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Harris L, Lewis S, Vardaman S. Exclusive Human Milk Diets and the Reduction of Necrotizing Enterocolitis. Adv Neonatal Care 2024; 24:400-407. [PMID: 38986129 DOI: 10.1097/anc.0000000000001183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
BACKGROUND Necrotizing enterocolitis (NEC) is common in preterm infants, especially infants less than 32 weeks gestation. Mortality from NEC is 7% and occurs in 1 out of 1000 preterm infants. Studies have shown the efficacy of an exclusive milk from mother diet in decreasing rates of NEC and associated mortality. PURPOSE To evaluate the effectiveness of an existing exclusive human milk diet (EHMD) protocol on the incidence of NEC in extremely premature infants. EHMD, for the purposes of this project is defined as breast milk of mother, with or without human milk-based fortifier. METHODS A single-center retrospective quasi-experimental study. The sample included 201 infants born less than 32 weeks gestation, weighing less than 1250 grams, small for gestational age (SGA) and with low Apgar scores. Outcomes measured included incidences of NEC, mortality, and co-morbidities in infants pre- and postinitiation of an EHMD protocol. RESULTS Just 4.8% of the EHMD group had a NEC diagnosis compared to 10.5% of the bovine-based (BOV) group. There was a 1% mortality rate of the EHMD group as compared to 6% in the BOV group. The EHMD group had a statistically significant greater weight gain during hospitalization as compared to infants fed BOV ( P = < .05). IMPLICATIONS FOR PRACTICE AND RESEARCH Neonatal intensive care units should consider EHMDs for use in this infant population. Future research is needed to support dissemination of the use of EHMD as standard of practice.
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MESH Headings
- Humans
- Enterocolitis, Necrotizing/prevention & control
- Enterocolitis, Necrotizing/epidemiology
- Milk, Human
- Infant, Newborn
- Retrospective Studies
- Female
- Male
- Infant, Premature
- Breast Feeding
- Infant, Premature, Diseases/prevention & control
- Infant, Premature, Diseases/mortality
- Infant, Extremely Premature
- Weight Gain
- Incidence
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Affiliation(s)
- Lydia Harris
- Memorial Hospital, Savannah, Georgia (Dr Harris); and Troy University, Phenix City, Alabama (Drs Lewis and Vardaman)
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González López C, Solís Sánchez G, Fernández Colomer B, Mantecón Fernández L, Lareu Vidal S, Arias Llorente RP, Ibáñez Fernández A, González García LG, Suárez Rodríguez M. Extrauterine growth restriction in very-low-birthweight infants: prevalence and concordance according to Fenton, Olsen, and INTERGROWTH-21st growth charts in a multicenter Spanish cohort. Eur J Pediatr 2024; 183:4073-4083. [PMID: 38960906 PMCID: PMC11322293 DOI: 10.1007/s00431-024-05673-6] [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: 03/26/2024] [Revised: 06/14/2024] [Accepted: 06/27/2024] [Indexed: 07/05/2024]
Abstract
Multiple criteria and growth references have been proposed for extrauterine growth restriction (EUGR). We hypothesized that these may impact the diagnosis of EUGR. The objective was to evaluate the prevalence of EUGR with its different definitions and the concordance according to Fenton, Olsen, and INTERGROWTH-21st in very-low-birthweight (VLBW) infants. This is an observational, retrospective, and multicenter study including VLBW infants from the Spanish SEN1500 Network from 2011 to 2020. Patients with major congenital anomalies, embryopathies, and gestational age less than 24 weeks were excluded. EUGR prevalence was calculated at discharge with cross-sectional, longitudinal, "true" cross-sectional, and "true" longitudinal definitions. Concordance was assessed with Fleiss' kappa coefficient. 23582 VLBW infants from 77 NICUs were included. In total, 50.4% were men with a median of gestational age of 29 (4) weeks. The prevalence of EUGR (cross-sectional, longitudinal, and "true") was variable for weight, length, and head circumference. Overall, the prevalence was higher with Fenton and lower with Olsen (cross-sectional and "true" cross-sectional) and INTERGROWTH-21st (longitudinal and "true" longitudinal). Agreement among the charts by weight was good only for cross-sectional EUGR and moderate for longitudinal, "true" cross-sectional, and "true" longitudinal. Concordance was good or very good for EUGR by length and head circumference.Conclusions: The prevalence of EUGR with the most commonly used definitions was variable in the cohort. Agreement among growth charts was moderate for all the definitions of EUGR by weight except cross-sectional and good or very good for length and head circumference. The choice of reference chart can impact the establishment of the diagnosis of EUGR. What is known: • EUGR has been defined in the literature and daily practice considering weight, length and head circumference with multiple criteria (cross-sectional, longitudinal, and "true" definition) • Different growth charts have been used for EUGR diagnosis What is new: • Prevalence of EUGR is variable depending on the definition and growth chart used in our cohort of VLBW infants • For the most frequently EUGR criteria used, traditionally considering weight, concordance among Fenton, Olsen and INTERGROWTH-21st growth charts is only moderate for all the definitions of EUGR by weight except cross-sectional definition. Concordance among the charts is good or very good for the different criteria of EUGR by head circumference and length.
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Affiliation(s)
- Clara González López
- Servicio de Neonatología, Área de Gestión Clínica de La Infancia y Adolescencia, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Gonzalo Solís Sánchez
- Servicio de Neonatología, Área de Gestión Clínica de La Infancia y Adolescencia, Hospital Universitario Central de Asturias, Oviedo, Spain.
- Instituto Investigación Sanitaria Principado de Asturias, ISPA, Oviedo, Spain.
- Departamento de Medicina, Universidad de Oviedo, Oviedo, Spain.
| | - Belén Fernández Colomer
- Servicio de Neonatología, Área de Gestión Clínica de La Infancia y Adolescencia, Hospital Universitario Central de Asturias, Oviedo, Spain
- Instituto Investigación Sanitaria Principado de Asturias, ISPA, Oviedo, Spain
| | - Laura Mantecón Fernández
- Servicio de Neonatología, Área de Gestión Clínica de La Infancia y Adolescencia, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Sonia Lareu Vidal
- Servicio de Neonatología, Área de Gestión Clínica de La Infancia y Adolescencia, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Rosa Patricia Arias Llorente
- Servicio de Neonatología, Área de Gestión Clínica de La Infancia y Adolescencia, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Aleida Ibáñez Fernández
- Servicio de Neonatología, Área de Gestión Clínica de La Infancia y Adolescencia, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Marta Suárez Rodríguez
- Servicio de Neonatología, Área de Gestión Clínica de La Infancia y Adolescencia, Hospital Universitario Central de Asturias, Oviedo, Spain
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Guellec I, Simon L, Vayssiere C, Senat MV, Ego A, Zeitlin J, Subtil D, Verspyck E, Lapillonne A, Roze JC, Claris O, Picaud JC, Monier I, Geraldine G. Growth charts for use at birth and in the neonatal period: Recommendations of the French Neonatal Society. J Pediatr Gastroenterol Nutr 2024; 79:352-361. [PMID: 38808729 DOI: 10.1002/jpn3.12238] [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: 09/20/2023] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 05/30/2024]
Abstract
INTRODUCTION The use of different growth charts can lead to confusion in discussions between professionals. There are obstetric charts (of fetal growth) and neonatal charts (of measurements at birth and of postnatal growth). These charts can be descriptive (derived from an unselected population) or prescriptive (derived from of a population at low risk and with optimal conditions for growth). OBJECTIVES (1) To describe available charts for infants at birth and in the neonatal period and compare them, and (2) to recommend one or more charts for use in neonatology in France. METHODS Bibliographic research was conducted on MEDLINE and completed by the guidelines of professional societies. RESULTS Antenatal information about fetal growth restriction or fetuses identified as small-for-gestational-age using Intrauterine charts must be integrated into the identification of newborns at risk, but the use of Intrauterine charts to evaluate birthweight is not recommended to allow consistency with postnatal charts used in neonatal practice. Z-score variations using the updated Fenton postnatal charts are the most appropriate for the assessment of birthweight and postnatal growth for infants born preterm. These charts are sex-specific, include the three measurements (length, weight, and head circumference) and enable longitudinal follow-up of growth up to 50 weeks of corrected age and are linked to the World Health Organization charts at term. The French Audipog charts, although are individualized, accessible online and can be used in maternity units to evaluate birthweight for term infants, but do not allow the follow-up of postnatal growth, while Fenton charts may be used to evaluate birthweight and postnatal growth in the first month for hospitalized term infants. CONCLUSION The updated Fenton charts are the neonatal charts that best suit the objectives of pediatricians in France for monitoring the growth of preterm newborns. The use of the Audipog charts at term remains an alternative in maternity wards, while Fenton charts can be used for hospitalized term newborns.
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Affiliation(s)
- Isabelle Guellec
- Neonatal Intensive Care Unit, Nice University Hospital, Nice, France
- Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, Paris, France
| | - Laure Simon
- Neonatal Intensive Care Unit, Nantes University Hospital, Nantes, France
| | | | - Marie-Victoire Senat
- Obstetrics Department, Kremlin Bicêtre University Hospital, AP-HP, Paris, France
| | - Anne Ego
- Public Health Department, Univ. Grenoble Alpes, CNRS, Grenoble Alpes University Hospital, Grenoble INP Institute of Engineering Univ. Grenoble Alpes, TIMC-IMAG, Grenoble, France
| | - Jennifer Zeitlin
- Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, Paris, France
| | - Damien Subtil
- Obstetrics Department, Lille University Hospital, Lille, France
| | - Eric Verspyck
- Obstetrics Department, Rouen University Hospital, Rouen, France
| | - Alexandre Lapillonne
- Neonatal Intensive Care Unit, Necker Enfants Malades Hospital, APHP, Paris, France
| | | | - Olivier Claris
- Neonatal Intensive Care Unit, Lyon Civil Hospices University Hospital, Lyon, France
| | - Jean-Charles Picaud
- Neonatal Intensive Care Unit, Lyon Civil Hospices University Hospital, Lyon, France
| | - Isabelle Monier
- Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, Paris, France
| | - Gascoin Geraldine
- Neonatal Intensive Care Unit, Toulouse University Hospital, Toulouse, France
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González López C, Solís Sánchez G, Fernández Colomer B, Mantecón Fernández L, Lareu Vidal S, Fernández Castiñeira S, Rubio Granda A, Pérez Pérez A, Suárez Rodríguez M. Impact of the Choice of Diagnostic Criteria and Growth Reference on the Prevalence of Extrauterine Growth Restriction in Extremely-Low-Birthweight Infants. CHILDREN (BASEL, SWITZERLAND) 2024; 11:934. [PMID: 39201869 PMCID: PMC11352271 DOI: 10.3390/children11080934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Revised: 07/28/2024] [Accepted: 07/29/2024] [Indexed: 09/03/2024]
Abstract
BACKGROUND AND OBJECTIVES Variable diagnostic criteria and growth charts have been used for extrauterine growth restriction (EUGR). The objective was to assess the prevalence and concordance of EUGR in extremely-low-birthweight (ELBW) infants with the most frequent diagnostic criteria and growth charts. MATERIALS AND METHODS An observational, retrospective and multicenter study was conducted from 2011 to 2020 including ELBW infants from the Spanish SEN1500 Network. EUGR prevalence was calculated at discharge using different definitions: cross-sectional (anthropometry less than the 10th centile), longitudinal (decrease of more than 1 SD from birth to discharge), "true" cross-sectional and "true" longitudinal (using the criteria previously described, excluding infants small for gestational age at birth). Concordance among Fenton, Olsen and INTERGROWTH-21st was assessed with Fleiss' Kappa coefficient. RESULTS The prevalence of EUGR was variable with the different definitions and growth references studied in the 7914 ELBW infants included. Overall, it was higher with Fenton for all the EUGR criteria studied by weight and length. The agreement among growth charts was substantial (κ > 0.6) for all the definitions except for longitudinal EUGR by weight (moderate, κ = 0.578). CONCLUSIONS The prevalence of EUGR was variable in our cohort with the different diagnostic criteria and growth charts. The agreement among charts was good for all the definitions of EUGR except longitudinal EUGR by weight.
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Affiliation(s)
- Clara González López
- Servicio de Neonatología, Área de Gestión Clínica de la Infancia y Adolescencia, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Gonzalo Solís Sánchez
- Servicio de Neonatología, Área de Gestión Clínica de la Infancia y Adolescencia, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
- Instituto Investigación Sanitaria Principado de Asturias, ISPA, 33011 Oviedo, Spain
- Departamento de Medicina, Universidad de Oviedo, 33003 Oviedo, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS), Instituto de Salud Carlos III, RD21/0012/0020, 28028 Madrid, Spain
| | - Belén Fernández Colomer
- Servicio de Neonatología, Área de Gestión Clínica de la Infancia y Adolescencia, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
- Instituto Investigación Sanitaria Principado de Asturias, ISPA, 33011 Oviedo, Spain
| | - Laura Mantecón Fernández
- Servicio de Neonatología, Área de Gestión Clínica de la Infancia y Adolescencia, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Sonia Lareu Vidal
- Servicio de Neonatología, Área de Gestión Clínica de la Infancia y Adolescencia, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Sara Fernández Castiñeira
- Servicio de Neonatología, Área de Gestión Clínica de la Infancia y Adolescencia, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Ana Rubio Granda
- Servicio de Neonatología, Área de Gestión Clínica de la Infancia y Adolescencia, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Alicia Pérez Pérez
- Área de Gestión Clínica de la Infancia y Adolescencia, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Marta Suárez Rodríguez
- Servicio de Neonatología, Área de Gestión Clínica de la Infancia y Adolescencia, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
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Fenton TR, Merlino Barr S, Elmrayed S, Alshaikh B. Expected and Desirable Preterm and Small Infant Growth Patterns. Adv Nutr 2024; 15:100220. [PMID: 38670164 PMCID: PMC11251411 DOI: 10.1016/j.advnut.2024.100220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024] Open
Abstract
Adequate nutrition is necessary for achieving optimal growth and neurodevelopment. Growth is a natural and expected process that happens concomitantly with rapid advancements in neurodevelopment. Serial weight, length, and head circumference growth measures are essential for monitoring development, although identifying pathological deviations from normal growth can pose challenges. Appropriate growth assessments require considerations that a range of sizes for length, head circumference, and weight are expected and appropriate. Because of genetic differences and morbidities, there is a considerable overlap between the growth of healthy infants and those with growth alterations. Parents tend to be over-concerned about children who plot low on growth charts and often need reassurance. Thus, the use of terms such as "poor" growth or growth "failure" are discouraged when growth is approximately parallel to growth chart curves even if their size is smaller than specific percentiles. No specific percentile should be set as a growth goal; individual variability should be expected. An infant's size at birth is important information that goes beyond the common use of prognostic predictions of appropriate compared with small or large for gestational age. The lower the birthweight, the lower the nutrient stores and the more important the need for nutrition support. Compared to term infants, preterm infants at term-equivalent age have a higher percentage of body fat, but this diminishes over the next months. Current research findings support expert recommendations that preterm infants should grow, after early postnatal weight loss, similar to the fetus and then term-born infants, which translates to growth approximately parallel to growth chart curves. There is no need for a trade-off between optimum cognition and optimum future health. Each high-risk infant needs individualized nutrition and growth assessments. This review aims to examine infant growth expectations and messaging for parents of preterm and term-born infants within the broader causal framework.
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Affiliation(s)
- Tanis R Fenton
- Community Health Sciences, O'Brien Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada.
| | | | - Seham Elmrayed
- Community Health Sciences, O'Brien Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada; Institute of Global Health and Human Ecology, American University in Cairo, Egypt
| | - Belal Alshaikh
- Community Health Sciences, O'Brien Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada; Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Strobel KM, Wood TR, Valentine GC, German KR, Gogcu S, Hendrixson DT, Kolnik SE, Law JB, Mayock DE, Comstock BA, Heagerty PJ, Juul SE. Contemporary definitions of infant growth failure and neurodevelopmental and behavioral outcomes in extremely premature infants at two years of age. J Perinatol 2024; 44:811-818. [PMID: 38195921 PMCID: PMC11161409 DOI: 10.1038/s41372-023-01852-9] [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: 08/02/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Associations of 2-year neurodevelopmental and behavioral outcomes with growth trajectories of preterm infants are unknown. METHODS This secondary analysis of a preterm cohort examined in-hospital and discharge to 2-year changes in anthropometric z-scores. Two-year follow-up included Bayley Scales of Infant Development (BSID-III) and Child Behavior Checklist. RESULTS Among 590 infants, adjusted in-hospital growth was not associated with any BSID-III subscale. Occipitofrontal circumference (OFC) growth failure (GF) in-hospital was associated with increased adjusted odds of attention problems (aOR 1.65 [1.03, 2.65]), aggressive behavior (aOR 2.34 [1.12, 4.89]), and attention-deficit-hyperactivity symptoms (aOR 1.86 [1.05, 3.30]). Infants with OFC GF at 2 years had lower adjusted BSID-III language scores (-4.0 [-8.0, -0.1]), increased odds of attention problems (aOR 2.29 [1.11, 4.74]), aggressive behavior (aOR 3.09 [1.00, 9.56]), and externalizing problems (aOR 3.01 [1.07, 8.45]) compared to normal OFC growth cohort. CONCLUSION Infants with OFC GF are at risk for neurodevelopmental and behavioral impairment. CLINICAL TRIAL REGISTRATION This study is a secondary analysis of pre-existing data from the PENUT Trial Registration: NCT01378273.
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Affiliation(s)
- Katie M Strobel
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, WA, USA.
| | - Thomas R Wood
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Gregory C Valentine
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Kendell R German
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Semsa Gogcu
- Division of Neonatology, Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - D Taylor Hendrixson
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Sarah E Kolnik
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Janessa B Law
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Dennis E Mayock
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Bryan A Comstock
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | | | - Sandra E Juul
- Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, WA, USA
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Vuong KT, Vega MR, Casey L, Swartz SJ, Srivaths P, Osborne SW, Rhee CJ, Arikan AA, Joseph C. Clearance and nutrition in neonatal continuous kidney replacement therapy using the Carpediem™ system. Pediatr Nephrol 2024; 39:1937-1950. [PMID: 38231233 DOI: 10.1007/s00467-023-06237-w] [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: 08/08/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Infants with kidney failure (KF) demonstrate poor growth partly due to obligate fluid and protein restrictions. Delivery of liberalized nutrition on continuous kidney replacement therapy (CKRT) is impacted by clinical instability, technical dialysis challenges, solute clearance, and nitrogen balance. We analyzed delivered nutrition and growth in infants receiving CKRT with the Cardio-Renal, Pediatric Dialysis Emergency Machine (Carpediem™). METHODS Single-center observational study of infants receiving CKRT with the Carpediem™ between June 1 and December 31, 2021. We collected prospective circuit characteristics, delivered nutrition, anthropometric measurements, and illness severity Score for Neonatal Acute Physiology-II. As a surrogate to normalized protein catabolic rate in maintenance hemodialysis, we calculated normalized protein nitrogen appearance (nPNA) using the Randerson II continuous dialysis model. Descriptive statistics, Spearman correlation coefficient, Mann Whitney, Wilcoxon signed rank, receiver operating characteristic curves, and Kruskal-Wallis analysis were performed using SAS version 9.4. RESULTS Eight infants received 31.9 (22.0, 49.7) days of CKRT using mostly (90%) regional citrate anticoagulation. Delivered nutritional volume, protein, total calories, enteral calories, nPNA, and nitrogen balance increased on CKRT. Using parenteral nutrition, 90 ml/kg/day should meet caloric and protein needs. Following initial weight loss of likely fluid overload, exploratory sensitivity analysis suggests weight gain occurred after 14 days of CKRT. Despite adequate nutritional delivery, goal weight (z-score = 0) and growth velocity were not achieved until 6 months after CKRT start. Most (5 infants, 62.5%) survived and transitioned to peritoneal dialysis (PD). CONCLUSIONS Carpediem™ is a safe and efficacious bridge to PD in neonatal KF. Growth velocity of infants on CKRT appears delayed despite delivery of adequate calories and protein.
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Affiliation(s)
- Kim T Vuong
- Division of Pediatric Nephrology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
| | - Molly R Vega
- Division of Pediatric Nephrology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Lauren Casey
- Division of Pediatric Nephrology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Sarah J Swartz
- Division of Pediatric Nephrology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Poyyapakkam Srivaths
- Division of Pediatric Nephrology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Scott W Osborne
- Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Christopher J Rhee
- Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Ayse Akcan Arikan
- Division of Pediatric Nephrology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
- Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Catherine Joseph
- Division of Pediatric Nephrology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
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Kumar V, Thakur A, Garg P, Kler N. Comparison of Three Modalities of Feeding in Preterm Infants ≤32 Weeks and ≤1,250 G: A Randomized Controlled Trial. Am J Perinatol 2024; 41:e1792-e1799. [PMID: 37059454 DOI: 10.1055/a-2074-1960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
OBJECTIVE Early establishment of enteral feeds is desirable in very preterm infants, but it may be associated with feeding intolerance. Several feeding methods have been studied with no strong evidence to suggest the preferred feeding method to establish early full enteral feeds. We studied three modalities of feeding in preterm infants ≤32 weeks and ≤1,250 g: continuous infusion (CI), intermittent bolus by infusion (IBI), and intermittent bolus by gravity (IBG) for their effect on time to reach full enteral feeds of 180 mL/kg/d. STUDY DESIGN We randomized 146 infants, 49 infants in each CI and IBI group and 48 infants in the IBG group. In the CI group, feeds were delivered by an infusion pump continuously over 24 hours. In the IBI group, feeds were given every 2 hours and infused over 15 minutes by an infusion pump. In the IBG group, feeds were delivered by gravity over 10 to 30 minutes. The intervention was continued till infants reached direct breast/cup feeds. RESULTS The mean (standard deviation) gestation in CI, IBI, and IBG groups were 28.4 (2.2), 28.5(1.9), and 28.6 (1.8) weeks, respectively. The time to reach full feeds in CI, IBI, and IBG were not significantly different (median [interquartile range]: 13 [10-16], 11.5 [9-17], and 13 [9.5-14.2] d, respectively, p = 0.71). The proportions of infants who developed feeding intolerance in CI, IBI, and IBG were similar (n [%]: 21 [51.2%], 20 [52.6%], and 22 [64.7%], respectively, p = 0.45). There was no difference in necrotizing enterocolitis ≥2 (p = 0.80), bronchopulmonary dysplasia (p = 0.86), intraventricular hemorrhage ≥2 (p = 0.35), patent ductus arteriosus requiring treatment (p = 0.44), retinopathy of prematurity requiring treatment (p = 0.51), and growth parameters at discharge. CONCLUSION In preterm infants, ≤32 weeks of gestation and birth weight ≤1,250 g, there was no difference in time to reach full enteral feeds in the three modalities of feeding. This study is registered with Clinical Trials Registry India (CTRI) and the registration number is CTRI/2017/06/008792. KEY POINTS · Gavage feeding in preterm infants is either continuous or intermittent bolus feeding.. · Intermittent bolus feeding was evaluated in a controlled time by infusion over 15 minutes.. · The time to reach full feeds was comparable for all three methods..
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Affiliation(s)
- Vijay Kumar
- Department of Neonatology, Institute of Medical Sciences and Sum Hospital, Bhubaneswar, Odisha, India
| | - Anup Thakur
- Department of Neonatology, Sir Ganga Ram Hospital, New Delhi, India
| | - Pankaj Garg
- Department of Neonatology, Sir Ganga Ram Hospital, New Delhi, India
| | - Neelam Kler
- Department of Neonatology, Sir Ganga Ram Hospital, New Delhi, India
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González-López C, Solís-Sánchez G, Lareu-Vidal S, Mantecón-Fernández L, Ibáñez-Fernández A, Rubio-Granda A, Suárez-Rodríguez M. Variability in Definitions and Criteria of Extrauterine Growth Restriction and Its Association with Neurodevelopmental Outcomes in Preterm Infants: A Narrative Review. Nutrients 2024; 16:968. [PMID: 38613002 PMCID: PMC11013404 DOI: 10.3390/nu16070968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
Extrauterine growth restriction (EUGR) has been used in the literature and clinical practice to describe inadequate growth in preterm infants. Significant variability is seen in the criteria for EUGR, with no standard definition reached to date. Moreover, no consensus on the optimal timing for assessment or the ideal growth monitoring tool has been achieved, and an ongoing debate persists on the appropriate terminology to express poor postnatal growth. To ensure an adequate understanding of growth and early intervention in preterm infants at higher risk, it is critical to relate the diagnostic criteria of EUGR to the ability to predict adverse outcomes, such as neurodevelopmental outcomes. This narrative review was conducted to present evidence that evaluates neurodevelopmental outcomes in preterm infants with EUGR, comparing separately the different definitions of this concept by weight (cross-sectional, longitudinal and "true" EUGR). In this article, we highlight the challenges of comparing various published studies on the subject, even when subclassifying by the definition of EUGR, due to the significant variability on the criteria used for each definition and for the evaluation of neurodevelopmental outcomes in different papers. This heterogeneity compromises the obtention of a single firm conclusion on the relation between different definitions of EUGR and adverse neurodevelopmental outcomes.
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Affiliation(s)
- Clara González-López
- Unidad de Neonatología, Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.G.-L.); (S.L.-V.); (L.M.-F.); (A.I.-F.); (A.R.-G.); (M.S.-R.)
| | - Gonzalo Solís-Sánchez
- Unidad de Neonatología, Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.G.-L.); (S.L.-V.); (L.M.-F.); (A.I.-F.); (A.R.-G.); (M.S.-R.)
- Instituto Investigación Sanitaria Principado de Asturias, ISPA, 33011 Oviedo, Spain
- Medical Department, University of Oviedo, 33003 Oviedo, Spain
| | - Sonia Lareu-Vidal
- Unidad de Neonatología, Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.G.-L.); (S.L.-V.); (L.M.-F.); (A.I.-F.); (A.R.-G.); (M.S.-R.)
- Instituto Investigación Sanitaria Principado de Asturias, ISPA, 33011 Oviedo, Spain
| | - Laura Mantecón-Fernández
- Unidad de Neonatología, Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.G.-L.); (S.L.-V.); (L.M.-F.); (A.I.-F.); (A.R.-G.); (M.S.-R.)
- Instituto Investigación Sanitaria Principado de Asturias, ISPA, 33011 Oviedo, Spain
| | - Aleida Ibáñez-Fernández
- Unidad de Neonatología, Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.G.-L.); (S.L.-V.); (L.M.-F.); (A.I.-F.); (A.R.-G.); (M.S.-R.)
| | - Ana Rubio-Granda
- Unidad de Neonatología, Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.G.-L.); (S.L.-V.); (L.M.-F.); (A.I.-F.); (A.R.-G.); (M.S.-R.)
| | - Marta Suárez-Rodríguez
- Unidad de Neonatología, Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.G.-L.); (S.L.-V.); (L.M.-F.); (A.I.-F.); (A.R.-G.); (M.S.-R.)
- Instituto Investigación Sanitaria Principado de Asturias, ISPA, 33011 Oviedo, Spain
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10
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Zibitt M, Ange B, Wynter Z, Mundy C, Herrmann S, Stansfield BK. Hypothyroxinemia and weight velocity in preterm infants. J Pediatr Endocrinol Metab 2024; 37:236-242. [PMID: 38281180 DOI: 10.1515/jpem-2023-0496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/12/2024] [Indexed: 01/30/2024]
Abstract
OBJECTIVES Hypothyroxinemia of prematurity (HOP) is characterized by low free thyroxine (FT4) associated with low or normal thyroid stimulating hormone (TSH). The objective of this study is to define FT4 and TSH values in very preterm infants (<32 weeks postmenstrual age, PMA) and correlate hypothyroxinemia and levothyroxine treatment with growth velocity at 28 days and 36 weeks PMA. METHODS Preterm neonates <32 weeks PMA admitted to the regional neonatal intensive care unit (NICU) at the Children's Hospital of Georgia (USA) between January 2010 and July 2022 were routinely screened for hypothyroxinemia. FT4 and TSH values were obtained on 589 eligible neonates between day of life (DOL) 4 and 14. Growth velocity (g/kg/day) from DOL 14 to DOL 28 and 36-weeks PMA were calculated for each neonate and potential explanatory variables (PMA, sex, and race) were incorporated into multivariate regression models to identify associations between HOP and growth velocity. RESULTS In 589 preterm infants, PMA at birth was strongly associated inversely with FT4 (R=0.5845) and modestly with TSH (R=0.2740). Both FT4 and gestational age, but not TSH or levothyroxine treatment, were associated with growth velocity at 28 days of life and at 36 weeks PMA. CONCLUSIONS We provide a large data set for identifying FT4 and TSH measurements and identify hypothyroxinemia of prematurity as a potential mediator of slow postnatal growth in very preterm infants.
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Affiliation(s)
- Meira Zibitt
- Department of Pediatrics, Augusta University, Augusta, GA, USA
| | - Brittany Ange
- Department of Surgery, Augusta University, Augusta, USA
- Department of Population Health Science, Augusta University, Augusta, GA, USA
| | - Zanna Wynter
- Department of Pediatrics, Augusta University, Augusta, GA, USA
| | - Cynthia Mundy
- Department of Pediatrics, Augusta University, Augusta, GA, USA
| | - Steve Herrmann
- Department of Pediatrics, Augusta University, Augusta, GA, USA
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11
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Nguyen PT, Nguyen PH, Tran LM, Khuong LQ, Nguyen SV, Young MF, Ramakrishnan U. Growth patterns of preterm and small for gestational age children during the first 10 years of life. Front Nutr 2024; 11:1348225. [PMID: 38468696 PMCID: PMC10925699 DOI: 10.3389/fnut.2024.1348225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 02/16/2024] [Indexed: 03/13/2024] Open
Abstract
Background Preterm and small for gestational age (SGA) remain significant public health concerns worldwide. Yet limited evidence exists on their growth patterns during childhood from low-or middle-income countries. Objectives We investigated the postnatal growth patterns of preterm and SGA compared to term appropriate for gestational age (AGA) children from birth to 10-11y, and examined the impact of birth status on child nutritional status during the school age years. Methods Children born to women who participated in a double-blinded randomized controlled trial of preconception micronutrient supplementation in Vietnam were classified into three groups: preterm AGA (n = 130), full-term SGA (n = 165) and full-term AGA (n = 1,072). Anthropometric data (weight and height) were collected prospectively at birth, 3, 6, 12, 18, 24 months and at 6-7 and 10-11y. We used ANOVA and multiple regression models to examine the differences in growth patterns from birth to 10-11y as well as child undernutrition and overnutrition by birth status. Results Children who were born preterm exhibited rapid postnatal growth, but still had lower HAZ at 1y and 2y and showed catch up to the AGA group at 6y. Compared to those born AGA, SGA infants had higher risk of thinness (BMIZ < -2) at 2y and 6y (adjusted Odds Ratio, AOR [95% CI] 2.5 [1.0, 6.1] and 2.6 [1.4, 4.6], respectively); this risk reduced at 10-11y (1.6 [0.9, 2.8]). The risk of stunting (HAZ < -2) was also 2.4 [1.5, 3.8] and 2.3 times [1.2, 4.1] higher in SGA than AGA group at ages 2y and 6-7y, respectively, with no differences at 10y. Although preterm children had higher rates of thinness and stunting at 2y compared to AGA children, these differences were not statistically significant. No associations were found between preterm or SGA and overweight /obesity at age 10-11y. Conclusion Children who were born term-SGA continued to demonstrate deficits in weight and height during childhood whereas those born preterm showed catch-up growth by age 6-7y. Additional efforts to reduce the burden of these conditions are needed, particularly during school-age and early adolescents when children are exposed to challenging environments and have higher demands for nutrition.
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Affiliation(s)
- Phuong Thi Nguyen
- Department of Pediatric, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Vietnam
| | - Phuong Hong Nguyen
- Department of Pediatric, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Vietnam
- Department of Nutrition, Diets, and Health, International Food Policy Research Institute, Washington, DC, United States
| | - Lan Mai Tran
- Hubert Department of Global Health, Emory University, Atlanta, GA, United States
| | - Long Quynh Khuong
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, United States
| | - Son Van Nguyen
- Department of Pediatric, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Vietnam
| | - Melissa F. Young
- Hubert Department of Global Health, Emory University, Atlanta, GA, United States
| | - Usha Ramakrishnan
- Hubert Department of Global Health, Emory University, Atlanta, GA, United States
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12
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Massirio P, Battaglini M, Bonato I, De Crescenzo S, Calevo MG, Malova M, Caruggi S, Parodi A, Preiti D, Zoia A, Uccella S, Tortora D, Severino M, Rossi A, Traggiai C, Nobili L, Striano P, Ramenghi LA. Early Extra-Uterine Growth Restriction in Very-Low-Birth-Weight Neonates with Normal or Mildly Abnormal Brain MRI: Effects on a 2-3-Year Neurodevelopmental Outcome. Nutrients 2024; 16:449. [PMID: 38337733 PMCID: PMC10856867 DOI: 10.3390/nu16030449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/26/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
Extra-uterine growth restriction (EUGR) is a common complication and a known risk factor for impaired development in very-low-birth-weight (VLBW) neonates. We report a population of 288 patients with no or with low-grade MRI lesions scanned at a term equivalent age (TEA) born between 2012 and 2018. Griffiths Mental Development Scale II (GMDS II) at 2 and 3 years, preterm complications and weight growth were retrospectively analyzed. EUGR was defined for weight z-score ˂ 10 percentile at TEA, 6 and 12 months of correct age or as z-score decreased by 1-point standard deviation (SDS) from birth to TEA and from TEA to 6 months. Multivariate analysis showed that a higher weight z-score at 6 months is protective for the global developmental quotient (DQ) at 2 years (OR 0.74; CI 95% 0.59-0.93; p = 0.01). EUGR at 6 months was associated with worse locomotor, personal/social, language and performance DQ at 2 years and worse language and practical reasoning DQ at 3 years. In conclusion, a worse weight z-score at 6 months of age seems to be an independent risk factor for significantly reduced GMDS in many areas. These results suggest that we should invest more into post-discharge nutrition, optimizing family nutritional education.
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Affiliation(s)
- Paolo Massirio
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (M.B.); (I.B.); (S.D.C.); (S.C.); (A.P.); (A.Z.); (L.A.R.)
| | - Marcella Battaglini
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (M.B.); (I.B.); (S.D.C.); (S.C.); (A.P.); (A.Z.); (L.A.R.)
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (S.U.); (L.N.); (P.S.)
| | - Irene Bonato
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (M.B.); (I.B.); (S.D.C.); (S.C.); (A.P.); (A.Z.); (L.A.R.)
| | - Sara De Crescenzo
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (M.B.); (I.B.); (S.D.C.); (S.C.); (A.P.); (A.Z.); (L.A.R.)
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (S.U.); (L.N.); (P.S.)
| | - Maria Grazia Calevo
- Epidemiology and Biostatistic Unit, Scientific Direction, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy;
| | - Mariya Malova
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (M.B.); (I.B.); (S.D.C.); (S.C.); (A.P.); (A.Z.); (L.A.R.)
| | - Samuele Caruggi
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (M.B.); (I.B.); (S.D.C.); (S.C.); (A.P.); (A.Z.); (L.A.R.)
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (S.U.); (L.N.); (P.S.)
| | - Alessandro Parodi
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (M.B.); (I.B.); (S.D.C.); (S.C.); (A.P.); (A.Z.); (L.A.R.)
| | - Deborah Preiti
- Psychology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy;
| | - Agata Zoia
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (M.B.); (I.B.); (S.D.C.); (S.C.); (A.P.); (A.Z.); (L.A.R.)
- Psychology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy;
| | - Sara Uccella
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (S.U.); (L.N.); (P.S.)
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Domenico Tortora
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (D.T.); (M.S.); (A.R.)
| | - Mariasavina Severino
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (D.T.); (M.S.); (A.R.)
| | - Andrea Rossi
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (D.T.); (M.S.); (A.R.)
- Department of Health Sciences (DISSAL), University of Genoa, 16132 Genoa, Italy
| | - Cristina Traggiai
- Neonatology Unit, International Evangelical Hospital, 16122 Genoa, Italy;
| | - Lino Nobili
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (S.U.); (L.N.); (P.S.)
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Pasquale Striano
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (S.U.); (L.N.); (P.S.)
- Paediatric Neurology and Muscle Disease Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Luca Antonio Ramenghi
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (M.B.); (I.B.); (S.D.C.); (S.C.); (A.P.); (A.Z.); (L.A.R.)
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy; (S.U.); (L.N.); (P.S.)
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Bauer-Rusek S, Shalit S, Yakobson D, Levkovitz O, Ghetti C, Gold C, Stordal AS, Arnon S. Music therapy and weight gain in preterm infants: Secondary analysis of the randomized controlled LongSTEP trial. J Pediatr Gastroenterol Nutr 2024; 78:113-121. [PMID: 38291685 DOI: 10.1002/jpn3.12061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/14/2023] [Accepted: 09/20/2023] [Indexed: 02/01/2024]
Abstract
OBJECTIVES This study assessed the association between MT and weight gain among preterm infants hospitalized in Neonatal Intensive Care Units. METHODS Data collected during the international, randomized, Longitudinal Study of Music Therapy's Effectiveness for Premature Infants and their Caregivers (LongSTEP) study were compared between the MT group and the standard care (SC) group. Weights were recorded at birth, enrollment, and discharge. Weight percentiles, Z-scores, weight gain velocity, and extrauterine growth restriction (EUGR) were calculated. RESULTS Among 201 preterm infants included, no significant differences in weight parameters (weight, weight percentiles, weight Z-scores; all p ≥ 0.23) were found between the MT group (n = 104) and the SC (n = 97) group at birth, enrollment, or discharge. No statistical differences in EUGR represented by change in Z-scores from birth to discharge were recorded between MT and SC (0.8 vs. 0.7). Among perinatal parameters, younger gestational age (p = 0.005) and male sex (p = 0.012) were associated with increased risk of EUGR at discharge. Antenatal steroid treatment, systemic infection, bronchopulmonary dysplasia, neurological morbidities, retinopathy of prematurity, necrotizing enterocolitis, parental factors (amount of skin-to-skin care, bonding, anxiety, and depression questionnaire scores), and type of enteral nutrition did not significantly influence weight gain parameters (all p > 0.05). CONCLUSIONS In the LongSTEP study, MT for preterm infants and families was not associated with better weight parameters compared to the SC group. The degree of prematurity remains the main risk factor for unfavorable weight parameters.
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Affiliation(s)
- Sofia Bauer-Rusek
- Department of Neonatology, Meir Medical Center, Kfar Saba, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shachar Shalit
- Department of Neonatology, Meir Medical Center, Kfar Saba, Israel
- Department of Nutrition and Dietetics, Meir Medical Center, Kfar Saba, Israel
| | - Dana Yakobson
- Department of Neonatology, Meir Medical Center, Kfar Saba, Israel
- Department of Music Therapy, Aalborg University, Aalborg, Denmark
| | - Orly Levkovitz
- Department of Neonatology, Meir Medical Center, Kfar Saba, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Claire Ghetti
- The Grieg Academy Music Therapy Research Center, University of Bergen, Bergen, Norway
| | - Christian Gold
- The Grieg Academy Music Therapy Research Center, University of Bergen, Bergen, Norway
- Norwegian Research Centre AS, University of Bergen, Bergen, Norway
| | | | - Shmuel Arnon
- Department of Neonatology, Meir Medical Center, Kfar Saba, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Yoon SJ, Kim D, Park SH, Han JH, Lim J, Shin JE, Eun HS, Lee SM, Park MS. Prediction of Postnatal Growth Failure in Very Low Birth Weight Infants Using a Machine Learning Model. Diagnostics (Basel) 2023; 13:3627. [PMID: 38132211 PMCID: PMC10743090 DOI: 10.3390/diagnostics13243627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
Accurate prediction of postnatal growth failure (PGF) can be beneficial for early intervention and prevention. We aimed to develop a machine learning model to predict PGF at discharge among very low birth weight (VLBW) infants using extreme gradient boosting. A total of 729 VLBW infants, born between 2013 and 2017 in four hospitals, were included. PGF was defined as a decrease in z-score between birth and discharge that was greater than 1.28. Feature selection and addition were performed to improve the accuracy of prediction at four different time points, including 0, 7, 14, and 28 days after birth. A total of 12 features with high contribution at all time points by feature importance were decided upon, and good performance was shown as an area under the receiver operating characteristic curve (AUROC) of 0.78 at 7 days. After adding weight change to the 12 features-which included sex, gestational age, birth weight, small for gestational age, maternal hypertension, respiratory distress syndrome, duration of invasive ventilation, duration of non-invasive ventilation, patent ductus arteriosus, sepsis, use of parenteral nutrition, and reach at full enteral nutrition-the AUROC at 7 days after birth was shown as 0.84. Our prediction model for PGF performed well at early detection. Its potential clinical application as a supplemental tool could be helpful for reducing PGF and improving child health.
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Affiliation(s)
- So Jin Yoon
- Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.J.Y.)
| | - Donghyun Kim
- Department of Advanced General Dentistry, Yonsei University College of Dentistry, Seoul 03722, Republic of Korea
- InVisionLab Inc., Seoul 05854, Republic of Korea
| | - Sook Hyun Park
- Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.J.Y.)
| | - Jung Ho Han
- Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.J.Y.)
| | - Joohee Lim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.J.Y.)
| | - Jeong Eun Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.J.Y.)
| | - Ho Seon Eun
- Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.J.Y.)
| | - Soon Min Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.J.Y.)
| | - Min Soo Park
- Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.J.Y.)
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Sériès T, Guillot M, Angoa G, Pronovost E, Ndiaye ABKT, Mohamed I, Simonyan D, Lavoie PM, Synnes A, Marc I. Does Growth Velocity Affect Associations between Birth Weight and Neurodevelopment for Infants Born Very Preterm? J Pediatr 2023; 260:113531. [PMID: 37268036 DOI: 10.1016/j.jpeds.2023.113531] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To determine how neonatal growth velocity affects the association between birth weight and neurodevelopmental outcomes in infants born preterm. STUDY DESIGN This study is a secondary analysis of the Maternal Omega-3 Supplementation to Reduce Bronchopulmonary Dysplasia in Very Preterm Infants (MOBYDIck) randomized multicenter trial conducted in breastfed infants born at <29 weeks of gestation, whose mothers were supplemented with docosahexaenoic acid or placebo during the neonatal period. Neurodevelopmental outcomes were assessed at 18-22 months of corrected age using the Bayley-III cognitive and language composite scores. The role of neonatal growth velocity was assessed with causal mediation and linear regression models. Subgroup analyses were stratified by birth weight z-score categories (<25th, ≥25th-≤75th, and >75th percentiles). RESULTS Neurodevelopmental outcomes were available for 379 children (mean gestational age, 26.7 ± 1.5 weeks). Growth velocity partially mediated the relationships between birth weight and cognitive (β = -1.1; 95% CI, -2.2 to -0.02; P = .05) and language scores (β = -2.1; 95% CI, -3.3 to -0.8; P = .002). An increase by 1 g/kg/day in growth velocity was associated with an increase by 1.1 point in the cognitive score (95% CI, -0.03 to 2.1; P = .06) and 1.9 point in the language score (95% CI, 0.7 to 3.1; P = .001), after adjustment for birth weight z-score. For children with birth weight <25th percentile, a 1 g/kg/day increase in growth velocity was associated with an increase by 3.3 points in the cognitive score (95% CI, 0.5 to 6.0; P = .02) and 4.1 points in the language score (95% CI, 1.3 to 7.0; P = .004). CONCLUSIONS Postnatal growth velocity mediated the relationship between birth weight and neurodevelopmental performance, with larger effects for children with lower birth weight. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT02371460.
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Affiliation(s)
- Thibaut Sériès
- School of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Mireille Guillot
- Department of Pediatrics, Faculty of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Québec, Canada
| | - Georgina Angoa
- Department of Pediatrics, Faculty of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Québec, Canada
| | - Etienne Pronovost
- Department of Pediatrics, Faculty of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Québec, Canada
| | | | - Ibrahim Mohamed
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Canada
| | - David Simonyan
- Clinical and Evaluative Research platform, Centre de recherche du Centre Hospitalier Universitaire de Québec-Université Laval, Québec, Canada
| | - Pascal M Lavoie
- Division of Neonatology, Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Anne Synnes
- Division of Neonatology, Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Isabelle Marc
- Department of Pediatrics, Faculty of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Québec, Canada.
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Lygerou I, Ilia S, Briassoulis P, Manousaki A, Koropouli M, Hatzidaki E, Briassoulis G. The Impact of Estimated Energy and Protein Balances on Extrauterine Growth in Preterm Infants. Nutrients 2023; 15:3556. [PMID: 37630744 PMCID: PMC10458304 DOI: 10.3390/nu15163556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Nutritional support of preterm infants remains a field of debate in the literature and clinical practice varies significantly. Adequate nutrition should promote growth and aim for optimal later neurodevelopment. However, it is often impaired by prematurity-associated morbidity and the physiologic immaturity of preterm infants. This study assessed the impact of energy and macronutrient provision on growth velocity and outcome and explored differences attributed to the heterogeneity of the preterm population. METHODS We retrospectively collected clinical and nutritional data from neonates hospitalized in two separate Neonatal Intensive Care Units (NICUs). Estimated energy and protein balance were calculated based on the ESPGHAN guidelines and their association with the growth outcome was explored. Growth assessment was based on somatometry Delta (Δ) z-scores at discharge. RESULTS In total, 174 neonates were included in the study. By day 14, most preterm infants were exclusively enterally fed, whereas there were infants in the <28 and 28-31+6 subgroups fed exclusively parenterally. Energy balance was positive for all gestational age (GA) subgroups except for those born <28 weeks. Protein balance was consistently positive for extremely premature but negative for late preterms. Cumulative substrates provisions were strong predictors of a positive energy or protein balance in the <34 weeks GA preterms on days 14 (ROC analyses, p < 0.001) and 7 (p < 0.05). A higher GA (p = 0.013) and enteral nutrition (p = 0.005) were additional predictors of a positive energy balance. All GA subgroups had a negative Δ z-score of weight at discharge. In the <34 GA subcohorts, a positive protein balance on day 14 (p = 0.009) and a short time to regain birth weight (exp(B) 3.1 (p = 0.004)) were independently associated with a positive Δ z-score of weight at discharge. CONCLUSIONS Early achievement of a positive energy and protein balance, based on the ESPGHAN guidelines, is crucial to ensure optimal postnatal growth and prevent extrauterine growth restriction, a relatively common occurrence in preterm infants.
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Affiliation(s)
- Ioanna Lygerou
- Postgraduate Program “Emergency and Intensive Care in Children Adolescents and Young Adults”, School of Medicine, University of Crete, 71003 Heraklion, Greece; (A.M.); (G.B.)
- Department of Neonatology/Neonatal Intensive Care Unit, University Hospital of Heraklion, School of Medicine, University of Crete, 71500 Heraklion, Greece;
| | - Stavroula Ilia
- Postgraduate Program “Emergency and Intensive Care in Children Adolescents and Young Adults”, School of Medicine, University of Crete, 71003 Heraklion, Greece; (A.M.); (G.B.)
- Pediatric Intensive Care Unit, University Hospital, School of Medicine, University of Crete, 71110 Heraklion, Greece;
| | - Panagiotis Briassoulis
- Pediatric Intensive Care Unit, University Hospital, School of Medicine, University of Crete, 71110 Heraklion, Greece;
- Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Anna Manousaki
- Postgraduate Program “Emergency and Intensive Care in Children Adolescents and Young Adults”, School of Medicine, University of Crete, 71003 Heraklion, Greece; (A.M.); (G.B.)
- Neonatal Intensive Care Unit, Venizelio General Hospital, 71409 Heraklion, Greece;
| | - Marina Koropouli
- Neonatal Intensive Care Unit, Venizelio General Hospital, 71409 Heraklion, Greece;
| | - Eleftheria Hatzidaki
- Department of Neonatology/Neonatal Intensive Care Unit, University Hospital of Heraklion, School of Medicine, University of Crete, 71500 Heraklion, Greece;
| | - George Briassoulis
- Postgraduate Program “Emergency and Intensive Care in Children Adolescents and Young Adults”, School of Medicine, University of Crete, 71003 Heraklion, Greece; (A.M.); (G.B.)
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Nel S, Pattinson RC, Vannevel V, Feucht UD, Mulol H, Wenhold FAM. Integrated growth assessment in the first 1000 d of life: an interdisciplinary conceptual framework. Public Health Nutr 2023; 26:1523-1538. [PMID: 37170908 PMCID: PMC10410405 DOI: 10.1017/s1368980023000940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/03/2023] [Accepted: 04/26/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVES Prenatal growth affects short- and long-term morbidity, mortality and growth, yet communication between prenatal and postnatal healthcare teams is often minimal. This paper aims to develop an integrated, interdisciplinary framework for foetal/infant growth assessment, contributing to the continuity of care across the first 1000 d of life. DESIGN A multidisciplinary think-tank met regularly over many months to share and debate their practice and research experience related to foetal/infant growth assessment. Participants’ personal practice and knowledge were verified against and supplemented by published research. SETTING Online and in-person brainstorming sessions of growth assessment practices that are feasible and valuable in resource-limited, low- and middle-income country (LMIC) settings. PARTICIPANTS A group of obstetricians, paediatricians, dietitians/nutritionists and a statistician. RESULTS Numerous measurements, indices and indicators were identified for growth assessment in the first 1000 d. Relationships between foetal, neonatal and infant measurements were elucidated and integrated into an interdisciplinary framework. Practices relevant to LMIC were then highlighted: antenatal Doppler screening, comprehensive and accurate birth anthropometry (including proportionality of weight, length and head circumference), placenta weighing and incorporation of length-for-age, weight-for-length and mid-upper arm circumference in routine growth monitoring. The need for appropriate, standardised clinical records and corresponding policies to guide clinical practice and facilitate interdisciplinary communication over time became apparent. CONCLUSIONS Clearer communication between prenatal, perinatal and postnatal health care providers, within the framework of a common understanding of growth assessment and a supportive policy environment, is a prerequisite to continuity of care and optimal health and development outcomes.
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Affiliation(s)
- Sanja Nel
- Department of Human Nutrition, University of Pretoria, Pretoria0002, South Africa
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
- Maternal and Infant Health Care Strategies Unit, South African Medical Research Council (SAMRC), Pretoria, South Africa
| | - Robert C Pattinson
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
- Maternal and Infant Health Care Strategies Unit, South African Medical Research Council (SAMRC), Pretoria, South Africa
- Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | - Valerie Vannevel
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
- Maternal and Infant Health Care Strategies Unit, South African Medical Research Council (SAMRC), Pretoria, South Africa
- Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | - Ute D Feucht
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
- Maternal and Infant Health Care Strategies Unit, South African Medical Research Council (SAMRC), Pretoria, South Africa
- Department of Paediatrics, University of Pretoria, Pretoria, South Africa
- Tshwane District Health Services, Gauteng Department of Health, Pretoria, South Africa
| | - Helen Mulol
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
- Maternal and Infant Health Care Strategies Unit, South African Medical Research Council (SAMRC), Pretoria, South Africa
- Department of Paediatrics, University of Pretoria, Pretoria, South Africa
| | - Friede AM Wenhold
- Department of Human Nutrition, University of Pretoria, Pretoria0002, South Africa
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
- Maternal and Infant Health Care Strategies Unit, South African Medical Research Council (SAMRC), Pretoria, South Africa
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Bagga N, Panigrahi N, Germain A, Namazova I, Rahman MM, Saugstad OD, Maheshwari A. Extrauterine Growth Restriction: Need for an Accurate Definition. NEWBORN (CLARKSVILLE, MD.) 2023; 2:198-202. [PMID: 37974930 PMCID: PMC10653204 DOI: 10.5005/jp-journals-11002-0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Neonates show considerable variation in growth that can be recognized through serial measurements of basic variables such as weight, length, and head circumference. If possible, measurement of subcutaneous and total body fat mass can also be useful. These biometric measurements at birth may be influenced by demographics, maternal and paternal anthropometrics, maternal metabolism, preconceptional nutritional status, and placental health. Subsequent growth may depend on optimal feeding, total caloric intake, total metabolic activity, genetic makeup, postnatal morbidities, medications, and environmental conditions. For premature infants, these factors become even more important; poor in utero growth can be an important reason for spontaneous or induced preterm delivery. Later, many infants who have had intrauterine growth restriction (IUGR) and are born small for gestational age (SGA) continue to show suboptimal growth below the 10th percentile, a condition that has been defined as extrauterine growth restriction (EUGR) or postnatal growth restriction (PNGR). More importantly, a subset of these growth-restricted infants may also be at high risk of abnormal neurodevelopmental outcomes. There is a need for well-defined criteria to recognize EUGR/PNGR, so that correctional steps can be instituted in a timely fashion.
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Affiliation(s)
- Nitasha Bagga
- Department of Neonatology, Rainbow Children’s Hospital, Hyderabad, Telangana, India; Global Newborn Society, Maryland, United States of America
| | - Nalinikanta Panigrahi
- Department of Neonatology, Rainbow Children’s Hospital, Hyderabad, Telangana, India; Global Newborn Society, Maryland, United States of America
| | - Aaron Germain
- Department of Neonatology, Johns Hopkins All Children’s Maternal, Fetal, and Neonatal Institute, St. Petersburg, Florida, United States of America
| | - Ilhama Namazova
- Department of Pediatrics, Azərbaycan Tibb Universiteti, Baku, Azerbaijan; Global Newborn Society, Maryland, United States of America
| | - Md Mozibur Rahman
- Department of Neonatology, Institute of Child and Mother Health, Dhaka, Bangladesh
| | | | - Akhil Maheshwari
- Department of Neonatology and Pediatrics, Louisiana State University Health Sciences Center – Shreveport, Louisiana, United States of America
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Jiang WX, Wang YC, Song HX, Xiao M, He F, Jiang SY, Gu XY, Sun JH, Cao Y, Zhou WH, Lee SK, Chen LP, Hu LY. Characteristics of home oxygen therapy for preterm infants with bronchopulmonary dysplasia in China: results of a multicenter cohort study. World J Pediatr 2023; 19:557-567. [PMID: 35951258 PMCID: PMC10198895 DOI: 10.1007/s12519-022-00591-9] [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: 01/10/2022] [Accepted: 06/30/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Home oxygen therapy (HOT) is indicated upon discharge in some preterm infants with severe bronchopulmonary dysplasia (BPD). There is a lack of evidence-based consensus on the indication for HOT among these infants. Because wide variation in the institutional use of HOT exists, little is known about the role of regional social-economic level in the wide variation of HOT. METHODS This was a secondary analysis of Chinese Neonatal Network (CHNN) data from January 1, 2019 to December 31, 2019. Infants at gestational ages < 32 weeks, with a birth weight < 1500 g, and with moderate or severe BPD who survived to discharge from tertiary hospitals located in 25 provinces were included in this study. Infants with major congenital anomalies and those who were discharged against medical advice were excluded. RESULTS Of 1768 preterm infants with BPD, 474 infants (26.8%) were discharged to home with oxygen. The proportion of HOT use in participating member hospitals varied from 0 to 89%, with five of 52 hospitals' observing proportions of HOT use that were significantly greater than expected, with 14 hospitals with observing proportions significantly less than expected, and with 33 hospitals with appropriate proportions. We noted a negative correlation between different performance groups of HOT and median GDP per capita (P = 0.04). CONCLUSIONS The use of HOT varied across China and was negatively correlated with the levels of provincial economic levels. A local HOT guideline is needed to address the wide variation in HOT use with respect to different regional economic levels in countries like China.
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Affiliation(s)
- Wen-Xing Jiang
- Division of Neonatology, Jiangxi Provincial Children's Hospital, 1666 Diezihu Avenue, Honggutan New Area, Nanchang, 330038, China
| | - Yan-Chen Wang
- NHC Key Laboratory of Neonatal Diseases, Fudan University, Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Hong-Xia Song
- Division of Neonatology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Mi Xiao
- Division of Neonatology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Fan He
- Division of Neonatology, Jiangxi Provincial Children's Hospital, 1666 Diezihu Avenue, Honggutan New Area, Nanchang, 330038, China
| | - Si-Yuan Jiang
- NHC Key Laboratory of Neonatal Diseases, Fudan University, Children's Hospital of Fudan University, Shanghai, 201102, China
- Division of Neonatology, Children's Hospital of Fudan University, 399 Wanyuan Road, Minhang District, Shanghai, 201102, China
| | - Xin-Yue Gu
- NHC Key Laboratory of Neonatal Diseases, Fudan University, Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Jian-Hua Sun
- Division of Neonatology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Yun Cao
- NHC Key Laboratory of Neonatal Diseases, Fudan University, Children's Hospital of Fudan University, Shanghai, 201102, China
- Division of Neonatology, Children's Hospital of Fudan University, 399 Wanyuan Road, Minhang District, Shanghai, 201102, China
| | - Wen-Hao Zhou
- NHC Key Laboratory of Neonatal Diseases, Fudan University, Children's Hospital of Fudan University, Shanghai, 201102, China
- Division of Neonatology, Children's Hospital of Fudan University, 399 Wanyuan Road, Minhang District, Shanghai, 201102, China
| | - Shoo Kim Lee
- Maternal-Infants Care Research Centre and Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, M5G 1X5, Canada
- University of Toronto, Toronto, ON, M5T 3M7, Canada
| | - Li-Ping Chen
- Division of Neonatology, Jiangxi Provincial Children's Hospital, 1666 Diezihu Avenue, Honggutan New Area, Nanchang, 330038, China.
| | - Li-Yuan Hu
- Division of Neonatology, Children's Hospital of Fudan University, 399 Wanyuan Road, Minhang District, Shanghai, 201102, China.
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20
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Yalçın N, Kaşıkcı M, Çelik HT, Demirkan K, Yiğit Ş, Yurdakök M. Development and validation of machine learning-based clinical decision support tool for identifying malnutrition in NICU patients. Sci Rep 2023; 13:5227. [PMID: 36997630 PMCID: PMC10063679 DOI: 10.1038/s41598-023-32570-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 03/29/2023] [Indexed: 04/01/2023] Open
Abstract
Hospitalized newborns have an increased risk of malnutrition and, especially preterm infants, often experience malnutrition-related extrauterine growth restriction (EUGR). The aim of this study was to predict the discharge weight and the presence of weight gain at discharge with machine learning (ML) algorithms. The demographic and clinical parameters were used to develop the models using fivefold cross-validation in the software-R with a neonatal nutritional screening tool (NNST). A total of 512 NICU patients were prospectively included in the study. Length of hospital stay (LOS), parenteral nutrition treatment (PN), postnatal age (PNA), surgery, and sodium were the most important variables in predicting the presence of weight gain at discharge with a random forest classification (AUROC:0.847). The AUROC of NNST-Plus, which was improved by adding LOS, PN, PNA, surgery, and sodium to NNST, increased by 16.5%. In addition, weight at admission, LOS, gestation-adjusted age at admission (> 40 weeks), sex, gestational age, birth weight, PNA, SGA, complications of labor and delivery, multiple birth, serum creatinine, and PN treatment were the most important variables in predicting discharge weight with an elastic net regression (R2 = 0.748). This is the first study on the early prediction of EUGR with promising clinical performance based on ML algorithms. It is estimated that the incidence of EUGR can be improved with the implementation of this ML-based web tool ( http://www.softmed.hacettepe.edu.tr/NEO-DEER/ ) in clinical practice.
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Affiliation(s)
- Nadir Yalçın
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, 06230, Ankara, Turkey.
| | - Merve Kaşıkcı
- Department of Biostatistics, Faculty of Medicine, Hacettepe University, 06230, Ankara, Turkey
| | - Hasan Tolga Çelik
- Division of Neonatology, Department of Child Health and Diseases, Faculty of Medicine, Hacettepe University, 06230, Ankara, Turkey
| | - Kutay Demirkan
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, 06230, Ankara, Turkey
| | - Şule Yiğit
- Division of Neonatology, Department of Child Health and Diseases, Faculty of Medicine, Hacettepe University, 06230, Ankara, Turkey
| | - Murat Yurdakök
- Division of Neonatology, Department of Child Health and Diseases, Faculty of Medicine, Hacettepe University, 06230, Ankara, Turkey
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21
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Yoon SA, Lee MH, Chang YS. Impact of time to full enteral feeding on long-term neurodevelopment without mediating by postnatal growth failure in very-low-birth-weight-infants. Sci Rep 2023; 13:2990. [PMID: 36804430 PMCID: PMC9941577 DOI: 10.1038/s41598-023-29646-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 02/08/2023] [Indexed: 02/22/2023] Open
Abstract
This study aimed to determine if time to achieve full enteral feeding (TFF) directly impacted long-term neurodevelopmental delay (NDD) and whether long-term postnatal growth failure (PGF) was a mediator of this association in very-low-birth-weight (VLBW) infants. Using prospectively collected cohort data from the Korean Neonatal Network, we included eligible VLBW infants who achieved TFF at least once and classified enrolled infants into four groups using exposure severity (P1 to P4 as TFF < 16, 16-30, 31-45, and > 45 postnatal days, respectively). After adjusting for confounding variables, survival without NDD was significantly decreased in P4 infants compared with that in P2 infants. P1 infants had a lower risk of weight and height PGF than P2 infants; however, P4 infants had higher risks of height and head circumference PGF than P2 infants. Weight and height PGF were significantly associated with an increased risk of NDD. In mediation analysis, early and delayed TFF revealed direct positive and negative impacts, respectively, on the risk of NDD without mediation by PGF. TFF impacted survival without NDD, and PGF did not mediate this association in VLBW infants. Additionally, these results can be translated into evidence-based quality improvement practice.
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Affiliation(s)
- Shin Ae Yoon
- grid.254229.a0000 0000 9611 0917Department of Pediatrics, Chungbuk National University Hospital, Chungbuk National University School of Medicine, 1 Sunhwan ro 776, Seowon-gu, Cheongju, 28644 Republic of Korea
| | - Myung Hee Lee
- Research and Statistical Center, Social Information Research Institute, Seoul, Republic of Korea ,MEDITOS, Institute of Biomedical and Clinical Research, Seoul, Republic of Korea
| | - Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea. .,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea. .,Samsung Medical Center, Cell and Gene Therapy Institute, Seoul, Republic of Korea.
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22
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Belyaeva IA, Bombardirova EP, Prihodko EA, Kruglyakov AY, Mikheeva AA, Larina AR. Clinical Phenotypes of Malnutrition in Young Children: Differential Nutritional Correction. CURRENT PEDIATRICS 2023. [DOI: 10.15690/vsp.v21i6.2495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This review article summarizes current data on malnutrition etiology and pathogenesis in infants. Topical requirements for revealing this condition, its diagnosis and severity assessment via centile metrics are presented. The characteristics of the most common clinical phenotypes of postnatal growth insufficiency in infants (premature infants with different degree of maturation, including patients with bronchopulmonary dysplasia) are described. Differential approaches for malnutrition nutritional correction in these children are presented. The final section of the article describes special nutritional needs for children with congenital heart defects in terms of hemodynamic disorders nature and severity. Modern nutritional strategies for preparation of these patients to surgery and for their postoperative period are presented. The use of high-calorie/high-protein product for malnutrition correction in the most vulnerable patients with described in this review phenotypes is worth noticing.
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Affiliation(s)
- I. A. Belyaeva
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery; Pirogov Russian National Research Medical University; Morozovskaya Children’s City Hospital
| | - E. P. Bombardirova
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery
| | | | | | - A. A. Mikheeva
- Research Institute for Healthcare Organization and Medical Management
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23
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Busgang SA, Spear EA, Andra SS, Narasimhan S, Bragg JB, Renzetti S, Curtin P, Bates M, Arora M, Gennings C, Stroustrup A. Application of growth modeling to assess the impact of hospital-based phthalate exposure on preterm infant growth parameters during the neonatal intensive care unit hospitalization. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 850:157830. [PMID: 35944631 PMCID: PMC10038013 DOI: 10.1016/j.scitotenv.2022.157830] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 05/29/2023]
Abstract
In this study, we use advanced growth modeling techniques and the rich biospecimen and data repositories of the NICU Hospital Exposures and Long-Term Health (NICU-HEALTH) study to assess the impact of NICU-based phthalate exposure on extrauterine growth trajectories between birth and NICU discharge. Repeated holdout weighed quantile sum (WQS) regression was used to assess the effect of phthalate mixtures on the latency to first growth spurt and on the rate of first growth spurt. Further, we assessed sex as an effect modifier of the relationship between a phthalate mixture and both outcomes. Nine phthalate metabolites, mono-ethyl phthalate (MEP), mono-benzyl phthalate (MBzP), mono-n-butyl phthalate (MBP), mono-isobutyl phthalate (MiBP), mono-(3-carboxypropyl) phthalate (MCPP), mono-2-ethylhexyl phthalate (MEHP), mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP), mono-(2-ethyl-5-carboxypentyl) phthalate (MECPP) were measured in weekly urine specimens from 101 NICU-HEALTH participants between birth and the first growth spurt. Phthalate levels varied by species but not by infant sex, and decreased over the course of the NICU hospitalization as presented in detail in Stroustrup et al., 2018. There was evidence of nonlinearity when assessing the effect of phthalates on latency to first growth spurt. Above a threshold level, a higher phthalate mixture with dominant contributors MCPP, MBzP, and MEP predicted a shorter latency to the first inflection point, or an earlier growth spurt. A higher phthalate mixture with dominant contributors MECPP, MEHHP, and MEOHP was associated with an increased rate of growth. Results of both models were clearly different for boys and girls, consistent with other studies showing the sexually dimorphic impact of early life phthalate exposure. These results suggest that growth curve modeling facilitates evaluation of discrete periods of rapid growth during the NICU hospitalization and exposure to specific phthalates during the NICU hospitalization may both alter the timing of the first growth spurt and result in more rapid growth in a sexually dimorphic manner.
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Affiliation(s)
- Stefanie A Busgang
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emily A Spear
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Division of Newborn Medicine, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Syam S Andra
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Srinivasan Narasimhan
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jennifer B Bragg
- Division of Newborn Medicine, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stefano Renzetti
- Department of Medical-Surgical Specialties, Radiological Sciences and Public Health, Università degli Studi Di Brescia, Brescia, Italy
| | - Paul Curtin
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mia Bates
- Division of Newborn Medicine, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Albert Einstein College of Medicine, Bronx, NY, USA
| | - Manish Arora
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Chris Gennings
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Annemarie Stroustrup
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Division of Newborn Medicine, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Division of Neonatology, Department of Pediatrics, Cohen Children's Medical Center at Northwell Health, New Hyde Park, NY, USA.
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24
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Aurich B, Apele‐Freimane D, Banaschewski T, Chouchana L, Day S, Kaguelidou F, Kelly LE, Kindblom JM, Neubert A, Wong ICK. c4c: Paediatric pharmacovigilance: Methodological considerations in research and development of medicines for children - A c4c expert group white paper. Br J Clin Pharmacol 2022; 88:4997-5016. [PMID: 34699077 PMCID: PMC9788092 DOI: 10.1111/bcp.15119] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/12/2021] [Accepted: 10/15/2021] [Indexed: 12/30/2022] Open
Abstract
Children frequently respond differently to therapies compared to adults. Differences also exist between paediatric age groups for pharmacokinetics and pharmacodynamics in both efficacy and safety. Paediatric pharmacovigilance requires an understanding of the unique aspects of children with regard to, for example, drug response, growth and development, clinical presentation of adverse drug reactions (ADRs), how they can be detected and population-specific factors (e.g., more frequent use of off-label/unlicensed drugs). In recognition of these challenges, a group of experts has been formed in the context of the conect4children (c4c) project to support paediatric drug development. This expert group collaborated to develop methodological considerations for paediatric drug safety and pharmacovigilance throughout the life-cycle of medicinal products which are described in this article. These considerations include practical points to consider for the development of the paediatric section of the risk management plan (RMP), safety in paediatric protocol development, safety data collection and analysis. Furthermore, they describe the specific details of post-marketing pharmacovigilance in children using, for example, spontaneous reports, electronic health care records, registries and record-linkage, as well as the use of paediatric pharmacoepidemiology studies for risk characterisation. Next the details of the assessment of benefit-risk and challenges related to medicinal product formulation in the context of a Paediatric Investigation Plan (PIP) are presented. Finally, practical issues in paediatric signal detection and evaluation are included. This paper provides practical points to consider for paediatric pharmacovigilance throughout the life-cycle of medicinal products for RMPs, protocol development, safety data collection and analysis and PIPs.
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Affiliation(s)
- Beate Aurich
- Department of PharmacologySaint‐Louis HospitalParisFrance
| | - Dina Apele‐Freimane
- Neonatal Intensive Care, Women and Child Health ClinicPauls Stradins Clinical University HospitalRigaLatvia
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry, Central Institute of Mental Health, Medical Faculty MannheimUniversity of HeidelbergMannheimGermany
| | - Laurent Chouchana
- Regional Center of Pharmacovigilance, Department of PharmacologyCochin Hospital, APHP, Centre, Université de ParisParisFrance
| | - Simon Day
- Clinical Trials Consulting and Training LimitedNorth MarstonUK
| | - Florentia Kaguelidou
- Department of Pediatric Pharmacology and Pharmacogenetics, APHP, Robert Debré Hospital; Center of Clinical Investigations, INSERM CIC1426Université de ParisParisFrance
| | - Lauren E. Kelly
- Department of Paediatrics and Child Health, Max Rady College of MedicineUniversity of ManitobaWinnipegCanada
| | - Jenny M. Kindblom
- Paediatric Clinical Research Center, Queen Silvia Children's HospitalSahlgrenska University HospitalGothenburgSweden
| | - Antje Neubert
- Department of Paediatrics and Adolescent MedicineUniversity Hospital Erlangen, Friedrich‐Alexander University Erlangen‐Nürnberg (FAU)ErlangenGermany
| | - Ian C. K. Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of MedicineThe University of Hong KongChina,Research Department of Practice and Policy, School of PharmacyUCLLondonUK
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Lyu Y, Zhu D, Wang Y, Jiang S, Lee SK, Sun J, Li L, Cao Y. Current epidemiology and factors contributing to postnatal growth restriction in very preterm infants in China. Early Hum Dev 2022; 173:105663. [PMID: 36087460 DOI: 10.1016/j.earlhumdev.2022.105663] [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: 04/29/2022] [Revised: 08/28/2022] [Accepted: 08/29/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Postnatal growth restriction (PGR) is common in very preterm infants (VPIs) and is associated with adverse short and long-term developmental outcomes. Postnatal growth status for VPIs in middle- or low-income countries remains unclear. AIMS To evaluate PGR in VPIs and identify maternal and neonatal factors, clinical practice, and major neonatal morbidities associated with PGR in China. STUDY DESIGN Prospective cohort study. SUBJECTS We included 6085 infants born at <32 weeks gestation who were admitted at 57 hospitals in the Chinese Neonatal Network in 2019. OUTCOME MEASURES Birth and discharge weights were converted to age-specific Z-scores. PGR was defined as a decrease in weight z-score from birth to discharge >2. RESULTS The overall incidence of PGR was 19.9 %. The mean (standard deviation [SD]) weight Z-score was 0.12 (0.78) at birth and decreased to -1.36 (0.98) at discharge. About 4.0 % of VPIs were small for gestational age (SGA) at birth and 25.5 % of SGA infants had PGR. The incidence of PGR increased with decreasing gestational age except in the SGA subgroup. Each 1-unit increase in birthweight Z-score was associated with a 1.49-fold increased risk for PGR. Late initiation of enteral feeds and late achievement of full enteral feeds were positively associated with PGR. The common morbidities that influenced PGR were necrotizing enterocolitis ≥ stage II, patent ductus arteriosus requiring medical or surgical treatment, sepsis, bronchopulmonary dysplasia, and respiratory distress syndrome requiring surfactants. CONCLUSION Nearly one fifth of VPIs were PGR, and one fourth of SGA had PGR, which warranted further study to investigate underlying causes by which to improve postnatal growth in very preterm infants in future.
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Affiliation(s)
- Yanyu Lyu
- Department of Neonatology, Children's Hospital of Capital Institute of Pediatrics, Beijing, China; Experiment Center, Capital Institute of Pediatrics, Beijing, China
| | - Dongzhe Zhu
- Department of Neonatology, Children's Hospital of Capital Institute of Pediatrics, Beijing, China
| | - Yanchen Wang
- NHC Key Laboratory of Neonatal Diseases, Fudan University, Children's Hospital of Fudan University, Shanghai, China
| | - Siyuan Jiang
- NHC Key Laboratory of Neonatal Diseases, Fudan University, Children's Hospital of Fudan University, Shanghai, China; Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Shoo K Lee
- Maternal-Infant Care Research Centre, Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Jianhua Sun
- Division of Neonatology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Li
- Department of Neonatology, Children's Hospital of Capital Institute of Pediatrics, Beijing, China
| | - Yun Cao
- NHC Key Laboratory of Neonatal Diseases, Fudan University, Children's Hospital of Fudan University, Shanghai, China; Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China.
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Casirati A, Somaschini A, Perrone M, Vandoni G, Sebastiani F, Montagna E, Somaschini M, Caccialanza R. Preterm birth and metabolic implications on later life: A narrative review focused on body composition. Front Nutr 2022; 9:978271. [PMID: 36185669 PMCID: PMC9521164 DOI: 10.3389/fnut.2022.978271] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
Preterm newborn infants are characterized by low body weight and lower fat mass at birth compared with full-term newborn neonates. Conversely, at term corrected age, body fat mass is more represented in preterm newborn infants, causing a predisposition to developing metabolic syndrome and cardiovascular diseases in later life with a different risk profile in men as compared with women. Postnatal growth is a complex change in anthropometric parameters and body composition. Both quantity and quality of growth are regulated by several factors such as fetal programming, early nutrition, and gut microbiota. Weight gain alone is not an optimal indicator of nutritional status as it does not accurately describe weight quality. The analysis of body composition represents a potentially useful tool to predict later metabolic and cardiovascular risk as it detects the quality of growth by differentiating between fat and lean mass. Longitudinal follow-up of preterm newborn infants could take advantage of body composition analysis in order to identify high-risk patients who apply early preventive strategies. This narrative review aimed to examine the state-of-the-art body composition among born preterm children, with a focus on those in the pre-school age group.
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Affiliation(s)
- Amanda Casirati
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- *Correspondence: Amanda Casirati,
| | - Alberto Somaschini
- Division of Cardiology and Cardiac Intensive Care Unit, San Paolo Hospital, Savona, Italy
| | - Michela Perrone
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Vandoni
- Clinical Nutrition, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Federica Sebastiani
- Endocrinology and Metabolic Diseases, Azienda USL IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elisabetta Montagna
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Abstract
The needs to assess preterm infant growth clinically differ from the needs to summarize growth for research. Clinically, growth assessments are used to understand individuals' growth relative to their individual genetic potential, morbidity status and nutrition care. Growth quantification for research purposes is used to quantify growth of groups using meaningful metrics. Historically, neonatology has lacked consistency in the use of growth metrics, over-used irrelevant categories and over-diagnosed growth failure. Understanding the numerous preterm infant expected growth patterns can help identify concerning growth.
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Mehta R, Petrova A. Urinary levels of energy metabolism hormones in association with the proportional intake of maternal milk and weight gain in very preterm neonates. J Neonatal Perinatal Med 2022; 15:599-607. [PMID: 35342054 DOI: 10.3233/npm-210936] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND This study prospectively investigated the levels of energy metabolism hormones in very preterm neonates to identify their change over time, association with intake of maternal milk, and weight gain velocity. METHODS We measured and compared the leptin, adiponectin, ghrelin, and insulin-like growth factor I (IGF-1) levels in the urine of 70 very preterm neonates, before the initiation of any enteral feeding (baseline level) and twice within 14 days on full enteral feeding (FEF). Regression models identified the role of intake of maternal milk on the levels of the tested energy metabolism hormones in the enteral-fed infants. We also analyzed the adequacy of the weight gain velocity defined by the fetal-infant growth reference (FIGR). We also collected and analyzed the infants' clinical and feeding characteristics during the birth hospitalization. RESULTS The preterm infants' baseline levels of the energy metabolism hormones significantly predicted their increase at the end of two weeks of observation on FEF. The leptin level was associated with increased intake of maternal milk, whereas the feeding volume was associated with increased ghrelin and IGF-1, and decreased leptin and adiponectin. Infants with comparable FIGR had higher leptin levels than those with inadequate weight gain velocity. CONCLUSION Early postnatal levels of leptin, adiponectin, ghrelin, and IGF-1 predicted the increase of these hormones in the fully enteral fed very preterm neonates. Moreover, greater intake of maternal milk by the study infants contributed to an increased leptin-associated weight gain velocity.
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Affiliation(s)
- R Mehta
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - A Petrova
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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29
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Weight gain speed and z-score behavior in large prematures for gestational age. NUTR HOSP 2022; 39:1220-1227. [DOI: 10.20960/nh.04124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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30
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Luo Z, You B, Zhang Y, Tang J, Zheng Z, Jia Y, Wang L, Zeng D, Li H, Wang X. Nonlinear relationship between early postnatal weight gain velocity and neurodevelopmental outcomes in very-low birth weight preterm infants: A secondary analysis based on a published prospective cohort study. Front Pediatr 2022; 10:944067. [PMID: 36425400 PMCID: PMC9679406 DOI: 10.3389/fped.2022.944067] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 10/13/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Extrauterine growth restriction among the very-low birth weight preterm infants (VLBWPIs) is associated with poorer cognitive development outcome, while the rapid weight gain in infancy increases the long-term risk of obesity and noncommunicable disease among VLBWPIs. However, the results of research on the association between early postnatal growth velocity and neurodevelopmental outcomes in VLBWPIs are still limited and controversial. OBJECTIVE We aimed to explore the association between the growth velocity in early postnatal and neurodevelopmental impairment (NDI) among VLBWPIs. METHODS This study was a secondary analysis of a previously published prospective cohort. It was based on data on 1,791 premature infants with a birth weight of less than 1500 g, registered in the database of the Premature Baby Foundation of Taiwan between 2007 and 2011. A binary logistic regression model was used to evaluate the association between the weight gain velocity in different periods [from birth to 6 months corrected age (CA), 6 to 12 months CA, and 12 to 24 months CA] and NDI, respectively. The generalized additive model and the smooth curve fitting (penalized spline method) were used to address nonlinearity, and a two-piece-wise binary logistic regression model was added to explain the nonlinearity further. RESULTS Nonlinearities were observed between NDI and the weight gain velocity from birth to 6 months CA [inflection point 20.36, <inflection point: odds ratio (OR) = 0.75, 95% confidence interval (CI) 0.67-0.84, >inflection point: OR = 1.01, 95% CI 0.97-1.05], 6-12 months CA [inflection point 9.44, <inflection point: OR = 0.89, 95% CI 0.84-0.94, >inflection point: OR = 1.05, 95% CI 1.05-(1.00, 1.11)], and 12-24 months CA [inflection point 16.00, <inflection point: OR = 0.93, 95% CI 0.88-0.98, >inflection point: OR = 1.75, 95% CI 1.05-(0.96, 3.08)]. CONCLUSION The neurodevelopmental benefits from a rapid weight gain velocity from birth to 24 months CA might be limited once the growth pace reaches an optimum level. It would help find a pattern of growth that facilitates optimal neurodevelopment, yet minimizes negative health consequences associated with overnutrition further.
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Affiliation(s)
- Zhongchen Luo
- School of Nursing, Guizhou Medical University, Guiyang, China
| | - Beibei You
- School of Nursing, Guizhou Medical University, Guiyang, China
| | - You Zhang
- School of Foreign Languages, Chongqing Medical University, Chongqing, China
| | - Jiao Tang
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zehong Zheng
- Engineering Training Center, Guizhou Minzu University, Huaxi, Guiyang, China
| | - Yuling Jia
- School of Nursing, Guizhou Medical University, Guiyang, China
| | - Li Wang
- School of Nursing, Guizhou Medical University, Guiyang, China
| | - Dan Zeng
- School of Nursing, Guizhou Medical University, Guiyang, China
| | - Hong Li
- School of Nursing, Guizhou Medical University, Guiyang, China
| | - Xiuhong Wang
- School of Nursing, Guizhou Medical University, Guiyang, China.,Department of Nursing, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
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Abstract
With advancements in neonatal care and nutrition, the postnatal growth of preterm infants has improved; however, it remains an issue. Accurate assessments of growth using a standardized reference are needed to interpret the intrauterine and postnatal growth patterns of preterm infants. Growth in the earlier periods of life can contribute to later outcomes, and the refinement of postnatal growth failure is needed to optimize outcomes. Catchup growth occurs mainly before discharge and until 24 months of age, and very low birth weight infants in Korea achieve retarded growth later in life. Knowing an infant's perinatal history, reducing morbidity rates during admission, and performing regular monitoring after discharge are required. Preterm infants with a lower birth weight or who were small for gestational age are at increased risk of poor neurodevelopmental outcomes. Furthermore, poor postnatal growth is predictive of adverse neurodevelopmental outcomes. Careful monitoring and early intervention will contribute to better development outcomes and national public health improvements.
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Affiliation(s)
- Joohee Lim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - So Jin Yoon
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Soon Min Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
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32
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Wang N, Zhang J, Wang B, Yu Z, Han S, Wang H, Chen R, Gu L, Gao Y, Hou W, Lu X. Transition From Parenteral to Enteral Nutrition and Postnatal Growth in Very Preterm Infants During Their First 28 Days of Life. Front Pediatr 2022; 10:775667. [PMID: 35359900 PMCID: PMC8960249 DOI: 10.3389/fped.2022.775667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Nutrition practices for preterm infants during the first few weeks of life can be divided into three phases: the parenteral nutrition (PN), enteral nutrition (EN), and transition (TN) phases; the TN phase includes both PN and EN. Our purpose was to analyze nutrition practices for very preterm infants during the TN phase and their association with the infants' growth during the first 28 days of life. METHODS Data from 268 very preterm infants <32 weeks old from six neonatal intensive care units were analyzed retrospectively. The TN phase was defined as enteral feedings of 30-120 ml/kg/d. Postnatal growth failure (PGF) was defined as a 28-day growth velocity <15 g/kg/d. Differences in protein and energy intake between the PGF and non-PGF groups during the TN phase were calculated, and risk factors for PGF were identified using multivariate regression analysis. RESULTS The total protein (parenteral + enteral) intake during the TN was 3.16 (2.89, 3.47) g/kg/d, which gradually decreased as the enteral feeding volume increased in the TN phase. The total energy (parenteral + enteral) intake during the TN phase was 115.72 (106.98, 122.60) kcal/kg/d. The PGF group had a lower total protein intake (parenteral + enteral) than the non-PGF group had [3.09 (2.85, 3.38) g/kg/d vs. 3.27 (3.06, 3.57) g/kg/d, P = 0.007, respectively]. No significant difference was found in energy intake during the TN phase. The variables associated with PGF included a lower total protein (parenteral + enteral) intake, a smaller day of age at the end of the TN phase, and a higher birth weight z-score. CONCLUSION Increasing the total protein intake (parenteral + enteral) during the TN could reduce the incidence of PGF.
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Affiliation(s)
- Na Wang
- Department of Pediatrics, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, China
| | - Jia Zhang
- Department of Pediatrics, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, China
| | - Bo Wang
- Department of Pediatrics, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, China
| | - Zhangbin Yu
- Department of Neonatology, Nanjing Maternity and Child Health Care Hospital, Women's Hospital of Nanjing Medical University, Nanjing, China
| | - Shuping Han
- Department of Neonatology, Nanjing Maternity and Child Health Care Hospital, Women's Hospital of Nanjing Medical University, Nanjing, China
| | - Huaiyan Wang
- Department of Neonatology, Changzhou Maternity and Child Health Care Hospital, Changzhou, China
| | - Rongrong Chen
- Department of Neonatology, Nantong Maternity and Child Health Care Hospital, Nantong, China
| | - Li Gu
- Department of Neonatology, Nantong Maternity and Child Health Care Hospital, Nantong, China
| | - Yan Gao
- Department of Neonatology, Lianyungang Maternity and Child Health Care Hospital, Lianyungang, China
| | - Weiwei Hou
- Department of Neonatology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Xingxing Lu
- Department of Neonatology, Northern Jiangsu People's Hospital, Yangzhou, China
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Improved nutritional outcomes with neurally adjusted ventilatory assist (NAVA) in premature infants: a single tertiary neonatal unit's experience. Eur J Pediatr 2022; 181:2155-2159. [PMID: 35194652 PMCID: PMC9056442 DOI: 10.1007/s00431-022-04411-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/13/2022] [Accepted: 02/06/2022] [Indexed: 11/25/2022]
Abstract
During neurally adjusted ventilatory assist (NAVA)/non-invasive (NIV) NAVA, a modified nasogastric feeding tube with electrodes, monitors the electrical activity of the diaphragm (Edi). The Edi waveform determines the delivered pressure from the ventilator. Infant breathing is in synchrony with the ventilator and therefore is more comfortable with less work of breathing. Our aim was to determine if infants on NAVA had improved nutritional outcomes compared to infants managed on conventional respiratory support. A retrospective study was undertaken. Infants on NAVA were matched with two conventionally ventilated controls by gestational age, birth weight, sex, antenatal steroid exposure, and whether inborn or transferred ex utero. NAVA/NIV-NAVA was delivered by the SERVO-n® Maquet Getinge group ventilator. Conventional ventilation included pressure and volume control ventilation, and non-invasive ventilation included nasal intermittent positive pressure ventilation, triggered biphasic positive airway pressure, continuous positive airway pressure and heated humidified high flow oxygen. The measured outcome was discharge weight z scores. Eighteen "NAVA" infants with median gestational age (GA) of 25.3 (23.6-27.1) weeks and birth weight (BW) of 765 (580-1060) grams were compared with 36 controls with GA 25.2 (23.4-28) weeks (p = 0.727) and BW 743 (560-1050) grams (p = 0.727). There was no significant difference in the rates of postnatal steroids (61% versus 36% p = 0.093), necrotising enterocolitis (22% versus 11% p = 0.279) in the NAVA/NIV NAVA compared to the control group. There were slightly more infants who were breastfed at discharge in the NAVA/NIV NAVA group compared to controls: breast feeds (77.8% versus 58.3%), formula feeds (11.1% versus 30.6%), and mixed feeds (11.1% versus 11.1%), but this difference was not significant (p = 0.275). There was no significant difference in the birth z scores 0.235 (-1.56 to 1.71) versus -0.05 (-1.51 to -1.02) (p = 0.248) between the groups. However, the discharge z score was significantly in favour of the NAVA/NIV-NAVA group: -1.22 (-2.66 to -0.12) versus -2.17 (-3.79 to -0.24) in the control group (p = 0.033).Conclusion: The combination of NAVA/NIV-NAVA compared to conventional invasive and non-invasive modes may contribute to improved nutritional outcomes in premature infants.
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de Sousa JCS, de Carvalho AVD, Monte de Prada LDC, Marinho AP, de Lima KF, Macedo SKDO, Santos CDP, da Câmara SMA, Barreto ACDNG, Pereira SA. Nutritional Factors Associated with Late-Onset Sepsis in Very Low Birth Weight Newborns. Nutrients 2021; 14:196. [PMID: 35011069 PMCID: PMC8747100 DOI: 10.3390/nu14010196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/16/2021] [Accepted: 12/24/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Delayed onset of minimal enteral nutrition compromises the immune response of preterm infants, increasing the risk of colonization and clinical complications (e.g., late-onset sepsis). This study aimed to analyze associations between late-onset sepsis in very low birth weight infants (<1500 g) and days of parenteral nutrition, days to reach full enteral nutrition, and maternal and nutritional factors. METHODS A cross-sectional study was carried out with very low birth weight infants admitted to a neonatal intensive care unit (NICU) of a reference maternity hospital of high-risk deliveries. Data regarding days of parenteral nutrition, days to reach full enteral nutrition, fasting days, extrauterine growth restriction, and NICU length of stay were extracted from online medical records. Late-onset sepsis was diagnosed (clinical or laboratory) after 48 h of life. Chi-squared, Mann-Whitney tests, and binary logistic regression were applied. RESULTS A total of 97 preterm infants were included. Of those, 75 presented late-onset sepsis with clinical (n = 40) or laboratory (n = 35) diagnosis. Maternal urinary tract infection, prolonged parenteral nutrition (>14 days), and extrauterine growth restriction presented 4.24-fold, 4.86-fold, and 4.90-fold higher chance of late-onset sepsis, respectively. CONCLUSION Very low birth weight infants with late-onset sepsis had prolonged parenteral nutrition and took longer to reach full enteral nutrition. They also presented a higher prevalence of extrauterine growth restriction than infants without late-onset sepsis.
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Affiliation(s)
- Juliany Caroline Silva de Sousa
- Neonatal Intensive Care Unit, Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte, Natal 59012-300, Brazil; (J.C.S.d.S.); (A.V.D.d.C.); (L.d.C.M.d.P.); (A.P.M.); (K.F.d.L.); (S.K.d.O.M.); (C.D.P.S.); (A.C.d.N.G.B.)
| | - Ana Verônica Dantas de Carvalho
- Neonatal Intensive Care Unit, Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte, Natal 59012-300, Brazil; (J.C.S.d.S.); (A.V.D.d.C.); (L.d.C.M.d.P.); (A.P.M.); (K.F.d.L.); (S.K.d.O.M.); (C.D.P.S.); (A.C.d.N.G.B.)
| | - Lorena de Carvalho Monte de Prada
- Neonatal Intensive Care Unit, Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte, Natal 59012-300, Brazil; (J.C.S.d.S.); (A.V.D.d.C.); (L.d.C.M.d.P.); (A.P.M.); (K.F.d.L.); (S.K.d.O.M.); (C.D.P.S.); (A.C.d.N.G.B.)
| | - Arthur Pedro Marinho
- Neonatal Intensive Care Unit, Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte, Natal 59012-300, Brazil; (J.C.S.d.S.); (A.V.D.d.C.); (L.d.C.M.d.P.); (A.P.M.); (K.F.d.L.); (S.K.d.O.M.); (C.D.P.S.); (A.C.d.N.G.B.)
| | - Kerolaynne Fonseca de Lima
- Neonatal Intensive Care Unit, Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte, Natal 59012-300, Brazil; (J.C.S.d.S.); (A.V.D.d.C.); (L.d.C.M.d.P.); (A.P.M.); (K.F.d.L.); (S.K.d.O.M.); (C.D.P.S.); (A.C.d.N.G.B.)
| | - Suianny Karla de Oliveira Macedo
- Neonatal Intensive Care Unit, Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte, Natal 59012-300, Brazil; (J.C.S.d.S.); (A.V.D.d.C.); (L.d.C.M.d.P.); (A.P.M.); (K.F.d.L.); (S.K.d.O.M.); (C.D.P.S.); (A.C.d.N.G.B.)
| | - Camila Dayze Pereira Santos
- Neonatal Intensive Care Unit, Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte, Natal 59012-300, Brazil; (J.C.S.d.S.); (A.V.D.d.C.); (L.d.C.M.d.P.); (A.P.M.); (K.F.d.L.); (S.K.d.O.M.); (C.D.P.S.); (A.C.d.N.G.B.)
| | | | - Anna Christina do Nascimento Granjeiro Barreto
- Neonatal Intensive Care Unit, Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte, Natal 59012-300, Brazil; (J.C.S.d.S.); (A.V.D.d.C.); (L.d.C.M.d.P.); (A.P.M.); (K.F.d.L.); (S.K.d.O.M.); (C.D.P.S.); (A.C.d.N.G.B.)
| | - Silvana Alves Pereira
- Neonatal Intensive Care Unit, Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte, Natal 59012-300, Brazil; (J.C.S.d.S.); (A.V.D.d.C.); (L.d.C.M.d.P.); (A.P.M.); (K.F.d.L.); (S.K.d.O.M.); (C.D.P.S.); (A.C.d.N.G.B.)
- Department of Physiotherapy, Universidade Federal do Rio Grande do Norte, Natal 59075-000, Brazil;
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35
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Bigio JZD, Falcão MC, Tannuri ACA. GROWTH ANALYSIS OF PRETERM NEWBORNS WITH GASTROSCHISIS DURING HOSPITALIZATION IN A NEONATAL INTENSIVE CARE UNIT. ARQUIVOS DE GASTROENTEROLOGIA 2021; 58:504-508. [PMID: 34909857 DOI: 10.1590/s0004-2803.202100000-90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/18/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Gastroschisis, especially complex type, prematurity and low birth weight are associated with a worse clinical outcome with higher mortality, higher incidence of sepsis and catheter-related infection, cholestasis, short bowel syndrome, greater number of days to achieve full diet, longer time of parenteral nutrition and longer hospitalization time. OBJECTIVE To evaluate the growth of preterm newborns with gastroschisis during their hospitalization in the neonatal intensive care unit. METHODS Descriptive study, based on a retrospective cohort (January 2012 to December 2018), including preterm newborns (gestational age less than 37 weeks) with simple and complex gastroschisis admitted in a tertiary neonatal intensive care unit. The following parameters were analyzed: maternal age, parity, type of delivery, birth weight, gender, gestational age, nutritional adequacy, type of gastroschisis, fasting time, parenteral nutrition time, time until achieving full enteral nutrition, hospitalization time, weight gain and outcome. The results were expressed in percentage, average, and median. RESULTS A total of 101 newborns with gastroschisis were admitted, of which 59.4% were premature (80.7% of late preterm infants). From the maternal data, the mean age was 21.2 years and 68.3% were primiparous. Regarding childbirth: 80% were cesarean sections. From newborns: the average birth weight was 2137 g, 56.6% were female, the average gestational age was 34.8 weeks, the average weight gain was 20.8 g/day during hospitalization and 83.3% were discharged from the hospital. CONCLUSION The growth analysis by weight gain (grams/day) during hospitalization in the intensive care unit showed that more than 90% of the sample presented acceptable or adequate weight gain.
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Affiliation(s)
- Juliana Zoboli Del Bigio
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Instituto da Criança, São Paulo, SP, Brasil
| | - Mário Cícero Falcão
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Instituto da Criança, São Paulo, SP, Brasil
| | - Ana Cristina Aoun Tannuri
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Instituto da Criança, São Paulo, SP, Brasil
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36
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Critical examination of relationships between early growth and childhood overweight in extremely preterm infants. J Perinatol 2021; 41:2774-2781. [PMID: 34404924 DOI: 10.1038/s41372-021-01182-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 07/19/2021] [Accepted: 07/29/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To identify the prevalence and risk factors for childhood overweight and obesity (OWO) at 3-year corrected age in children born <1500 g <29 weeks gestation. STUDY DESIGN A multicentre retrospective cohort study for preterm infants admitted to neonatal intensive care units between 2001 and 2014. RESULTS Data were available for 911 (89.4%) of the 1019 infants who met the inclusion criteria. Of them, 22 (2.4%) had OWO. There were no associations between OWO and being small for gestational age (RR = 1.3, 95% confidence interval (CI): 0.3-5.4) or weight <10th percentile at 36 weeks (RR = 1.1, 95% CI: 0.4-2.8). OWO was associated with low maternal education (RR = 7.4, 95% CI: 2.1-26), maternal diabetes (RR = 5.2, 95% CI: 1.9-15) and neonatal brain injury (RR = 4.9, 95% CI: 1.8-14). Adjusting for concurrent child weight at 3 years of age resulted in an overadjustment bias. CONCLUSION Small size at birth or at 36 weeks gestation in extremely preterm infants is not associated with increased risk of early childhood overgrowth or obesity. CLINICAL TRIAL REGISTRATION NCT03064022.
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Gates A, Thompson AB, Marin T, Waller JL, Patel J, Stansfield BK. Novel multinutrient human milk-based human milk fortifier promotes growth and tolerance in premature infants. JPEN J Parenter Enteral Nutr 2021; 46:817-827. [PMID: 34370335 DOI: 10.1002/jpen.2249] [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: 11/09/2022]
Abstract
BACKGROUND The objective of this study was to determine whether human milk supplemented with a novel human milk-based human milk fortifier (Novel HMF), compared with a bovine milk-based HMF (Bovine HMF), supports preterm infant growth through 36 weeks' postmenstrual age (PMA). METHODS This single-center, prospective trial compared growth and nutrition outcomes of preterm infants provided a human milk-based diet (mother's own milk or donor milk) supplemented with a Novel HMF with historic controls provided Bovine HMF. Preterm infants with an estimated gestational age (EGA) between 23 and 33 weeks' PMA and birth weight between 750 and 1800 g were eligible for study inclusion. Weight, length, and head circumference (HC) were monitored weekly. The occurrence of late-onset sepsis, nil per os (NPO) days, necrotizing enterocolitis, metabolic acidosis, and serious adverse events were monitored. RESULTS Birth weight, length, HC, and EGA were similar between the Novel HMF (n = 37) and Bovine HMF (n = 49) groups. The days to regain birth weight was shorter in the Novel HMF group (9.4 ± 4.0 vs 11.4 ± 4.8, P = .0343), with similar weight gain (g/day) from birth to 36 weeks' PMA. Adjusted weight growth velocity (g/kg/day) was significantly higher in the Novel HMF group at 14 and 21 days but similar at 36 weeks' PMA. The Novel HMF group experienced fewer NPO days with a similar total number of feeding days. CONCLUSIONS A novel, multinutrient, human milk-based HMF is well tolerated and meets the nutrition needs of preterm infants.
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Affiliation(s)
- Amy Gates
- Division of Neonatology, Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Amy B Thompson
- Division of Neonatology, Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Terri Marin
- College of Nursing, Augusta University, Augusta, Georgia, USA
| | - Jennifer L Waller
- Division of Biostatistics and Data Science, Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Jenny Patel
- Division of Neonatology, Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Brian K Stansfield
- Division of Neonatology, Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
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Wang N, Zhang J, Yu Z, Tang B, Zhang L, Yin Y, Wang Z, Li S, Jiang S, Hou W, Gao Y, Wang H, Chen X, Deng X, Lu Y, Zhu L, Bo L, Han S. Evaluation of nutrition status of very preterm infants in neonatal intensive care units using different growth indicators. Nutr Clin Pract 2021; 36:1312-1319. [PMID: 34339517 DOI: 10.1002/ncp.10741] [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] [Received: 01/14/2021] [Accepted: 06/06/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Nutrition status of very preterm infants in the neonatal intensive care unit (NICU) is strongly associated with postnatal growth. This study aimed to develop indicators of nutrition status using growth data of very preterm infants during hospitalization. METHODS The data of 596 newborns from eight NICUs were retrospectively analyzed. Inclusion criteria were birth at <32 weeks' gestation, NICU admission ≤24 h after delivery, and length of hospital stay ≥28 days. Three indicators were evaluated: (indicator I) prevalence of extrauterine growth restriction (EUGR); (indicator II) z-score for change in weight from birth to discharge, adjusted for birth weight z-score and gestational age; and (indicator III) change in weight z-score from birth to discharge, adjusted for birth weight z-score, gestational age, and time to regain birth weight. Using data from NICU 1 as the reference for the latter two indicators, we established linear regression models of the adjusted change in weight z-score from birth to discharge. The difference between the observed value and the baseline value (calculated by the two models) served as the nutrition indices. RESULTS The prevalence of EUGR differed significantly between the eight NICUs (P = .009). Statistically significant differences were found between the mean indices calculated by the other two models (all P < .05). CONCLUSIONS Indicator III, change in weight z-score from birth to discharge (adjusted for birth weight z-score, gestational age, and time to regain birth weight), appears to be the most accurate for evaluating the quality of nutrition in the NICU.
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Affiliation(s)
- Na Wang
- The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, Jiangsu, China
| | - Jia Zhang
- The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, Jiangsu, China
| | - Zhangbin Yu
- Nanjing Maternity and Child Health Care Hospital, Women's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Bin Tang
- The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, Jiangsu, China
| | - Lin Zhang
- Changzhou Maternity and Child Health Care Hospital, Changzhou, Jiangsu, China
| | - Yujie Yin
- Jiangsu Province Hospital, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zengqin Wang
- Xuzhou Maternity and Child Health Care Hospital, Xuzhou, Jiangsu, China
| | - Shuangshuang Li
- Nantong Maternity and Child Health Care Hospital, Nantong, Jiangsu, China
| | - Shanyu Jiang
- Wuxi Maternity and Child Health Care Hospital, Wuxi, Jiangsu, China
| | - Weiwei Hou
- Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
| | - Yan Gao
- Lianyungang Maternity and Child Health Care Hospital, Lianyungang, Jiangsu, China
| | - Huaiyan Wang
- Changzhou Maternity and Child Health Care Hospital, Changzhou, Jiangsu, China
| | - Xiaoqing Chen
- Jiangsu Province Hospital, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaoyi Deng
- Xuzhou Maternity and Child Health Care Hospital, Xuzhou, Jiangsu, China
| | - Yi Lu
- Nantong Maternity and Child Health Care Hospital, Nantong, Jiangsu, China
| | - Lingling Zhu
- Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
| | - Lin Bo
- Lianyungang Maternity and Child Health Care Hospital, Lianyungang, Jiangsu, China
| | - Shuping Han
- Nanjing Maternity and Child Health Care Hospital, Women's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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Phillips JL, Jones KM, Patel PH, Kamdar T, Lopilato AC. Impact of parenteral nutrition guideline implementation on growth of very low-birth-weight infants in a neonatal intensive care unit. JPEN J Parenter Enteral Nutr 2021; 46:836-841. [PMID: 34297359 DOI: 10.1002/jpen.2237] [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: 11/06/2022]
Abstract
BACKGROUND In preterm neonates, parenteral nutrition (PN) is utilized to provide adequate energy and maintain the expected growth rate of a fetus. To optimize growth, our institution implemented comprehensive guidelines for prescribing PN. This study compared the effect of this change on growth outcomes of very low-birth-weight (VLBW) infants at 28 days' postnatal age (PNA). METHODS Neonates <1250 g who received PN for >7 days were divided into preimplementation and postimplementation cohorts based on date of birth. The primary objective was to compare the average weight velocity (g/kg/day) of neonates at 28 days' PNA. Secondary objectives included identifying the average number of days to regain birth weight and comparing the percentage of infants above the 10th percentile for weight for age at 28 days with those at baseline. RESULTS There were 204 neonates in cohort 1 (before implementation) and 176 neonates in cohort 2 (after). No difference in weight velocity was identified (12.9 ± 5.2 vs 12.1 ± 4.9 g/kg/day; P = .177). No difference was detected in days to regain birth weight (9.2 ± 4.6 vs 9.9 ± 4.7; P = .909) or in the percentage of patients above the 10th percentile for weight for age (birth: 85.3% vs 83.5% [P = .634]; 28 days: 73% vs 64.8% [P = .082]). CONCLUSION No difference was observed in the weight velocity of VLBW neonates <1250 g at birth when using the implemented guideline for PN prescription writing at our institution.
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Affiliation(s)
- Jordan L Phillips
- Department of Pharmacy, AdventHealth for Children, Orlando, Florida, USA
| | - Kristen M Jones
- Department of Pharmacy, AdventHealth for Children, Orlando, Florida, USA
| | - Priyanka H Patel
- Department of Pharmacy, AdventHealth for Children, Orlando, Florida, USA
| | - Tanvi Kamdar
- AHMG Neonatology at Central Florida, AdventHealth for Children, Orlando, Florida, USA
| | - Alex C Lopilato
- Department of Pharmacy, Nemours Children's Hospital, Orlando, Florida, USA
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Salas AA, Bhatia A, Carlo WA. Postnatal growth of preterm infants 24 to 26 weeks of gestation and cognitive outcomes at 2 years of age. Pediatr Res 2021; 89:1804-1809. [PMID: 32942289 PMCID: PMC7965787 DOI: 10.1038/s41390-020-01158-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/25/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Weight z scores at 36 weeks of postmenstrual age (PMA) define postnatal growth failure (PGF) and malnutrition. This study aimed to determine weight z scores at 36 weeks PMA that are associated with adverse cognitive outcomes at 2 years of age. METHODS In this retrospective cohort study, 350 infants 24-26 weeks of gestation born between 2006 and 2014 and followed at 2 years were included. Weight z scores at birth and at 36 weeks PMA were calculated using the INTERGROWTH-21st growth curves. The primary outcome was cognitive delay at 2 years of age (Bayley-III cognitive score < 85). RESULTS Neither the traditional definition of PGF (z score below -1.3) nor the recently proposed definition of malnutrition (z score decline of 1.2 or greater) was associated with cognitive delay. Both a weight z score below -1.0 at 36 weeks PMA (RR: 1.65; 95% CI: 1.10-2.49; p < 0.05) and a decline below -1.0 in weight z score from birth to 36 weeks PMA (RR: 1.40; 95% CI: 1.00-1.94; p < 0.05) were associated with a higher risk of cognitive delay. CONCLUSION With optimal cutoffs, INTERGROWTH-21st weight z scores can predict the risk of cognitive delay. IMPACT New growth curves generated with longitudinal data could overcome some limitations of traditional growth curves generated with cross-sectional data. When these new growth curves are used to assess the growth of preterm infants, alternative definitions for postnatal growth alterations may be needed. This study examines the association between postnatal growth alterations defined by the INTEGROWTH-21st growth curves and adverse cognitive outcomes at 2 years of age. With alternative definitions of postnatal growth failure and malnutrition, the INTERGROWTH-21st growth curves can help establish the association between postnatal growth of extremely preterm infants and adverse neurodevelopmental outcomes in early childhood.
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Affiliation(s)
- Ariel A. Salas
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
| | - Anisha Bhatia
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
| | - Waldemar A. Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
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41
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Han J, Jiang Y, Huang J, Zhang Y, Zhang Y, Zhang Y, Chen X, Li Y, Yan W. Postnatal growth of preterm infants during the first two years of life: catch-up growth accompanied by risk of overweight. Ital J Pediatr 2021; 47:66. [PMID: 33726805 PMCID: PMC7968173 DOI: 10.1186/s13052-021-01019-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 03/02/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Early postanal growth of preterm infants has many effects on early and late health. However, evidence on growth pattern in Chinese preterm infant population during early life is insufficient. This study aims to describe the growth trajectory, catch-up growth, and risk of overweight of preterm infants during the first 2 years of life in a Chinese community population. METHODS All preterm infants (n = 10,624) received routine childcare in one primary maternal and child healthcare network in 8 years were included. Body weight and length/height at corrected age (CA) 40 weeks, CA 3 months, 6 months, 9 months, 12 months, 18 months, and 24 months were extracted and converted to z-scores based on the World Health Organization (WHO) standards. According to the intrauterine growth status, infants were divided into small for gestational age (SGA), appropriate for gestational age (AGA), and large for gestational age (LGA) infants. Changes of z-score were used to describe the growth velocity. Generalized estimating equation (GEE) model was used to analyze growth trajectory trends over time. RESULTS Body weight and length/height were overall above the WHO standards during the first 2 years of life. Z-score increased significantly by 0.08 (95% CI: 0.06-0.10) in weight and 0.07 (95% CI: 0.04-0.09) in length/height from CA 40 weeks to 3 months and then levelled off until CA 24 months after adjustment. Almost 90% of AGA and LGA infants achieved growth targets (≥25th percentile of WHO standards), and over 85% of SGA infants achieved catch-up growth (≥10th percentile of WHO standards) before CA 24 months. However, the risk of overweight appeared during this period, with the proportion of infants with the risk of overweight being at the peak at CA 3 months (25.6% of all preterm infants and 39.4% of LGA infants). Growth trajectories of SGA showed increasing trends, but those of LGA showed decreasing trends during the first 2 years. CONCLUSIONS Body weight and length/height of preterm infants are above the WHO standards in the Chinese community population during the first 2 years of life. Catch-up growth is accompanied by risk of overweight as early as CA 3 months. (349 words).
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Affiliation(s)
- Junyan Han
- Children's Hospital of Fudan University, 399 Wanyuan Road, Minhang District, Shanghai, 201102, China
- National Children's Medical Center, 399 Wanyuan Road, Minhang District, Shanghai, 201102, China
| | - Yuan Jiang
- Children's Hospital of Fudan University, 399 Wanyuan Road, Minhang District, Shanghai, 201102, China
- National Children's Medical Center, 399 Wanyuan Road, Minhang District, Shanghai, 201102, China
| | - Jun Huang
- Shanghai Minhang District Maternal and Child Health Care Hospital, 805 Gudai Road, Minhang District, Shanghai, 201102, China
| | - Yue Zhang
- Shanghai Minhang District Maternal and Child Health Care Hospital, 805 Gudai Road, Minhang District, Shanghai, 201102, China
| | - Ying Zhang
- Shanghai Minhang District Maternal and Child Health Care Hospital, 805 Gudai Road, Minhang District, Shanghai, 201102, China
| | - Yi Zhang
- Children's Hospital of Fudan University, 399 Wanyuan Road, Minhang District, Shanghai, 201102, China
- National Children's Medical Center, 399 Wanyuan Road, Minhang District, Shanghai, 201102, China
| | - Xiaotian Chen
- Children's Hospital of Fudan University, 399 Wanyuan Road, Minhang District, Shanghai, 201102, China
- National Children's Medical Center, 399 Wanyuan Road, Minhang District, Shanghai, 201102, China
| | - Yun Li
- Shanghai Minhang District Maternal and Child Health Care Hospital, 805 Gudai Road, Minhang District, Shanghai, 201102, China.
| | - Weili Yan
- Children's Hospital of Fudan University, 399 Wanyuan Road, Minhang District, Shanghai, 201102, China.
- National Children's Medical Center, 399 Wanyuan Road, Minhang District, Shanghai, 201102, China.
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Fenton TR, Nasser R, Creighton D, Tang S, Sauve R, Bilan D, Fenton CJ, Eliasziw M. Weight, length, and head circumference at 36 weeks are not predictive of later cognitive impairment in very preterm infants. J Perinatol 2021; 41:606-614. [PMID: 33037316 DOI: 10.1038/s41372-020-00855-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/15/2020] [Accepted: 09/26/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess diagnostic accuracy of 36-week anthropometric weight, length, and head circumference <10th and <3rd percentiles to predict preterm infant cognitive impairment. STUDY DESIGN Cohort study of 898 preterm <30-week very-low-birth weight (<1500 g) infants. Anthropometric measures' accuracy to predict cognitive impairment (Bayley-III Cognitive Composite score) <80, 21-months corrected age (CA) and Wechsler Preschool and Primary Scale of Intelligence Quotient (intellectual outcomes) <70, 36-months CA, were determined using receiver operating characteristic (ROC) curves. RESULT Thirty-six-week weight, length or head circumference <10th or <3rd percentile did not predict cognitive impairment; areas under ROC curves were <0.6. Sensitivities and specificities for 10th and 3rd percentile cut points were all poor, with most not exceeding 70%, whether the Fenton 2013 or INTERGROWTH 2015 growth charts were used. Brain injury and low maternal education were better predictors of cognitive impairment. CONCLUSION Preterm infant 36-week anthropometric measurements are not accurate predictors of cognitive impairment.
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Affiliation(s)
- Tanis R Fenton
- Community Health Sciences, O'Brien 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.
| | - Roseann Nasser
- Saskatchewan Heath Authority, Nutrition and Food Services, Pasqua Hospital, Regina, SK, Canada
| | - Dianne Creighton
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Selphee Tang
- Neonatal Follow-up Clinic, Alberta Health Services, Calgary, AB, Canada
| | - Reg Sauve
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Denise Bilan
- Saskatchewan Heath Authority, Nutrition and Food Services, Pasqua Hospital, Regina, SK, Canada
| | - Carol J Fenton
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Misha Eliasziw
- Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
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Kombo L, Smith J, Van Wyk L. Somatic Growth of Enteral-Only Fed Extremely Low Birth Weight Infants in a Resource-Restricted Setting. J Trop Pediatr 2021; 67:6054284. [PMID: 33370442 DOI: 10.1093/tropej/fmaa119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM To determine the growth and prevalence of extrauterine growth restriction (EUGR) in extremely low birth weight (ELBW) infants receiving enteral-only nutrition in a resource-restricted (RR) environment. METHODS Information on nutritional intake, provided largely from fortified breastmilk, was collected retrospectively for 72 ELBW (<1000 g) infants admitted to Tygerberg Hospital, Cape Town, South Africa over a 1 year period. Anthropometric data for the first 49 postnatal days were compared to gender-specific INTERGROWTH-21st standards. RESULTS Full enteral feeds (150 ml/kg) were reached by Day 10-14 with energy >100 Kcal/kg/day from Day 10, and protein >3.5 mg/kg/day from Day 14, onwards. Growth velocity remained below 15 g/kg/day at Day 49. INTERGROWTH-21st Z-scores decreased from -0.8 ± 1.1 at birth to -2.4 ± 1.5 at Day 49. Adequate weight growth velocity (≥15 g/kg/day) was associated with maternal hypertension, completed antenatal steroids, caesarean section delivery and small for gestational age status. CONCLUSION This is the first study to evaluate growth of ELBW infants in a RR setting where enteral-only nutrition, principally from fortified breastmilk, was the primary feeding option. The incidence of EUGR, although high, was similar to the incidence in well-resourced settings, where total parenteral nutrition is routinely provided. Lay summaryExtra-uterine growth restriction (EUGR) is high in extremely low birth weight infants receiving enteral-only nutrition. However, EUGR rates are similar to infants receiving parenteral nutrition. Despite developmental immaturity, it is possible for these infants to achieve fetal growth rates. More aggressive feeding and fortification strategies may be necessary and will need to be balanced against the risk and fear of necrotizing enterocolitis. Enteral-only feeding regimens, especially in resource-restricted environments, should be audited regularly to ensure provision of feeds with the most optimal protein, and protein to energy ratios possible.
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Affiliation(s)
- Lena Kombo
- Department of Paediatrics & Child Health, Stellenbosch University, Tygerberg Hospital, Cape Town 7500, South Africa
| | - Johan Smith
- Department of Paediatrics & Child Health, Stellenbosch University, Tygerberg Hospital, Cape Town 7500, South Africa
| | - Lizelle Van Wyk
- Department of Paediatrics & Child Health, Stellenbosch University, Tygerberg Hospital, Cape Town 7500, South Africa
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Cardoso M, Virella D, Macedo I, Silva D, Pereira-da-Silva L. Customized Human Milk Fortification Based on Measured Human Milk Composition to Improve the Quality of Growth in Very Preterm Infants: A Mixed-Cohort Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020823. [PMID: 33477964 PMCID: PMC7835734 DOI: 10.3390/ijerph18020823] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/16/2021] [Accepted: 01/18/2021] [Indexed: 12/11/2022]
Abstract
Adequate nutrition of very preterm infants comprises fortification of human milk (HM), which helps to improve their nutrition and health. Standard HM fortification involves a fixed dose of a multi-nutrient HM fortifier, regardless of the composition of HM. This fortification method requires regular measurements of HM composition and has been suggested to be a more accurate fortification method. This observational study protocol is designed to assess whether the target HM fortification method (contemporary cohort) improves the energy and macronutrient intakes and the quality of growth of very preterm infants, compared with the previously used standard HM fortification (historical cohorts). In the contemporary cohort, a HM multi-nutrient fortifier and modular supplements of protein and fat are used for HM fortification, and the enteral nutrition recommendations of the European Society for Paediatric Gastroenterology Hepatology and Nutrition for preterm infants will be considered. For both cohorts, the composition of HM is assessed using the Miris Human Milk analyzer (Uppsala, Sweden). The quality of growth will be assessed by in-hospital weight, length, and head circumference growth velocities and a single measurement of adiposity (fat mass percentage and fat mass index) performed just after discharge, using the air displacement plethysmography method (Pea Pod, Cosmed, Italy). ClinicalTrials.gov registration number: NCT04400396.
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Affiliation(s)
- Manuela Cardoso
- Nutrition Unit, Maternidade Dr. Alfredo da Costa, Centro Hospitalar Universitário de Lisboa Central, 2890-495 Lisbon, Portugal;
| | - Daniel Virella
- Research Unit, Centro Hospitalar Universitário de Lisboa Central, 1169-045 Lisbon, Portugal;
- Neonatal Intensive Care Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, 1169-045 Lisbon, Portugal
| | - Israel Macedo
- Neonatal Intensive Care Unit, Maternidade Dr. Alfredo da Costa, Centro Hospitalar Universitário de Lisboa Central, 2890-495 Lisbon, Portugal;
| | - Diana Silva
- Faculdade de Ciências de Nutrição e da Alimentação, Universidade do Porto, 4150-180 Porto, Portugal;
| | - Luís Pereira-da-Silva
- Neonatal Intensive Care Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, 1169-045 Lisbon, Portugal
- Nutrition Lab., Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, 1169-045 Lisbon, Portugal
- Comprehensive Health Research Centre (CHRC), Medicine of Woman, Childhood and Adolescence, NOVA Medical School, Universidade Nova de Lisboa, 1349-008 Lisbon, Portugal
- Correspondence: ; Tel.: +351-917-235-528
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Makker K, Ji Y, Hong X, Wang X. Antenatal and neonatal factors contributing to extra uterine growth failure (EUGR) among preterm infants in Boston Birth Cohort (BBC). J Perinatol 2021; 41:1025-1032. [PMID: 33589730 PMCID: PMC7883994 DOI: 10.1038/s41372-021-00948-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/16/2020] [Accepted: 01/20/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Identify antenatal and neonatal factors associated with primary outcome of EUGR. METHODS 1063 preterm infants from a subset of the BBC were included in this prospective cohort study. Regression analysis was carried out to evaluate associations of EUGR with antenatal factors and neonatal factors. RESULTS 6.1% of the infants had in-utero growth restriction (IUGR) at birth and 21.7% of infants had EUGR. The adjusted odds ratio for EUGR status were significant for birth weight (OR 0.99, p = 0.00, CI 0.99-0.99), for GA at birth (OR 4.58, p = 0.00, CI 3.25-6.44), for PDA (OR 2.9, p = 0.02, CI 1.17-7.1), for NEC (OR 5.14, p = 0.012, CI 1.44-18.3) and for day of life of reaching full feeds (OR 1.04, p = 0.001, CI 1.01-1.06). CONCLUSION This study highlights important factors associated with EUGR. Additional studies are needed to gain further insight.
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Affiliation(s)
- Kartikeya Makker
- Division of Neonatology Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Yuelong Ji
- grid.21107.350000 0001 2171 9311Center on the Early Life Origins of Disease, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Xiumei Hong
- grid.21107.350000 0001 2171 9311Center on the Early Life Origins of Disease, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Xiaobin Wang
- grid.21107.350000 0001 2171 9311Center on the Early Life Origins of Disease, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA ,grid.21107.350000 0001 2171 9311Division of General Pediatrics, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD USA
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Manzotti A, Cerritelli F, Lombardi E, La Rocca S, Biasi P, Chiera M, Galli M, Lista G. The Neonatal Assessment Manual scorE: A Reliability Study on Hospitalized Neonates. Front Pediatr 2021; 9:715091. [PMID: 34631618 PMCID: PMC8492991 DOI: 10.3389/fped.2021.715091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/18/2021] [Indexed: 01/20/2023] Open
Abstract
Despite clinical improvements in neonatal intensive care units (NICUs), prematurity keeps causing several comorbidities. To enhance the management of such conditions, in previous studies we devised the Neonatal Assessment Manual scorE (NAME) model, a structured touch-based assessment that aims to evaluate how newborns respond to gentle touch-based stimuli. The present study aimed to begin assessing the NAME interrater reliability and specific agreements. At the "Vittore Buzzi" Pediatric Hospital NICU ward in Milan, Italy, we enrolled 144 newborns, 85 male and 59 female, with a mean age of 35.9 weeks (±4.1) and a weight of 2,055.3 g (±750.6). Two experienced manual professionals performed the NAME procedure on all the infants. Regarding the total sample and the analysis by sex, we found moderate and statistically significant results for the interrater reliability (p < 0.001) and the specific agreements (p < 0.05), in particular for the "Marginal" score. Furthermore, interrater reliability significantly (p < 0.05) increased as age and weight increased, whereas there was an almost constant moderate and significant (p < 0.05) agreement especially for the "Marginal" score. Therefore, we found preliminary results showing that the NAME could be a reliable diagnostic tool for assessing the newborns' general condition.
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Affiliation(s)
- Andrea Manzotti
- RAISE lab, Foundation COME Collaboration, Pescara, Italy.,Division of Neonatology, Department of Pediatrics, "V. Buzzi" Children's Hospital, ASST-FBF-Sacco, Milan, Italy.,Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
| | | | - Erica Lombardi
- RAISE lab, Foundation COME Collaboration, Pescara, Italy.,Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
| | - Simona La Rocca
- RAISE lab, Foundation COME Collaboration, Pescara, Italy.,Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
| | - Pamela Biasi
- RAISE lab, Foundation COME Collaboration, Pescara, Italy.,Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
| | - Marco Chiera
- RAISE lab, Foundation COME Collaboration, Pescara, Italy
| | - Matteo Galli
- RAISE lab, Foundation COME Collaboration, Pescara, Italy.,Research Department, SOMA, Istituto Osteopatia Milano, Milan, Italy
| | - Gianluca Lista
- Division of Neonatology, Department of Pediatrics, "V. Buzzi" Children's Hospital, ASST-FBF-Sacco, Milan, Italy
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Charpak N, Montealegre‐Pomar A, Bohorquez A. Systematic review and meta-analysis suggest that the duration of Kangaroo mother care has a direct impact on neonatal growth. Acta Paediatr 2021; 110:45-59. [PMID: 32683720 DOI: 10.1111/apa.15489] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/28/2020] [Accepted: 07/15/2020] [Indexed: 11/30/2022]
Abstract
AIM A 2016 Cochrane review showed that Kangaroo mother care (KMC) had a moderate impact on preterm growth, with high heterogeneity among studies. This systematic review and meta-analysis considered new evidence on KMC, particularly the duration. METHOD Databases were searched for papers published in English, French, Spanish and Portuguese up to 2017. Randomised controlled trials (RCT) of preterm or low birth weight infants were included if they compared growth between KMC and conventional care. Anthropometric measures were related to duration. RESULTS We identified 1368 papers, and 13 RCTs covering 743 KMC infants and 718 controls met the selection criteria. Infants held in KMC for at least 6 h/d gained more weight than the controls, with a mean difference of 8.99 g/d (95% confidence interval 8.14-9.84, I2 = 0%). This difference persisted between 2 and 6 h/d and disappeared with 2 hours or less. When we used g/kg/d, the weight gain was higher when the duration was at least 8 h/d. Only babies who received 6 h/d gained more length and head circumference. CONCLUSIONS The effect of the KMC on growth was directly related to the duration.
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Affiliation(s)
- Nathalie Charpak
- Kangaroo Foundation Bogotá Colombia
- Department of Pediatrics Faculty of Medicine Pontificia Universidad Javeriana Bogotá Colombia
| | - Adriana Montealegre‐Pomar
- Kangaroo Foundation Bogotá Colombia
- Department of Pediatrics Faculty of Medicine Pontificia Universidad Javeriana Bogotá Colombia
| | - Adriana Bohorquez
- Department of Psychiatry and Mental Health Faculty of Medicine Pontificia Universidad Javeriana Bogotá Colombia
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Pahl A, Young L, Buus-Frank ME, Marcellus L, Soll R. Non-pharmacological care for opioid withdrawal in newborns. Cochrane Database Syst Rev 2020; 12:CD013217. [PMID: 33348423 PMCID: PMC8130993 DOI: 10.1002/14651858.cd013217.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The prevalence of substance use, both prescribed and non-prescribed, is increasing in many areas of the world. Substance use by women of childbearing age contributes to increasing rates of neonatal abstinence syndrome (NAS). Neonatal opioid withdrawal syndrome (NOWS) is a newer term describing the subset of NAS related to opioid exposure. Non-pharmacological care is the first-line treatment for substance withdrawal in newborns. Despite the widespread use of non-pharmacological care to mitigate symptoms of NAS, there is not an established definition of, and standard for, non-pharmacological care practices in this population. Evaluation of safety and efficacy of non-pharmacological practices could provide clear guidance for clinical practice. OBJECTIVES To evaluate the safety and efficacy of non-pharmacological treatment of infants at risk for, or having symptoms consistent with, opioid withdrawal on the length of hospitalization and use of pharmacological treatment for symptom management. Comparison 1: in infants at risk for, or having early symptoms consistent with, opioid withdrawal, does non-pharmacological treatment reduce the length of hospitalization and use of pharmacological treatment? Comparison 2: in infants receiving pharmacological treatment for symptoms consistent with opioid withdrawal, does concurrent non-pharmacological treatment reduce duration of pharmacological treatment, maximum and cumulative doses of opioid medication, and length of hospitalization? SEARCH METHODS We used the standard search strategy of Cochrane Neonatal to search CENTRAL (2019, Issue 10); Ovid MEDLINE; and CINAHL on 11 October 2019. We also searched clinical trials databases and the reference lists of retrieved articles for randomized controlled trials (RCTs), quasi-RCTs, and cluster trials. SELECTION CRITERIA We included trials comparing single or bundled non-pharmacological interventions to no non-pharmacological treatment or different single or bundled non-pharmacological interventions. We assessed non-pharmacological interventions independently and in combination based on sufficient similarity in population, intervention, and comparison groups studied. We categorized non-pharmacological interventions as: modifying environmental stimulation, feeding practices, and support of the mother-infant dyad. We presented non-randomized studies identified in the search process narratively. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We used the GRADE approach to assess the certainty of evidence. Primary outcomes in infants at risk for, or having early symptoms consistent with, opioid withdrawal included length of hospitalization and pharmacological treatment with one or more doses of opioid or sedative medication. Primary outcomes in infants receiving opioid treatment for symptoms consistent with opioid withdrawal included length of hospitalization, length of pharmacological treatment with opioid or sedative medication, and maximum and cumulative doses of opioid medication. MAIN RESULTS We identified six RCTs (353 infants) in which infants at risk for, or having symptoms consistent with, opioid withdrawal participated between 1975 and 2018. We identified no RCTs in which infants receiving opioid treatment for symptoms consistent with opioid withdrawal participated. The certainty of evidence for all outcomes was very low to low. We also identified and excluded 34 non-randomized studies published between 2005 and 2018, including 29 in which infants at risk for, or having symptoms consistent with, opioid withdrawal participated and five in which infants receiving opioid treatment for symptoms consistent with opioid withdrawal participated. We identified seven preregistered interventional clinical trials that may qualify for inclusion at review update when complete. Of the six RCTs, four studies assessed modifying environmental stimulation in the form of a mechanical rocking bed, prone positioning, non-oscillating waterbed, or a low-stimulation nursery; one study assessed feeding practices (comparing 24 kcal/oz to 20 kcal/oz formula); and one study assessed support of the maternal-infant dyad (tailored breastfeeding support). There was no evidence of a difference in length of hospitalization in the one study that assessed modifying environmental stimulation (mean difference [MD) -1 day, 95% confidence interval [CI) -2.82 to 0.82; 30 infants; very low-certainty evidence) and the one study of support of the maternal-infant dyad (MD -8.9 days, 95% CI -19.84 to 2.04; 14 infants; very low-certainty evidence). No studies of feeding practices evaluated the length of hospitalization. There was no evidence of a difference in use of pharmacological treatment in three studies of modifying environmental stimulation (typical risk ratio [RR) 1.00, 95% CI 0.86 to 1.16; 92 infants; low-certainty evidence), one study of feeding practices (RR 0.92, 95% CI 0.63 to 1.33; 49 infants; very low-certainty evidence), and one study of support of the maternal-infant dyad (RR 0.50, 95% CI 0.13 to 1.90; 14 infants; very low-certainty evidence). Reported secondary outcomes included neonatal intensive care unit (NICU) admission, days to regain birth weight, and weight nadir. One study of support of the maternal-infant dyad reported NICU admission (RR 0.50, 95% CI 0.13 to 1.90; 14 infants; very low-certainty evidence). One study of feeding practices reported days to regain birth weight (MD 1.10 days, 95% CI 2.76 to 0.56; 46 infants; very low-certainty evidence). One study that assessed modifying environmental stimulation reported weight nadir (MD -0.28, 95% CI -1.15 to 0.59; 194 infants; very low-certainty evidence) and one study of feeding practices reported weight nadir (MD -0.8, 95% CI -2.24 to 0.64; 46 infants; very low-certainty evidence). AUTHORS' CONCLUSIONS We are uncertain whether non-pharmacological care for opioid withdrawal in newborns affects important clinical outcomes including length of hospitalization and use of pharmacological treatment based on the six included studies. The outcomes identified for this review were of very low- to low-certainty evidence. Combined analysis was limited by heterogeneity in study design and intervention definitions as well as the number of studies. Many prespecified outcomes were not reported. Although caregivers are encouraged by experts to optimize non-pharmacological care for opioid withdrawal in newborns prior to initiating pharmacological care, we do not have sufficient evidence to inform specific clinical practices. Larger well-designed studies are needed to determine the effect of non-pharmacological care for opioid withdrawal in newborns.
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Affiliation(s)
- Adrienne Pahl
- Pediatrics, University of Vermont Medical Center, Burlington, VT, USA
| | - Leslie Young
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Madge E Buus-Frank
- The Children's Hospital at Dartmouth, Lebanon, New Hampshire, USA
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire, USA
| | | | - Roger Soll
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
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Martínez-Jiménez MD, Gómez-García FJ, Gil-Campos M, Pérez-Navero JL. Comorbidities in childhood associated with extrauterine growth restriction in preterm infants: a scoping review. Eur J Pediatr 2020; 179:1255-1265. [PMID: 32096070 DOI: 10.1007/s00431-020-03613-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 02/11/2020] [Accepted: 02/12/2020] [Indexed: 11/30/2022]
Abstract
Extrauterine growth restriction (EUGR) is a frequent morbidity of preterm infants that can affect short- and long-term prognosis as it involves different EUGR-related alterations in growth and neurological development, as well as cardiometabolic risk. However, knowledge about the prognosis of EUGR is scarce. Thus, the objective of this study is to review the evidence regarding EUGR-related comorbidities in childhood by a systematic approach. This review was carried out using the Joanna Briggs Institute Reviewers' Manual Methodology and the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses)-Search Extension for scoping review. The MEDLINE and EMBASE databases were used to identify papers published until September 2017. Twenty-four publications were included and 19 examined cohort studies. EUGR is mainly associated with (1) lower weight, length, and head circumference measures in childhood; (2) poor neurodevelopment; and (3) alterations in cardiometabolic risk markers. The definition for EUGR and the populations studied differ among authors.Conclusion: EUGR is mainly associated with poor growth and neurodevelopment, as well as with cardiometabolic alterations in childhood. Evidence is based on observational studies with variability in the included populations due to the lack of consensus regarding the definition for EUGR. Finding a gold standard definition becomes paramount in order to select phenotypes at risk later in life. What is known? • EUGR is a frequent condition of preterm infants. Up to date little is known about the effect of the metabolic programming on prognosis. What is new? • The available evidence, which is based on observational studies with variability in the population and the existing different definitions for EUGR, do not enable appropriate data collection. EUGR is mainly associated with poor growth and neurodevelopment, as well as with cardiometabolic alterations in childhood.
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Affiliation(s)
- M D Martínez-Jiménez
- Neonatology Unit. Reina Sofia University Hospital; Pediatric Research Unit, Maimónides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, Córdoba, Spain
| | - F J Gómez-García
- Maimónides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, Córdoba, Spain
| | - M Gil-Campos
- Pediatric Research Unit, Reina Sofia University Hospital Maimónides Biomedical Research Institute of Córdoba (IMIBIC), CIBERObn, University of Córdoba, Avda. Menéndez Pidal sn, 14004, Córdoba, Spain.
| | - J L Pérez-Navero
- Department of Pediatrics, Reina Sofia University Hospital; Pediatric Research Unit, Maimónides Biomedical Research Institute of Córdoba (IMIBIC), CIBERER, University of Córdoba, Córdoba, Spain
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