greater cerebellar volume. No relationship was seen between carbohydrate or protein intake in the first month of life and cerebral volume at term-equivalent age. CONCLUSION Early cumulative lipid intake in the first month of life is associated with significantly greater cerebellar volume by term-equivalent age in very premature infants. Our findings emphasize the importance of early, aggressive nutrition interventions to optimize cerebellar development in VLBW infants.
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Affiliation(s)
- Katherine M Ottolini
- Department of Neonatology, 18th Medical Operations Squadron, Kadena AB, Okinawa, Japan
- Department of Pediatrics, Division of Neonatology, Uniformed Services University, Bethesda, Maryland, USA
| | - Nickie Andescavage
- Department of Neonatology, Children's National Hospital, Washington, District of Columbia, USA
- Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Kushal Kapse
- Developing Brain Research Laboratory, Children's National Hospital, Washington, District of Columbia, USA
| | - Marni Jacobs
- Division of Biostatistics & Study Methodology, Children's National Hospital, Washington, District of Columbia, USA
| | - Jonathan Murnick
- Department of Radiology, Children's National Hospital, Washington, District of Columbia, USA
| | - Rebecca VanderVeer
- Department of Neonatology, Children's National Hospital, Washington, District of Columbia, USA
| | - Sudeepta Basu
- Department of Neonatology, Children's National Hospital, Washington, District of Columbia, USA
- Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Mariam Said
- Department of Neonatology, Children's National Hospital, Washington, District of Columbia, USA
- Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Catherine Limperopoulos
- Developing Brain Research Laboratory, Children's National Hospital, Washington, District of Columbia, USA
- Department of Radiology, George Washington University School of Medicine, Washington, District of Columbia, USA
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13
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Fenton TR, Cormack B, Goldberg D, Nasser R, Alshaikh B, Eliasziw M, Hay WW, Hoyos A, Anderson D, Bloomfield F, Griffin I, Embleton N, Rochow N, Taylor S, Senterre T, Schanler RJ, Elmrayed S, Groh-Wargo S, Adamkin D, Shah PS. "Extrauterine growth restriction" and "postnatal growth failure" are misnomers for preterm infants. J Perinatol 2020; 40:704-714. [PMID: 32214217 DOI: 10.1038/s41372-020-0658-5] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 03/02/2020] [Accepted: 03/11/2020] [Indexed: 11/09/2022]
Abstract
Preterm infants are increasingly diagnosed as having "extrauterine growth restriction" (EUGR) or "postnatal growth failure" (PGF). Usually EUGR/PGF is diagnosed when weight is <10th percentile at either discharge or 36-40 weeks postmenstrual age. The reasons why the phrases EUGR/PGF are unhelpful include, they: (i) are not predictive of adverse outcome; (ii) are based only on weight without any consideration of head or length growth, proportionality, body composition, or genetic potential; (iii) ignore normal postnatal weight loss; (iv) are usually assessed prior to growth slowing of the reference fetus, around 36-40 weeks, and (v) are usually based on an arbitrary statistical growth percentile cut-off. Focus on EUGR/PGF prevalence may benefit with better attention to nutrition but may also harm with nutrition delivery above infants' actual needs. In this paper, we highlight challenges associated with such arbitrary cut-offs and opportunities for further refinement of understanding growth and nutritional needs of preterm neonates.
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Affiliation(s)
- Tanis R Fenton
- Community Health Sciences, Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Nutrition Services, Alberta Health Services, Calgary, AB, Canada.
| | - Barbara Cormack
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | - Roseann Nasser
- Saskatchewan Health Authority, Nutrition and Food Services, Regina, SK, Canada
| | - Belal Alshaikh
- Community Health Sciences, Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Misha Eliasziw
- Public Health and Community Medicine, Tufts University, Boston, MA, USA
| | | | - Angela Hoyos
- Clínica del Country, Universidad el Bosque, Bogotá, Colombia
| | - Diane Anderson
- Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Frank Bloomfield
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Ian Griffin
- Clinical and Translational Research, Biomedical research Institute of New Jersey, Cedar Knolls, NJ, USA
| | - Nicholas Embleton
- Newcastle Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Niels Rochow
- Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Sarah Taylor
- Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | | | - Richard J Schanler
- Neonatal Services, Cohen Children's Medical Center, Northwell Health, Zucker School of Medicine at Hofstra, New York, NY, USA
| | - Seham Elmrayed
- Community Health Sciences, Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sharon Groh-Wargo
- Pediatrics and Nutrition, Case Western Reserve University, Cleveland, OH, USA
| | - David Adamkin
- Pediatrics, University of Louisville, Louisville, KY, USA
| | - Prakesh S Shah
- Paediatrics and Institute of HPME, University of Toronto, Mount Sinai Hospital, Toronto, ON, Canada
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14
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Sánchez-García AM, Zaragoza-Martí A, Murcia-López AC, Navarro-Ruiz A, Noreña-Peña A. Adequacy of Parenteral Nutrition in Preterm Infants According to Current Recommendations: A Study in A Spanish Hospital. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17062131. [PMID: 32210085 PMCID: PMC7142515 DOI: 10.3390/ijerph17062131] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/15/2020] [Accepted: 03/21/2020] [Indexed: 12/25/2022]
Abstract
Background: In preterm infants, it is important to ensure adequate nutritional intake to accomplish foetal growth requirements. This study evaluated clinical practice regarding the prescription of parenteral nutrition in preterm infants in the neonatology unit of a tertiary hospital. Methods: It was a retrospective observational study of a sample of preterm infants (n = 155) born between January 2015 and December 2017 who were prescribed parenteral nutrition. Compliance with the hospital’s protocol and with the guidelines of the scientific societies American Society for Parenteral and Enteral Nutrition (ASPEN), European Society for Clinical Nutrition and Metabolism (ESPEN) and Spanish Society of Clinical Nutrition and Metabolism (SENPE) was evaluated. The differences in macronutrient intake and total duration of parenteral nutrition were analysed according to gestational age and birth weight. Results: The established protocol was followed in a high percentage (95.5%–100%) except with respect to the initiation of supplying established trace elements (64.9%). Compliance with the recommendations set forth in the guidelines was between 82.1% and 100%, with the exception of the initial carbohydrate intake recommended by ASPEN and ESPEN, for which compliance was 8.3%. Lower gestational age and birth weight were correlated with longer duration of parenteral nutrition (p < 0.001). Conclusions: A lower gestational age and birth weight are related to a longer duration of parenteral nutrition. The results of this study demonstrate the importance of developing and evaluating protocols in clinical practice.
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Affiliation(s)
- Ana María Sánchez-García
- Department of Pharmacy Services, University General Hospital of Elche, 03203 Elche, Spain; (A.M.S.G.); (A.C.M.L.); (A.N.R.)
| | - Ana Zaragoza-Martí
- Department of Nursing, Faculty of Health Science, University of Alicante, 03690 Alicante, Spain;
- Correspondence: ; Tel.: +34-965-903-240
| | - Ana Cristina Murcia-López
- Department of Pharmacy Services, University General Hospital of Elche, 03203 Elche, Spain; (A.M.S.G.); (A.C.M.L.); (A.N.R.)
| | - Andrés Navarro-Ruiz
- Department of Pharmacy Services, University General Hospital of Elche, 03203 Elche, Spain; (A.M.S.G.); (A.C.M.L.); (A.N.R.)
| | - Ana Noreña-Peña
- Department of Nursing, Faculty of Health Science, University of Alicante, 03690 Alicante, Spain;
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15
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Gerritsen L, Lindeboom R, Hummel T. Prescribed Protein Intake Does Not Meet Recommended Intake in Moderate- and Late-Preterm Infants: Contribution to Weight Gain and Head Growth. Nutr Clin Pract 2020; 35:729-737. [PMID: 32125013 DOI: 10.1002/ncp.10464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The purpose of the study was to evaluate differences between prescribed and recommended protein intake in moderate-preterm (MP) and late-preterm (LP) infants and examine the contribution of the first week's prescribed protein intake to growth until term age. METHODS Data on intake and anthropometrics were collected retrospectively in 235 preterm infants admitted to our general hospital's neonatal ward: 60 MP (320/7 -336/7 weeks' gestational age) and 175 LP (340/7 -366/7 weeks' gestational age). Differences between prescribed and recommended protein intake during the first postnatal week and z-score change for weight and head circumference (HC) between birth and term age were calculated. Multiple regression was used to evaluate the independent contribution of first week's prescribed protein intake to growth until term age. RESULTS At day 7, 58% of MP and 19% of LP infants reached recommended protein intake. At term age, mean z-score change was -0.4 for weight and +0.1 for HC. Mean protein intake (g/kg/d) was associated with z-score change of +0.34 (95% CI, 0.14-0.53; P < .001) for weight and +0.25 (95% CI, 0-0.5; P = .03) for HC. Reaching recommended protein intake at day 7 was only independently associated with weight z-score change (+0.22 [95% CI, 0.04-0.41; P = .002]). CONCLUSION First week's prescribed protein intake does not meet recommended intake. Higher protein intakes in the first postnatal week result in increased weight gain and head growth until term age. Desirability and feasibility of increasing the protein intake need careful consideration and further discussion.
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Affiliation(s)
- Linda Gerritsen
- Department of Pediatrics, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Robert Lindeboom
- Amsterdam UMC, Academic Medical Center, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, University of Amsterdam, the Netherlands
| | - Thalia Hummel
- Department of Pediatrics, Medisch Spectrum Twente, Enschede, the Netherlands
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16
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Wang L, Liu D, Shen H, Wang Y, Han L, He Z. Analysis of Amino Acid Patterns With Nutrition Regimens in Preterm Infants With Extrauterine Growth Retardation. Front Pediatr 2020; 8:184. [PMID: 32426308 PMCID: PMC7212428 DOI: 10.3389/fped.2020.00184] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 03/30/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Amino acid (AA) metabolic patterns have emerged as an analytical technique to characterize biomarkers compromising normal growth and elucidate underlying nutritional exposure. This study aimed to identify AA metabolites most likely associated with poor growth and examine the association between AA metabolites and nutrition regimens in preterm infants during transition from parenteral nutrition (PN) to enteral nutrition (EN), using gas chromatography-mass spectrometry (GC-MS). Methods: This observational cohort study was conducted in infants born at <32 weeks' gestation with birth weight of <1,500 g. The outcome of extrauterine growth retardation (EUGR) based on whether the weight was <10th percentile for post-menstrual age, was evaluated when full EN reached. Samples were collected at four sampling points according to nutritional status. AA profiles in dried sampling point spots (DBS) were quantified using GC-MS; and were compared simultaneously. The correlation of AA concentration with growth and nutritional parameters was examined using multivariate analysis. Results: We identified 40 eligible infants: 20 in the EUGR group and 20 in the non-EUGR group. AA deficiency progressively emerged during the transition. Lower concentrations of four AAs, including citrulline (Cit), were associated with increased risk of EUGR when adjusted for gestational age, birth weight z-score, age when trophic EN was started, as well as average energy and protein intakes in synchronous nutritional period. Moreover, a lower Cit concentration was positively correlated with the compromised protein and energy deficits in EN during early transition. Conclusion: A low Cit concentration during transition from PN to full EN should be noticed by the clinician to more closely examine nutrition practices to prevent EUGR.
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Affiliation(s)
- Li Wang
- Department of Neonatology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Danyang Liu
- Department of Neonatology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haiqing Shen
- Department of Neonatology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Wang
- Department of Clinical Nutrition, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lianshu Han
- Department of Pediatric Endocrine and Metabolic Diseases Laboratory, Shanghai Institute for Pediatric Research, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhenjuan He
- Department of Neonatology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Perinatal Research Laboratory, Shanghai Institute for Pediatric Research, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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17
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Asbury MR, Unger S, Kiss A, Ng DVY, Luk Y, Bando N, Bishara R, Tomlinson C, O'Connor DL. Optimizing the growth of very-low-birth-weight infants requires targeting both nutritional and nonnutritional modifiable factors specific to stage of hospitalization. Am J Clin Nutr 2019; 110:1384-1394. [PMID: 31536118 PMCID: PMC6885476 DOI: 10.1093/ajcn/nqz227] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 08/16/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Data on how baseline characteristics, acuity, morbidity, and nutrition work in combination to affect the growth of very-low-birth-weight (VLBW, <1500 g) infants are limited. OBJECTIVE We aimed to determine factors associated with in-hospital weight, length, and head circumference (HC) trajectories of VLBW infants. METHODS VLBW infants (n = 316) from the GTA-DoMINO trial were included. Linear mixed-effects models assessed relations of baseline characteristics, acuity (at birth, across hospitalization), major morbidities, and nutrition (enteral feeding type, macronutrient/energy intakes) with changes in anthropometrics over hospitalization (days 1-8, 9-29, 30-75). RESULTS Specific factors and the strength of their associations with growth depended on in-hospital time interval. Small-for-gestational-age infants experienced weight gain (4.3 g · kg-1 · d-1; 95% CI: 2.0, 6.5 g · kg-1 · d-1) during days 1-8, versus weight loss (-4.6 g · kg-1 · d-1; 95% CI: -5.6, -3.7 g · kg-1 · d-1) among appropriate-for-gestational-age infants (P < 0.001). Positive-pressure ventilation (versus oxygen/room air) was associated with slower weight (-1.8 g · kg-1 · d-1) and HC (-0.25 cm/wk) gain during days 9-29 (P < 0.001). Morbidities were negatively associated with growth after days 1-8, with patent ductus arteriosus (PDA) showing negative associations with weight (-2.7 g · kg-1 · d-1), length (-0.11 cm/wk), and HC (-0.21 cm/wk) gain during days 9-29 (P < 0.001). Macronutrient/energy intakes were associated with weight across hospitalization (P ≤ 0.01), with greater weight gain (1.3-3.0 g · kg-1 · d-1) among infants achieving macronutrient/energy recommendations during days 9-29 and 30-75. Macronutrient/energy intakes were associated with HC during the first month (P = 0.013-0.003), with greater HC gain (0.07-0.12 cm/wk) among infants achieving protein, lipid, and energy recommendations during days 9-29. CONCLUSIONS Baseline characteristics, acuity, morbidity, and nutrition factors were independently associated with VLBW infant growth. A focus on achieving macronutrient/energy recommendations and improving nutrient delivery to PDA-diagnosed infants may yield improvements to their growth. This trial was registered at www.isrctn.com as ISRCTN35317141.
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Affiliation(s)
- Michelle R Asbury
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada,Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sharon Unger
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada,Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Pediatrics, Mount Sinai Health System, Toronto, Ontario, Canada
| | - Alex Kiss
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,Evaluative and Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Dawn V Y Ng
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada,Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Yunnie Luk
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada,Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nicole Bando
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rosine Bishara
- Women & Babies Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Christopher Tomlinson
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada,Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada,Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Deborah L O'Connor
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada,Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Pediatrics, Mount Sinai Health System, Toronto, Ontario, Canada,Address correspondence to DLO (e-mail: )
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18
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Lacerda DC, Manhães-de-Castro R, Gouveia HJCB, Tourneur Y, Costa de Santana BJ, Assunção Santos RE, Olivier-Coq J, Ferraz-Pereira KN, Toscano AE. Treatment with the essential amino acid L-tryptophan reduces masticatory impairments in experimental cerebral palsy. Nutr Neurosci 2019; 24:927-939. [PMID: 31766953 DOI: 10.1080/1028415x.2019.1695360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose Children with cerebral palsy (CP) often exhibit difficulties in feeding resulting from deficits in chewing. This study investigates the therapeutic potential of L-tryptophan (TRI) to reduce deficits in chewing in rats subjected to an experimental model of CP.Methods A total of 80 Wistar albino rats were used. Pups were randomly assigned to 4 experimental groups: Control Saline, Control TRI, CP Saline, and CP TRI groups. The experimental model of CP was based on the combination of perinatal anoxia associated with postnatal sensorimotor restriction of the hind limbs. TRI was administered subcutaneously during the lactation period. Anatomical and behavioral parameters were evaluated during maturation, including body weight gain, food intake, chewing movements, relative weight and the distribution of the types of masseter muscle fibers.Results The induction of CP limited body weight gain, decreased food intake and led to impairment in the morphological and functional parameters of chewing. Moreover, for a comparable amount of food ingested, CP TRI animals grew the most. In addition, supplementation with TRI improved the number of chewing movements, and increased the weight and proportion of type IIB fibers of the masseter in rats subjected to CP.Conclusion These results demonstrate that experimental CP impaired the development of mastication and that TRI supplementation increased masticatory maturation in animals subjected to CP.
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Affiliation(s)
- Diego Cabral Lacerda
- Post Graduate Program in Nutrition, Federal University of Pernambuco Recife, Brazil
| | | | | | | | | | | | - Jacques Olivier-Coq
- Institut de Neuroscience de la Timone (INT), UMR 7289, CNRS Aix Marseille Université, Marseille, France
| | | | - Ana Elisa Toscano
- Department of Nursing, CAV, Federal University of Pernambuco Recife, Brazil
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19
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Pillai A, Albersheim S, Elango R. High-dose parenteral amino acid intake in very low birthweight infants: what is the current evidence? Curr Opin Clin Nutr Metab Care 2019; 22:236-241. [PMID: 30883467 DOI: 10.1097/mco.0000000000000560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW There is uncertainty regarding optimal dosing for parenteral amino acids in preterm infants and wide variability exists in clinical practice. There is new data from clinical trials trying to address these concerns. We review the recent evidence on parenteral high-dose amino acid intake in very low birth weight (VLBW) neonates with a focus on relevant clinical outcomes. RECENT FINDINGS Preterm infants often receive less protein than intended in the first week of life. Parenteral amino acid administration in doses that exceed requirements, however, leads to increased oxidation and higher blood urea concentrations. Amino acid doses greater than 3.5 g/kg/day have not shown to improve mortality, neonatal morbidities including sepsis, necrotizing enterocolitis, chronic lung disease, growth parameters or neurodevelopmental outcomes at 2 years of age. SUMMARY Parenteral amino acid administration in VLBW infants should be initiated soon after birth at a dose of at least 1.5 g/kg/day to maintain anabolism. The maximum dose for parenteral amino acid should be between 2.5 and 3.5 g/kg/day, with adequate nonprotein calories and micronutrients to ensure efficient protein utilization and growth.
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Affiliation(s)
- Anish Pillai
- Neonatal-Perinatal Medicine, BC Women's Hospital and Health Centre
- Department of Pediatrics, University of British Columbia
- BC Children's Hospital Research Institute
| | - Susan Albersheim
- Neonatal-Perinatal Medicine, BC Women's Hospital and Health Centre
- Department of Pediatrics, University of British Columbia
- BC Children's Hospital Research Institute
| | - Rajavel Elango
- Neonatal-Perinatal Medicine, BC Women's Hospital and Health Centre
- Department of Pediatrics, University of British Columbia
- BC Children's Hospital Research Institute
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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20
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Darrow MCJ, Li H, Prince A, McClary J, Walsh MC. Improving extrauterine growth: evaluation of an optimized, standardized neonatal parenteral nutrition protocol. J Perinatol 2019; 39:504-512. [PMID: 30531931 DOI: 10.1038/s41372-018-0279-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/12/2018] [Accepted: 10/18/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Poor extrauterine growth in very low birth weight (VLBW) neonates is common and associated with worsened long-term outcomes. We aimed to decrease growth restriction, measured by the change in weight z-score from birth to 36 weeks post menstrual age, from - 1.13 (baseline) to < -1 within 12 months. STUDY DESIGN The Model for Improvement was used in the design and implementation of an optimized, standardized parenteral nutrition protocol. Three Plan-Do-Study-Act cycles were completed and a [Formula: see text] and S control chart was created for the primary outcome. RESULT Mean weight z-score change from birth to 36 weeks post menstrual age improved by 23% to - 0.87. Improvements in early weight gain and linear growth were seen as well. CONCLUSION Use of the Model for Improvement to implement an optimized, standardized parenteral nutrition protocol can help improve extrauterine growth among VLBW infants.
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Affiliation(s)
- Maj Cory J Darrow
- Department of Pediatrics, Uniformed Services University of Health Sciences, Bethesda, MD, USA.,18th Medical Operations Squadron Kadena AB, Okinawa, Japan
| | - Hong Li
- Case Western Reserve University, Cleveland, OH, USA
| | - Allison Prince
- Case Western Reserve University, Cleveland, OH, USA.,University Hospitals Cleveland Medical Center, Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Jacquelyn McClary
- Case Western Reserve University, Cleveland, OH, USA.,University Hospitals Cleveland Medical Center, Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Michele C Walsh
- Case Western Reserve University, Cleveland, OH, USA. .,University Hospitals Cleveland Medical Center, Rainbow Babies and Children's Hospital, Cleveland, OH, USA.
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Brennan AM, Kiely ME, Fenton S, Murphy BP. Standardized Parenteral Nutrition for the Transition Phase in Preterm Infants: A Bag That Fits. Nutrients 2018; 10:nu10020170. [PMID: 29393903 PMCID: PMC5852746 DOI: 10.3390/nu10020170] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 01/12/2018] [Accepted: 01/30/2018] [Indexed: 12/21/2022] Open
Abstract
The optimal composition of standardized parenteral nutrition (SPN) is not yet known, contributing to nutrient deficit accrual and growth failure, with the period of parenteral nutrition weaning, i.e., transition (TN) phase, being identified as particularly vulnerable. We created a comprehensive nutrition database, representative of the nutritional course of a diverse range of preterm infants (n = 59, birth weight ≤ 1500 g, gestation < 34 weeks) by collecting hourly macronutrient intake data as part of a prospective, observational study over 19 months. Using a nutrient modeling technique for the TN phase, various amino acid (AA) concentrations of SPN were tested within the database, whilst acknowledging the nutritional contribution from enteral feeds until target AA intakes were consistently achieved. From the modeling, the AA composition of SPN was determined at 3.5 g/100 mL, which was the maximum to avoid exceeding target intakes at any point in the TN phase. However, in order to consistently achieve target AA intakes, additional nutritional strategies were required, which included increasing the exclusion of enteral feeds in fluid and nutrient calculations from <20 mL/kg/day to <40 mL/kg/day, and earlier fortification of breastmilk at 80 mL/kg/day. This data-driven nutrient modeling process supported the development of an improved SPN regimen for our preterm population in the TN phase.
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Affiliation(s)
- Ann-Marie Brennan
- Department of Clinical Nutrition and Dietetics, Cork University Maternity Hospital, T12 YE02 Cork, Ireland.
- Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, T12 DFK4 Cork, Ireland.
| | - Mairead E Kiely
- Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, T12 DFK4 Cork, Ireland.
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, T12 Y337 Cork, Ireland.
| | - Sarah Fenton
- Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, T12 DFK4 Cork, Ireland.
- Pharmacy Department, Cork University Hospital, T12 YE02 Cork, Ireland.
| | - Brendan P Murphy
- Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, T12 DFK4 Cork, Ireland.
- Department of Neonatology, Cork University Maternity Hospital, T12 YE02 Cork, Ireland.
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Ng DVY, Unger S, Asbury M, Kiss A, Bishara R, Bando N, Tomlinson C, Gibbins S, O'Connor DL. Neonatal Morbidity Count Is Associated With a Reduced Likelihood of Achieving Recommendations for Protein, Lipid, and Energy in Very Low Birth Weight Infants: A Prospective Cohort Study. JPEN J Parenter Enteral Nutr 2017; 42:623-632. [PMID: 28537798 DOI: 10.1177/0148607117710441] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 04/27/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Serious morbidity may elevate nutrient requirements and affect adherence to feeding guidelines for very low birth weight (VLBW) infants. An understanding of factors affecting nutrient intakes of VLBW infants will facilitate development of strategies to improve nutrient provision. Our aim was to examine the impact of neonatal morbidity count on achieving recommended nutrient intakes in VLBW infants. METHODS VLBW infants enrolled in the Donor Milk for Improved Neurodevelopmental Outcomes trial (ISRCTN35317141, n = 363) were included. Serious morbidities and daily parenteral and enteral intakes were collected prospectively. RESULTS Median intakes of infants with and without ≥1 morbidity met protein recommendations (3.5-4.5 g/kg/d) by week 2, although not maintained after week 4. Infants with ≥1 morbidity (vs without) were 2 weeks slower in achieving lipid (4.8-6.6 g/kg/d; week 4 vs 2) and energy (110-130 kcal/kg/d; week 5 vs 3) and 1 week slower in achieving carbohydrate recommendations (11.6-13.2 g/kg/d; week 4 vs 3). Adjusted hazard ratios of first achieving recommendations on any given day in infants with any 1 or 2 morbidities were 0.6 (95% confidence interval [CI], 0.5-0.9) and 0.6 (0.4-0.9), respectively, for protein; 0.5 (0.4-0.7) and 0.3 (0.2-0.5) for lipid; and 0.5 (0.4-0.7) and 0.3 (0.2-0.4) for energy. CONCLUSION Morbidity is associated with a decreased likelihood of achieving lipid and consequently energy recommendations. This and the decline in protein intakes after the early neonatal period require further investigation to ensure optimal nutrition in this vulnerable population.
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Affiliation(s)
- Dawn V Y Ng
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,SickKids Research Institute, Toronto, Ontario, Canada
| | - Sharon Unger
- SickKids Research Institute, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Michelle Asbury
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,SickKids Research Institute, Toronto, Ontario, Canada
| | - Alex Kiss
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Rosine Bishara
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Nicole Bando
- SickKids Research Institute, Toronto, Ontario, Canada
| | - Chris Tomlinson
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,SickKids Research Institute, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | | | - Deborah L O'Connor
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,SickKids Research Institute, Toronto, Ontario, Canada.,Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
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Roelants JA, Joosten KFM, van der Geest BMA, Hulst JM, Reiss IKM, Vermeulen MJ. First week weight dip and reaching growth targets in early life in preterm infants. Clin Nutr 2017; 37:1526-1533. [PMID: 28912010 DOI: 10.1016/j.clnu.2017.08.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 08/17/2017] [Accepted: 08/23/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND & AIMS Aggressive parenteral nutritional practices were implemented in clinical practice over a decade ago to prevent early growth retardation in preterm infants. We aimed to study adherence to current nutritional recommendations in a population of very preterm infants, and to evaluate growth in early life. METHODS Preterm infants (gestational age <30 weeks and birth weight <1500 g) were included in a prospective observational cohort study. Data on parenteral and enteral intake were collected on days 1-7, 14, 21 and 28 (d28) of life. Growth data were collected at birth, at moment of maximal weight loss (dip), and either at discharge from the neonatal intensive care unit or at d28, whichever came first. Nutritional intakes were compared to recommendations of current guidelines. The target growth rate was 15-20 g/kg/d. RESULTS Fifty-nine infants (63% male) were included. Median gestational age was 27 3/7 (interquartile range 25 6/7;28 4/7), and birth weight was 920 g (720;1200). Median macronutrient intakes were within or above the targets on all study days, but energy targets were not met before day 5. Median growth rates were 9.5 and 18.1 g/kg/d, when calculated from respectively birth and dip to discharge/d28. Eight (14%) versus 46 (78%) infants met the growth targets, when evaluated from respectively birth and dip to discharge/d28. CONCLUSIONS In this cohort, only energy intake up to day 5 was lower than recommended. Growth targets were achieved in the majority of the infants, but only when evaluated from dip onward, not from birth.
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Affiliation(s)
- Jorine A Roelants
- Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands; Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Koen F M Joosten
- Department of Pediatrics, Intensive Care Unit, Erasmus MC - Sophia Children's Hospital, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Brigitte M A van der Geest
- Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands; Department of Dietetics, Erasmus MC - Sophia Children's Hospital, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Jessie M Hulst
- Department of Pediatrics, Division of Pediatric Gastroenterology, Erasmus MC - Sophia Children's Hospital, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Irwin K M Reiss
- Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Marijn J Vermeulen
- Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands.
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