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Paulsen ME, Marka N, Nagel EM, Gonzalez Villamizar JD, Nathan BM, Ramel SE. An exploratory study of clinical factors associated with IGF-1 and IGFBP-3 in preterm infants. Pediatr Res 2024:10.1038/s41390-023-02970-y. [PMID: 38191823 PMCID: PMC11228126 DOI: 10.1038/s41390-023-02970-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 10/17/2023] [Accepted: 11/26/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Despite advances in parenteral nutrition, postnatal growth failure in very low birthweight (VLBW) preterm infants is common and associated with chronic health problems. Insulin-like growth factor 1 (IGF-1) is positively associated with improved infant growth, but factors which promote IGF-1 levels in this population have not been clearly identified. The objective of this study was to explore early factors that influence IGF-1 in VLBW preterm infants. METHODS VLBW infants were enrolled into a prospective, randomized controlled nutrition trial (N = 87). Outcome measures included IGF-1 and IGFBP-3 levels measured at 35 weeks PMA. Linear regression analyses tested the relationships between candidate clinical predictors and levels of IGF-1 and IGFBP-3. RESULTS Higher protein intake, longer duration of parenteral nutrition, and lower IGFBP-3 levels at 1 week of life were associated with lower IGF-1 levels at 35 weeks PMA. Neither early markers of insulin resistance nor degree of illness were associated with IGF-1 levels at 35 weeks PMA. CONCLUSION Optimization of early nutrient intake, and attention to route of delivery, may have a lasting influence on IGF-1/IGFBP-3, and in turn, long-term health outcomes. IMPACT In very low birthweight preterm infants, early protein intake, duration of parenteral nutrition, and insulin-like growth factor binding protein 3 (IGFBP-3) levels at 1 week of life are positively associated with insulin-like growth factor 1 (IGF-1) levels at 35 weeks postmenstrual age. Data from this study highlight the influence of early nutrition on components of the endocrine axis in preterm infants. Strategies aimed at early initiation of enteral nutrition, as well as optimizing composition of parenteral nutrition, may bolster hormones involved in promoting preterm infant growth.
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Affiliation(s)
- Megan E Paulsen
- Division of Neonatology, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA.
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA.
| | - Nicholas Marka
- Biostatistical Design and Analysis Center, Clinical Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
| | - Emily M Nagel
- University of Minnesota School of Public Health, Minneapolis, MN, USA
| | | | - Brandon M Nathan
- Division of Endocrinology, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Sara E Ramel
- Division of Neonatology, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
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2
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Lin YC, Chu CH, Chen YJ, Chen RB, Huang CC. Early-Life Slow Enteral Feeding Progression Pattern Is Associated with Longitudinal Head-Size Growth Faltering and Neurodevelopmental Impairment Outcomes in Extremely Preterm Infants. Nutrients 2023; 15:nu15051277. [PMID: 36904276 PMCID: PMC10005088 DOI: 10.3390/nu15051277] [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: 02/04/2023] [Revised: 03/02/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVE To determine whether feeding progression patterns in the first eight postnatal weeks, depicted by clustering analysis of daily enteral feeding volume, are associated with longitudinal head-circumference (HC) growth and neurodevelopmental outcomes in extremely preterm (EP) infants. METHODS 200 infants who were admitted at gestational ages 23-27 weeks between 2011 and 2018; survived to discharge; and underwent longitudinal HC growth measurements at birth, term-equivalent age (TEA), corrected age (CA) 6-month, 12-month, and 24-month; and neurodevelopmental assessment using the Bayley Scales of Infant Development at CA 24 months were included for analysis. RESULTS kmlShape analysis identified two distinct enteral feeding progression patterns: fast progression in 131 (66%) infants and slow progression in 69 (34%) infants. Compared to the fast progression group, the slow progression group showed significantly lower daily enteral volumes after day 13, was older in postnatal age reaching full feeding, had a higher rate of Delta z scores of HC (zHC) < -1 (p < 0.001) between birth and TEA, and displayed lower longitudinal zHC from TEA to CA 24 months. The slow progression group also showed higher rates of microcephaly [42% vs. 16%, p < 0.001; adjusted odd ratio (aOR): 3.269, p = 0.001] and neurodevelopmental impairment (NDI) (38% vs. 19%, p = 0.007; aOR: 2.095, p = 0.035) at CA 24 months. For NDI, the model including feeding progression patterns showed a lower Akaike information criterion score and a better goodness of fit than the model that did not include feeding patterns. CONCLUSION Characterizing feeding progression pattern may help identify EP infants at high-risk of head-size growth faltering and NDI at early childhood.
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Affiliation(s)
- Yung-Chieh Lin
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Cheng-Kung University, Tainan 701401, Taiwan
| | - Chi-Hsiang Chu
- Department of Statistics, Tunghai University, Taichung 407224, Taiwan
- Department of Statistics, Institute of Data Science, National Cheng Kung University, Tainan 701401, Taiwan
| | - Yen-Ju Chen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Cheng-Kung University, Tainan 701401, Taiwan
| | - Ray-Bing Chen
- Department of Statistics, Institute of Data Science, National Cheng Kung University, Tainan 701401, Taiwan
| | - Chao-Ching Huang
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan
- Department of Pediatrics, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
- Correspondence: ; Tel.: +886-62353535-5273
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3
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Slagle C, Gist KM, Starr MC, Hemmelgarn TS, Goldstein SL, Kent AL. Fluid Homeostasis and Diuretic Therapy in the Neonate. Neoreviews 2022; 23:e189-e204. [PMID: 35229135 DOI: 10.1542/neo.23-3-e189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Understanding physiologic water balance and homeostasis mechanisms in the neonate is critical for clinicians in the NICU as pathologic fluid accumulation increases the risk for morbidity and mortality. In addition, once this process occurs, treatment is limited. In this review, we will cover fluid homeostasis in the neonate, explain the implications of prematurity on this process, discuss the complexity of fluid accumulation and the development of fluid overload, identify mitigation strategies, and review treatment options.
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Affiliation(s)
- Cara Slagle
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, College of Medicine, Cincinnati, OH
| | - Katja M Gist
- Division of Cardiology, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, College of Medicine, Cincinnati, OH
| | - Michelle C Starr
- Division of Pediatric Nephrology, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children, Indianapolis, IN
| | - Trina S Hemmelgarn
- Division of Pharmacology, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, College of Pharmacy, Cincinnati, OH
| | - Stuart L Goldstein
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, College of Medicine, Cincinnati, OH
| | - Alison L Kent
- Department of Pediatrics, University of Rochester, NY, and Australian National University Medical School, Canberra, ACT, Australia
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4
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Metabolic-endocrine disruption due to preterm birth impacts growth, body composition, and neonatal outcome. Pediatr Res 2022; 91:1350-1360. [PMID: 34040160 PMCID: PMC9197767 DOI: 10.1038/s41390-021-01566-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/19/2021] [Accepted: 04/22/2021] [Indexed: 02/05/2023]
Abstract
Despite optimized nutrition, preterm-born infants grow slowly and tend to over-accrete body fat. We hypothesize that the premature dissociation of the maternal-placental-fetal unit disrupts the maintenance of physiological endocrine function in the fetus, which has severe consequences for postnatal development. This review highlights the endocrine interactions of the maternal-placental-fetal unit and the early perinatal period in both preterm and term infants. We report on hormonal levels (including tissue, thyroid, adrenal, pancreatic, pituitary, and placental hormones) and nutritional supply and their impact on infant body composition. The data suggest that the premature dissociation of the maternal-placental-fetal unit leads to a clinical picture similar to panhypopituitarism. Further, we describe how the premature withdrawal of the maternal-placental unit, neonatal morbidities, and perinatal stress can cause differences in the levels of growth-promoting hormones, particularly insulin-like growth factors (IGF). In combination with the endocrine disruption that occurs following dissociation of the maternal-placental-fetal unit, the premature adaptation to the extrauterine environment leads to early and fast accretion of fat mass in an immature body. In addition, we report on interventional studies that have aimed to compensate for hormonal deficiencies in infants born preterm through IGF therapy, resulting in improved neonatal morbidity and growth. IMPACT: Preterm birth prematurely dissociates the maternal-placental-fetal unit and disrupts the metabolic-endocrine maintenance of the immature fetus with serious consequences for growth, body composition, and neonatal outcomes. The preterm metabolic-endocrine disruption induces symptoms resembling anterior pituitary failure (panhypopituitarism) with low levels of IGF-1, excessive postnatal fat mass accretion, poor longitudinal growth, and failure to thrive. Appropriate gestational age-adapted nutrition alone seems insufficient for the achievement of optimal growth of preterm infants. Preliminary results from interventional studies show promising effects of early IGF-1 supplementation on postnatal development and neonatal outcomes.
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5
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Zhao W, Yin Y, Qin F, Lin X, Zhang L. Effects of early intake of amino acid on the neurodevelopmental outcomes in very low birth weight infants at correct age of 20 months and school age. Ir J Med Sci 2021; 191:283-288. [PMID: 33608833 DOI: 10.1007/s11845-021-02526-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 01/20/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Inadequate nutrition leads to poor neurodevelopmental outcomes in very low-birth weight infants (VLBWIs). This study aimed to investigate the beneficial effects of early amino acid intake on the neurodevelopmental outcomes in VLBWIs at 20 months of correct age and school age. METHODS The information of VLBWIs that received amino acid intake were retrospectively analyzed in this study. The cases in early group (EAA) received amino acid within 24 h, but the cases in standard group (SAA) after 48 h post-natal. The body weight, height, and Bayley score of the infants at correct age of 20 months were compared between groups. And the cognitive outcomes at school age were evaluated using Wechsler Intelligence Scale and Das-Naglieri cognitive assessment system. RESULTS There were no differences at baseline characteristics of the VLBWIs between EAA and SAA groups. Compared with the SAA group, the infants in EAA group had shorter time to regain birth weight (P < 0.05). The head circumference, MDI, and PDI in EAA group at 20 months of correct age were significantly higher than that in SAA group (both P < 0.05). According to the Wechsler scale and Das-Naglieri scores, the infants in EAA group had markedly improved cognitive outcomes compared with those in SAA group (all P < 0.05). CONCLUSION The results of this study revealed that early amino acid intake within 24 h could significantly improve the neurodevelopmental and cognitive outcomes in VLBWIs at 20 months of correct age and school age.
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Affiliation(s)
- Wei Zhao
- Department of Neonatology, Weifang People's Hospital, Shandong, 261041, Weifang, China
| | - Yane Yin
- Department of Neonatology, Weifang People's Hospital, Shandong, 261041, Weifang, China
| | - Fuxiang Qin
- Department of Neonatology, Weifang People's Hospital, Shandong, 261041, Weifang, China
| | - Xinyu Lin
- Department of Neonatology, Weifang People's Hospital, Shandong, 261041, Weifang, China
| | - Liming Zhang
- Department of Neonatology, Weifang People's Hospital, Shandong, 261041, Weifang, China.
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6
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Abrams SA. Long-Term Growth and Body Composition Consequences of Using Fortified Donor Milk or Preterm Formula for Very-Low-Birth-Weight Infants. J Nutr 2020; 150:188-189. [PMID: 31618419 DOI: 10.1093/jn/nxz264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 09/26/2019] [Accepted: 09/30/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Steven A Abrams
- Department of Pediatrics, Dell Medical School at the University of Texas, Austin, TX, USA
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7
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Morniroli D, Dessì A, Giannì ML, Roggero P, Noto A, Atzori L, Lussu M, Fanos V, Mosca F. Is the body composition development in premature infants associated with a distinctive nuclear magnetic resonance metabolomic profiling of urine? J Matern Fetal Neonatal Med 2018; 32:2310-2318. [PMID: 29357769 DOI: 10.1080/14767058.2018.1432040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Preterm infants' body composition at term-corrected age differs from that of term infants but appears to be similar at the age of 3 months. The aim of this study was to compare the metabolomic pattern of preterm infants at term and at 3 months with that of term infants and to determine its association with body composition development. METHOD We designed a pilot study. Growth and body composition were evaluated by an air displacement plethysmography system in 13 preterm infants and seven term newborns at term and at 3 months of corrected age. Urine samples were collected at the same time points and analysed by nuclear magnetic resonance. RESULTS At term-corrected age, preterm infants showed a higher fat mass percentage compared with that of term newborns, whereas at 3 months of corrected age, the body composition parameters were similar between the groups. At the first time point, nuclear magnetic resonance analysis showed a urinary increase in choline/phosphocholine, betaine and glucose in preterm infants. At the second time point, the preterm group exhibited a urinary increase in choline/phosphocholine and a decrease in betaine. CONCLUSIONS The increased urinary excretion of choline, a betaine precursor, could reflect a potential altered metabolism in preterm infants.
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Affiliation(s)
- Daniela Morniroli
- a NICU, Department of Clinical Sciences and Community Health , Fondazione IRCCS Ca` Granda Ospedale Maggiore Policlinico, Universita` degli Studi di Milano , Milano , Italy
| | - Angelica Dessì
- b Neonatal Intensive Care Unit, Puericulture Institute and Neonatal Section, Azienda Ospedaliera Universitaria, University of Cagliari , Cagliari , Italy
| | - Maria Lorella Giannì
- a NICU, Department of Clinical Sciences and Community Health , Fondazione IRCCS Ca` Granda Ospedale Maggiore Policlinico, Universita` degli Studi di Milano , Milano , Italy
| | - Paola Roggero
- a NICU, Department of Clinical Sciences and Community Health , Fondazione IRCCS Ca` Granda Ospedale Maggiore Policlinico, Universita` degli Studi di Milano , Milano , Italy
| | - Antonio Noto
- b Neonatal Intensive Care Unit, Puericulture Institute and Neonatal Section, Azienda Ospedaliera Universitaria, University of Cagliari , Cagliari , Italy
| | - Luigi Atzori
- c Department of Biomedical Sciences , University of Cagliari , Cagliari , Italy
| | - Milena Lussu
- c Department of Biomedical Sciences , University of Cagliari , Cagliari , Italy
| | - Vassilios Fanos
- b Neonatal Intensive Care Unit, Puericulture Institute and Neonatal Section, Azienda Ospedaliera Universitaria, University of Cagliari , Cagliari , Italy
| | - Fabio Mosca
- a NICU, Department of Clinical Sciences and Community Health , Fondazione IRCCS Ca` Granda Ospedale Maggiore Policlinico, Universita` degli Studi di Milano , Milano , Italy
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8
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Biasini A, Monti F, Laguardia MC, Stella M, Marvulli L, Neri E. High protein intake in human/maternal milk fortification for ≤1250 gr infants: intrahospital growth and neurodevelopmental outcome at two years. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 88:470-476. [PMID: 29350662 PMCID: PMC6166167 DOI: 10.23750/abm.v88i4.5316] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 05/24/2016] [Accepted: 05/24/2016] [Indexed: 01/12/2023]
Abstract
Background and aim of the study: Extrauterine growth restriction and failure to thrive remain a major problem in Extremely Low Birth Weight infants. Nutritional support in preterm babies has the objective to improve the achieve rate of growth similar to those of the fetus in utero at the equivalent gestational age. The aim of the study was to evaluate feeding tolerance, intrahospital growth, neurological outcome and anthropometric data until 24 months of corrected age (mca) from different protein intake assumed by preterm babies <1250 g during their stay in NICU. Methods: The study evaluates auxological/neurodevelopmental outcomes until 24 months of corrected age (mca) in preterm infants with different protein intake (control group-CG: 3,5g Kg–1 perday; intervention group-PSG: 4,8g Kg–1 per day). Results: PSG group showed a significant higher length growth at 9 mca (p 0,04) and hearing/language score of Griffiths Mental Development Score (GMDS) at 12 (p 0,03) and 18 mca (p<0,05) comparing with CG. PSG-ELBW preterms showed an higher intrahospital head circumference (p 0,02) and length growth rate (p 0,04), greater Performance (p 0,04) and Hearing/Language (p 0,03) scores of GMDS at 3 and 12 mca. PSG-SGA preterms showed significantly higher scores in GMDS scores at 18 and 24 mca except for the locomotor domain. Conclusions: Supplemental enteral proteins lead to benefits of reduced postnatal growth restriction and better neurological outcome in preterm infants <1000 g and in those SGA <1250 g. (www.actabiomedica.it)
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Affiliation(s)
- Augusto Biasini
- Pediatric and Neonatal Intensive Care Unit; Bufalini Hospital Cesena.
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9
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Ruys CA, van de Lagemaat M, Finken MJ, Lafeber HN. Follow-up of a randomized trial on postdischarge nutrition in preterm-born children at age 8 y. Am J Clin Nutr 2017; 106:549-558. [PMID: 28637773 DOI: 10.3945/ajcn.116.145375] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 05/18/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Early nutritional interventions may modulate health risks in preterm-born infants. Previously, we showed that preterm-born infants fed an isocaloric protein- and mineral-enriched postdischarge formula (PDF) from term age to 6-mo corrected age (CA) gained more lean mass than did those fed term formula (TF). Long-term follow-up of randomized nutritional trials is important to test the hypothesis that short-term positive effects on health are sustainable.Objective: The aim of this follow-up study was to compare body size, body composition, and metabolic health at age 8 y in preterm-born children who were randomly assigned to receive either PDF or TF from term age until 6-mo CA.Design: A total of 79 of 152 children (52%) from the original randomized controlled trial were enrolled for follow-up at age 8 y. Weight, height, and head circumference were measured by using standard methods. Body composition, including fat mass, lean mass, bone mineral content, and bone mineral density, was determined by dual-energy X-ray absorptiometry. Blood pressure was measured in the supine position by using an automatic device. Metabolic variables, including glucose, insulin, insulin-like growth factor I, triglycerides, cholesterol, cortisol, and leptin, were measured after an overnight fast. Nutritional habits at age 8 y were assessed by using a 3-d nutritional diary.Results: At age 8 y, no differences were found in body size, body composition, bone variables, and metabolic health variables when comparing children fed PDF with those fed TF. Adjustment for known and possible confounders did not change these results.Conclusions: In this follow-up study in preterm-born children, we showed that the favorable effects of PDF at 6-mo CA either were not maintained or could not be confirmed because of attrition at the age of 8 y. We suggest that future research should focus on nutritional interventions in the pre- and postdischarge period as a continuum rather than as separate entities. This trial was registered at www.trialregister.nl as NTR 2972 (follow-up study [STEP-2 (Study Towards the Effects of Post-discharge Nutrition 2)]) and NTR 55 [original randomized controlled trial (STEP)].
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Affiliation(s)
| | | | - Martijn Jj Finken
- Pediatric Endocrinology, VU University Medical Center, Amsterdam, Netherlands
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10
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Impact of homogenization of pasteurized human milk on gastric digestion in the preterm infant: A randomized controlled trial. Clin Nutr ESPEN 2017; 20:1-11. [DOI: 10.1016/j.clnesp.2017.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 05/01/2017] [Indexed: 12/14/2022]
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11
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Demerath EW, Johnson W, Davern BA, Anderson CG, Shenberger JS, Misra S, Ramel SE. New body composition reference charts for preterm infants. Am J Clin Nutr 2017; 105:70-77. [PMID: 27806978 DOI: 10.3945/ajcn.116.138248] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 09/27/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The American Academy of Pediatrics (AAP) has recommended that nutritional management of the preterm infant should aim to achieve body composition that replicates the in utero fetus, but intrauterine body composition reference charts for preterm infants are lacking. OBJECTIVE Our objective was to create body composition reference curves for preterm infants that approximate the body composition of the in utero fetus from 30 to 36 wk of gestation. DESIGN A total of 223 ethnically diverse infants born at 30 + 0 to 36 + 6 wk of gestation were enrolled. Inclusion and exclusion criteria were specified so that the sample would represent healthy appropriately growing fetuses (e.g., singleton, birth weight appropriate for their gestational age, and medically stable). Cross-sectional reference values were generated for fat mass (FM), fat-free mass (FFM), and percentage body fat (PBF) by gestational age (GA), with the use of air-displacement plethysmography (ADP) and the lambda-mu-sigma method for percentile estimation. RESULTS GA-specific percentile values and a percentile and z score calculator for FFM, FM, and PBF are presented. These values aligned closely with ADP centile values published for term infants from 36 to 38 wk of gestation. The medians were also similar to the mean values for the reference fetus derived from chemical analysis previously. CONCLUSIONS To our knowledge, these are the first body composition reference charts for total FM and FFM at birth in preterm infants to assist in following AAP guidelines. Future work will test the clinical utility of body composition monitoring for improving nutritional management in this population. This trial was registered at clinicaltrials.gov as NCT02855814.
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Affiliation(s)
- Ellen W Demerath
- Division of Epidemiology and Community Health, School of Public Health, and
| | - William Johnson
- Medical Research Council Human Nutrition Research, Cambridge, United Kingdom
| | - Bridget A Davern
- Division of Neonatology, School of Medicine, University of Minnesota, Minneapolis, MN
| | | | | | - Sonya Misra
- Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA; and
| | - Sara E Ramel
- Division of Neonatology, School of Medicine, University of Minnesota, Minneapolis, MN
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12
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Blakstad EW, Moltu SJ, Nakstad B, Veierød MB, Strømmen K, Júlíusson PB, Almaas AN, Rønnestad AE, Brække K, Drevon CA, Iversen PO. Enhanced nutrition improves growth and increases blood adiponectin concentrations in very low birth weight infants. Food Nutr Res 2016; 60:33171. [PMID: 27914187 PMCID: PMC5136127 DOI: 10.3402/fnr.v60.33171] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 10/12/2016] [Accepted: 11/04/2016] [Indexed: 12/27/2022] Open
Abstract
Background Adequate nutrient supply is essential for optimal postnatal growth in very low birth weight (VLBW, birth weight<1,500 g) infants. Early growth may influence the risk of metabolic syndrome later in life. Objective To evaluate growth and blood metabolic markers (adiponectin, leptin, and insulin-like growth factor-1 (IGF-1)) in VLBW infants participating in a randomized nutritional intervention study. Design Fifty VLBW infants were randomized to an enhanced nutrient supply or a standard nutrient supply. Thirty-seven infants were evaluated with growth measurements until 2 years corrected age (CA). Metabolic markers were measured at birth and 5 months CA. Results Weight gain and head growth were different in the two groups from birth to 2 years CA (weight gain: pinteraction=0.006; head growth: pinteraction=0.002). The intervention group improved their growth z-scores after birth, whereas the control group had a pronounced decline, followed by an increase and caught up with the intervention group after discharge. At 5 months CA, adiponectin concentrations were higher in the intervention group and correlated with weight gain before term (r=0.35) and nutrient supply (0.35≤r≤0.45). Leptin concentrations correlated with weight gain after term and IGF-1 concentrations with length growth before and after term and head growth after term (0.36≤r≤0.53). Conclusion Enhanced nutrient supply improved early postnatal growth and may have prevented rapid catch-up growth later in infancy. Adiponectin concentration at 5 months CA was higher in the intervention group and correlated positively with early weight gain and nutrient supply. Early nutrition and growth may affect metabolic markers in infancy. Clinical Trial Registration (ClinicalTrials.gov) no.: NCT01103219
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Affiliation(s)
- Elin W Blakstad
- Department of Pediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway.,Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway;
| | - Sissel J Moltu
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Neonatal Intensive Care, Women and Children's Division, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Britt Nakstad
- Department of Pediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway
| | - Marit B Veierød
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway.,Oslo Centre of Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kenneth Strømmen
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Neonatal Intensive Care, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Pétur B Júlíusson
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Astrid N Almaas
- Department of Pediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway.,Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Arild E Rønnestad
- Department of Neonatal Intensive Care, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Kristin Brække
- Department of Neonatal Intensive Care, Women and Children's Division, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Christian A Drevon
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Per O Iversen
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
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Hay WW, Ziegler EE. Growth failure among preterm infants due to insufficient protein is not innocuous and must be prevented. J Perinatol 2016; 36:500-2. [PMID: 27339826 DOI: 10.1038/jp.2016.85] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- W W Hay
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - E E Ziegler
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
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14
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Justice L, Ellis M, St George-Hyslop C, Donnellan A, Trauth A, Drouillard B, Watt C, Callow L. Utilizing the PCICS Nursing Guidelines in Managing the CICU Patient. World J Pediatr Congenit Heart Surg 2016; 6:604-15. [PMID: 26467875 DOI: 10.1177/2150135115593131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The Pediatric Cardiac Intensive Care Society (PCICS) Nursing Guidelines were developed to provide an evidence-based resource for bedside cardiac intensive care unit nursing care. Guideline topics include postoperative care, hemodynamic monitoring, arrhythmia management, and nutrition. These evidence-based care guidelines were presented at the 10th International Meeting of PCICS and have been utilized in the preparation of this article. They can be accessed at http://www.pcics.org/resources/pediatric-neonatal/. Utilization of these guidelines in practice is illustrated for single ventricle stage 1 palliation, Fontan operation, truncus arteriosus, and atrioventricular septal defect.
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Affiliation(s)
- Lindsey Justice
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Misty Ellis
- Department of Pediatric Critical Care, University of Louisville, Kosair Children's Hospital, Louisville, KY, USA
| | - Cecilia St George-Hyslop
- Department of Cardiac Critical Care. Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Amy Donnellan
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Amiee Trauth
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Brenda Drouillard
- Department of Cardiac Critical Care. Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Claire Watt
- Department of Cardiac Critical Care. Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Louise Callow
- Michigan Congenital Heart Center, University of Michigan, CS Mott Children's Hospital, Ann Arbor, MI, USA
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15
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Smith CJ, Ryckman KK, Barnabei VM, Howard BV, Isasi CR, Sarto GE, Tom SE, Van Horn LV, Wallace RB, Robinson JG. The impact of birth weight on cardiovascular disease risk in the Women's Health Initiative. Nutr Metab Cardiovasc Dis 2016; 26:239-45. [PMID: 26708645 PMCID: PMC4788544 DOI: 10.1016/j.numecd.2015.10.015] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 10/14/2015] [Accepted: 10/29/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Cardiovascular disease (CVD) is among the leading causes of morbidity and mortality worldwide. Traditional risk factors predict 75-80% of an individual's risk of incident CVD. However, the role of early life experiences in future disease risk is gaining attention. The Barker hypothesis proposes fetal origins of adult disease, with consistent evidence demonstrating the deleterious consequences of birth weight outside the normal range. In this study, we investigate the role of birth weight in CVD risk prediction. METHODS AND RESULTS The Women's Health Initiative (WHI) represents a large national cohort of post-menopausal women with 63,815 participants included in this analysis. Univariable proportional hazards regression analyses evaluated the association of 4 self-reported birth weight categories against 3 CVD outcome definitions, which included indicators of coronary heart disease, ischemic stroke, coronary revascularization, carotid artery disease and peripheral arterial disease. The role of birth weight was also evaluated for prediction of CVD events in the presence of traditional risk factors using 3 existing CVD risk prediction equations: one body mass index (BMI)-based and two laboratory-based models. Low birth weight (LBW) (<6 lbs.) was significantly associated with all CVD outcome definitions in univariable analyses (HR = 1.086, p = 0.009). LBW was a significant covariate in the BMI-based model (HR = 1.128, p < 0.0001) but not in the lipid-based models. CONCLUSION LBW (<6 lbs.) is independently associated with CVD outcomes in the WHI cohort. This finding supports the role of the prenatal and postnatal environment in contributing to the development of adult chronic disease.
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Affiliation(s)
- C J Smith
- University of Iowa Department of Epidemiology, College of Public Health, 145 N. Riverside Drive, Iowa City, IA, 52242, USA
| | - K K Ryckman
- University of Iowa Department of Epidemiology, College of Public Health, 145 N. Riverside Drive, Iowa City, IA, 52242, USA
| | - V M Barnabei
- University at Buffalo, Department of Obstetrics and Gynecology, 219 Bryant Street, Buffalo, NY, 14221, USA
| | - B V Howard
- Medstar Health Research Institute, Hyattsville, MD, USA; Georgetown/Howard Universities Center for Clinical and Translational Research, USA
| | - C R Isasi
- Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, NY, USA
| | - G E Sarto
- University of Wisconsin, Department of Obstetrics and Gynecology, Madison, WI, USA
| | - S E Tom
- University of Maryland, School of Pharmacy, Baltimore, MD, USA
| | - L V Van Horn
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - R B Wallace
- University of Iowa Department of Epidemiology, College of Public Health, 145 N. Riverside Drive, Iowa City, IA, 52242, USA
| | - J G Robinson
- University of Iowa Department of Epidemiology, College of Public Health, 145 N. Riverside Drive, Iowa City, IA, 52242, USA.
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16
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Williams TC, Drake AJ. What a general paediatrician needs to know about early life programming. Arch Dis Child 2015; 100:1058-63. [PMID: 25990501 DOI: 10.1136/archdischild-2014-307958] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 04/28/2015] [Indexed: 01/13/2023]
Abstract
The process whereby early exposure to an adverse environment has an influence on later life outcomes has been called 'early life programming'. While epidemiological evidence for this has been available for decades, only in recent years have the mechanisms, in particular epigenetic modifications, for this process begun to be elucidated. We discuss the evidence for early life programming, the possible mechanisms, how effects may be transmitted across generations, and conclude by looking at some examples relevant to general paediatrics.
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Affiliation(s)
- Thomas C Williams
- Neonatal Unit, Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Amanda J Drake
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, The Queen's Medical Research Institute, Edinburgh, UK
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17
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Abstract
Preterm hyperglycaemia in the first 2 weeks of life is common under 29 weeks gestation and is associated with increased mortality and morbidity. While the definition of hyperglycaemia is reasonably consistent (>8 mmol/L) the treatment threshold varies widely in clinical practice. Insulin therapy is the most common approach despite international guidance urging caution because of hypoglycaemia. Significant hypoglycaemia is unusual outside studies targeting normoglycaemia. Insulin treatment also forms part of a nutritional strategy aiming to optimise early protein and energy intake so minimising the risk of preterm postnatal growth failure. Early parenteral amino acids also improve blood glucose control. There is some evidence of improved postnatal head growth with this approach but longer term neurodevelopmental studies are required. Glucose reduction is the alternative approach. This compromises early nutritional intake but avoids the potential for long-term cardiovascular and metabolic complications linked with high postnatal nutritional intakes and theoretically, insulin treatment.
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Affiliation(s)
- Colin Morgan
- Department of Neonatology, Liverpool Women's Hospital, Crown Street, Liverpool L8 7SS, UK.
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18
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Sammallahti S, Lahti M, Pyhälä R, Lahti J, Pesonen AK, Heinonen K, Hovi P, Eriksson JG, Strang-Karlsson S, Järvenpää AL, Andersson S, Kajantie E, Räikkönen K. Infant Growth after Preterm Birth and Mental Health in Young Adulthood. PLoS One 2015; 10:e0137092. [PMID: 26327229 PMCID: PMC4556664 DOI: 10.1371/journal.pone.0137092] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 08/13/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Faster growth after preterm birth benefits long-term cognitive functioning. Whether these benefits extend to mental health remains largely unknown. We examined if faster growth in infancy is associated with better self-reported mental health in young adults born preterm at very low birth weight (VLBW) (< 1500 g). STUDY DESIGN As young adults, participants of the Helsinki Study of Very Low Birth Weight Adults self-reported symptoms of depression and attention deficit/hyperactivity disorder (ADHD) (n = 157) and other psychiatric problems (n = 104). As main predictors of mental health outcomes in linear regression models, we used infant weight, length, and head circumference at birth, term, and 12 months of corrected age, and growth between these time points. Growth data were collected from records and measures at term and at 12 months of corrected age were interpolated. Additionally, we examined the moderating effects of intrauterine growth restriction. RESULTS Size at birth, term, or 12 months of corrected age, or growth between these time points were not associated with mental health outcomes (p-values >0.05). Intrauterine growth restriction did not systematically moderate any associations. CONCLUSIONS Despite the high variability in early growth of VLBW infants, the previously described association between slow growth in infancy and poorer cognitive functioning in later life is not reflected in symptoms of depression, ADHD, and other psychiatric problems. This suggests that the development of cognitive and psychiatric problems may have dissimilar critical periods in VLBW infants.
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Affiliation(s)
- Sara Sammallahti
- Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland
- National Institute for Health and Welfare, Helsinki, Finland
- Children’s Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
- * E-mail:
| | - Marius Lahti
- Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland
| | - Riikka Pyhälä
- Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland
| | - Jari Lahti
- Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland
- Folkhälsan Research Centre, Helsinki, Finland
| | | | - Kati Heinonen
- Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland
| | - Petteri Hovi
- National Institute for Health and Welfare, Helsinki, Finland
- Children’s Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Johan G. Eriksson
- National Institute for Health and Welfare, Helsinki, Finland
- Folkhälsan Research Centre, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
- Vasa Central Hospital, Vasa, Finland
- Unit of General Practice, Helsinki University Central Hospital, Helsinki, Finland
| | - Sonja Strang-Karlsson
- National Institute for Health and Welfare, Helsinki, Finland
- Children’s Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Anna-Liisa Järvenpää
- Children’s Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Sture Andersson
- Children’s Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Eero Kajantie
- National Institute for Health and Welfare, Helsinki, Finland
- Children’s Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
- Department of Obstetrics and Gynaecology, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Katri Räikkönen
- Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland
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19
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Abstract
PURPOSE OF REVIEW To outline new evidence published from 2013 to 2014 about breast milk fortification in preterm infants. RECENT FINDINGS Breast milk is the feeding choice for preterm infants because of its immunoprotective properties. However, breast milk's nutrient content is not sufficient for preterm infants, and interindividual variation is high. The variation challenges standard fortification, which assumes a standard breast milk composition. Two new fortification strategies (adjustable fortification and target fortification) optimize macronutrient intake and improve growth. Adjustable fortification uses blood urea nitrogen levels to adjust fortifier strength. Target fortification analyzes breast milk and fortifies macronutrients individually to achieve targeted intake. Its feasibility is shown in clinical routine. Current breast milk analyzers used for target fortification achieve acceptable precision for protein and fat but not for lactose and energy. Evidence of benefits for postdischarge breast milk fortification is lacking. Eliminating cow's milk products and feeding exclusively breast milk may decrease the occurrence of feeding intolerance and necrotizing enterocolitis. To facilitate exclusively breast milk diets, a collaboration of prenatal, nutrition and lactation stakeholders is key. Fortification increases osmolality; however, safety cutoffs to prevent necrotizing enterocolitis are unclear. There is also new evidence that composition and structure of various macronutrients and micronutrients affect growth and development, and might play a role in future fortification concepts. SUMMARY Recent research focuses on the variability of breast milk composition, its impact on postnatal growth patterns and the usefulness of target fortification. As well, diets exclusively composed of human milk are a promising approach to improve feeding tolerance. For safe fortification, osmolality cutoff levels are needed.
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Affiliation(s)
- Niels Rochow
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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20
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Buchholz BM, Rüland A, Kiefer N, Poetzsch B, von Websky M, Kalff JC, Merz WM. Conception, Pregnancy, and Lactation Despite Chronic Intestinal Failure Requiring Home Parenteral Nutrition. Nutr Clin Pract 2015; 30:807-14. [DOI: 10.1177/0884533615574003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Anna Rüland
- Department of Obstetrics and Prenatal Medicine, University Bonn Medical School, Bonn, Germany
| | - Nicholas Kiefer
- Department of Anesthesiology and Intensive Care Medicine, University Bonn Medical School, Bonn, Germany
| | - Bernd Poetzsch
- Institute of Experimental Hematology and Transfusion Medicine, University Bonn Medical School, Bonn, Germany
| | - Martin von Websky
- Department of Surgery, University Bonn Medical School, Bonn, Germany
| | - Jörg C. Kalff
- Department of Surgery, University Bonn Medical School, Bonn, Germany
| | - Waltraut M. Merz
- Department of Obstetrics and Prenatal Medicine, University Bonn Medical School, Bonn, Germany
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21
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Roggero P, Giannì ML, Forzenigo L, Tondolo T, Taroni F, Liotto N, Piemontese P, Biondetti P, Mosca F. No relative increase in intra-abdominal adipose tissue in healthy unstressed preterm infants at term. Neonatology 2015; 107:14-9. [PMID: 25301293 DOI: 10.1159/000364855] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 05/26/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Preterm infants may be at risk for altered adiposity, a known risk factor for unfavorable metabolic and cardiovascular outcomes. OBJECTIVES The aim was to compare body composition (total body fat mass (FM), subcutaneous and intra-abdominal adipose tissue (AT)) between infants born preterm and at term. METHODS We conducted an observational, cross-sectional study that involved 50 infants born preterm free from major co-morbidities and 34 term healthy breastfed infants. Anthropometric measurements, body composition (total body FM, subcutaneous and intra-abdominal AT) were assessed at 40-42 weeks postconceptional age for preterm infants and within 15 days of birth for term infants. Total body FM was assessed by an air displacement plethysmography system and subcutaneous abdominal and intra-abdominal AT were assessed by magnetic resonance imaging using a commercially available software program. RESULTS Compared to term infants, mean (SD) total body FM (g) (636.7 (247) vs. 418.4 (253), p < 0.0001) and mean (SD) subcutaneous abdominal AT (g) (123 (36) vs. 98.9 (22), p < 0.001) were significantly higher in preterm infants but mean (SD) fat-free mass (g) (2,530 (420) vs. 2,965 (389), p < 0.0001) and mean (SD) intra-abdominal AT (10.9 (5.2) vs. 18.2 (13.2), p = 0.001) were significantly lower. CONCLUSIONS In the absence of severe illness during the hospital stay, prematurity, although associated with increased total body FM, does not appear to be associated with a relative increase in intra-abdominal AT compared to term infants.
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Affiliation(s)
- Paola Roggero
- Neonatal Intensive Care Unit, Department of Clinical Science and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
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22
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Dietary proteins and IGF I levels in preterm infants: determinants of growth, body composition, and neurodevelopment. Pediatr Res 2015; 77:156-63. [PMID: 25335084 DOI: 10.1038/pr.2014.172] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 10/08/2014] [Indexed: 01/28/2023]
Abstract
It has been demonstrated that a high-protein diet in preterm born infants during the first weeks of life may enable a growth rate equal to that seen in utero and may also result in a better long-term neurodevelopmental outcome. This diet may limit immediate postnatal growth retardation and may hence lower the risk of increased fat deposition after birth leading to the metabolic syndrome in later life. Insulin-like growth factor I (IGF I) has proven to play an important role in early postnatal growth of preterm infants, but also seems to have a persisting influence on body composition in childhood. Furthermore, increased IGF I concentrations in preterm infants have been associated with improved neurodevelopmental outcome. This review will elaborate on the role of dietary proteins and IGF I on growth, body composition, and neurodevelopment of preterm infants. Possible causal pathways will be explored and areas for future research will be proposed.
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23
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Elitt CM, Rosenberg PA. The challenge of understanding cerebral white matter injury in the premature infant. Neuroscience 2014; 276:216-38. [PMID: 24838063 DOI: 10.1016/j.neuroscience.2014.04.038] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 04/15/2014] [Accepted: 04/15/2014] [Indexed: 12/18/2022]
Abstract
White matter injury in the premature infant leads to motor and more commonly behavioral and cognitive problems that are a tremendous burden to society. While there has been much progress in understanding unique vulnerabilities of developing oligodendrocytes over the past 30years, there remain no proven therapies for the premature infant beyond supportive care. The lack of translational progress may be partially explained by the challenge of developing relevant animal models when the etiology remains unclear, as is the case in this disorder. There has been an emphasis on hypoxia-ischemia and infection/inflammation as upstream etiologies, but less consideration of other contributory factors. This review highlights the evolution of white matter pathology in the premature infant, discusses the prevailing proposed etiologies, critically analyzes a sampling of common animal models and provides detailed support for our hypothesis that nutritional and hormonal deprivation may be additional factors playing critical and overlooked roles in white matter pathology in the premature infant.
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Affiliation(s)
- C M Elitt
- Department of Neurology and the F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA 02115, USA; Program in Neuroscience, Harvard Medical School, Boston, MA 02115, USA
| | - P A Rosenberg
- Department of Neurology and the F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA 02115, USA; Program in Neuroscience, Harvard Medical School, Boston, MA 02115, USA.
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24
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Giannì ML, Roggero P, Amato O, Picciolini O, Piemontese P, Liotto N, Taroni F, Mosca F. Randomized outcome trial of nutrient-enriched formula and neurodevelopment outcome in preterm infants. BMC Pediatr 2014; 14:74. [PMID: 24645671 PMCID: PMC3994650 DOI: 10.1186/1471-2431-14-74] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 03/11/2014] [Indexed: 11/10/2022] Open
Abstract
Background Preterm infants are at risk for adverse neurodevelopment. Furthermore, nutrition may play a key role in supporting neurodevelopment. The aim of this study was to evaluate whether a nutrient-enriched formula fed to preterm infants after hospital discharge could improve their neurodevelopment at 24 months (term-corrected age). Methods We conducted an observer-blinded, single-center, randomized controlled trial in infants admitted to the Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Italy between 2009 and 2011. Inclusion criteria were gestational age < 32 weeks and/or birth weight < 1500 g, and being fed human milk for < 20% of the total milk intake. Exclusion criteria were congenital malformations or conditions that could interfere with growth or body composition. Included infants were randomized to receive a standard full-term formula or a nutrient-enriched formula up until 6 months of corrected age, using two computer-generated randomization lists; one appropriate for gestational age (AGA) and one for small for gestational age (SGA) infants. We assessed neurodevelopment at 24 months of corrected age using the Griffiths Mental Development Scale and related subscales (locomotor, personal-social, hearing and speech, hand and eye coordination, and performance). Results Of the 207 randomized infants, 181 completed the study. 52 AGA and 35 SGA infants were fed a nutrient-enriched formula, whereas 56 AGA and 38 SGA infants were fed a standard full-term formula. The general quotient at 24 months of corrected age was not significantly different between infants randomized to receive a nutrient-enriched formula compared with a standard term formula up until 6 months of corrected age (AGA infants: 93.8 ± 12.6 vs. 92.4 ± 10.4, respectively; SGA infants: 96.1 ± 9.9 vs. 98.2 ± 9, respectively). The scores of related subscales were also similar among groups. Conclusions This study found that feeding preterm infants a nutrient-enriched formula after discharge does not affect neurodevelopment at 24 months of corrected age, in either AGA or SGA infants, free from major comorbidities. Trial registration Current Controlled Trials (http://www.controlled-trials.com/ISRCTN30189842) London, UK.
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Affiliation(s)
- Maria Lorella Giannì
- NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Commenda 12, 20122 Milano, Italy.
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25
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van Goudoever JB, Boehm G. Introduction: bringing science to early life nutrition. Am J Clin Nutr 2013; 98:519S-20S. [PMID: 23824721 DOI: 10.3945/ajcn.112.044164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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