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Tsukayama M, Azuma H, Oshiro I, Goya H, Yoshida T, Nakanishi K. Effects of early parenteral nutrition on the development of premature infants born at 22-23 weeks of gestation: a retrospective cohort study evaluated by brain magnetic resonance imaging. Eur J Clin Nutr 2024:10.1038/s41430-024-01504-x. [PMID: 39251887 DOI: 10.1038/s41430-024-01504-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 08/24/2024] [Accepted: 08/28/2024] [Indexed: 09/11/2024]
Abstract
BACKGROUND The effect of early parenteral nutrition (EPN) therapy on brain development in extremely premature infants at a gestational age (GA) of 22-25 weeks remains unknown. OBJECTIVES This study investigated the effect of EPN therapy on GA 22 to 25 weeks of gestation using magnetic resonance imaging (MRI) global brain abnormality score (GBAS). SUBJECTS Forty-six preterm infants born before 26 weeks of gestation were divided into the GA 22-23 weeks (GA 22-23; n = 18) and GA 24-25 weeks (GA 24-25; n = 28) group. METHODS Each infant received ≥3.0 g/kg/day of amino acids from day 1 of life and ≥1.0 g/kg/day of lipid emulsion the next day. Weight change during hospitalization, GBAS at discharge, and developmental quotient (DQ) until three years old were compared between the groups. RESULTS GA 22-23 showed long-term postnatal weight loss, but weight at 41 weeks of postmenstrual age did not differ between the groups. The GBAS score was not significantly different, but the head circumference was smaller in GA 22-23 than in GA 24-25 until 2 years old. The DQ at 1-1.5 years old was lower in GA 22-23 than that of GA 24-25; however, there was no significant difference in DQ after 2 years old between the groups. CONCLUSIONS The effect of nutritional support with EPN therapy in premature neonates born at <24 weeks of gestation may still be inadequate. GBAS is useful for assessing brain development in very preterm infants, and the importance of nutritional support during the first few weeks of life should continue to be explored.
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Affiliation(s)
- Mayumi Tsukayama
- Maternity and Perinatal Care Center, University of the Ryukyus Hospital, Okinawa, Japan
- Department of Child Health and Welfare (Pediatrics), Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Haruna Azuma
- Department of Child Health and Welfare (Pediatrics), Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Itsuki Oshiro
- Department of Child Health and Welfare (Pediatrics), Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Hideki Goya
- Maternity and Perinatal Care Center, University of the Ryukyus Hospital, Okinawa, Japan
| | - Tomohide Yoshida
- Maternity and Perinatal Care Center, University of the Ryukyus Hospital, Okinawa, Japan.
- Department of Child Health and Welfare (Pediatrics), Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
| | - Koichi Nakanishi
- Department of Child Health and Welfare (Pediatrics), Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
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Peila C, Spada E, Deantoni S, Iuliano E, Moro GE, Giribaldi M, Cavallarin L, Cresi F, Coscia A. The "Fortilat" Randomized Clinical Trial Follow-Up: Neurodevelopmental Outcome at 18 Months of Age. Nutrients 2020; 12:nu12123807. [PMID: 33322629 PMCID: PMC7764145 DOI: 10.3390/nu12123807] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/06/2020] [Accepted: 12/09/2020] [Indexed: 01/03/2023] Open
Abstract
Adequate nutrition is fundamental to neonatal survival and short-term outcomes, but it also has long-term consequences on quality of life and neurologic development of preterm infants. Donkey milk has been suggested as a valid alternative for children allergic to cows’ milk proteins, due to its biochemical similarity to human milk; we, hence, hypothesized that donkey milk could be a suitable basis for developing an innovative human milk fortifier for feeding preterm infants. The aim of the current study was to extend the findings and to evaluate the neurodevelopmental outcomes at 18 months of corrected age of the infants enrolled in the clinical trial named “Fortilat”. Infants born ≤1500 g and <32 weeks of gestational age were randomized to receive either a combination of bovine milk-based multicomponent fortifier and protein supplement or a combination of a novel multicomponent fortifier and protein supplement derived from donkey milk. The followed fortification protocol was the same for the two groups and the two diets were designed to be isoproteic and isocaloric. All infants enrolled were included in a developmental assessment program. The neurodevelopmental assessment was performed at 18 ± 6 months of corrected age. Minor and major neurodevelopmental impairment and General Quotient (GQ) at the Griffiths-II Mental Development Scale were considered. The GQ was considered both in continuous and as two classes: lower than and higher than (or equal to) a defined cutoff (GQcl). The difference in GQ and GQcl between the two arms was estimated using Mann–Whitney–Wilcoxon test or Fischer exact test, respectively, on the assumption of casual loss at follow-up. A further analysis was performed using generalized linear models. There were 103 children (bovine milk-derived fortifier arm = 54, donkey milk-derived fortifier arm = 49) included for the neurodevelopmental follow-up. All observations were included in the interval of 18 ± 6 months of corrected age. No significant difference was observed between the two arms in the incidence of neurologic sequelae and the GQs were similar in the two arms. Our results demonstrated no difference for the donkey milk-derived fortifier compared to standard bovine-derived fortifier regarding long-term neurodevelopmental outcomes.
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Affiliation(s)
- Chiara Peila
- Department of Public Health and Pediatric, Neonatal Unit of Turin University, Via Ventimiglia 3, 10126 Turin, Italy; (E.S.); (S.D.); (E.I.); (F.C.); (A.C.)
- Correspondence:
| | - Elena Spada
- Department of Public Health and Pediatric, Neonatal Unit of Turin University, Via Ventimiglia 3, 10126 Turin, Italy; (E.S.); (S.D.); (E.I.); (F.C.); (A.C.)
| | - Sonia Deantoni
- Department of Public Health and Pediatric, Neonatal Unit of Turin University, Via Ventimiglia 3, 10126 Turin, Italy; (E.S.); (S.D.); (E.I.); (F.C.); (A.C.)
| | - Ester Iuliano
- Department of Public Health and Pediatric, Neonatal Unit of Turin University, Via Ventimiglia 3, 10126 Turin, Italy; (E.S.); (S.D.); (E.I.); (F.C.); (A.C.)
| | - Guido E. Moro
- Italian Association of Human Milk Banks, Via Libero Temolo 4, 20126 Milan, Italy;
| | - Marzia Giribaldi
- Institute of Sciences of Food Production, National Research Council, Largo Braccini 2, 10095 Grugliasco, Italy; (M.G.); (L.C.)
- Research Centre for Engineering and Agro-Food Processing, Council for Agricultural Research and Economics, Strada delle Cacce 73, 10135 Turin, Italy
| | - Laura Cavallarin
- Institute of Sciences of Food Production, National Research Council, Largo Braccini 2, 10095 Grugliasco, Italy; (M.G.); (L.C.)
| | - Francesco Cresi
- Department of Public Health and Pediatric, Neonatal Unit of Turin University, Via Ventimiglia 3, 10126 Turin, Italy; (E.S.); (S.D.); (E.I.); (F.C.); (A.C.)
| | - Alessandra Coscia
- Department of Public Health and Pediatric, Neonatal Unit of Turin University, Via Ventimiglia 3, 10126 Turin, Italy; (E.S.); (S.D.); (E.I.); (F.C.); (A.C.)
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Peila C, Spada E, Bertino E, Deantoni S, Percivati F, Moro GE, Giribaldi M, Cavallarin L, Cresi F, Coscia A. The "Fortilat" Randomized Clinical Trial Follow-Up: Auxological Outcome at 18 Months of Age. Nutrients 2020; 12:nu12123730. [PMID: 33287300 PMCID: PMC7761645 DOI: 10.3390/nu12123730] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 11/25/2020] [Accepted: 11/30/2020] [Indexed: 11/23/2022] Open
Abstract
Human milk fortification is a routine clinical practice for feeding preterm infants. We hypothesized that donkey milk can be a suitable basis for developing an innovative human milk fortifier. Our randomized controlled single-blind clinical trial, named “Fortilat”, evaluated the feeding tolerance, growth and clinical short-term outcomes in a population of preterm infants fed with a novel multi-component fortifier and a protein concentrate derived from donkey milk. The aim of the current study is to extend the previous findings and to evaluate the auxological outcomes of the infants enrolled in the “Fortilat” trial at 18 months of age. In the previous trial “Fortilat”, the fortification protocol followed was the same for the two groups, and the two diets were designed to be isoproteic and isocaloric. All infants enrolled in the trial were included in a premature infant developmental evaluation program consisting of hospital visits at 40 ± 1 weeks of postmenstrual age, and at 6, 12 and 18 months of corrected age. Weight, head circumference and length were expressed in z-score using neonatal Intergrowth21st and INeS charts at birth, and WHO 0–5 years growth charts at 18 months. 122 children (Bovine-arm = 62, Donkey-arm = 60) were included in this study. All the observations were recorded in the interval of 18 ± 3 months of the correct age. The two groups did not differ for head circumference, length or weight at 18 months of age. Our data show that fortifiers derived from donkey milk had not different long term auxological outcomes of standard bovine-derived fortifier, but the new donkey milk fortifier was well tolerated in our population.
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Affiliation(s)
- Chiara Peila
- Department of Public Health and Pediatric, Neonatal Unit of Turin University, Via Ventimiglia 3, 10126 Turin, Italy; (E.S.); (E.B.); (S.D.); (F.P.); (F.C.); (A.C.)
- Correspondence:
| | - Elena Spada
- Department of Public Health and Pediatric, Neonatal Unit of Turin University, Via Ventimiglia 3, 10126 Turin, Italy; (E.S.); (E.B.); (S.D.); (F.P.); (F.C.); (A.C.)
| | - Enrico Bertino
- Department of Public Health and Pediatric, Neonatal Unit of Turin University, Via Ventimiglia 3, 10126 Turin, Italy; (E.S.); (E.B.); (S.D.); (F.P.); (F.C.); (A.C.)
| | - Sonia Deantoni
- Department of Public Health and Pediatric, Neonatal Unit of Turin University, Via Ventimiglia 3, 10126 Turin, Italy; (E.S.); (E.B.); (S.D.); (F.P.); (F.C.); (A.C.)
| | - Federica Percivati
- Department of Public Health and Pediatric, Neonatal Unit of Turin University, Via Ventimiglia 3, 10126 Turin, Italy; (E.S.); (E.B.); (S.D.); (F.P.); (F.C.); (A.C.)
| | - Guido E. Moro
- Italian Association of Human Milk Banks, Via Libero Temolo 4, 20126 Milan, Italy;
| | - Marzia Giribaldi
- Institute of Sciences of Food Production, National Research Council, Largo Braccini 2, 10095 Grugliasco, Italy; (M.G.); (L.C.)
- Research Centre for Engineering and Agro-Food Processing, Council for Agricultural Research and Economics (CREA), Strada delle Cacce 73, 10135 Turin, Italy
| | - Laura Cavallarin
- Institute of Sciences of Food Production, National Research Council, Largo Braccini 2, 10095 Grugliasco, Italy; (M.G.); (L.C.)
| | - Francesco Cresi
- Department of Public Health and Pediatric, Neonatal Unit of Turin University, Via Ventimiglia 3, 10126 Turin, Italy; (E.S.); (E.B.); (S.D.); (F.P.); (F.C.); (A.C.)
| | - Alessandra Coscia
- Department of Public Health and Pediatric, Neonatal Unit of Turin University, Via Ventimiglia 3, 10126 Turin, Italy; (E.S.); (E.B.); (S.D.); (F.P.); (F.C.); (A.C.)
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Khasawneh W, Khassawneh M, Mazin M, Al-Theiabat M, Alquraan T. Clinical and Nutritional Determinants of Extrauterine Growth Restriction Among Very Low Birth Weight Infants. Int J Gen Med 2020; 13:1193-1200. [PMID: 33239903 PMCID: PMC7682780 DOI: 10.2147/ijgm.s284943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/28/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose To identify the clinical and nutritional factors associated with extrauterine growth restriction (EUGR) among very low birth weight infants (VLBW) in a tertiary hospital in Jordan. Patients and Methods We conducted a retrospective analysis of all VLBW infants admitted at King Abdullah University Hospital between July 2015 and June 2020. Clinical factors, nutritional intake, and growth parameters were collected and analyzed. A multilogistic regression model was applied to identify factors associated with EUGR. Results Of the 247 VLBW infants included in analysis, 112 (45%) were males, 30 (12%) were below 1000 g, and 72 (29%) were small for gestational age (SGA). EUGR was diagnosed in 198 (80%) at discharge. The rates of EUGR among SGA and non-SGA infants were 97% and 73%, respectively. The EUGR infants had a higher gestational age (30.7 vs 29.8 weeks, p=0.04), a lower birth weight (1209 vs 1300 g, p=0.005), a longer ventilatory support (5.7 vs 2.2 days, p=0.03), a higher incidence of sepsis (23% vs 10%, p=0.05), and a longer hospitalization (46 vs 38 days, p=0.03). With multilogistic regression model, the factors associated with EUGR include small-for-gestational age (AOR 9, 95% C.I. 2, 50), >3-day delay in feeding initiation (AOR 3.8, 95% C.I. 1.2,10), >14-day delay in achieving full feeds (AOR 3.3, 95% C.I. 1.2, 8), <3 g/kg of protein intake on the 8th day (AOR 2.1, 95% C.I. 1.1, 4.1), <100 kcal/kg of total caloric intake on the 15th day (AOR 3.8, 95% C.I. 1.6, 8.9), and occurrence of sepsis (AOR 3, 95% C.I. 1.1, 9). Conclusion The rate of EUGR in our unit is high. In addition to being SGA at birth, sepsis and suboptimal protein and caloric intake in the first two weeks of life were significantly associated with this complication. A more aggressive enteral and parenteral nutritional approach is needed to minimize postnatal growth delay.
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Affiliation(s)
- Wasim Khasawneh
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad Khassawneh
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mai Mazin
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Muath Al-Theiabat
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Tuka Alquraan
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Delayed initiation of enteral feeds is associated with postnatal growth failure among preterm infants managed at a rural hospital in Uganda. BMC Pediatr 2020; 20:86. [PMID: 32093661 PMCID: PMC7038603 DOI: 10.1186/s12887-020-1986-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 02/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prematurity is the leading cause of mortality in children under 5 years of age globally and is also frequently associated with postnatal growth failure (PGF). Although most preterm births occur in low resource settings, little is known about their postnatal growth outcomes especially in rural areas. We evaluated the incidence and factors associated with PGF among preterm infants managed at a rural hospital in Uganda. METHODS Retrospective cohort study of preterm infants discharged from Kiwoko Hospital neonatal intensive care unit (NICU) from July 2017 to June 2018. Inclusion criteria included gestational age 26 up to but not including 37 weeks, admission within 24 h of birth and at least 7 days hospital stay. Exclusion criteria included major congenital anomalies and missing gestational age or birth weight. Birth and discharge weights from clinical notes were plotted on Fenton 2013 growth charts. Gestation age was determined by last normal menstruation period (LNMP), extracted from the mother's antenatal card or early obstetric ultrasound scan reports. Postnatal growth failure was diagnosed if discharge weight was less than the 10th percentile for estimated gestational age. Other data from the clinical notes included demographic characteristics, neonatal morbidities as assigned by the attending physician and infant feeding practices. Multivariable logistic regression was used to explore factors associated with PGF. RESULTS A total of 349 preterm infants with a mean gestational age of 31 (range 26 to 36) weeks were included. The incidence proportion of PGF was 254/349 (73%). Factors significantly associated with postnatal growth failure included: delayed initiation of enteral feeds [AOR = 3.70, 95% (CI 1.64 to 8.33)], sepsis [AOR = 6.76, 95% (CI 2.15 to 21.2)], multiple gestation [AOR = 1.81, 95% (CI 1.01 to 3.24)] and male gender [AOR = 1.71 95% (CI 1.01 to 2.91)]. CONCLUSION Nearly three quarters of preterm infants managed at a rural hospital in Uganda had postnatal growth failure. Delayed initiation of enteral feeds and sepsis were highly associated with postnatal growth failure. Enteral feeds should be initiated as soon as possible in these infants to reduce early protein deficits and hence postnatal growth failure.
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Wang L, Liu D, Shen H, Wang Y, Han L, He Z. Analysis of Amino Acid Patterns With Nutrition Regimens in Preterm Infants With Extrauterine Growth Retardation. Front Pediatr 2020; 8:184. [PMID: 32426308 PMCID: PMC7212428 DOI: 10.3389/fped.2020.00184] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 03/30/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Amino acid (AA) metabolic patterns have emerged as an analytical technique to characterize biomarkers compromising normal growth and elucidate underlying nutritional exposure. This study aimed to identify AA metabolites most likely associated with poor growth and examine the association between AA metabolites and nutrition regimens in preterm infants during transition from parenteral nutrition (PN) to enteral nutrition (EN), using gas chromatography-mass spectrometry (GC-MS). Methods: This observational cohort study was conducted in infants born at <32 weeks' gestation with birth weight of <1,500 g. The outcome of extrauterine growth retardation (EUGR) based on whether the weight was <10th percentile for post-menstrual age, was evaluated when full EN reached. Samples were collected at four sampling points according to nutritional status. AA profiles in dried sampling point spots (DBS) were quantified using GC-MS; and were compared simultaneously. The correlation of AA concentration with growth and nutritional parameters was examined using multivariate analysis. Results: We identified 40 eligible infants: 20 in the EUGR group and 20 in the non-EUGR group. AA deficiency progressively emerged during the transition. Lower concentrations of four AAs, including citrulline (Cit), were associated with increased risk of EUGR when adjusted for gestational age, birth weight z-score, age when trophic EN was started, as well as average energy and protein intakes in synchronous nutritional period. Moreover, a lower Cit concentration was positively correlated with the compromised protein and energy deficits in EN during early transition. Conclusion: A low Cit concentration during transition from PN to full EN should be noticed by the clinician to more closely examine nutrition practices to prevent EUGR.
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Affiliation(s)
- Li Wang
- Department of Neonatology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Danyang Liu
- Department of Neonatology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haiqing Shen
- Department of Neonatology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Wang
- Department of Clinical Nutrition, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lianshu Han
- Department of Pediatric Endocrine and Metabolic Diseases Laboratory, Shanghai Institute for Pediatric Research, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhenjuan He
- Department of Neonatology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Perinatal Research Laboratory, Shanghai Institute for Pediatric Research, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Tozzi MG, Moscuzza F, Michelucci A, Scaramuzzo RT, Cosini C, Chesi F, Caligo MA, Ciantelli M, Ghirri P. Nutrition, epigenetic markers and growth in preterm infants. J Matern Fetal Neonatal Med 2019; 34:3963-3968. [PMID: 31842645 DOI: 10.1080/14767058.2019.1702952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background and aim: Maternal diet and early nutrition of newborns may affect the phenotype later in adulthood. Susceptibility of epigenetic mechanisms to the nutritional environment is a critical element in neonatal development. Epigenetic mechanisms could be considered as a bridge between environmental stimuli and long lasting phenotype. IC2, a key region on 11p15, is involved in the control of growth and regulates CDKN1C, PHLDA2 and KCNQ1, growth inhibitor genes. Our aim was to investigate the relationship between epigenetic markers, nutrition and postnatal growth.Methods: We enrolled 37 newborns (gestational age at birth was <34 weeks) admitted to Neonatal Intensive Care Unit at University Hospital of Pisa.Results: We observed a relationship between reduced protein and lipid intake and IC2 hypermethylation (p = .003 and p = .001 respectively) and we also investigated the correlation between growth pattern and IC2 methylation.Conclusion: The reduced growth, in part related to a reduced intake of nutrients (lipids and proteins), might be due to IC2 hypermethylation, causing an increased expression of growth inhibitor genes. IC2 hypermethylation could be a marker of reduced infants' growth and may guides us to nutritional interventional strategies for a precocious prevention of extrauterine growth restriction (EUGR).
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Affiliation(s)
- Maria Giulia Tozzi
- Division of Neonatology and NICU, Department of Clinical and Experimental Medicine, Pisa, Italy
| | - Francesca Moscuzza
- Division of Neonatology and NICU, Department of Clinical and Experimental Medicine, Pisa, Italy
| | | | - Rosa T Scaramuzzo
- Division of Neonatology and NICU, Department of Clinical and Experimental Medicine, Pisa, Italy
| | - Cinzia Cosini
- Molecular Genetics Lab, University Hospital of Pisa, Pisa, Italy
| | - Francesca Chesi
- Division of Neonatology and NICU, Department of Clinical and Experimental Medicine, Pisa, Italy
| | | | - Massimiliano Ciantelli
- Division of Neonatology and NICU, Department of Clinical and Experimental Medicine, Pisa, Italy
| | - Paolo Ghirri
- Division of Neonatology and NICU, Department of Clinical and Experimental Medicine, Pisa, Italy
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Tozzi MG, Moscuzza F, Michelucci A, Lorenzoni F, Cosini C, Ciantelli M, Ghirri P. ExtraUterine Growth Restriction (EUGR) in Preterm Infants: Growth Patterns, Nutrition, and Epigenetic Markers. A Pilot Study. Front Pediatr 2018; 6:408. [PMID: 30619799 PMCID: PMC6306451 DOI: 10.3389/fped.2018.00408] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 12/07/2018] [Indexed: 02/05/2023] Open
Abstract
Background/Aims: IntraUterine (IUGR) and ExtraUterine Growth Restriction (EUGR) may induce reprogramming mechanisms, finalized to survive before and after birth. Nutritional factors and other environmental signals could regulate gene expression through epigenetic modification, but the molecular mechanisms involved are not yet well understood. Epigenetic mechanisms could be considered as a bridge between environmental stimuli and long lasting phenotype, acquired during the intrauterine life and the first weeks of life. Our aim was to investigate the relationship between growth patterns, nutritional determinants, and epigenetic pathways. Methods: We enrolled 38 newborns admitted to Neonatal Intensive Care Unit (NICU) at University Hospital of Pisa. Gestational age at birth was <34 weeks and post-menstrual age (PMA) was 36-42 weeks at discharge. We excluded infants with malformations or clinical syndromes. EUGR was defined as the reduction in weight z score between birth and discharge >1 SD. We also evaluated DNA methylation of Imprinting Centre 1 (IC1) at birth and at discharge. Results: We observed a decrease in SD of weight and head circumference mainly during the first weeks of life. We found a correlation between EUGR for weight and for head circumference and an increased IC1 methylation (p = 0.018 and p = 0.0028, respectively). We observed a relationship between reduced protein and lipid intake and IC1 hypermethylation (p = 0.009 and p = 0.043, respectively). Conclusion: IC1 hypermethylation could be a reprogramming mechanism to promote a catch-up growth, by means of an increased Insulin-like growth factor 2 (IGF2) expression, that may have potential effects on metabolic homeostasis later in life.
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Affiliation(s)
- Maria Giulia Tozzi
- Division of Neonatology and NICU, Department of Clinical and Experimental Medicine, Pisa, Italy
| | - Francesca Moscuzza
- Division of Neonatology and NICU, Department of Clinical and Experimental Medicine, Pisa, Italy
| | | | - Francesca Lorenzoni
- Division of Neonatology and NICU, Department of Clinical and Experimental Medicine, Pisa, Italy
| | - Cinzia Cosini
- Molecular Genetics Lab, University Hospital of Pisa, Pisa, Italy
| | - Massimiliano Ciantelli
- Division of Neonatology and NICU, Department of Clinical and Experimental Medicine, Pisa, Italy
| | - Paolo Ghirri
- Division of Neonatology and NICU, Department of Clinical and Experimental Medicine, Pisa, Italy
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