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Abdo CVBP, Belém CGMS, Colosimo EA, Viana MCFB, Silva IN. Association of preterm birth with poor metabolic outcomes in schoolchildren. J Pediatr (Rio J) 2023; 99:464-470. [PMID: 37059119 PMCID: PMC10492147 DOI: 10.1016/j.jped.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 04/16/2023] Open
Abstract
OBJECTIVE To investigate, at school age, the metabolic profile of children born preterm. METHODS A cross-sectional study of children 5 to 8 years old, born with gestational age (GA) < 34 weeks and/or weight ≤ 1,500 grams. Clinical and anthropometric data were assessed by a single trained pediatrician. Biochemical measurements were done at the organization's Central Laboratory using standard methods. Data on health conditions, eating, and daily life habits were retrieved from medical charts and through validated questionnaires. Binary logistic and linear regression models were built to identify the association between variables, weight excess, and GA. RESULTS Out of 60 children (53.3% female), 6.8 ± 0.7 years old, 16.6% presented excess weight, 13.3% showed increased insulin resistance markers and 36.7% had abnormal blood pressure values. Those presenting excess weight had higher waist circumferences and higher HOMA-IR than normal-weight children (OR = 1.64; CI = 1.035-2.949). Eating and daily life habits were not different among overweight and normal-weight children. The small-for-gestational-age (SGA) and appropriate-for-gestational-age (AGA, 83.3%) birth weight children did not differ regarding clinical (body weight, blood pressure) or biochemical variables (serum lipids, blood glucose, HOMA-IR). CONCLUSION Schoolchildren born preterm, regardless of being AGA or SGA, were overweight, and presented increased abdominal adiposity, reduced insulin sensitivity, and altered lipid profile, justifying longitudinal follow-up regarding adverse metabolic outcomes in the future.
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Affiliation(s)
- Cristiane Valéria Batista Pereira Abdo
- Endocrinologia Pediátrica, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Medicina (Saúde da Criança e do Adolescente), Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Enrico Antonio Colosimo
- Departamento de Estatística, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Ivani Novato Silva
- Departamento de Pediatria, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
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Abstract
For the preterm infant with respiratory insufficiency requiring supplemental oxygen, tight control of oxygen saturation (SpO2) is advocated, but difficult to achieve in practice. Automated control of oxygen delivery has emerged as a potential solution, with six control algorithms currently embedded in commercially-available respiratory support devices. To date, most clinical evaluations of these algorithms have been short-lived crossover studies, in which a benefit of automated over manual control of oxygen titration has been uniformly noted, along with a reduction in severe SpO2 deviations and need for manual FiO2 adjustments. A single non-randomised study has examined the effect of implementation of automated oxygen control with the CLiO2 algorithm as standard care for preterm infants; no clear benefits in relation to clinical outcomes were noted, although duration of mechanical ventilation was lessened. The results of randomised controlled trials are awaited. Beyond the gathering of evidence regarding a treatment effect, we contend that there is a need for a better understanding of the function of contemporary control algorithms under a range of clinical conditions, further exploration of techniques of adaptation to individualise algorithm performance, and a concerted effort to apply this technology in low resource settings in which the majority of preterm infants receive care. Attainment of these goals will be paramount in optimisation of oxygen therapy for preterm infants globally.
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Affiliation(s)
- Peter A Dargaville
- Department of Paediatrics, Royal Hobart Hospital, Hobart, Australia; Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
| | - Andrew P Marshall
- School of Engineering, University of Tasmania, Hobart, Tasmania, Australia
| | - Lachlann McLeod
- School of Engineering, University of Tasmania, Hobart, Tasmania, Australia
| | - Hylke H Salverda
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Arjan B Te Pas
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Timothy J Gale
- School of Engineering, University of Tasmania, Hobart, Tasmania, Australia
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Abstract
Fortification refers to the practice of enriching human milk feeds for very preterm babies with macronutrients, minerals and vitamins. Though standard of care in some parts of the world, adoption of fortification is not universal. Fortification entered into use on the assumption that human milk macronutrient content, principally protein, is insufficient to support the growth and development of very preterm babies. However, because of the substantial variability in human milk composition, routine fortification risks exposing some babies to very high protein intakes, which may be dangerous. Some clinicians fear fortification with cow-milk derived products will increase the risk of necrotising enterocolitis, leading them to favour commercial fortifiers made from pooled human milk over cow milk based products, a practice that has additional ethical implications. Randomised controlled trials of multi-nutrient fortification to-date are inadequate. No trial has had power to detect important functional effects; the majority are methodologically weak and focus primarily upon short-term growth. Evidence to guide practice is inadequate. There is an urgent need for collaboration to conduct high-quality research to end these long-standing uncertainties.
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Affiliation(s)
- Neena Modi
- Imperial College London, Chelsea and Westminster Hospital campus, 369 Fulham Road, London, SW10 9NH, UK.
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Raban S, Santhakumaran S, Keraan Q, Joolay Y, Uthaya S, Horn A, Modi N, Harrison M. A randomised controlled trial of high vs low volume initiation and rapid vs slow advancement of milk feeds in infants with birthweights ≤ 1000 g in a resource-limited setting. Paediatr Int Child Health 2016; 36:288-295. [PMID: 26369284 DOI: 10.1179/2046905515y.0000000056] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Optimal feeding regimens for infants ≤ 1000 g have not been established and are a global healthcare concern. AIMS AND OBJECTIVES A controlled trial to establish the safety and efficacy of high vs low volume initiation and rapid vs slow advancement of milk feeds in a resource-limited setting was undertaken. METHODS Infants ≤ 1000 g birthweight were randomised to one of four arms, either low (4 ml/kg/day) or high (24 ml/kg/day) initiation and either slow (24 ml/kg/day) or rapid (36 ml/kg/day) advancement of exclusive feeds of human milk (mother's or donor) until a weight of 1200 g was reached. After this point, formula was used to supplement insufficient mother's milk. The primary outcome was time to reach 1500 g. RESULTS infants were recruited (51: low/slow; 47: low/rapid; 52: high/slow; 50: high/rapid). Infants on rapid advancement regimens reached 1500 g most rapidly (hazard ratio 1.48, 95% CI 1.05-2.09, P=0.03). The rapid advancement groups also regained birthweight more rapidly (hazard ratio 1.77, 95% CI 1.26-2.50, P=0.001). There was no apparent effect of high vs low initiation volumes but there was some evidence of interaction between interventions. There were no significant differences in other secondary outcomes, including necrotising enterocolitis, feed intolerance and late-onset sepsis. CONCLUSIONS In this small pilot study, higher initiation feed volumes and larger daily increments appeared to be well tolerated and resulted in more rapid early weight gain. These data provide justification for a larger study in resource-limited settings to address mortality, necrotising enterocolitis and other important outcomes.
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Affiliation(s)
- Shukri Raban
- a Division of Neonatal Medicine, Department of Paediatrics , University of Cape Town , South Africa
| | - Shalini Santhakumaran
- b Section of Neonatal Medicine, Department of Medicine , London School of Hygiene and Tropical Medicine , UK
| | - Quanitah Keraan
- a Division of Neonatal Medicine, Department of Paediatrics , University of Cape Town , South Africa
| | - Yaseen Joolay
- a Division of Neonatal Medicine, Department of Paediatrics , University of Cape Town , South Africa
| | - Sabita Uthaya
- c Section of Neonatal Medicine, Department of Medicine , Imperial College , London , UK
| | - Alan Horn
- a Division of Neonatal Medicine, Department of Paediatrics , University of Cape Town , South Africa
| | - Neena Modi
- c Section of Neonatal Medicine, Department of Medicine , Imperial College , London , UK
| | - Michael Harrison
- a Division of Neonatal Medicine, Department of Paediatrics , University of Cape Town , South Africa
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Mazmanyan P, Mellor K, Doré CJ, Modi N. A randomised controlled trial of flow driver and bubble continuous positive airway pressure in preterm infants in a resource-limited setting. Arch Dis Child Fetal Neonatal Ed 2016; 101:F16-20. [PMID: 26271753 DOI: 10.1136/archdischild-2015-308464] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 07/13/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The variable-flow flow driver (FD; EME) and continuous-flow bubble (Fisher-Paykel) continuous positive airway pressure (CPAP) systems are widely used. As these differ in cost and technical requirements, determining comparative efficacy is important particularly where resources are limited. DESIGN We performed a randomised, controlled, equivalence trial of CPAP systems. We specified the margin of equivalence as 2 days. We analysed binary variables by logistical regression adjusted for gestation, and log transformed continuous variables by multiple linear regression adjusted for gestation, sex and antenatal steroids. SETTING A neonatal unit with no blood gas analyser or surfactant availability and limited X-ray and laboratory facilities PATIENTS Neonates <37 weeks of gestation. INTERVENTIONS We provided CPAP at delivery followed by randomisation to FD or bubble (B). OUTCOMES Primary outcome included total days receiving CPAP; secondary outcomes included days receiving CPAP, supplemental oxygen, ventilation, death, pneumothorax and nasal excoriation. RESULTS We randomised 125 infants (B 66, FD 59). Differences in infant outcomes on B and FD were not statistically significant. The median (range) for CPAP days for survivors was B 0.8 (0.04 to 17.5), FD 0.5 (0.04 to 5.3). B:FD (95% CI) ratios were CPAP days 1.3 (0.9 to 2.1), CPAP plus supplementary oxygen days 1.2 (0.7 to 1.9). B:FD (95% CI) ORs were death 2.3 (0.2 to 28), ventilation 2.1 (0.5 to 9), nasal excoriation 1.2 (0.2 to 8) and pneumothorax 2.4 (0.2 to 26). CONCLUSIONS In a resource-limited setting we found B CPAP equivalent to FD CPAP in the total number of days receiving CPAP within a margin of 2 days. TRIAL REGISTRATION NUMBER ISRCTN22578364.
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Affiliation(s)
- P Mazmanyan
- Scientific Research Centre of Maternal and Child Health, Yerev, Armenia
| | | | - C J Doré
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - N Modi
- Department of Medicine, Section of Neonatal Medicine, Chelsea & Westminster Campus, Imperial College London, London, UK
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Ifflaender S, Rüdiger M, Konstantelos D, Lange U, Burkhardt W. Individual course of cranial symmetry and proportion in preterm infants up to 6 months of corrected age. Early Hum Dev 2014; 90:511-5. [PMID: 24751496 DOI: 10.1016/j.earlhumdev.2014.03.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 03/25/2014] [Accepted: 03/29/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION A significant proportion of preterm infants have dolichocephaly and/or deformational plagiocephaly (DP) at term equivalent age. However, quantitative data on the clinical course after discharge is limited in these infants. AIMS To quantify the individual course of cranial symmetry and proportion in infants born <32 gestational weeks up to six months of corrected age (CA) and to investigate, whether measurements at discharge predict subsequent cranial deformations. METHODS A total of 56 infants were examined at discharge, three and six months of CA. Cranial proportion and symmetry were quantified using a 3D laser scan method. Classification and prevalence data were obtained using age related reference values. Predictive value of DP at discharge regarding subsequent deformation was evaluated. RESULTS Cranial Vault Asymmetry Index was 3.9% at discharge, 4.5% at three months and 3.7% at six months of CA. Prevalence of DP was 34% at discharge, 46% at three months and 27% at six months. Cranial Index was 71.4% at discharge and constantly increased over the examination period. Prevalence of dolichocephaly was high at discharge (77%) and subsequently decreased. While severe DP at discharge was predictive for a persistent deformation (PPV 0.78), 46% of infants without DP at discharge developed DP by six months of CA. DISCUSSION Despite a high prevalence at discharge, the decreased prevalence of DP and dolichocephaly at six months of CA suggests an optimistic course. However, changes in head shape are hardly predictable for the individual infant. Thus, an accurate quantification should be part of neonatal follow-up programs.
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Affiliation(s)
- Sascha Ifflaender
- Department of Neonatology and Pediatric Intensive Care, Medizinische Fakultät Carl Gustav Carus an der TU Dresden, Germany
| | - Mario Rüdiger
- Department of Neonatology and Pediatric Intensive Care, Medizinische Fakultät Carl Gustav Carus an der TU Dresden, Germany.
| | - Dimitrios Konstantelos
- Department of Neonatology and Pediatric Intensive Care, Medizinische Fakultät Carl Gustav Carus an der TU Dresden, Germany
| | - Ulrike Lange
- Department of Neonatology and Pediatric Intensive Care, Medizinische Fakultät Carl Gustav Carus an der TU Dresden, Germany
| | - Wolfram Burkhardt
- Department of Neonatology and Pediatric Intensive Care, Medizinische Fakultät Carl Gustav Carus an der TU Dresden, Germany
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Ifflaender S, Rüdiger M, Konstantelos D, Wahls K, Burkhardt W. Prevalence of head deformities in preterm infants at term equivalent age. Early Hum Dev 2013; 89:1041-7. [PMID: 24016482 DOI: 10.1016/j.earlhumdev.2013.08.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 08/16/2013] [Accepted: 08/16/2013] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Due to a rising number of head deformities in healthy newborns, there has been an increasing interest in nonsynostotic head deformities in children over recent years. Although preterm infants are more likely to have anomalous head shapes than term newborns, there is limited data available on early prevalence of head deformities in preterm infants. AIMS The purposes of the present study were to acquire quantitative data on head shape of preterm infants at Term Equivalent Age (TEA), to determine the prevalence of symmetrical and asymmetrical head deformities and to identify possible risk factors. METHODS In a cross-sectional study design, Cranial Vault Asymmetry Index (CVAI) and Cranial Index (CI) calculated from routine head-scans with a non-invasive laser shape digitizer were recorded and categorized in type and severity of deformation for three different groups of gestational age. Perinatal and postnatal patient data was tested for possible associations. RESULTS Scans of 195 infants were included in the study. CVAI at TEA was higher in very preterm (4.1%) compared to term and late preterm infants. Prevalence of deformational plagiocephaly was 38% in very preterm infants. CI was lower in very (71.4%) and late (77.2%) preterm infants compared to term infants (80.0%). Compared to term babies (11%), a large number of very (73%) and late (28%) preterm infants exhibited dolichocephaly at TEA. DISCUSSION Prevalence of symmetrical and asymmetrical head deformities in preterm infants is high at TEA. Interventions are required to prevent head deformities in preterm infants during the initial hospital stay.
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Affiliation(s)
- Sascha Ifflaender
- Department of Neonatology and Pediatric Intensive Care, University Hospital Carl Gustav Carus, Dresden, Germany
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