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Ikeda N, Shepherd E, Makrides M, McPhee AJ, Gibson RA, Gould JF. The effects of parenteral fish oil on neurodevelopment in preterm infants: A narrative review. Prostaglandins Leukot Essent Fatty Acids 2024; 201:102620. [PMID: 38763084 DOI: 10.1016/j.plefa.2024.102620] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/09/2024] [Accepted: 05/09/2024] [Indexed: 05/21/2024]
Abstract
OBJECTIVE This narrative review aimed to summarize studies assessing the effects of parenteral fish oil on neurodevelopment in preterm infants. METHODS PubMed was searched (July 1985 to October 2023). We reviewed randomized controlled trials, and observational studies assessing intravenous lipid emulsion with fish oil in preterm infants (born less than 37 weeks' gestation), that reported long-term neurodevelopmental outcomes. RESULTS We identified four publications relating to three randomized controlled trials in addition to four cohort studies. Study designs and outcomes were heterogenous and precluded meta-analyses. Results of trials were null for a selection of neurodevelopmental outcomes, however possible benefits of parenteral fish oil supplementation for neurodevelopment was reported in three cohort studies. Certainty of the evidence is hindered by methodological limitations of available trials and observational studies. CONCLUSIONS Further research is required to firmly establish the effects of parenteral fish oil on preterm neurodevelopment.
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Affiliation(s)
- N Ikeda
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan.
| | - E Shepherd
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - M Makrides
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - A J McPhee
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Neonatal Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - R A Gibson
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - J F Gould
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia; School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
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Gould JF, Roberts RM, Anderson PJ, Makrides M, Sullivan TR, Gibson RA, McPhee AJ, Doyle LW, Bednarz JM, Best KP, Opie G, Travadi J, Cheong JLY, Davis PG, Sharp M, Simmer K, Tan K, Morris S, Lui K, Bolisetty S, Liley H, Stack J, Collins CT. High-Dose Docosahexaenoic Acid in Newborns Born at Less Than 29 Weeks' Gestation and Behavior at Age 5 Years: Follow-Up of a Randomized Clinical Trial. JAMA Pediatr 2024; 178:45-54. [PMID: 37983037 PMCID: PMC10660239 DOI: 10.1001/jamapediatrics.2023.4924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/14/2023] [Indexed: 11/21/2023]
Abstract
Importance Children born at less than 29 weeks' gestation are at risk of behavioral difficulties. This may be due in part to the lack of transplacental supply of docosahexaenoic acid (DHA), a key fatty acid with structural and functional roles in the brain. Objective To determine whether meeting the neonatal DHA requirement through supplementation is associated with improved behavioral functioning of children born at less than 29 weeks' gestation. Design, Setting and Participants This was a follow-up of children from 10 Australian participating centers in a multi-center, blinded, parallel group randomized clinical trial of infants born at less than 29 weeks' gestation conducted from June 2012 and September 2015, excluding those with additional fatty acid supplementation or major congenital or chromosomal abnormalities. Follow-up took place from August 2018 to May 2021. Parents of surviving children who had not withdrawn from the original trial were invited to complete questionnaires when the child turned 5 years' corrected age. Interventions Infants were randomized to receive daily enteral emulsions providing 60 mg/kg/d of DHA or a soy-oil emulsion (with no DHA) from within the first 3 days of enteral feeding until 36 weeks' postmenstrual age or discharge home, whichever occurred first. Main Outcomes and Measures The primary outcome of this follow-up was parent-rated behavior and emotional functioning as indicated by the Total Difficulties score of the Strengths and Difficulties Questionnaire. Parents also completed questionnaires about their child's behavioral manifestations of executive functioning, as well as a range of health outcomes to assess potential longer-term side effects of DHA intervention. Results Primary outcome data were available for 731 children (76% of 958 surviving eligible children; 361 in the intervention group and 370 in the control group). Of these 731, 452 (47%) were female, and the mean (SD) corrected age at follow-up was 5.4 (0.5) years. Following imputation for missing data, the mean Total Difficulties score was the same in both groups (intervention group, n = 465; mean [SD], 11.8 [6.3]; control group, n = 493; mean [SD], 11.8 [6.0]; mean difference adjusted for sex, gestational age stratum, and hospital, 0.01; 95% CI, -0.87 to 0.89; P = .98). There was no evidence for differences between the groups in any secondary outcomes of behavior, executive functioning, or health. Conclusions and Relevance In this follow-up of a randomized clinical trial, enteral DHA supplementation at the equivalent of the estimated in utero dose for infants born at less than 29 weeks' gestation did not improve behavioral functioning at age 5 years. There were no indications of adverse effects with DHA supplementation. Trial Registration Australian New Zealand Clinical Trial Registry: ACTRN12612000503820.
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Affiliation(s)
- Jacqueline F. Gould
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, North Adelaide, South Australia, Australia
- Discipline of Paediatrics, Faculty of Health and Medical Sciences, The University of Adelaide, North Terrace Adelaide, South Australia, Australia
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, North Terrace Adelaide, Adelaide, South Australia, Australia
| | - Rachel M. Roberts
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, North Terrace Adelaide, Adelaide, South Australia, Australia
| | - Peter J. Anderson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Maria Makrides
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, North Adelaide, South Australia, Australia
- Discipline of Paediatrics, Faculty of Health and Medical Sciences, The University of Adelaide, North Terrace Adelaide, South Australia, Australia
| | - Thomas R. Sullivan
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, North Adelaide, South Australia, Australia
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, North Terrace Adelaide, South Australia, Australia
| | - Robert A. Gibson
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, North Adelaide, South Australia, Australia
- School of Agriculture, Food and Wine, The University of Adelaide, Waite Campus, Glen Osmond, South Australia, Australia
| | - Andrew J. McPhee
- Neonatal Medicine, Women’s and Children’s Hospital, North Adelaide, South Australia, Australia
| | - Lex W. Doyle
- Department of Obstetrics and Gynaecology, The Royal Women’s Hospital, Parkville, Melbourne, Victoria, Australia
| | - Jana M. Bednarz
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, North Adelaide, South Australia, Australia
| | - Karen P. Best
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, North Adelaide, South Australia, Australia
- Discipline of Paediatrics, Faculty of Health and Medical Sciences, The University of Adelaide, North Terrace Adelaide, South Australia, Australia
| | - Gillian Opie
- Neonatal Services, Mercy Hospital for Women, Heidelberg, Melbourne, Victoria, Australia
| | - Javeed Travadi
- Newborn Services, John Hunter Children’s Hospital, New Lambton Heights, New South Wales, Australia
- Neonatal Intensive Care Unit, Department of Paediatrics, Te Whatu Ora Waikato, Waikato Hospital, Hamilton, New Zealand
| | - Jeanie L. Y. Cheong
- Neonatal Medicine, The Royal Women’s Hospital, Parkville, Melbourne, Victoria, Australia
| | - Peter G. Davis
- Neonatal Medicine, The Royal Women’s Hospital, Parkville, Melbourne, Victoria, Australia
| | - Mary Sharp
- King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Karen Simmer
- The University of Western Australia, Perth, Western Australia, Australia
| | - Kenneth Tan
- Department of Paediatrics, Monash University, Monash Children’s Hospital, Clayton, Victoria, Australia
| | - Scott Morris
- Neonatal-Perinatal Medicine, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, Australia
| | - Kei Lui
- School of Clinical Medicine, Discipline of Paediatrics and Child Health, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Helen Liley
- Mater Research – The Faculty of Medicine, The University of Queensland, South Brisbane, Queensland, Australia
| | - Jacqueline Stack
- Neonatal Intensive Care Unit, Liverpool Hospital, Elizabeth, Liverpool, New South Wales, Australia
| | - Carmel T. Collins
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, North Adelaide, South Australia, Australia
- Discipline of Paediatrics, Faculty of Health and Medical Sciences, The University of Adelaide, North Terrace Adelaide, South Australia, Australia
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Gould JF, Bednarz JM, Sullivan TR, McPhee AJ, Gibson RA, Makrides M. Subgroup analyses of a randomized trial of DHA supplementation for infants born preterm with assessments of cognitive development up to 7-years of age: What happens in infants born <29 weeks' gestation? Prostaglandins Leukot Essent Fatty Acids 2023; 198-199:102593. [PMID: 37979339 DOI: 10.1016/j.plefa.2023.102593] [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: 08/06/2023] [Revised: 10/27/2023] [Accepted: 10/27/2023] [Indexed: 11/20/2023]
Abstract
A recent trial showed that high-dose docosahexaenoic acid (high-DHA) supplementation of infants born <29 weeks' gestation improves intelligence quotient (IQ) at five years' corrected age. However, this finding has not been detected by other trials of DHA, which either did not measure IQ or included more mature infants. We analyzed the subgroup of 204 infants born <29 weeks' from our earlier randomized trial of high-DHA (∼1 % total fatty acids) or standard-DHA (∼ 0.3 % total fatty acids). Participants were assessed for cognition at 18 months, and IQ and behavior at seven years' corrected age. No group differences were detected for mean cognitive, IQ or behavior scores. At 18 months, 18.8 % of children in the high-DHA group had a cognitive score <85, compared with 31.1 % of children in the standard-DHA group, but at seven years there was no difference. Although an underpowered post-hoc subgroup analysis, this study provides limited support to recommendations that infants born <29 weeks' gestation require supplemental DHA.
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Affiliation(s)
- J F Gould
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, 72 King William Road, North Adelaide 5006, Australia.
| | - J M Bednarz
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, 72 King William Road, North Adelaide 5006, Australia; School of Psychology & Discipline of Paediatrics, Faculty of Health and Medical Sciences, The University of Adelaide, North Terrace Adelaide, Australia
| | - T R Sullivan
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, 72 King William Road, North Adelaide 5006, Australia; School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, North Terrace Adelaide, Australia
| | - A J McPhee
- Neonatal Medicine, Women's and Children's Hospital, 72 King William Road, North Adelaide, Australia
| | - R A Gibson
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, 72 King William Road, North Adelaide 5006, Australia; School of Agriculture, Food and Wine, The University of Adelaide, Waite Campus, Glen Osmond, Australia
| | - M Makrides
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, 72 King William Road, North Adelaide 5006, Australia; Discipline of Paediatrics, Faculty of Health and Medical Sciences, The University of Adelaide, North Terrace Adelaide 5000, Australia
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Marc I, Lavoie PM, McPhee AJ, Collins CT, Simonyan D, Pronovost E, Guillot M, Gould JF, Mohamed I, Beltempo M, Boutin A, Fortier I, Sullivan TR, Moore L, Makrides M. Enteral supplementation with high-dose docosahexaenoic acid on the risk of bronchopulmonary dysplasia in very preterm infants: a collaborative study protocol for an individual participant data meta-analysis. BMJ Open 2023; 13:e076223. [PMID: 37518076 PMCID: PMC10387660 DOI: 10.1136/bmjopen-2023-076223] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
INTRODUCTION Severe bronchopulmonary dysplasia (BPD) is a well-known factor consistently associated with impaired cognitive outcomes. Regarding reported benefits on long-term neurodevelopmental outcomes, the potential adverse effects of high-dose docosahexaenoic acid (DHA) supplementation on this short-term neonatal morbidity need further investigations in infants born very preterm. This study will determine whether high-dose DHA enteral supplementation during the neonatal period is associated with the risk of severe BPD at 36 weeks' postmenstrual age (PMA) compared with control, in contemporary cohorts of preterm infants born at less than 29 weeks of gestation. METHODS AND ANALYSIS As part of an Australian-Canadian collaboration, we will conduct an individual participant data (IPD) meta-analysis of randomised controlled trials targeting infants born at less than 29 weeks of gestation and evaluating the effect of high-dose DHA enteral supplementation in the neonatal period compared with a control. Primary outcome will be severe grades of BPD (yes/no) at 36 weeks' PMA harmonised according to a recent definition that predicts early childhood morbidities. Other outcomes will be survival without severe BPD, death, BPD severity grades, serious brain injury, severe retinopathy of prematurity, patent ductus arteriosus and necrotising enterocolitis requiring surgery, sepsis, combined neonatal morbidities and growth. Severe BPD will be compared between groups using a multivariate generalised estimating equations log-binomial regression model. Subgroup analyses are planned for gestational age, sex, small-for-gestational age, presence of maternal chorioamnionitis and mode of delivery. ETHICS AND DISSEMINATION The conduct of each trial was approved by institutional research ethics boards and written informed consent was obtained from participating parents. A collaboration and data sharing agreement will be signed between participating authors and institutions. This IPD meta-analysis will document the role of DHA in nutritional management of BPD. Findings will be disseminated through conferences, media interviews and publications to peer-reviewed journals. PROSPERO REGISTRATION NUMBER CRD42023431063. TRIAL REGISTRATION NUMBER NCT05915806.
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Affiliation(s)
- Isabelle Marc
- Department of Pediatrics, CHU de Québec-Université Laval, Quebec City, Québec, Canada
| | - Pascal M Lavoie
- Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew J McPhee
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Carmel T Collins
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - David Simonyan
- Clinical and Evaluative Research Platform, CHU de Québec-Université Laval, Quebec City, Québec, Canada
| | - Etienne Pronovost
- Department of Pediatrics, CHU de Québec-Université Laval, Quebec City, Québec, Canada
| | - Mireille Guillot
- Department of Pediatrics, CHU de Québec-Université Laval, Quebec City, Québec, Canada
| | - Jacqueline F Gould
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Medicine and School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
| | - Ibrahim Mohamed
- Department of Pediatrics, Université de Montréal, Montreal, Québec, Canada
| | - Marc Beltempo
- Department of Pediatrics, McGill University Health Centre, Montreal, Québec, Canada
| | - Amélie Boutin
- Department of Pediatrics, CHU de Québec-Université Laval, Quebec City, Québec, Canada
| | - Isabel Fortier
- Maelstrom Research, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Thomas R Sullivan
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Lynne Moore
- Department of Social and Preventive Medicine, Université Laval, Quebec City, Québec, Canada
| | - Maria Makrides
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
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Sullivan TR, Gould JF, Bednarz JM, McPhee AJ, Gibson R, Anderson PJ, Best KP, Sharp M, Cheong JL, Opie GF, Travadi J, Davis PG, Simmer K, Collins CT, Doyle LW, Makrides M. Mediation Analysis to Untangle Opposing Associations of High-Dose Docosahexaenoic Acid With IQ and Bronchopulmonary Dysplasia in Children Born Preterm. JAMA Netw Open 2023; 6:e2317870. [PMID: 37294565 PMCID: PMC10257101 DOI: 10.1001/jamanetworkopen.2023.17870] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/26/2023] [Indexed: 06/10/2023] Open
Abstract
Importance High-dose omega-3 docosahexaenoic acid (DHA) supplementation of children born at less than 29 weeks' gestation has been shown to improve IQ despite increasing the risk of bronchopulmonary dysplasia (BPD). Given that BPD is associated with poorer cognitive outcomes, it is unclear whether the increased risk of BPD with DHA supplementation is associated with decreased benefit to IQ. Objective To investigate whether the increased risk of BPD with DHA supplementation was associated with diminished IQ benefit. Design, Setting, and Participants This cohort study used data collected from a multicenter, blinded, randomized controlled trial of DHA supplementation in children born at less than 29 weeks' gestation. Participants were recruited from 2012 to 2015 and followed up until 5 years' corrected age. Data were analyzed from November 2022 to February 2023. Interventions Enteral DHA emulsion (60 mg/kg/d, to match the estimated in-utero requirement) or a control emulsion from the first 3 days of enteral feeds until 36 weeks' postmenstrual age or discharge home. Main Outcomes and Measures Physiological BPD was assessed at 36 weeks' postmenstrual age. IQ was assessed at 5 years' corrected age using the Wechsler Preschool and Primary Scale of Intelligence, 4th Edition; children from the 5 highest-recruiting Australian hospitals were assessed. The total effect of DHA supplementation on IQ was divided into direct and indirect effects using mediation analysis, with BPD as the presumed mediating variable. Results Among 656 surviving children from hospitals involved in IQ follow-up (mean [SD] gestational age at birth, 26.8 [1.4] weeks; 346 males [52.7%]), there were 323 children with DHA supplementation and 333 children in the control group. Mean IQ was 3.45 points (95% CI, 0.38 to 6.53 points) higher in the DHA group than the control group, despite an increase in the risk of BPD (160 children [49.7%] vs 143 children [42.8%] with BPD). The indirect effect of DHA on IQ via BPD was not statistically significant (-0.17 points; 95% CI, -0.62 to 0.13 points), with most of the effect of DHA on IQ occurring independently of BPD (direct effect = 3.62 points; 95% CI, 0.55 to 6.81 points). Conclusions and Relevance This study found that associations of DHA with BPD and IQ were largely independent. This finding suggests that if clinicians supplement children born preterm with high-dose DHA, any resulting increase in BPD risk would not be associated with meaningful reductions in the IQ benefit.
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Affiliation(s)
- Thomas R. Sullivan
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Jacqueline F. Gould
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Discipline of Paediatrics, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Jana M. Bednarz
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Andrew J. McPhee
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Neonatal Services, Women’s and Children’s Hospital, North Adelaide, South Australia, Australia
| | - Robert Gibson
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Agriculture, Food and Wine, Waite Campus, University of Adelaide, Adelaide, South Australia, Australia
| | - Peter J. Anderson
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Karen P. Best
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Discipline of Paediatrics, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Mary Sharp
- King Edward Memorial Hospital, Subiaco, Western Australia, Australia
- Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth, Western Australia, Australia
| | - Jeanie L.Y. Cheong
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Newborn Research, Royal Women's Hospital, Parkville, Victoria, Australia
- Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Gillian F. Opie
- Neonatal Services, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Javeed Travadi
- Department of Child Health, Neonatal Intensive Care Unit, Waikato Hospital, Waikato, Hamilton, New Zealand
- Newborn Services, John Hunter Children’s Hospital, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Peter G. Davis
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Newborn Research, Royal Women's Hospital, Parkville, Victoria, Australia
- Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Karen Simmer
- Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth, Western Australia, Australia
| | - Carmel T. Collins
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Discipline of Paediatrics, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Lex W. Doyle
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Newborn Research, Royal Women's Hospital, Parkville, Victoria, Australia
- Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Maria Makrides
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Discipline of Paediatrics, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
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Best KP, Gould JF, Makrides M, Sullivan T, Cheong J, Zhou SJ, Kane S, Safa H, Sparks A, Doyle LW, McPhee AJ, Nippita TAC, Afzali HHA, Grivell R, Mackerras D, Knight E, Wood S, Green T. Prenatal iodine supplementation and early childhood neurodevelopment: the PoppiE trial - study protocol for a multicentre randomised controlled trial. BMJ Open 2023; 13:e071359. [PMID: 37164467 PMCID: PMC10173960 DOI: 10.1136/bmjopen-2022-071359] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
INTRODUCTION Observational studies suggest both low and high iodine intakes in pregnancy are associated with poorer neurodevelopmental outcomes in children. This raises concern that current universal iodine supplement recommendations for pregnant women in populations considered to be iodine sufficient may negatively impact child neurodevelopment. We aim to determine the effect of reducing iodine intake from supplements for women who have adequate iodine intake from food on the cognitive development of children at 24 months of age. METHODS AND ANALYSIS A multicentre, randomised, controlled, clinician, researcher and participant blinded trial with two parallel groups. Using a hybrid decentralised clinical trial model, 754 women (377 per group) less than 13 weeks' gestation with an iodine intake of ≥165 µg/day from food will be randomised to receive either a low iodine (20 µg/day) multivitamin and mineral supplement or an identical supplement containing 200) µg/day (amount commonly used in prenatal supplements in Australia), from enrolment until delivery. The primary outcome is the developmental quotient of infants at 24 months of age assessed with the Cognitive Scale of the Bayley Scales of Infant Development, fourth edition. Secondary outcomes include infant language and motor development; behavioural and emotional development; maternal and infant clinical outcomes and health service utilisation of children. Cognitive scores will be compared between groups using linear regression, with adjustment for location of enrolment and the treatment effect described as a mean difference with 95% CI. ETHICS AND DISSEMINATION Ethical approval has been granted from the Women's and Children's Health Network Research Ethics Committee (HREC/17/WCHN/187). The results of this trial will be presented at scientific conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04586348.
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Affiliation(s)
- Karen P Best
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jacqueline F Gould
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Maria Makrides
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Thomas Sullivan
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jeanie Cheong
- Newborn Services, Royal Women's Hospital, Parkville, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Shao J Zhou
- School of Agriculture, Food & Wine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Stefan Kane
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
- Department of Maternal Fetal Medicine, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Huda Safa
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Obstetrics and Gynaecology, Mater Mothers' Hospital, Brisbane, Queensland, Australia
| | - A Sparks
- Department of Neonatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Lex W Doyle
- Department of Maternal Fetal Medicine, Royal Women's Hospital, Parkville, Victoria, Australia
- Obstetrics and Gynaecology, Royal Women's Hospital, Parkville, Victoria, Australia
| | - A J McPhee
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Tanya A C Nippita
- Women and Babies, Kolling Institute of Medical Research, St Leonards, New South Wales, Australia
- Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Hossein H A Afzali
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Rosalie Grivell
- Department of Obstetrics and Gynaecology, Flinders University, Adelaide, South Australia, Australia
| | - D Mackerras
- Menzies School of Health Research, Casuarina, Northern Territory, Australia
| | - E Knight
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Simon Wood
- Faculty of Land and Food Systems, University of British Columbia, Victoria, British Columbia, Canada
- Faculty of Science and Engineering, Curtin University, Perth, Western Australia, Australia
| | - Tim Green
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
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Best KP, Yelland LN, Collins CT, McPhee AJ, Rogers GB, Choo J, Gibson RA, Murguia-Peniche T, Varghese J, Cooper TR, Makrides M. Growth of late preterm infants fed nutrient-enriched formula to 120 days corrected age-A randomized controlled trial. Front Pediatr 2023; 11:1146089. [PMID: 37205223 PMCID: PMC10185835 DOI: 10.3389/fped.2023.1146089] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/29/2023] [Indexed: 05/21/2023] Open
Abstract
Objectives We aimed to compare the effects of nutrient-enriched formula with standard term formula on rate of body weight gain of late preterm infants appropriately grown for gestational age. Study design A multi-center, randomized, controlled trial. Late preterm infants (34-37 weeks' gestation), with weight appropriate for gestational age (AGA), were randomized to nutrient enriched formula (NEF) with increased calories (22 kcal/30 ml) from protein, added bovine milk fat globule membrane, vitamin D and butyrate or standard term formula 20 kcal/30 ml (STF). Breastfed term infants were enrolled as an observational reference group (BFR). Primary outcome was rate of body weight gain from enrollment to 120 days corrected age (d/CA). Planned sample size was 100 infants per group. Secondary outcomes included body composition, weight, head circumference and length gain, and medically confirmed adverse events to 365 d/CA. Results The trial was terminated early due to recruitment challenges and sample size was substantially reduced. 40 infants were randomized to NEF (n = 22) and STF (n = 18). 39 infants were enrolled in the BFR group. At 120 d/CA there was no evidence of a difference in weight gain between randomized groups (mean difference 1.77 g/day, 95% CI, -1.63 to 5.18, P = 0.31). Secondary outcomes showed a significant reduction in risk of infectious illness in the NEF group at 120 d/CA [relative risk 0.37 (95% CI, 0.16-0.85), P = 0.02]. Conclusion We saw no difference in rate of body weight gain between AGA late preterm infants fed NEF compared to STF. Results should be interpreted with caution due to small sample size. Clinical Trial Registration The Australia New Zealand Clinical Trials Registry (ACTRN 12618000092291). "mailto:maria.makrides@sahmri.com" maria.makrides@sahmri.com.
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Affiliation(s)
- Karen P. Best
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Lisa N. Yelland
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- School of Public Health, The University of Adelaide, Adelaide, SA, Australia
| | - Carmel T. Collins
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Andrew J. McPhee
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Geraint B. Rogers
- Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Infection and Immunity, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Jocelyn Choo
- Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Infection and Immunity, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Robert A. Gibson
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- School of Agriculture, Food and Wine, University of Adelaide, Adelaide, SA, Australia
| | - Teresa Murguia-Peniche
- School of Medicine, Indiana University, Evansville, IN, United States
- Medical Sciences, Mead Johnson Nutrition|Reckitt, Evansville, IN, United States
| | - Jojy Varghese
- Department of Neonatology, Lyell McEwin Hospital, Adelaide, SA, Australia
| | - Timothy R. Cooper
- Medical Sciences, Mead Johnson Nutrition|Reckitt, Evansville, IN, United States
| | - Maria Makrides
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
- Correspondence: Maria Makrides
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8
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Gould JF, Makrides M, Gibson RA, Sullivan TR, McPhee AJ, Anderson PJ, Best KP, Sharp M, Cheong JLY, Opie GF, Travadi J, Bednarz JM, Davis PG, Simmer K, Doyle LW, Collins CT. Neonatal Docosahexaenoic Acid in Preterm Infants and Intelligence at 5 Years. N Engl J Med 2022; 387:1579-1588. [PMID: 36300974 DOI: 10.1056/nejmoa2206868] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Docosahexaenoic acid (DHA) is a component of neural tissue. Because its accretion into the brain is greatest during the final trimester of pregnancy, infants born before 29 weeks' gestation do not receive the normal supply of DHA. The effect of this deficiency on subsequent cognitive development is not well understood. METHODS We assessed general intelligence at 5 years in children who had been enrolled in a trial of neonatal DHA supplementation to prevent bronchopulmonary dysplasia. In the previous trial, infants born before 29 weeks' gestation had been randomly assigned in a 1:1 ratio to receive an enteral emulsion that provided 60 mg of DHA per kilogram of body weight per day or a control emulsion from the first 3 days of enteral feeds until 36 weeks of postmenstrual age or discharge home, whichever occurred first. Children from 5 of the 13 centers in the original trial were invited to undergo assessment with the Wechsler Preschool and Primary Scale of Intelligence (WPPSI) at 5 years of corrected age. The primary outcome was the full-scale intelligence quotient (FSIQ) score. Secondary outcomes included the components of WPPSI. RESULTS A total of 1273 infants underwent randomization in the original trial; of the 656 surviving children who had undergone randomization at the centers included in this follow-up study, 480 (73%) had an FSIQ score available - 241 in the DHA group and 239 in the control group. After imputation of missing data, the mean (±SD) FSIQ scores were 95.4±17.3 in the DHA group and 91.9±19.1 in the control group (adjusted difference, 3.45; 95% confidence interval, 0.38 to 6.53; P = 0.03). The results for secondary outcomes generally did not support that obtained for the primary outcome. Adverse events were similar in the two groups. CONCLUSIONS In infants born before 29 weeks' gestation who had been enrolled in a trial to assess the effect of DHA supplementation on bronchopulmonary dysplasia, the use of an enteral DHA emulsion until 36 weeks of postmenstrual age was associated with modestly higher FSIQ scores at 5 years of age than control feeding. (Funded by the Australian National Health and Medical Research Council and Nu-Mega Ingredients; N3RO Australian New Zealand Clinical Trials Registry number, ACTRN12612000503820.).
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Affiliation(s)
- Jacqueline F Gould
- From SAHMRI Women and Kids, South Australian Health and Medical Research Institute (J.F.G., M.M., R.A.G., T.R.S., A.J.M., K.P.B., J.M.B., C.T.C.), the Schools of Medicine (J.F.G., M.M., A.J.M., K.P.B., C.T.C.), Psychology (J.F.G.), Agriculture, Food, and Wine (R.A.G.), and Public Health (T.R.S.), University of Adelaide, and the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M.), Adelaide, SA, Newborn Research, Royal Women's Hospital (J.L.Y.C., P.G.D., L.W.D.), the Murdoch Children's Research Institute (P.J.A., J.L.Y.C., P.G.D., L.W.D.), and the Departments of Obstetrics and Gynaecology (J.L.Y.C., P.G.D., L.W.D.) and Paediatrics (L.W.D.), University of Melbourne, the School of Psychological Sciences, Monash University (P.J.A.), and the Department of Paediatrics, Mercy Hospital for Women (G.F.O.), Melbourne, VIC, King Edward Memorial Hospital, Subiaco, WA (M.S.), Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth, WA (M.S., K.S.), and the Neonatal Intensive Care Unit, John Hunter Children's Hospital, New Lambton Heights, NSW (J.T.) - all in Australia
| | - Maria Makrides
- From SAHMRI Women and Kids, South Australian Health and Medical Research Institute (J.F.G., M.M., R.A.G., T.R.S., A.J.M., K.P.B., J.M.B., C.T.C.), the Schools of Medicine (J.F.G., M.M., A.J.M., K.P.B., C.T.C.), Psychology (J.F.G.), Agriculture, Food, and Wine (R.A.G.), and Public Health (T.R.S.), University of Adelaide, and the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M.), Adelaide, SA, Newborn Research, Royal Women's Hospital (J.L.Y.C., P.G.D., L.W.D.), the Murdoch Children's Research Institute (P.J.A., J.L.Y.C., P.G.D., L.W.D.), and the Departments of Obstetrics and Gynaecology (J.L.Y.C., P.G.D., L.W.D.) and Paediatrics (L.W.D.), University of Melbourne, the School of Psychological Sciences, Monash University (P.J.A.), and the Department of Paediatrics, Mercy Hospital for Women (G.F.O.), Melbourne, VIC, King Edward Memorial Hospital, Subiaco, WA (M.S.), Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth, WA (M.S., K.S.), and the Neonatal Intensive Care Unit, John Hunter Children's Hospital, New Lambton Heights, NSW (J.T.) - all in Australia
| | - Robert A Gibson
- From SAHMRI Women and Kids, South Australian Health and Medical Research Institute (J.F.G., M.M., R.A.G., T.R.S., A.J.M., K.P.B., J.M.B., C.T.C.), the Schools of Medicine (J.F.G., M.M., A.J.M., K.P.B., C.T.C.), Psychology (J.F.G.), Agriculture, Food, and Wine (R.A.G.), and Public Health (T.R.S.), University of Adelaide, and the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M.), Adelaide, SA, Newborn Research, Royal Women's Hospital (J.L.Y.C., P.G.D., L.W.D.), the Murdoch Children's Research Institute (P.J.A., J.L.Y.C., P.G.D., L.W.D.), and the Departments of Obstetrics and Gynaecology (J.L.Y.C., P.G.D., L.W.D.) and Paediatrics (L.W.D.), University of Melbourne, the School of Psychological Sciences, Monash University (P.J.A.), and the Department of Paediatrics, Mercy Hospital for Women (G.F.O.), Melbourne, VIC, King Edward Memorial Hospital, Subiaco, WA (M.S.), Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth, WA (M.S., K.S.), and the Neonatal Intensive Care Unit, John Hunter Children's Hospital, New Lambton Heights, NSW (J.T.) - all in Australia
| | - Thomas R Sullivan
- From SAHMRI Women and Kids, South Australian Health and Medical Research Institute (J.F.G., M.M., R.A.G., T.R.S., A.J.M., K.P.B., J.M.B., C.T.C.), the Schools of Medicine (J.F.G., M.M., A.J.M., K.P.B., C.T.C.), Psychology (J.F.G.), Agriculture, Food, and Wine (R.A.G.), and Public Health (T.R.S.), University of Adelaide, and the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M.), Adelaide, SA, Newborn Research, Royal Women's Hospital (J.L.Y.C., P.G.D., L.W.D.), the Murdoch Children's Research Institute (P.J.A., J.L.Y.C., P.G.D., L.W.D.), and the Departments of Obstetrics and Gynaecology (J.L.Y.C., P.G.D., L.W.D.) and Paediatrics (L.W.D.), University of Melbourne, the School of Psychological Sciences, Monash University (P.J.A.), and the Department of Paediatrics, Mercy Hospital for Women (G.F.O.), Melbourne, VIC, King Edward Memorial Hospital, Subiaco, WA (M.S.), Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth, WA (M.S., K.S.), and the Neonatal Intensive Care Unit, John Hunter Children's Hospital, New Lambton Heights, NSW (J.T.) - all in Australia
| | - Andrew J McPhee
- From SAHMRI Women and Kids, South Australian Health and Medical Research Institute (J.F.G., M.M., R.A.G., T.R.S., A.J.M., K.P.B., J.M.B., C.T.C.), the Schools of Medicine (J.F.G., M.M., A.J.M., K.P.B., C.T.C.), Psychology (J.F.G.), Agriculture, Food, and Wine (R.A.G.), and Public Health (T.R.S.), University of Adelaide, and the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M.), Adelaide, SA, Newborn Research, Royal Women's Hospital (J.L.Y.C., P.G.D., L.W.D.), the Murdoch Children's Research Institute (P.J.A., J.L.Y.C., P.G.D., L.W.D.), and the Departments of Obstetrics and Gynaecology (J.L.Y.C., P.G.D., L.W.D.) and Paediatrics (L.W.D.), University of Melbourne, the School of Psychological Sciences, Monash University (P.J.A.), and the Department of Paediatrics, Mercy Hospital for Women (G.F.O.), Melbourne, VIC, King Edward Memorial Hospital, Subiaco, WA (M.S.), Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth, WA (M.S., K.S.), and the Neonatal Intensive Care Unit, John Hunter Children's Hospital, New Lambton Heights, NSW (J.T.) - all in Australia
| | - Peter J Anderson
- From SAHMRI Women and Kids, South Australian Health and Medical Research Institute (J.F.G., M.M., R.A.G., T.R.S., A.J.M., K.P.B., J.M.B., C.T.C.), the Schools of Medicine (J.F.G., M.M., A.J.M., K.P.B., C.T.C.), Psychology (J.F.G.), Agriculture, Food, and Wine (R.A.G.), and Public Health (T.R.S.), University of Adelaide, and the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M.), Adelaide, SA, Newborn Research, Royal Women's Hospital (J.L.Y.C., P.G.D., L.W.D.), the Murdoch Children's Research Institute (P.J.A., J.L.Y.C., P.G.D., L.W.D.), and the Departments of Obstetrics and Gynaecology (J.L.Y.C., P.G.D., L.W.D.) and Paediatrics (L.W.D.), University of Melbourne, the School of Psychological Sciences, Monash University (P.J.A.), and the Department of Paediatrics, Mercy Hospital for Women (G.F.O.), Melbourne, VIC, King Edward Memorial Hospital, Subiaco, WA (M.S.), Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth, WA (M.S., K.S.), and the Neonatal Intensive Care Unit, John Hunter Children's Hospital, New Lambton Heights, NSW (J.T.) - all in Australia
| | - Karen P Best
- From SAHMRI Women and Kids, South Australian Health and Medical Research Institute (J.F.G., M.M., R.A.G., T.R.S., A.J.M., K.P.B., J.M.B., C.T.C.), the Schools of Medicine (J.F.G., M.M., A.J.M., K.P.B., C.T.C.), Psychology (J.F.G.), Agriculture, Food, and Wine (R.A.G.), and Public Health (T.R.S.), University of Adelaide, and the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M.), Adelaide, SA, Newborn Research, Royal Women's Hospital (J.L.Y.C., P.G.D., L.W.D.), the Murdoch Children's Research Institute (P.J.A., J.L.Y.C., P.G.D., L.W.D.), and the Departments of Obstetrics and Gynaecology (J.L.Y.C., P.G.D., L.W.D.) and Paediatrics (L.W.D.), University of Melbourne, the School of Psychological Sciences, Monash University (P.J.A.), and the Department of Paediatrics, Mercy Hospital for Women (G.F.O.), Melbourne, VIC, King Edward Memorial Hospital, Subiaco, WA (M.S.), Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth, WA (M.S., K.S.), and the Neonatal Intensive Care Unit, John Hunter Children's Hospital, New Lambton Heights, NSW (J.T.) - all in Australia
| | - Mary Sharp
- From SAHMRI Women and Kids, South Australian Health and Medical Research Institute (J.F.G., M.M., R.A.G., T.R.S., A.J.M., K.P.B., J.M.B., C.T.C.), the Schools of Medicine (J.F.G., M.M., A.J.M., K.P.B., C.T.C.), Psychology (J.F.G.), Agriculture, Food, and Wine (R.A.G.), and Public Health (T.R.S.), University of Adelaide, and the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M.), Adelaide, SA, Newborn Research, Royal Women's Hospital (J.L.Y.C., P.G.D., L.W.D.), the Murdoch Children's Research Institute (P.J.A., J.L.Y.C., P.G.D., L.W.D.), and the Departments of Obstetrics and Gynaecology (J.L.Y.C., P.G.D., L.W.D.) and Paediatrics (L.W.D.), University of Melbourne, the School of Psychological Sciences, Monash University (P.J.A.), and the Department of Paediatrics, Mercy Hospital for Women (G.F.O.), Melbourne, VIC, King Edward Memorial Hospital, Subiaco, WA (M.S.), Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth, WA (M.S., K.S.), and the Neonatal Intensive Care Unit, John Hunter Children's Hospital, New Lambton Heights, NSW (J.T.) - all in Australia
| | - Jeanie L Y Cheong
- From SAHMRI Women and Kids, South Australian Health and Medical Research Institute (J.F.G., M.M., R.A.G., T.R.S., A.J.M., K.P.B., J.M.B., C.T.C.), the Schools of Medicine (J.F.G., M.M., A.J.M., K.P.B., C.T.C.), Psychology (J.F.G.), Agriculture, Food, and Wine (R.A.G.), and Public Health (T.R.S.), University of Adelaide, and the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M.), Adelaide, SA, Newborn Research, Royal Women's Hospital (J.L.Y.C., P.G.D., L.W.D.), the Murdoch Children's Research Institute (P.J.A., J.L.Y.C., P.G.D., L.W.D.), and the Departments of Obstetrics and Gynaecology (J.L.Y.C., P.G.D., L.W.D.) and Paediatrics (L.W.D.), University of Melbourne, the School of Psychological Sciences, Monash University (P.J.A.), and the Department of Paediatrics, Mercy Hospital for Women (G.F.O.), Melbourne, VIC, King Edward Memorial Hospital, Subiaco, WA (M.S.), Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth, WA (M.S., K.S.), and the Neonatal Intensive Care Unit, John Hunter Children's Hospital, New Lambton Heights, NSW (J.T.) - all in Australia
| | - Gillian F Opie
- From SAHMRI Women and Kids, South Australian Health and Medical Research Institute (J.F.G., M.M., R.A.G., T.R.S., A.J.M., K.P.B., J.M.B., C.T.C.), the Schools of Medicine (J.F.G., M.M., A.J.M., K.P.B., C.T.C.), Psychology (J.F.G.), Agriculture, Food, and Wine (R.A.G.), and Public Health (T.R.S.), University of Adelaide, and the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M.), Adelaide, SA, Newborn Research, Royal Women's Hospital (J.L.Y.C., P.G.D., L.W.D.), the Murdoch Children's Research Institute (P.J.A., J.L.Y.C., P.G.D., L.W.D.), and the Departments of Obstetrics and Gynaecology (J.L.Y.C., P.G.D., L.W.D.) and Paediatrics (L.W.D.), University of Melbourne, the School of Psychological Sciences, Monash University (P.J.A.), and the Department of Paediatrics, Mercy Hospital for Women (G.F.O.), Melbourne, VIC, King Edward Memorial Hospital, Subiaco, WA (M.S.), Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth, WA (M.S., K.S.), and the Neonatal Intensive Care Unit, John Hunter Children's Hospital, New Lambton Heights, NSW (J.T.) - all in Australia
| | - Javeed Travadi
- From SAHMRI Women and Kids, South Australian Health and Medical Research Institute (J.F.G., M.M., R.A.G., T.R.S., A.J.M., K.P.B., J.M.B., C.T.C.), the Schools of Medicine (J.F.G., M.M., A.J.M., K.P.B., C.T.C.), Psychology (J.F.G.), Agriculture, Food, and Wine (R.A.G.), and Public Health (T.R.S.), University of Adelaide, and the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M.), Adelaide, SA, Newborn Research, Royal Women's Hospital (J.L.Y.C., P.G.D., L.W.D.), the Murdoch Children's Research Institute (P.J.A., J.L.Y.C., P.G.D., L.W.D.), and the Departments of Obstetrics and Gynaecology (J.L.Y.C., P.G.D., L.W.D.) and Paediatrics (L.W.D.), University of Melbourne, the School of Psychological Sciences, Monash University (P.J.A.), and the Department of Paediatrics, Mercy Hospital for Women (G.F.O.), Melbourne, VIC, King Edward Memorial Hospital, Subiaco, WA (M.S.), Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth, WA (M.S., K.S.), and the Neonatal Intensive Care Unit, John Hunter Children's Hospital, New Lambton Heights, NSW (J.T.) - all in Australia
| | - Jana M Bednarz
- From SAHMRI Women and Kids, South Australian Health and Medical Research Institute (J.F.G., M.M., R.A.G., T.R.S., A.J.M., K.P.B., J.M.B., C.T.C.), the Schools of Medicine (J.F.G., M.M., A.J.M., K.P.B., C.T.C.), Psychology (J.F.G.), Agriculture, Food, and Wine (R.A.G.), and Public Health (T.R.S.), University of Adelaide, and the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M.), Adelaide, SA, Newborn Research, Royal Women's Hospital (J.L.Y.C., P.G.D., L.W.D.), the Murdoch Children's Research Institute (P.J.A., J.L.Y.C., P.G.D., L.W.D.), and the Departments of Obstetrics and Gynaecology (J.L.Y.C., P.G.D., L.W.D.) and Paediatrics (L.W.D.), University of Melbourne, the School of Psychological Sciences, Monash University (P.J.A.), and the Department of Paediatrics, Mercy Hospital for Women (G.F.O.), Melbourne, VIC, King Edward Memorial Hospital, Subiaco, WA (M.S.), Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth, WA (M.S., K.S.), and the Neonatal Intensive Care Unit, John Hunter Children's Hospital, New Lambton Heights, NSW (J.T.) - all in Australia
| | - Peter G Davis
- From SAHMRI Women and Kids, South Australian Health and Medical Research Institute (J.F.G., M.M., R.A.G., T.R.S., A.J.M., K.P.B., J.M.B., C.T.C.), the Schools of Medicine (J.F.G., M.M., A.J.M., K.P.B., C.T.C.), Psychology (J.F.G.), Agriculture, Food, and Wine (R.A.G.), and Public Health (T.R.S.), University of Adelaide, and the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M.), Adelaide, SA, Newborn Research, Royal Women's Hospital (J.L.Y.C., P.G.D., L.W.D.), the Murdoch Children's Research Institute (P.J.A., J.L.Y.C., P.G.D., L.W.D.), and the Departments of Obstetrics and Gynaecology (J.L.Y.C., P.G.D., L.W.D.) and Paediatrics (L.W.D.), University of Melbourne, the School of Psychological Sciences, Monash University (P.J.A.), and the Department of Paediatrics, Mercy Hospital for Women (G.F.O.), Melbourne, VIC, King Edward Memorial Hospital, Subiaco, WA (M.S.), Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth, WA (M.S., K.S.), and the Neonatal Intensive Care Unit, John Hunter Children's Hospital, New Lambton Heights, NSW (J.T.) - all in Australia
| | - Karen Simmer
- From SAHMRI Women and Kids, South Australian Health and Medical Research Institute (J.F.G., M.M., R.A.G., T.R.S., A.J.M., K.P.B., J.M.B., C.T.C.), the Schools of Medicine (J.F.G., M.M., A.J.M., K.P.B., C.T.C.), Psychology (J.F.G.), Agriculture, Food, and Wine (R.A.G.), and Public Health (T.R.S.), University of Adelaide, and the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M.), Adelaide, SA, Newborn Research, Royal Women's Hospital (J.L.Y.C., P.G.D., L.W.D.), the Murdoch Children's Research Institute (P.J.A., J.L.Y.C., P.G.D., L.W.D.), and the Departments of Obstetrics and Gynaecology (J.L.Y.C., P.G.D., L.W.D.) and Paediatrics (L.W.D.), University of Melbourne, the School of Psychological Sciences, Monash University (P.J.A.), and the Department of Paediatrics, Mercy Hospital for Women (G.F.O.), Melbourne, VIC, King Edward Memorial Hospital, Subiaco, WA (M.S.), Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth, WA (M.S., K.S.), and the Neonatal Intensive Care Unit, John Hunter Children's Hospital, New Lambton Heights, NSW (J.T.) - all in Australia
| | - Lex W Doyle
- From SAHMRI Women and Kids, South Australian Health and Medical Research Institute (J.F.G., M.M., R.A.G., T.R.S., A.J.M., K.P.B., J.M.B., C.T.C.), the Schools of Medicine (J.F.G., M.M., A.J.M., K.P.B., C.T.C.), Psychology (J.F.G.), Agriculture, Food, and Wine (R.A.G.), and Public Health (T.R.S.), University of Adelaide, and the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M.), Adelaide, SA, Newborn Research, Royal Women's Hospital (J.L.Y.C., P.G.D., L.W.D.), the Murdoch Children's Research Institute (P.J.A., J.L.Y.C., P.G.D., L.W.D.), and the Departments of Obstetrics and Gynaecology (J.L.Y.C., P.G.D., L.W.D.) and Paediatrics (L.W.D.), University of Melbourne, the School of Psychological Sciences, Monash University (P.J.A.), and the Department of Paediatrics, Mercy Hospital for Women (G.F.O.), Melbourne, VIC, King Edward Memorial Hospital, Subiaco, WA (M.S.), Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth, WA (M.S., K.S.), and the Neonatal Intensive Care Unit, John Hunter Children's Hospital, New Lambton Heights, NSW (J.T.) - all in Australia
| | - Carmel T Collins
- From SAHMRI Women and Kids, South Australian Health and Medical Research Institute (J.F.G., M.M., R.A.G., T.R.S., A.J.M., K.P.B., J.M.B., C.T.C.), the Schools of Medicine (J.F.G., M.M., A.J.M., K.P.B., C.T.C.), Psychology (J.F.G.), Agriculture, Food, and Wine (R.A.G.), and Public Health (T.R.S.), University of Adelaide, and the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M.), Adelaide, SA, Newborn Research, Royal Women's Hospital (J.L.Y.C., P.G.D., L.W.D.), the Murdoch Children's Research Institute (P.J.A., J.L.Y.C., P.G.D., L.W.D.), and the Departments of Obstetrics and Gynaecology (J.L.Y.C., P.G.D., L.W.D.) and Paediatrics (L.W.D.), University of Melbourne, the School of Psychological Sciences, Monash University (P.J.A.), and the Department of Paediatrics, Mercy Hospital for Women (G.F.O.), Melbourne, VIC, King Edward Memorial Hospital, Subiaco, WA (M.S.), Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth, WA (M.S., K.S.), and the Neonatal Intensive Care Unit, John Hunter Children's Hospital, New Lambton Heights, NSW (J.T.) - all in Australia
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Gould JF, Yelland LN, Gibson RA, McPhee AJ, Varghese J, Grivell R, Makrides M. Protocol for a multicentre prospective observational study of families with full-term infants on postnatal wards and in the community to capture feeding practices across the first year of life: the Mother Infant Lactation Questionnaire (MILQ) study. BMJ Open 2022; 12:e066355. [PMID: 36261242 PMCID: PMC9582306 DOI: 10.1136/bmjopen-2022-066355] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Breastmilk is considered the gold standard for infant nutrition. Breast feeding is recommended as the sole source of nutrition between birth until around 6 months of age and should be continued beyond this age as complementary foods are introduced. While breast feeding initiation is generally high in developed countries, continuation of breast feeding appears to drop rapidly. This is a prospective observational study of life that aims to characterise a current picture of infant feeding practices across the first year, and motivations for feeding practices, and to identify barriers and enablers for breast feeding. METHODS AND ANALYSIS Caregivers with newborn singleton infants of normal birth weight are approached on the postnatal units of three hospitals in South Australia, or through targeted online advertising campaigns promoting the study. Caregivers are asked to complete surveys when their infant reaches 3, 5 and 7 weeks', and at 3, 4, 5, 6, 9 and 12 months of age. Initially, baseline characteristics, intentions and preferences for infant milk feeds, as well as reasons for preferences are captured. Latter surveys query how infants are being fed, difficulties or barriers to breast feeding, as well as any enablers (if breast feeding). Once infants reach 5 months of age, surveys capture complementary feeding. A large opportunistic sample from the Adelaide community with a minimum of 1000 mother-infant pairs will be enrolled. The data will be analysed descriptively and using regression models. ETHICS AND DISSEMINATION Women's and Children's Health Network Human Research Ethics Committee reviewed and approved the study (approval no HREC/19/WCHN/140, approval date: 22 November 2019). Study results will be disseminated through academic meetings, peer-reviewed journals, in-services for postnatal healthcare services, results letters for participants and social media. TRIAL REGISTRATION NUMBER ACTRN12620000529943.
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Affiliation(s)
- Jacqueline F Gould
- Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Psychology & Discipline of Paediatrics, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Lisa N Yelland
- Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Robert A Gibson
- Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- FOODplus Research Centre, University of Adelaide School of Agriculture Food and Wine - Waite Campus, Glen Osmond, South Australia, Australia
| | - Andrew J McPhee
- Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Neonatal Medicine, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Jojy Varghese
- Dept. of Paediatrics, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
| | - Rosalie Grivell
- Department of Obstetrics and Gynaecology, Flinders University, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Maria Makrides
- Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Discipline of Paediatrics, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
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10
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Keir A, Rumbold A, Collins CT, McPhee AJ, Varghese J, Morris S, Sullivan TR, Leemaqz S, Middleton P, Makrides M, Best KP. Breastfeeding outcomes in late preterm infants: A multi-centre prospective cohort study. PLoS One 2022; 17:e0272583. [PMID: 35969612 PMCID: PMC9377594 DOI: 10.1371/journal.pone.0272583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 07/21/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives To describe (1) infant feeding practices during initial hospitalisation and up to 6 months corrected age (CA) in infants born late preterm with mothers intending to breastfeed, (2) the impact of early feeding practices on hospital length of stay and (3) maternal and infant factors associated with duration of breastfeeding. Methods We conducted a prospective cohort study of infants born at 34+0 to 36+6 weeks gestational age during 2018–2020. Families were followed up until the infant reached 6 months of age (corrected for prematurity). Feeding practices during the birth hospitalisation, length of initial hospital stay, and the prevalence of exclusive or any breastfeeding at 6 weeks, 3 months, and 6 months CA were examined. Associations between maternal and infant characteristics and breastfeeding at 6 weeks, 3 months and 6 months CA were assessed using multivariable logistic regression models. Results 270 infants were enrolled, of these, 30% were multiple births. Overall, 78% of infants received only breastmilk as their first feed, and 83% received formula during the hospitalisation. Seventy-four per cent of infants were exclusively breastfed at discharge, 41% at 6 weeks CA, 35% at 3 months CA, and 29% at 6 months CA. The corresponding combined exclusive and partial breastfeeding rates (any breastfeeding) were 72%, 64%, and 53% of babies at 6 weeks CA, 3 months CA, and 6 months CA, respectively. The mean duration of hospitalisation was 2.9 days longer (95% confidence interval (CI) 0.31, 5.43 days) in infants who received any formula compared with those receiving only breastmilk (adjusted for GA, maternal age, multiple birth, site, and neonatal intensive care unit admission). In multivariable models, receipt of formula as the first milk feed was associated with a reduction in exclusive breastfeeding at 6 weeks CA (odds ratio = 0.22; 95% CI 0.09 to 0.53) and intention to breastfeed >6 months with an increase (odds ratio = 4.98; 95% CI 2.39 to 10.40). Intention to breastfeed >6 months remained an important predictor of exclusive breastfeeding at 3 and 6 months CA. Conclusions Our study demonstrates that long-term exclusive breastfeeding rates were low in a cohort of women intending to provide breastmilk to their late preterm infants, with approximately half providing any breastmilk at 6 months CA. Formula as the first milk feed and intention to breastfeed >6 months were significant predictors of breastfeeding duration. Improving breastfeeding outcomes may require strategies to support early lactation and a better understanding of the ongoing support needs of this population.
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Affiliation(s)
- Amy Keir
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia
- Department of Neonatal Medicine, Women’s and Children’s Hospital, North Adelaide, South Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia
- * E-mail:
| | - Alice Rumbold
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia
| | - Carmel T. Collins
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia
| | - Andrew J. McPhee
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia
| | - Jojy Varghese
- Lyell McEwin Hospital, Elizabeth Vale, South Australia
| | - Scott Morris
- Department of Neonatology, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Thomas R. Sullivan
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia
- School of Public Health, The University of Adelaide, Adelaide, South Australia
| | - Shalem Leemaqz
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia
| | - Philippa Middleton
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia
| | - Maria Makrides
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia
| | - Karen P. Best
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia
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11
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Keir AK, Summers L, Gillis J, McPhee AJ, Rumbold A. Impact of human donor milk on maternal milk use at discharge: assessment using control charts. Arch Dis Child Fetal Neonatal Ed 2022; 107:452-453. [PMID: 34172509 DOI: 10.1136/archdischild-2020-321416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Amy K Keir
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, North Adelaide, South Australia, Australia .,Adelaide Medical School and the Robinson Research Institute, The University of Adelaide, North Adelaide, South Australia, Australia.,Women's and Babies Division, Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
| | - Laura Summers
- Women's and Babies Division, Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
| | - Jennifer Gillis
- Women's and Babies Division, Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
| | - Andrew J McPhee
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, North Adelaide, South Australia, Australia.,Adelaide Medical School and the Robinson Research Institute, The University of Adelaide, North Adelaide, South Australia, Australia.,Women's and Babies Division, Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
| | - Alice Rumbold
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, North Adelaide, South Australia, Australia.,Adelaide Medical School and the Robinson Research Institute, The University of Adelaide, North Adelaide, South Australia, Australia
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12
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McPhee AJ, Collins CT, Gibson RA, Makrides M. The Role of Long-Chain Polyunsaturated Fatty Acids in Very Preterm Nutrition. Nestle Nutr Inst Workshop Ser 2022; 96:107-115. [PMID: 35537426 DOI: 10.1159/000519392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 05/29/2021] [Indexed: 06/14/2023]
Abstract
Infants born very preterm miss out on the in utero transfer of the omega-3 and omega-6 long-chain polyunsaturated fatty acids that occurs during the third trimester. A number of studies have explored the impact of increasing the enteral intakes of omega-3 +/- omega-6 long-chain polyunsaturated fatty acids to match fetal accretion rates in such infants. These studies have shown early transient improvements in vision and development with both strategies, but with the use of omega-3 supplementation alone appearing to increase the incidence of bronchopulmonary dysplasia. A recent study of omega-3 + omega-6 supplementation demonstrated a significant reduction in the incidence of severe retinopathy of prematurity in a high-risk population, without apparent adverse effects; a larger study is needed to confirm the observed benefits, to assess safety, and to determine long-term developmental outcomes of this strategy.
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Affiliation(s)
- Andrew J McPhee
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Carmel T Collins
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Discipline of Paediatrics, Adelaide Medical School, Adelaide, South Australia, Australia
| | - Robert A Gibson
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Agriculture Food and Wine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Maria Makrides
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
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13
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Abbas S, Keir AK, Makrides M, Klein LD, Grzeskowiak LE, McPhee AJ, Rumbold AR. Tailoring Human Milk Oligosaccharides to Prevent Necrotising Enterocolitis Among Preterm Infants. Front Nutr 2021; 8:702888. [PMID: 34395496 PMCID: PMC8357978 DOI: 10.3389/fnut.2021.702888] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/28/2021] [Indexed: 12/24/2022] Open
Abstract
Necrotising enterocolitis (NEC) is a devastating disease affecting preterm infants, with little improvement in mortality rates and treatment strategies in the last 30 years. Human milk oligosaccharides (HMOs) are emerging as a potential preventive therapy, with multiple protective functions postulated. Our aim is to summarise the evidence concerning the role of HMOs in NEC development and emerging strategies to tailor the delivery of HMOs to preterm infants. Most research efforts to date have focused on supplementing preterm infants with simple oligosaccharides, which are structurally different to HMOs and derived mainly from plants. Clinical trials demonstrate limited benefits for NEC prevention arising from the use of these supplements. Alternative strategies under investigation include optimising HMOs for infants receiving donor human milk, concentrating oligosaccharides from donor human milk and from animal milks, as well as more sophisticated synthetic oligosaccharide production strategies. Critically, high quality evidence to support implementation of any of these approaches in the neonatal unit is lacking. Whether it is a specific HMO alone or a combination of HMOs that exert protective effects remains to be elucidated. Further challenges include how best to manufacture and administer oligosaccharides whilst retaining bioactivity and safety, including evaluation of the long-term effects of altering the balance of HMOs and gut microbiota in preterm infants. While several human clinical trials are underway, further research is needed to understand whether a tailored approach to oligosaccharide supplementation is beneficial for preterm infants.
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Affiliation(s)
- Safiyyah Abbas
- Women's and Children's Health Network, Adelaide, SA, Australia
| | - Amy K Keir
- Women's and Children's Health Network, Adelaide, SA, Australia.,SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia.,Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | - Maria Makrides
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | - Laura D Klein
- Business Growth and Innovation, Australian Red Cross Lifeblood, Sydney, NSW, Australia
| | - Luke E Grzeskowiak
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Andrew J McPhee
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Alice R Rumbold
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia.,Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
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14
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Gould JF, Roberts RM, Anderson PJ, Makrides M, Sullivan TR, Gibson RA, McPhee AJ, Doyle LW, Opie G, Travadi J, Cheong JLY, Davis PG, Sharp M, Simmer K, Tan K, Morris S, Lui K, Bolisetty S, Liley H, Stack J, Best KP, Collins CT. Protocol for assessing if behavioural functioning of infants born <29 weeks' gestation is improved by omega-3 long-chain polyunsaturated fatty acids: follow-up of a randomised controlled trial. BMJ Open 2021; 11:e044740. [PMID: 33952546 PMCID: PMC8103387 DOI: 10.1136/bmjopen-2020-044740] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 03/10/2021] [Accepted: 03/17/2021] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION During the last trimester of pregnancy, the fetal brain undergoes a rapid growth spurt and accumulates essential nutrients including docosahexaenoic acid (DHA). This takes place ex-utero for infants born <29 weeks' gestation, without the in-utero provisions of DHA. Infants born <29 weeks' are more likely to experience behavioural and emotional difficulties than their term-born counterparts. It has been hypothesised that supplementing preterm infants with dietary DHA may alleviate insufficiency and subsequently prevent or minimise behavioural problems. This protocol describes a follow-up of infants born <29 weeks gestation who were enrolled in a randomised controlled trial (RCT) of DHA supplementation. We aim to determine whether DHA supplementation improves the behaviour, and general health of these infants. METHODS AND ANALYSIS Infants born <29 weeks' gestation were enrolled in a multicentre blinded RCT of enteral DHA supplementation. Infants were randomised to receive an enteral emulsion that provided 60 mg/kg/day of DHA or a control emulsion commenced within the first 3 days of enteral feeding, until 36 weeks' postmenstrual age or discharge home, whichever occurred first. Families of surviving children (excluding those who withdrew from the study) from the Australian sites (up to 955) will be invited to complete a survey. The survey will include questions regarding child behavioural and emotional functioning, executive functioning, respiratory health and general health. We hypothesise that the DHA intervention will have a benefit on the primary outcome, parent-rated behaviour and emotional status as measured using the Total Difficulties score of the Strengths and Difficulties Questionnaire. Detecting a 2-point difference between groups (small effect size of 0.25 SD) with 90% power will require follow-up of 676 participants. ETHICS AND DISSEMINATION The Women's and Children Health Network Human Research Ethics Committee reviewed and approved the study (HREC/16/WCHN/184). Results will be disseminated in peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER ACTRN12612000503820.
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Affiliation(s)
- Jacqueline F Gould
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Psychology and Discipline of Paediatrics, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Rachel M Roberts
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Peter J Anderson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Maria Makrides
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Discipline of Paediatrics, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Thomas R Sullivan
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Robert A Gibson
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Agriculture, Food and Wine, University of Adelaide, Waite Campus, Glen Osmond, South Australia, Australia
| | - Andrew J McPhee
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Neonatal Medicine, Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
| | - Lex William Doyle
- Department Obstetrics and Gynaecology, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Gillian Opie
- Neonatal Services, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Javeed Travadi
- Newborn Services, John Hunter Children's Hospital, New Lambton Heights, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Jeanie L Y Cheong
- Neonatal Medicine, Royal Women's Hospital, Parkville, Melbourne, Australia
| | - Peter G Davis
- Neonatal Medicine, Royal Women's Hospital, Parkville, Melbourne, Australia
| | - Mary Sharp
- Neonatal Follow up, King Edward Memorial Hospital for Women Perth, Perth, Western Australia, Australia
| | - Karen Simmer
- Neonatal Research, The University of Western Australia, Perth, Western Australia, Australia
| | - Kenneth Tan
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
- Monash Children's Hospital, Clayton, New South Wales, Australia
| | - Scott Morris
- Paediatric Neonatal Clinic, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Kei Lui
- Newborn Care Centre, Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Srinivas Bolisetty
- Newborn Care Centre, Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Helen Liley
- Mater Research - The Faculty of Medicine, The University of Queensland, South Brisbane, Queensland, Australia
| | - Jacqueline Stack
- Neonatal Intensive Care Unit, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Karen P Best
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Discipline of Paediatrics, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Carmel T Collins
- Discipline of Paediatrics, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Women and Kids, South Australian Health and Medical Research Institute, North Adelaide, South Australia, Australia
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15
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Gould JF, Makrides M, Sullivan TR, Anderson PJ, Gibson RA, Best KP, McPhee AJ, Doyle LW, Opie G, Travadi J, Cheong J, Davis PG, Sharp M, Simmer K, Collins CT. Protocol for assessing whether cognition of preterm infants <29 weeks' gestation can be improved by an intervention with the omega-3 long-chain polyunsaturated fatty acid docosahexaenoic acid (DHA): a follow-up of a randomised controlled trial. BMJ Open 2021; 11:e041597. [PMID: 33550243 PMCID: PMC7925903 DOI: 10.1136/bmjopen-2020-041597] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Docosahexaenoic acid (DHA) is an omega-3 (n-3) fatty acid that accumulates into neural tissue during the last trimester of pregnancy, as the fetal brain is undergoing a growth spurt. Infants born <29 weeks' gestation are deprived the normal in utero supply of DHA during this period of rapid brain development. Insufficient dietary DHA postnatally may contribute to the cognitive impairments common among this population. This follow-up of the N-3 fatty acids for improvement in respiratory outcomes (N3RO) randomised controlled trial aims to determine if enteral DHA supplementation in infants born <29 weeks' gestation during the first months of life improves cognitive development at 5 years of age corrected for prematurity. METHODS AND ANALYSIS N3RO was a randomised controlled trial of enteral DHA supplementation (60 mg/kg/day) or a control emulsion (without DHA) in 1273 infants born <29 weeks' gestation to determine the effect on bronchopulmonary dysplasia (BPD). We showed that DHA supplementation did not reduce the risk of BPD and may have increased the risk.In this follow-up at 5 years' corrected age, a predefined subset (n=655) of children from five Australian sites will be invited to attend a cognitive assessment with a psychologist. Children will be administered the Wechsler Preschool and Primary Scale of Intelligence (fourth edition) and a measure of inhibitory control (fruit stroop), while height, weight and head circumference will be measured.The primary outcome is full-scale IQ. To ensure 90% power, a minimum of 592 children are needed to detect a four-point difference in IQ between the groups.Research personnel and families remain blinded to group assignment. ETHICS AND DISSEMINATION The Women's and Children Health Network Human Research Ethics Committee reviewed and approved the study (HREC/17/WCHN/187). Caregivers will give informed consent prior to taking part in this follow-up study. Findings of this study will be disseminated through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER ACTRN12612000503820.
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Affiliation(s)
- Jacqueline F Gould
- Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Psychology & Discipline of Paediatrics, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Maria Makrides
- Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Discipline of Paediatrics, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Thomas R Sullivan
- Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Peter J Anderson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Robert A Gibson
- Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Agriculture, Food and Wine, University of Adelaide, Adelaide, South Australia, Australia
| | - Karen P Best
- Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Discipline of Paediatrics, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Andrew J McPhee
- Neonatal Medicine, Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
| | - Lex William Doyle
- Obstetrics and Gynaecology, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Gillian Opie
- Neonatal Services, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Javeed Travadi
- Newborn Services, John Hunter Children's Hospital, Newcastle, New South Wales, Australia
| | - Jeanie Cheong
- Newborn Research, Royal Women's Hospital, Parkville, Victoria, Australia
- Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Peter G Davis
- Newborn Research, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Mary Sharp
- King Edward Memorial Hospital for Women Perth, Subiaco, Western Australia, Australia
| | - Karen Simmer
- Neonatal Research, The University of Western Australia, Perth, Western Australia, Australia
| | - Carmel T Collins
- Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Discipline of Paediatrics, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
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Suganuma H, Collins CT, McPhee AJ, Leemaqz S, Liu G, Andersen CC, Bonney D, Gibson RA. Effect of parenteral lipid emulsion on preterm infant PUFAs and their downstream metabolites. Prostaglandins Leukot Essent Fatty Acids 2021; 164:102217. [PMID: 33291053 DOI: 10.1016/j.plefa.2020.102217] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 07/06/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Oxylipins synthesized by oxidation of long-chain polyunsaturated fatty acids (LCPUFAs) are bioactive downstream lipid mediators. The aim of this study was to describe oxylipin levels in preterm infants born 30 to 33 weeks' gestation who were enrolled in a randomized controlled trial in which peripheral parenteral nutrition (P-PN), including lipid emulsion (containing soy, medium chain triglyceride, olive and fish oil), was compared with 10% glucose on growth during the transition to enteral feeds. METHODS Of the 92 infants randomized to the P-PN study, the first 72 (P-PN n = 34, control n = 38) had blood taken for fatty acid analyses. P-PN infants received parenteral nutrition including 3% protein, 8% glucose and 17% SMOFlipid® lipid (containing soy, medium chain triglyceride, olive and fish oil), and control infants 10% glucose. Both groups commenced enteral feeds when clinically stable. 32 oxylipins and 5 free fatty acids were screened (using ultra-high-performance liquid chromatography-tandem mass spectrometry), and 5 total LCPUFA were measured (using gas chromatography), on study days 1 (baseline), 2, 4, 7, 14 and 21. RESULTS Both total and free LA, ALA and EPA were significantly higher in the P-PN group compared with control over the first week of life. Whereas total AA was significantly lower and free DHA significantly higher over the same time period. All LA, ALA, EPA and four DHA derived oxylipins detected were significantly higher in the P-PN group compared with the control group during the first week of life, with three AA derived oxylipins significantly lower and one significantly higher. CONCLUSIONS Parenteral lipid emulsion resulted in a change in total and free fatty acids and related oxylipins with the profiles suggesting increased omega-6 driven inflammation. Further studies to investigate the association between the oxylipin levels and nutrition and to determine whether the oxylipin profiles influence the clinical outcome in preterm infants are warranted.
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Affiliation(s)
- Hiroki Suganuma
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Discipline of Paediatrics, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Carmel T Collins
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Discipline of Paediatrics, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia.
| | - Andrew J McPhee
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Neonatal Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Shalem Leemaqz
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Ge Liu
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; School of Agriculture Food and Wine, The University of Adelaide, PMB 1, Glen Osmond, Adelaide, South Australia 5064, Australia
| | - Chad C Andersen
- Neonatal Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Dennis Bonney
- Neonatal Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Robert A Gibson
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; School of Agriculture Food and Wine, The University of Adelaide, PMB 1, Glen Osmond, Adelaide, South Australia 5064, Australia.
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17
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Suganuma H, Bonney D, Andersen CC, McPhee AJ, Sullivan TR, Gibson RA, Collins CT. The efficacy and safety of peripheral intravenous parenteral nutrition vs 10% glucose in preterm infants born 30 to 33 weeks' gestation: a randomised controlled trial. BMC Pediatr 2020; 20:384. [PMID: 32799841 PMCID: PMC7429781 DOI: 10.1186/s12887-020-02280-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/07/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Preterm infants born 30 to 33 weeks' gestation often require early support with intravenous fluids because of respiratory distress, hypoglycemia or feed intolerance. When full feeds are anticipated to be reached within the first week, risks associated with intravenous delivery mode and type must be carefully considered. Recommendations are for parenteral nutrition to be infused via central venous lines (because of the high osmolarity), however, given the risks associated with central lines, clinicians may opt for 10% glucose via peripheral venous catheter when the need is short-term. We therefore compare a low osmolarity peripheral intravenous parenteral nutrition (P-PN) solution with peripheral intravenous 10% glucose on growth rate in preterm infants born 30 to 33 weeks' gestation. METHODS In this parallel group, single centre, superiority, non-blinded, randomised controlled trial, 92 (P-PN 42, control 50) infants born 30+ 0 to 33+ 6 weeks' gestation, were randomised within 24 h of age, to receive either P-PN (8% glucose, 30 g/L amino acids, 500 IU/L heparin and SMOFlipid®) or a control of peripheral intravenous 10% glucose. Both groups received enteral feeds according to hospital protocol. The primary outcome was rate of weight gain from birth to 21 days of age. RESULTS The rate of weight gain was significantly increased in P-PN infants compared with control (P-PN, n = 42, 18.7, SD 6.6 g/d vs control, n = 50, 14.8, SD 6.0 g/d; adjusted mean difference 3.9 g/d, 95% CI 1.3 to 6.6; P = 0.004), with the effect maintained to discharge home. Days to regain birthweight were significantly reduced and length gain significantly increased in P-PN infants. One infant in the P-PN group had a stage 3 extravasation which rapidly resolved. Blood urea nitrogen and triglyceride levels were significantly higher in the P-PN group in the first week of life, but there were no instances of abnormally high levels. There were no significant differences in any other clinical or biochemical outcomes. CONCLUSION P-PN improves the rate of weight gain to discharge home in preterm infants born 30 to 33 weeks gestation compared with peripheral intravenous 10% glucose. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12616000925448 . Registered 12 July 2016.
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Affiliation(s)
- Hiroki Suganuma
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute Adelaide, South Australia, Australia
- Discipline of Paediatrics, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Dennis Bonney
- Neonatal Medicine, Women's and Children's Hospital, Adelaide, SA, Australia
| | - Chad C Andersen
- Neonatal Medicine, Women's and Children's Hospital, Adelaide, SA, Australia
| | - Andrew J McPhee
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute Adelaide, South Australia, Australia
- Neonatal Medicine, Women's and Children's Hospital, Adelaide, SA, Australia
| | - Thomas R Sullivan
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute Adelaide, South Australia, Australia
- School of Public Health, The University of Adelaide, Adelaide, SA, Australia
| | - Robert A Gibson
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute Adelaide, South Australia, Australia
- School of Agriculture Food and Wine, The University of Adelaide, Adelaide, SA, Australia
| | - Carmel T Collins
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute Adelaide, South Australia, Australia.
- Discipline of Paediatrics, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia.
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18
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Gao C, Liu G, McPhee AJ, Miller J, Gibson RA. A simple system for measuring the level of free fatty acids in human milk collected as dried milk spot. Prostaglandins Leukot Essent Fatty Acids 2020; 158:102035. [PMID: 31757711 DOI: 10.1016/j.plefa.2019.102035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 09/23/2019] [Revised: 11/12/2019] [Accepted: 11/12/2019] [Indexed: 01/01/2023]
Abstract
Breast milk dried on filter paper is a useful collection device for the study of breast milk because it avoids the costs associated with cold-chain storage and transportation. Although the fatty acid profile of breast milks as dried spots is stable, changes to the composition of lipid classes of breast milk due to lipase activity have been reported and are best reflected by its free fatty acid (FFA) concentration. This study aimed to develop a robust dried milk spot (DMS) system where fats in the breast milk are stable at room temperature, and the FFA concentration of the milk can be accurately measured without interference by the high level of triglyceride, which normally constitutes around 98% of the fats in fresh milk. Our system involves applying a small amount breast milk (20 µL) on silica gel impregnated filter paper and microwaving at high power to denature lipases. At the time of analysis, the milk fats are eluted with acetone, re-constituted in heptane and injected directly into a gas chromatograph equipped with an acid modified polyethylene glycol column. This DMS method was validated against the conventional TLC method across a range of FFA concentrations. The breast milk fats collected using this DMS system are stable at room temperature for at least eight weeks which allows for transportation by post and has the potential for use in multi-centred international clinical trials.
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Affiliation(s)
- Chang Gao
- School of Agriculture, Food and Wine, University of Adelaide, SA 5065, Australia; Women and Kids, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA 5001, Australia
| | - Ge Liu
- Women and Kids, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA 5001, Australia
| | - Andrew J McPhee
- Women and Kids, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA 5001, Australia; Neonatal Medicine, Women's and Children's Hospital, Adelaide, SA 5006, Australia
| | - Jaqueline Miller
- Women and Kids, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA 5001, Australia; Nutrition and Dietetics, Flinders University, Adelaide, SA 5001, Australia
| | - Robert A Gibson
- School of Agriculture, Food and Wine, University of Adelaide, SA 5065, Australia; Women and Kids, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA 5001, Australia.
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19
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Suganuma H, McPhee AJ, Collins CT, Liu G, Leemaqz S, Andersen CC, Ikeda N, Ohkawa N, Taha AY, Gibson RA. Intravenous fat induces changes in PUFA and their bioactive metabolites: Comparison between Japanese and Australian preterm infants. Prostaglandins Leukot Essent Fatty Acids 2020; 156:102026. [PMID: 31753522 DOI: 10.1016/j.plefa.2019.102026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 08/14/2019] [Revised: 10/29/2019] [Accepted: 11/05/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Oxylipins are biologically active signaling molecules that initiate and resolve inflammation; they are synthesized by oxidation of polyunsaturated fatty acids (PUFAs) and reflect PUFA intake and status. The PUFA intake in preterm infants differs between countries because of the type of lipid emulsions used and the PUFA content of breast milk. We compared total blood PUFA, free PUFA and their oxylipin levels in dried whole blood samples from preterm infants born in Australia and Japan. METHODS We enrolled 30 and 14 preterm infants born less than 31 weeks' gestation, from Adelaide and Japan respectively. Blood samples were obtained from cord blood, and on postnatal days 4, 7, 14 and 28. Total PUFAs were measured using gas chromatography, while free fatty acids and oxylipins were screened using ultra high-performance liquid chromatography mass spectroscopy. RESULTS Differences in the levels of blood PUFA between the centres were found which were in line with the timing and type of lipid emulsion administration. Significant differences in longitudinal levels were seen more often in free PUFA and their oxylipins than in total blood PUFA. This was particularly true for AA and DHA. In contrast, differences in the levels could be seen in total blood EPA, as well as in free EPA and its oxylipins. Further, levels of many free PUFA and their oxylipins were higher in Japanese infants than in Australian infants. CONCLUSION Differences in total and free fatty acids and unesterified oxylipins, were observed during the first weeks of life and between preterm infants born in Australia and Japan, which were likely a reflection of the type of lipid emulsion and timing of administration. The clinical significance of these changes remains to be explored.
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Affiliation(s)
- Hiroki Suganuma
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Discipline of Paediatrics, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Andrew J McPhee
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Neonatal Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Carmel T Collins
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Discipline of Paediatrics, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Ge Liu
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; School of Agriculture Food and Wine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Shalem Leemaqz
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Chad C Andersen
- Neonatal Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Naho Ikeda
- Neonatal Center, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Natsuki Ohkawa
- Neonatal Center, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Ameer Y Taha
- Department of Food Science and Technology, University of California Davis, California, United States of America
| | - Robert A Gibson
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; School of Agriculture Food and Wine, The University of Adelaide, Adelaide, South Australia, Australia.
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20
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Simmonds LA, Sullivan TR, Skubisz M, Middleton PF, Best KP, Yelland LN, Quinlivan J, Zhou SJ, Liu G, McPhee AJ, Gibson RA, Makrides M. Omega-3 fatty acid supplementation in pregnancy-baseline omega-3 status and early preterm birth: exploratory analysis of a randomised controlled trial. BJOG 2020; 127:975-981. [PMID: 32034969 DOI: 10.1111/1471-0528.16168] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To identify a polyunsaturated fatty acid (PUFA) biomarker able to detect which women with singleton pregnancies are most likely to benefit from omega-3 supplementation to reduce their risk of early preterm birth. DESIGN Exploratory analysis of a randomised controlled trial. SETTING Six Australian hospitals. POPULATION Women with a singleton pregnancy enrolled in the ORIP trial. METHODS Using maternal capillary whole blood collected ~14 weeks' gestation, the fatty acids in total blood lipids were quantified using gas chromatography. Interaction tests examined whether baseline PUFA status modified the effect of omega-3 supplementation on birth outcomes. MAIN OUTCOME MEASURE Early preterm birth (<34 weeks' gestation). RESULTS A low total omega-3 PUFA status in early pregnancy was associated with a higher risk of early preterm birth. Among women with a total omega-3 status ≤4.1% of total fatty acids, omega-3 supplementation substantially reduced the risk of early preterm birth compared with control (0.73 versus 3.16%; relative risk = 0.23, 95% confidence interval [CI] 0.07-0.79). Conversely, women with higher total omega-3 status in early pregnancy were at lower risk of early preterm birth. Supplementing women with a baseline status above 4.9% increased early preterm birth (2.20 versus 0.97%; relative risk = 2.27, 95% CI 1.13-4.58). CONCLUSIONS Women with singleton pregnancies and low total omega-3 PUFA status early in pregnancy have an increased risk of early preterm birth and are most likely to benefit from omega-3 supplementation to reduce this risk. Women with higher total omega-3 status are at lower risk and additional omega-3 supplementation may increase their risk. TWEETABLE ABSTRACT Low total omega-3 fat status helps identify which women benefit from extra omega-3 to reduce early prematurity.
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Affiliation(s)
- L A Simmonds
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - T R Sullivan
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - M Skubisz
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,Department of Obstetrics and Gynaecology, Women's and Children's Hospital, North Adelaide, SA, Australia
| | - P F Middleton
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,School of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - K P Best
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,School of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - L N Yelland
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,School of Public Health, The University of Adelaide, Adelaide, SA, Australia
| | - J Quinlivan
- The Institute of Health Research, University of Notre Dame, Fremantle, WA, Australia
| | - S J Zhou
- The School of Agriculture, Food and Wine, The University of Adelaide, Adelaide, SA, Australia
| | - G Liu
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,The School of Agriculture, Food and Wine, The University of Adelaide, Adelaide, SA, Australia
| | - A J McPhee
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,Neonatal Services, Women's and Children's Hospital, North Adelaide, SA, Australia
| | - R A Gibson
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,The School of Agriculture, Food and Wine, The University of Adelaide, Adelaide, SA, Australia
| | - M Makrides
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,School of Medicine, The University of Adelaide, Adelaide, SA, Australia
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21
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Abstract
The importance of omega-3 long chain polyunsaturated fatty acids in the perinatal period has been the focus of research for several decades. Infants born preterm miss out on the last trimester in utero transfer of omega-3 fatty acids and consequently have lower blood levels than infants born at term. Preterm infant formula was supplemented with the omega-3 docosahexaenoic acid and the omega-6 arachidonic acid from 2000 (to the level found in the breast milk of women consuming a western diet) based on trials reporting improvements in visual acuity. Docosahexaenoic acid supplementation beyond this level has not shown improvements in clinical or developmental outcomes, however the effect on childhood development in the most preterm infants remains to be resolved. Maternal omega-3 supplementation during pregnancy has the potential to reduce the incidence of preterm birth but may also, in some pregnancies, prolong gestation beyond term and increase fetal size.
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Affiliation(s)
- Carmel T Collins
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Discipline of Paediatrics, Adelaide Medical School, Adelaide, South Australia, Australia.
| | - Robert A Gibson
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; School of Agriculture Food and Wine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Andrew J McPhee
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Neonatal Medicine, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Maria Makrides
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
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22
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Ryan FJ, Drew DP, Douglas C, Leong LEX, Moldovan M, Lynn M, Fink N, Sribnaia A, Penttila I, McPhee AJ, Collins CT, Makrides M, Gibson RA, Rogers GB, Lynn DJ. Changes in the Composition of the Gut Microbiota and the Blood Transcriptome in Preterm Infants at Less than 29 Weeks Gestation Diagnosed with Bronchopulmonary Dysplasia. mSystems 2019; 4:e00484-19. [PMID: 31662429 PMCID: PMC6819732 DOI: 10.1128/msystems.00484-19] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 10/09/2019] [Indexed: 12/21/2022] Open
Abstract
Bronchopulmonary dysplasia (BPD) is a common chronic lung condition in preterm infants that results in abnormal lung development and leads to considerable morbidity and mortality, making BPD one of the most common complications of preterm birth. We employed RNA sequencing and 16S rRNA gene sequencing to profile gene expression in blood and the composition of the fecal microbiota in infants born at <29 weeks gestational age and diagnosed with BPD in comparison to those of preterm infants that were not diagnosed with BPD. 16S rRNA gene sequencing, performed longitudinally on 255 fecal samples collected from 50 infants in the first months of life, identified significant differences in the relative levels of abundance of Klebsiella, Salmonella, Escherichia/Shigella, and Bifidobacterium in the BPD infants in a manner that was birth mode dependent. Transcriptome sequencing (RNA-Seq) analysis revealed that more than 400 genes were upregulated in infants with BPD. Genes upregulated in BPD infants were significantly enriched for functions related to red blood cell development and oxygen transport, while several immune-related pathways were downregulated. We also identified a gene expression signature consistent with an enrichment of immunosuppressive CD71+ early erythroid cells in infants with BPD. Intriguingly, genes that were correlated in their expression with the relative abundances of specific taxa in the microbiota were significantly enriched for roles in the immune system, suggesting that changes in the microbiota might influence immune gene expression systemically.IMPORTANCE Bronchopulmonary dysplasia (BPD) is a serious inflammatory condition of the lung and is the most common complication associated with preterm birth. A large body of evidence now suggests that the gut microbiota can influence immunity and inflammation systemically; however, the role of the gut microbiota in BPD has not been evaluated to date. Here, we report that there are significant differences in the gut microbiota of infants born at <29 weeks gestation and subsequently diagnosed with BPD, which are particularly pronounced when infants are stratified by birth mode. We also show that erythroid and immune gene expression levels are significantly altered in BPD infants. Interestingly, we identified an association between the composition of the microbiota and immune gene expression in blood in early life. Together, these findings suggest that the composition of the microbiota may influence the risk of developing BPD and, more generally, may shape systemic immune gene expression.
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Affiliation(s)
- Feargal J Ryan
- Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Damian P Drew
- Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Chloe Douglas
- Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Lex E X Leong
- Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Max Moldovan
- Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Miriam Lynn
- Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Naomi Fink
- Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Anastasia Sribnaia
- Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Irmeli Penttila
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Andrew J McPhee
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Neonatal Medicine, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Carmel T Collins
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Maria Makrides
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Robert A Gibson
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Agriculture, Food, and Wine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Geraint B Rogers
- Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - David J Lynn
- Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
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23
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Gao C, Miller J, Middleton PF, Huang YC, McPhee AJ, Gibson RA. Changes to breast milk fatty acid composition during storage, handling and processing: A systematic review. Prostaglandins Leukot Essent Fatty Acids 2019; 146:1-10. [PMID: 31186148 DOI: 10.1016/j.plefa.2019.04.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 01/29/2019] [Revised: 04/30/2019] [Accepted: 04/30/2019] [Indexed: 11/23/2022]
Abstract
This review evaluated the effect of various storage and handling conditions on the fat composition of expressed breast milk (EBM). Three databases PubMed, Embase and Scopus were searched in April 2019 with words from the three key components: human milk, handling process (i.e. storage and/or pasteurization), and fatty acid composition. The comparisons were EBM subjected to handling processes versus fresh EBM or versus EBM subjected to another handling processes. Both intervention and observational studies were included, and the outcomes measured included total fat and lipid classes of the EBM. We included 42 studies (43 reports), 41 of which were assessed to be of good quality. Relative changes to the fat composition of EBM subjected to handling processes were calculated based on the data provided in the included studies, and the results were synthesized narratively. The total fat content and total fatty acid composition of EBM was not generally influenced by storage and handling process, with most changes less than 10%, which is likely a result of methodological variation. A reduction in EBM triglyceride concentration and concomitant increase in free fatty acid concentration were seen after exposing to various conditions, probably due to endogenous lipase.
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Affiliation(s)
- Chang Gao
- School of Agriculture, Food and Wine, University of Adelaide, Urrbrae, SA 5065, Australia; Women and Kids theme, South Australia Health and Medical Research Institute (SAHMRI), Adelaide, SA 5006, Australia
| | - Jacqueline Miller
- Women and Kids theme, South Australia Health and Medical Research Institute (SAHMRI), Adelaide, SA 5006, Australia; Nutrition and Dietetics, Flinders University, Adelaide, SA 5001, Australia
| | - Philippa F Middleton
- Women and Kids theme, South Australia Health and Medical Research Institute (SAHMRI), Adelaide, SA 5006, Australia; Adelaide Medical School, Discipline of Paediatrics, University of Adelaide, Adelaide, SA 5006, Australia
| | - Yi-Chao Huang
- School of Agriculture, Food and Wine, University of Adelaide, Urrbrae, SA 5065, Australia; Women and Kids theme, South Australia Health and Medical Research Institute (SAHMRI), Adelaide, SA 5006, Australia; School of Environment and Guangdong Key Laboratory of Environmental Pollution and Health, Jinan University, Guangzhou 510632, China
| | - Andrew J McPhee
- Women and Kids theme, South Australia Health and Medical Research Institute (SAHMRI), Adelaide, SA 5006, Australia; Neonatal Medicine, Women's and Children's Hospital, Adelaide, SA 5006, Australia
| | - Robert A Gibson
- School of Agriculture, Food and Wine, University of Adelaide, Urrbrae, SA 5065, Australia; Women and Kids theme, South Australia Health and Medical Research Institute (SAHMRI), Adelaide, SA 5006, Australia.
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24
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Gunaratne AW, Makrides M, Collins CT, Gibson RA, McPhee AJ, Sullivan TR, Gould JF, Green TJ, Doyle LW, Davis PG, French NP, Colditz PB, Simmer K, Morris SA, Best KP. Docosahexaenoic acid supplementation of preterm infants and parent-reported symptoms of allergic disease at 7 years corrected age: follow-up of a randomized controlled trial. Am J Clin Nutr 2019; 109:1600-1610. [PMID: 31070712 DOI: 10.1093/ajcn/nqz010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/17/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Docosahexaenoic acid (DHA, 22:6n-3) supplementation in the prenatal period is associated with a reduction in the incidence of some symptoms of allergic disease. Infants born preterm are at increased risk of allergic disease, but it is unknown if DHA supplementation reduces the risk of childhood allergies. OBJECTIVES The aim of this study was to determine if supplementation of infants born at <33 wk gestation with high-DHA compared with standard-DHA enteral feeds decreases the incidence and severity of parent-reported allergic disease symptoms at a corrected age (CA) of 7 y. METHODS This study was a follow-up of an Australian multicenter randomized controlled trial. Infants were given high-DHA (∼1% total fatty acids) or standard-DHA (∼0.3% total fatty acids) enteral feeds from 2-4 d of postnatal age until 40 wk postmenstrual age. Parent-reported incidence of respiratory allergic disease symptoms including wheeze and rhinitis at 7 y CA were the main outcomes. Other outcomes included the incidence of eczema symptoms; severity of any symptoms; and the incidence of wheeze, rhinitis, rhinoconjunctivitis, and eczema from birth to 7 y CA. RESULTS Data were available for 569 of 657 (87%) children originally randomized. Symptoms of wheeze or rhinitis at 7 y CA did not differ between high- and standard-DHA groups [wheeze: RR: 1.10; 95% CI: 0.73, 1.65; P = 0.66; rhinitis: RR: 1.09; 95% CI: 0.81, 1.46; P = 0.59]. There was no difference in other allergic disease symptoms at 7 y CA or in the severity of symptoms. Parent-reported symptoms of wheeze, rhinitis, rhinoconjunctivitis, or eczema from birth to 7 y CA did not differ between the groups. CONCLUSIONS High-dose DHA supplementation of infants born at <33 wk gestation did not alter allergic disease symptoms or severity at 7 y CA, or from birth to 7 y CA compared with standard-dose DHA. This trial was registered with the Australian New Zealand Clinical Trials Registry as ANZCTR 12606000327583 (http://www.anzctr.org.au).
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Affiliation(s)
- Anoja W Gunaratne
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Adelaide Medical School
| | - Maria Makrides
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Adelaide Medical School
| | - Carmel T Collins
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Adelaide Medical School
| | - Robert A Gibson
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,School of Agriculture, Food and Wine
| | - Andrew J McPhee
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Department of Neonatal Medicine, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Thomas R Sullivan
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jacqueline F Gould
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Adelaide Medical School
| | - Tim J Green
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Adelaide Medical School
| | - Lex W Doyle
- Clinical Sciences, The Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Peter G Davis
- Clinical Sciences, The Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Noel P French
- Centre of Neonatal Research and Education, The University of Western Australia, Perth, Western Australia, Australia.,King Edward Memorial Hospital and Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia
| | - Paul B Colditz
- Perinatal Research Centre, University of Queensland Centre for Clinical Research, The University of Queensland, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Karen Simmer
- Centre of Neonatal Research and Education, The University of Western Australia, Perth, Western Australia, Australia.,King Edward Memorial Hospital and Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia
| | - Scott A Morris
- Department of Neonatal Perinatal Medicine, Flinders Medical Centre and College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Karen P Best
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Adelaide Medical School
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Suganuma H, McPhee AJ, Bratkovic D, Gibson RA, Andersen CC. Serial fatty acid profiles in a preterm infant with long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency. Pediatr Int 2019; 61:415-416. [PMID: 31025818 DOI: 10.1111/ped.13802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/17/2018] [Accepted: 02/07/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Hiroki Suganuma
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Andrew J McPhee
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Neonatal Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Drago Bratkovic
- Metabolic Unit, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Robert A Gibson
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,School of Agriculture Food and Wine, University of Adelaide, Adelaide, South Australia, Australia
| | - Chad C Andersen
- Neonatal Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia
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26
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Zhou SJ, Condo D, Ryan P, Skeaff SA, Howell S, Anderson PJ, McPhee AJ, Makrides M. Association Between Maternal Iodine Intake in Pregnancy and Childhood Neurodevelopment at Age 18 Months. Am J Epidemiol 2019; 188:332-338. [PMID: 30452542 DOI: 10.1093/aje/kwy225] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 09/25/2018] [Indexed: 12/20/2022] Open
Abstract
There are limited and inconsistent data suggesting that mild iodine deficiency in pregnancy might be associated with poorer developmental outcomes in children. Between 2011 and 2015, we conducted a prospective cohort study in Australia examining the relationship between maternal iodine intake in pregnancy and childhood neurodevelopment, assessed using Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III), in 699 children at 18 months. Maternal iodine intake and urinary iodine concentration (UIC) were assessed at study entry (<20 weeks' gestation) and at 28 weeks' gestation. Maternal iodine intake in the lowest (<220 μg/day) or highest (≥391 μg/day) quartile was associated with lower cognitive, language, and motor scores (mean differences ranged from 2.4 (95% confidence interval (CI): 0.01, 4.8) to 7.0 (95% CI: 2.8, 11.1) points lower) and higher odds (odds ratios ranged from 2.7 (95% CI: 1.3, 5.6) to 2.8 (95% CI: 1.3, 5.7)) of cognitive developmental delay (Bayley-III score <1 SD) compared with mothers with an iodine intake in the middle quartiles. There was no association between UIC in pregnancy and Bayley-III outcomes regardless of whether UIC and the outcomes were analyzed as continuous or categorical variables. Both low and high iodine intakes in pregnancy were associated with poorer childhood neurodevelopment in this iodine-sufficient population.
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Affiliation(s)
- Shao J Zhou
- School of Agriculture, Food and Wine, University of Adelaide, South Australia, Australia
- Robinson Research Institute, University of Adelaide, South Australia, Australia
| | - Dominique Condo
- School of Exercise and Nutritional Science, Faculty of Health, Deakin University, Geelong, Australia
| | - Philip Ryan
- School of Population Health, University of Adelaide, South Australia, Australia
| | - Sheila A Skeaff
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Stuart Howell
- School of Population Health, University of Adelaide, South Australia, Australia
| | - Peter J Anderson
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Victoria, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Andrew J McPhee
- Women's and Children's Health Network, Adelaide, South Australia, Australia
| | - Maria Makrides
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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Dodd JM, Louise J, Deussen AR, Grivell RM, Dekker G, McPhee AJ, Hague W. Effect of metformin in addition to dietary and lifestyle advice for pregnant women who are overweight or obese: the GRoW randomised, double-blind, placebo-controlled trial. Lancet Diabetes Endocrinol 2019; 7:15-24. [PMID: 30528218 DOI: 10.1016/s2213-8587(18)30310-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 10/18/2018] [Accepted: 10/18/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Maternal overweight and obesity are associated with well recognised pregnancy complications. Antenatal dietary and lifestyle interventions have a modest effect on gestational weight gain without affecting pregnancy outcomes. We aimed to assess the effects on maternal and infant outcomes of antenatal metformin given in addition to dietary and lifestyle advice among overweight and obese pregnant women. METHODS GRoW was a multicentre, randomised, double-blind, placebo-controlled trial in which pregnant women at 10-20 weeks' gestation with a BMI of 25 kg/m2 or higher were recruited from three public maternity units in Adelaide, SA, Australia. Women were randomly assigned (1:1) via a computer-generated schedule to receive either metformin (to a maximum dose of 2000 mg per day) or matching placebo. Participants, their antenatal care providers, and research staff (including outcome assessors) were masked to treatment allocation. All women received an antenatal dietary and lifestyle intervention. The primary outcome was the proportion of infants with birthweight greater than 4000 g. Secondary outcomes included measures of maternal weight gain, maternal diet and physical activity, maternal pregnancy and birth outcomes, maternal quality of life and emotional wellbeing, and infant birth outcomes. Outcomes were analysed on an intention-to-treat basis (including all randomly assigned women who did not withdraw consent to use their data, and who did not have a miscarriage or termination of pregnancy before 20 weeks' gestation, or a stillbirth). The trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12612001277831. FINDINGS Of 524 women who were randomly assigned between May, 28 2013 and April 26, 2016, 514 were included in outcome analyses (256 in the metformin group and 258 in the placebo group). Median gestational age at trial entry was 16·29 weeks (IQR 14·43-18·00) and median BMI was 32·32 kg/m2 (28·90-37·10); 167 (32%) participants were overweight and 347 (68%) were obese. There was no significant difference in the proportion of infants with birthweight greater than 4000 g (40 [16%] with metformin vs 37 [14%] with placebo; adjusted risk ratio [aRR] 0·97, 95% CI 0·65 to 1·47; p=0·899). Women receiving metformin had lower average weekly gestational weight gain (adjusted mean difference -0·08 kg, 95% CI -0·14 to -0·02; p=0·007) and were more likely to have gestational weight gain below recommendations (aRR 1·46, 95% CI 1·10 to 1·94; p=0·008). Total gestational weight gain, pregnancy and birth outcomes, maternal diet and physical activity, and maternal quality of life and emotional wellbeing did not differ significantly between groups. Similar numbers of women in both treatment groups (76% [159/208] in the metformin group and 73% [144/196] in the placebo group) reported side-effects including nausea, diarrhoea, and vomiting. Two stillbirths (placebo group) and one neonatal death (metformin group) occurred; none of the perinatal deaths were determined to be attributable to participation in the trial. INTERPRETATION For pregnant women who are overweight or obese, metformin given in addition to dietary and lifestyle advice initiated at 10-20 weeks' gestation does not improve pregnancy and birth outcomes. FUNDING Australian National Health and Medical Research Council.
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Affiliation(s)
- Jodie M Dodd
- Discipline of Obstetrics & Gynaecology and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia; Department of Perinatal Medicine, Women's and Children's Hospital, North Adelaide, SA, Australia.
| | - Jennie Louise
- Discipline of Obstetrics & Gynaecology and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia; School of Public Health, University of Adelaide, Adelaide, SA, Australia
| | - Andrea R Deussen
- Discipline of Obstetrics & Gynaecology and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Rosalie M Grivell
- Department of Obstetrics and Gynaecology, Flinders University, Bedford Park, SA, Australia
| | - Gustaaf Dekker
- Discipline of Obstetrics & Gynaecology and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia; Lyell McEwin Hospital, Elizabeth Vale, SA, Australia
| | - Andrew J McPhee
- Department of Neonatal Medicine, Women's and Children's Hospital, North Adelaide, SA, Australia
| | - William Hague
- Discipline of Obstetrics & Gynaecology and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia; Department of Perinatal Medicine, Women's and Children's Hospital, North Adelaide, SA, Australia
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28
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Goodchild L, Hussey L, McPhee AJ, Lizarondo L, Gillis J, Collins CT. Promoting early expression of breast milk in mothers of preterm infants in a neonatal unit. ACTA ACUST UNITED AC 2018; 16:2027-2037. [DOI: 10.11124/jbisrir-2017-003534] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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29
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Abstract
OBJECTIVE Our objective was to evaluate the effect of an antenatal dietary and lifestyle intervention in pregnant women who are overweight or obese on child outcomes at age 18 months. METHODS We conducted a follow-up study of children at 18 months of age who were born to women who participated in the Limiting Weight Gain in Overweight and Obese Women during Pregnancy to Improve Health Outcomes randomized trial. The primary follow-up study outcome was prevalence of child BMI z scores >85th percentile. Secondary study outcomes included a range of anthropometric measures, neurodevelopment, general health, and child feeding. Intention to treat principles were used in analyses, according to the treatment group allocated at randomization. RESULTS A total of 1602 children were assessed at age 18 months (lifestyle advice, n = 816; standard care, n = 786), representing 75.0% of the eligible sample (n = 2136). There were no statistically significant differences in the prevalence of child BMI z scores >85th percentile for children born to women in the lifestyle advice group, compared with the standard care group (lifestyle advice, 505 [47.11%] versus standard care, 483 [45.36%]; adjusted relative risk: 1.04; 95% confidence interval: 0.94 to 1.16; P = .45). There was no evidence of effects on child growth, adiposity, neurodevelopment, or dietary and physical activity patterns. CONCLUSIONS There is no evidence that providing pregnant women who were overweight or obese with an antenatal dietary and lifestyle intervention altered 18-month child growth and adiposity.
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Affiliation(s)
- Jodie M Dodd
- Discipline of Obstetrics and Gynaecology, Robinson Research Institute and .,Women's and Babies Division, Perinatal Medicine and
| | - Jennie Louise
- Discipline of Obstetrics and Gynaecology, Robinson Research Institute and.,Adelaide Health Technology Assessment, School of Public Health, University of Adelaide, Adelaide, Australia; and Departments of
| | - Andrea R Deussen
- Discipline of Obstetrics and Gynaecology, Robinson Research Institute and
| | - Andrew J McPhee
- Neonatal Medicine, Women's and Children's Hospital, Adelaide, Australia
| | - Julie A Owens
- Discipline of Obstetrics and Gynaecology, Robinson Research Institute and
| | - Jeffrey S Robinson
- Discipline of Obstetrics and Gynaecology, Robinson Research Institute and
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30
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Yelland LN, Sullivan TR, Collins CT, Price DJ, McPhee AJ, Lee KJ. Accounting for twin births in sample size calculations for randomised trials. Paediatr Perinat Epidemiol 2018; 32:380-387. [PMID: 29727020 DOI: 10.1111/ppe.12471] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 11/29/2022]
Abstract
BACKGROUND Including twins in randomised trials leads to non-independence or clustering in the data. Clustering has important implications for sample size calculations, yet few trials take this into account. Estimates of the intracluster correlation coefficient (ICC), or the correlation between outcomes of twins, are needed to assist with sample size planning. Our aims were to provide ICC estimates for infant outcomes, describe the information that must be specified in order to account for clustering due to twins in sample size calculations, and develop a simple tool for performing sample size calculations for trials including twins. METHODS ICCs were estimated for infant outcomes collected in four randomised trials that included twins. The information required to account for clustering due to twins in sample size calculations is described. A tool that calculates the sample size based on this information was developed in Microsoft Excel and in R as a Shiny web app. RESULTS ICC estimates ranged between -0.12, indicating a weak negative relationship, and 0.98, indicating a strong positive relationship between outcomes of twins. Example calculations illustrate how the ICC estimates and sample size calculator can be used to determine the target sample size for trials including twins. CONCLUSIONS Clustering among outcomes measured on twins should be taken into account in sample size calculations to obtain the desired power. Our ICC estimates and sample size calculator will be useful for designing future trials that include twins. Publication of additional ICCs is needed to further assist with sample size planning for future trials.
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Affiliation(s)
- Lisa N Yelland
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,School of Public Health, The University of Adelaide, Adelaide, SA, Australia
| | - Thomas R Sullivan
- School of Public Health, The University of Adelaide, Adelaide, SA, Australia
| | - Carmel T Collins
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - David J Price
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.,Victorian Infectious Diseases Reference Laboratory Epidemiology Unit at The Peter Doherty Institute for Infection and Immunity, The University of Melbourne and Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Andrew J McPhee
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia.,Department of Neonatal Medicine, Women's and Children's Hospital, Adelaide, SA, Australia
| | - Katherine J Lee
- Melbourne Children's Trials Centre, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
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31
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Miller J, Tonkin E, Damarell RA, McPhee AJ, Suganuma M, Suganuma H, Middleton PF, Makrides M, Collins CT. A Systematic Review and Meta-Analysis of Human Milk Feeding and Morbidity in Very Low Birth Weight Infants. Nutrients 2018; 10:nu10060707. [PMID: 29857555 PMCID: PMC6024377 DOI: 10.3390/nu10060707] [Citation(s) in RCA: 208] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 05/25/2018] [Accepted: 05/29/2018] [Indexed: 12/30/2022] Open
Abstract
This systematic review and meta-analysis synthesised the post-1990 literature examining the effect of human milk on morbidity, specifically necrotising enterocolitis (NEC), late onset sepsis (LOS), retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD) and neurodevelopment in infants born ≤28 weeks' gestation and/or publications with reported infant mean birth weight of ≤1500 g. Online databases including Medline, PubMed, CINAHL, Scopus, and the Cochrane Central Register of Controlled Trials were searched, and comparisons were grouped as follows: exclusive human milk (EHM) versus exclusive preterm formula (EPTF), any human milk (HM) versus EPTF, higher versus lower dose HM, and unpasteurised versus pasteurised HM. Experimental and observational studies were pooled separately in meta-analyses. Risk of bias was assessed for each individual study and the GRADE system used to judge the certainty of the findings. Forty-nine studies (with 56 reports) were included, of which 44 could be included in meta-analyses. HM provided a clear protective effect against NEC, with an approximate 4% reduction in incidence. HM also provided a possible reduction in LOS, severe ROP and severe NEC. Particularly for NEC, any volume of HM is better than EPTF, and the higher the dose the greater the protection. Evidence regarding pasteurisation is inconclusive, but it appears to have no effect on some outcomes. Improving the intake of mother's own milk (MOM) and/or donor HM results in small improvements in morbidity in this population.
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MESH Headings
- Enteral Nutrition
- Enterocolitis, Necrotizing/etiology
- Enterocolitis, Necrotizing/physiopathology
- Enterocolitis, Necrotizing/prevention & control
- Evidence-Based Medicine
- Humans
- Infant
- Infant Formula
- Infant Nutritional Physiological Phenomena
- Infant, Extremely Premature
- Infant, Newborn
- Infant, Premature, Diseases/etiology
- Infant, Premature, Diseases/physiopathology
- Infant, Premature, Diseases/prevention & control
- Infant, Very Low Birth Weight
- Milk, Human
- Neonatal Sepsis/etiology
- Neonatal Sepsis/physiopathology
- Neonatal Sepsis/prevention & control
- Neurodevelopmental Disorders/etiology
- Neurodevelopmental Disorders/physiopathology
- Neurodevelopmental Disorders/prevention & control
- Premature Birth/diet therapy
- Premature Birth/physiopathology
- Severity of Illness Index
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Affiliation(s)
- Jacqueline Miller
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, SA 5006, Australia.
- Nutrition and Dietetics, Flinders University, Adelaide, SA 5001, Australia.
| | - Emma Tonkin
- Nutrition and Dietetics, Flinders University, Adelaide, SA 5001, Australia.
| | - Raechel A Damarell
- Nutrition and Dietetics, Flinders University, Adelaide, SA 5001, Australia.
| | - Andrew J McPhee
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, SA 5006, Australia.
- Neonatal Medicine, Women's and Children's Hospital, Adelaide, SA 5006, Australia.
| | - Machiko Suganuma
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, SA 5006, Australia.
| | - Hiroki Suganuma
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, SA 5006, Australia.
| | - Philippa F Middleton
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, SA 5006, Australia.
- Adelaide Medical School, Discipline of Paediatrics, The University of Adelaide, Adelaide, SA 5006, Australia.
| | - Maria Makrides
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, SA 5006, Australia.
- Adelaide Medical School, Discipline of Paediatrics, The University of Adelaide, Adelaide, SA 5006, Australia.
| | - Carmel T Collins
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, SA 5006, Australia.
- Adelaide Medical School, Discipline of Paediatrics, The University of Adelaide, Adelaide, SA 5006, Australia.
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Reid J, Makrides M, McPhee AJ, Stark MJ, Miller J, Collins CT. The Effect of Increasing the Protein Content of Human Milk Fortifier to 1.8 g/100 mL on Growth in Preterm Infants: A Randomised Controlled Trial. Nutrients 2018; 10:nu10050634. [PMID: 29772833 PMCID: PMC5986513 DOI: 10.3390/nu10050634] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 05/11/2018] [Accepted: 05/15/2018] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to assess the effect of feeding high protein human milk fortifier (HMF) on growth in preterm infants. In this single-centre randomised trial, 60 infants born 28–32 weeks’ gestation were randomised to receive a higher protein HMF providing 1.8 g protein (n = 31) or standard HMF providing 1 g protein per 100 mL expressed breast milk (EBM) (n = 29). The primary outcome was rate of weight gain. Baseline characteristics were similar between groups. There was no difference between high and standard HMF groups for weight gain (mean difference (MD) −14 g/week; 95% CI −32, 4; p = 0.12), length gain (MD −0.01 cm/week; 95% CI −0.06, 0.03; p = 0.45) or head circumference gain (MD 0.007 cm/week; 95% CI −0.05, 0.06; p = 0.79), despite achieving a 0.7 g/kg/day increase in protein intake in the high protein group. Infants in the high protein group had a higher proportion of lean body mass at trial entry; however, there was no group by time effect on lean mass gains over the study. Increasing HMF protein content to 1.8 g per 100 mL EBM does not improve growth in preterm infants born 28–32 weeks’ gestation.
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Affiliation(s)
- Jessica Reid
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, SA 5006, Australia.
| | - Maria Makrides
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, SA 5006, Australia.
- Adelaide Medical School, Discipline of Paediatrics, The University of Adelaide, Adelaide, SA 5006, Australia.
| | - Andrew J McPhee
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, SA 5006, Australia.
- Neonatal Medicine, Women's and Children's Hospital, Adelaide, SA 5006, Australia.
| | - Michael J Stark
- Neonatal Medicine, Women's and Children's Hospital, Adelaide, SA 5006, Australia.
- The Robinson Research Institute, The University of Adelaide, Adelaide, SA 5006, Australia.
| | - Jacqueline Miller
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, SA 5006, Australia.
- Nutrition and Dietetics, Flinders University, Adelaide, SA 5006, Australia.
| | - Carmel T Collins
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, SA 5006, Australia.
- Adelaide Medical School, Discipline of Paediatrics, The University of Adelaide, Adelaide, SA 5006, Australia.
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33
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Crowther CA, Ashwood P, McPhee AJ, Flenady V, Tran T, Dodd JM, Robinson JS. Vaginal progesterone pessaries for pregnant women with a previous preterm birth to prevent neonatal respiratory distress syndrome (the PROGRESS Study): A multicentre, randomised, placebo-controlled trial. PLoS Med 2017; 14:e1002390. [PMID: 28949973 PMCID: PMC5614421 DOI: 10.1371/journal.pmed.1002390] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 08/17/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Neonatal respiratory distress syndrome, as a consequence of preterm birth, is a major cause of early mortality and morbidity. The withdrawal of progesterone, either actual or functional, is thought to be an antecedent to the onset of labour. There remains limited information on clinically relevant health outcomes as to whether vaginal progesterone may be of benefit for pregnant women with a history of a previous preterm birth, who are at high risk of a recurrence. Our primary aim was to assess whether the use of vaginal progesterone pessaries in women with a history of previous spontaneous preterm birth reduced the risk and severity of respiratory distress syndrome in their infants, with secondary aims of examining the effects on other neonatal morbidities and maternal health and assessing the adverse effects of treatment. METHODS Women with a live singleton or twin pregnancy between 18 to <24 weeks' gestation and a history of prior preterm birth at less than 37 weeks' gestation in the preceding pregnancy, where labour occurred spontaneously or in association with cervical incompetence or following preterm prelabour rupture of the membranes, were eligible. Women were recruited from 39 Australian, New Zealand, and Canadian maternity hospitals and assigned by randomisation to vaginal progesterone pessaries (equivalent to 100 mg vaginal progesterone) (n = 398) or placebo (n = 389). Participants and investigators were masked to the treatment allocation. The primary outcome was respiratory distress syndrome and severity. Secondary outcomes were other respiratory morbidities; other adverse neonatal outcomes; adverse outcomes for the woman, especially related to preterm birth; and side effects of progesterone treatment. Data were analysed for all the 787 women (100%) randomised and their 799 infants. FINDINGS Most women used their allocated study treatment (740 women, 94.0%), with median use similar for both study groups (51.0 days, interquartile range [IQR] 28.0-69.0, in the progesterone group versus 52.0 days, IQR 27.0-76.0, in the placebo group). The incidence of respiratory distress syndrome was similar in both study groups-10.5% (42/402) in the progesterone group and 10.6% (41/388) in the placebo group (adjusted relative risk [RR] 0.98, 95% confidence interval [CI] 0.64-1.49, p = 0.912)-as was the severity of any neonatal respiratory disease (adjusted treatment effect 1.02, 95% CI 0.69-1.53, p = 0.905). No differences were seen between study groups for other respiratory morbidities and adverse infant outcomes, including serious infant composite outcome (155/406 [38.2%] in the progesterone group and 152/393 [38.7%] in the placebo group, adjusted RR 0.98, 95% CI 0.82-1.17, p = 0.798). The proportion of infants born before 37 weeks' gestation was similar in both study groups (148/406 [36.5%] in the progesterone group and 146/393 [37.2%] in the placebo group, adjusted RR 0.97, 95% CI 0.81-1.17, p = 0.765). A similar proportion of women in both study groups had maternal morbidities, especially those related to preterm birth, or experienced side effects of treatment. In 9.9% (39/394) of the women in the progesterone group and 7.3% (28/382) of the women in the placebo group, treatment was stopped because of side effects (adjusted RR 1.35, 95% CI 0.85-2.15, p = 0.204). The main limitation of the study was that almost 9% of the women did not start the medication or forgot to use it 3 or more times a week. CONCLUSIONS Our results do not support the use of vaginal progesterone pessaries in women with a history of a previous spontaneous preterm birth to reduce the risk of neonatal respiratory distress syndrome or other neonatal and maternal morbidities related to preterm birth. Individual participant data meta-analysis of the relevant trials may identify specific women for whom vaginal progesterone might be of benefit. TRIAL REGISTRATION Current Clinical Trials ISRCTN20269066.
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Affiliation(s)
- Caroline A. Crowther
- Liggins Institute, University of Auckland, Auckland, New Zealand
- School of Medicine, The University of Adelaide, Adelaide, Australia
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Pat Ashwood
- School of Medicine, The University of Adelaide, Adelaide, Australia
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Andrew J. McPhee
- School of Medicine, The University of Adelaide, Adelaide, Australia
- Department of Neonatal Medicine, Women’s and Children’s Hospital, Adelaide, Australia
| | - Vicki Flenady
- Mater Research Institute, Faculty of Medicine, University of Queensland, Australia
| | - Thach Tran
- School of Medicine, The University of Adelaide, Adelaide, Australia
- Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, Australia
| | - Jodie M. Dodd
- School of Medicine, The University of Adelaide, Adelaide, Australia
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Jeffrey S. Robinson
- School of Medicine, The University of Adelaide, Adelaide, Australia
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
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Tieu J, McPhee AJ, Crowther CA, Middleton P, Shepherd E. Screening for gestational diabetes mellitus based on different risk profiles and settings for improving maternal and infant health. Cochrane Database Syst Rev 2017; 8:CD007222. [PMID: 28771289 PMCID: PMC6483271 DOI: 10.1002/14651858.cd007222.pub4] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a form of diabetes that occurs in pregnancy. Although GDM usually resolves following birth, it is associated with significant morbidities for mothers and their infants in the short and long term. There is strong evidence to support treatment for GDM. However, there is uncertainty as to whether or not screening all pregnant women for GDM will improve maternal and infant health and if so, the most appropriate setting for screening. This review updates a Cochrane Review, first published in 2010, and subsequently updated in 2014. OBJECTIVES To assess the effects of screening for gestational diabetes mellitus based on different risk profiles and settings on maternal and infant outcomes. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register (31 January 2017), ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (14 June 2017), and reference lists of retrieved studies. SELECTION CRITERIA We included randomised and quasi-randomised trials evaluating the effects of different protocols, guidelines or programmes for screening for GDM based on different risk profiles and settings, compared with the absence of screening, or compared with other protocols, guidelines or programmes for screening. We planned to include trials published as abstracts only and cluster-randomised trials, but we did not identify any. Cross-over trials are not eligible for inclusion in this review. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study eligibility, extracted data and assessed the risk of bias of the included trials. We resolved disagreements through discussion or through consulting a third reviewer. MAIN RESULTS We included two trials that randomised 4523 women and their infants. Both trials were conducted in Ireland. One trial (which quasi-randomised 3742 women, and analysed 3152 women) compared universal screening versus risk factor-based screening, and one trial (which randomised 781 women, and analysed 690 women) compared primary care screening versus secondary care screening. We were not able to perform meta-analyses due to the different interventions and comparisons assessed.Overall, there was moderate to high risk of bias due to one trial being quasi-randomised, inadequate blinding, and incomplete outcome data in both trials. We used GRADEpro GDT software to assess the quality of the evidence for selected outcomes for the mother and her child. Evidence was downgraded for study design limitations and imprecision of effect estimates. Universal screening versus risk-factor screening (one trial) MotherMore women were diagnosed with GDM in the universal screening group than in the risk-factor screening group (risk ratio (RR) 1.85, 95% confidence interval (CI) 1.12 to 3.04; participants = 3152; low-quality evidence). There were no data reported under this comparison for other maternal outcomes including hypertensive disorders of pregnancy, caesarean birth, perineal trauma, gestational weight gain, postnatal depression, and type 2 diabetes. ChildNeonatal outcomes: large-for-gestational age, perinatal mortality, mortality or morbidity composite, hypoglycaemia; and childhood/adulthood outcomes: adiposity, type 2 diabetes, and neurosensory disability, were not reported under this comparison. Primary care screening versus secondary care screening (one trial) MotherThere was no clear difference between the primary care and secondary care screening groups for GDM (RR 0.91, 95% CI 0.50 to 1.66; participants = 690; low-quality evidence), hypertension (RR 1.41, 95% CI 0.77 to 2.59; participants = 690; low-quality evidence), pre-eclampsia (RR 0.80, 95% CI 0.36 to 1.78; participants = 690;low-quality evidence), or caesarean section birth (RR 1.00, 95% CI 0.80 to 1.27; participants = 690; low-quality evidence). There were no data reported for perineal trauma, gestational weight gain, postnatal depression, or type 2 diabetes. ChildThere was no clear difference between the primary care and secondary care screening groups for large-for-gestational age (RR 1.37, 95% CI 0.96 to 1.96; participants = 690; low-quality evidence), neonatal complications: composite outcome, including: hypoglycaemia, respiratory distress, need for phototherapy, birth trauma, shoulder dystocia, five minute Apgar less than seven at one or five minutes, prematurity (RR 0.99, 95% CI 0.57 to 1.71; participants = 690; low-quality evidence), or neonatal hypoglycaemia (RR 1.10, 95% CI 0.28 to 4.38; participants = 690; very low-quality evidence). There was one perinatal death in the primary care screening group and two in the secondary care screening group (RR 1.10, 95% CI 0.10 to 12.12; participants = 690; very low-quality evidence). There were no data for neurosensory disability, or childhood/adulthood adiposity or type 2 diabetes. AUTHORS' CONCLUSIONS There are insufficient randomised controlled trial data evaluating the effects of screening for GDM based on different risk profiles and settings on maternal and infant outcomes. Low-quality evidence suggests universal screening compared with risk factor-based screening leads to more women being diagnosed with GDM. Low to very low-quality evidence suggests no clear differences between primary care and secondary care screening, for outcomes: GDM, hypertension, pre-eclampsia, caesarean birth, large-for-gestational age, neonatal complications composite, and hypoglycaemia.Further, high-quality randomised controlled trials are needed to assess the value of screening for GDM, which may compare different protocols, guidelines or programmes for screening (based on different risk profiles and settings), with the absence of screening, or with other protocols, guidelines or programmes. There is a need for future trials to be sufficiently powered to detect important differences in short- and long-term maternal and infant outcomes, such as those important outcomes pre-specified in this review. As only a proportion of women will be diagnosed with GDM in these trials, large sample sizes may be required.
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Affiliation(s)
- Joanna Tieu
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and GynaecologyWomen's and Children's Hospital, 1st floor, Queen Victoria Building72 King William RoadAdelaideSouth AustraliaAustralia5006
| | - Andrew J McPhee
- Women's and Children's HospitalNeonatal Medicine72 King William RoadNorth AdelaideSouth AustraliaAustralia5006
| | - Caroline A Crowther
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and GynaecologyWomen's and Children's Hospital, 1st floor, Queen Victoria Building72 King William RoadAdelaideSouth AustraliaAustralia5006
- The University of AucklandLiggins InstitutePrivate Bag 9201985 Park RoadAucklandNew Zealand
| | - Philippa Middleton
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research InstituteWomen's and Children's Hospital72 King William RoadAdelaideSouth AustraliaAustralia5006
| | - Emily Shepherd
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and GynaecologyWomen's and Children's Hospital, 1st floor, Queen Victoria Building72 King William RoadAdelaideSouth AustraliaAustralia5006
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35
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Collins CT, Makrides M, McPhee AJ, Sullivan TR, Davis PG, Thio M, Simmer K, Rajadurai VS, Travadi J, Berry MJ, Liley HG, Opie GF, Tan K, Lui K, Morris SA, Stack J, Stark MJ, Chua MC, Jayagobi PA, Holberton J, Bolisetty S, Callander IR, Harris DL, Gibson RA. Docosahexaenoic Acid and Bronchopulmonary Dysplasia in Preterm Infants. N Engl J Med 2017; 376:1245-1255. [PMID: 28355511 DOI: 10.1056/nejmoa1611942] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Studies in animals and in humans have suggested that docosahexaenoic acid (DHA), an n-3 long-chain polyunsaturated fatty acid, might reduce the risk of bronchopulmonary dysplasia, but appropriately designed trials are lacking. METHODS We randomly assigned 1273 infants born before 29 weeks of gestation (stratified according to sex, gestational age [<27 weeks or 27 to <29 weeks], and center) within 3 days after their first enteral feeding to receive either an enteral emulsion providing DHA at a dose of 60 mg per kilogram of body weight per day or a control (soy) emulsion without DHA until 36 weeks of postmenstrual age. The primary outcome was bronchopulmonary dysplasia, defined on a physiological basis (with the use of oxygen-saturation monitoring in selected infants), at 36 weeks of postmenstrual age or discharge home, whichever occurred first. RESULTS A total of 1205 infants survived to the primary outcome assessment. Of the 592 infants assigned to the DHA group, 291 (49.1% by multiple imputation) were classified as having physiological bronchopulmonary dysplasia, as compared with 269 (43.9%) of the 613 infants assigned to the control group (relative risk adjusted for randomization strata, 1.13; 95% confidence interval [CI], 1.02 to 1.25; P=0.02). The composite outcome of physiological bronchopulmonary dysplasia or death before 36 weeks of postmenstrual age occurred in 52.3% of the infants in the DHA group and in 46.4% of the infants in the control group (adjusted relative risk, 1.11; 95% CI, 1.00 to 1.23; P=0.045). There were no significant differences between the two groups in the rates of death or any other neonatal illnesses. Bronchopulmonary dysplasia based on a clinical definition occurred in 53.2% of the infants in the DHA group and in 49.7% of the infants in the control group (P=0.06). CONCLUSIONS Enteral DHA supplementation at a dose of 60 mg per kilogram per day did not result in a lower risk of physiological bronchopulmonary dysplasia than a control emulsion among preterm infants born before 29 weeks of gestation and may have resulted in a greater risk. (Funded by the Australian National Health and Medical Research Council and others; Australian New Zealand Clinical Trials Registry number, ACTRN12612000503820 .).
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Affiliation(s)
- Carmel T Collins
- From Healthy Mothers, Babies, and Children, South Australian Health and Medical Research Institute (C.T.C., M.M., A.J.M., R.A.G.), the Schools of Medicine (C.T.C., M.M., A.J.M., M.J.S.), Public Health (T.R.S.), and Agriculture, Food, and Wine (R.A.G.) and the Robinson Research Institute (M.J.S.), University of Adelaide, the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M., M.J.S.), and the School of Medicine (S.A.M.), Flinders University, Adelaide, SA, the Newborn Research Centre, Royal Women's Hospital (P.G.D., M.T.), University of Melbourne (P.G.D., M.T.), Murdoch Children's Research Institute (M.T.), the Department of Paediatrics, Mercy Hospital for Women (G.F.O., J.H.), the Department of Paediatrics, Monash University and Monash Newborn, Monash Children's Hospital (K.T.), Melbourne, VIC, the Clinical Trials Centre, University of Sydney (K.S.), School of Women's and Children's Health, University of New South Wales (K.L., J.S.), and Newborn Care, Royal Hospital for Women (S.B.), Sydney, the Neonatal Intensive Care Unit, John Hunter Children's Hospital and School of Medicine and Public Health, University of Newcastle, Newcastle, NSW (J.T.), the Neonatal Intensive Care Unit, Liverpool Hospital, Liverpool, NSW (J.S., I.R.C.), the Department of Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth (K.S.), and Newborn Services, Mater Misericordiae, and Mater Research Institute, University of Queensland, Brisbane (H.G.L.) - all in Australia; the Department of Paediatrics and Child Health, University of Otago, Wellington (M.J.B.), the Newborn Intensive Care Unit, Waikato Hospital, Hamilton (D.L.H.), and Liggins Institute, University of Auckland, Auckland (D.L.H.) - all in New Zealand; and the Department of Neonatology, KK Women's and Children's Hospital (V.S.R., M.-C.C., P.A.J.), Yong Loo Lin School of Medicine, National University of Singapore (V.S.R., M.-C.C.), and Duke-National University of Singapore Medical School (V.S.R., M.-C.C.) - all in Singapore
| | - Maria Makrides
- From Healthy Mothers, Babies, and Children, South Australian Health and Medical Research Institute (C.T.C., M.M., A.J.M., R.A.G.), the Schools of Medicine (C.T.C., M.M., A.J.M., M.J.S.), Public Health (T.R.S.), and Agriculture, Food, and Wine (R.A.G.) and the Robinson Research Institute (M.J.S.), University of Adelaide, the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M., M.J.S.), and the School of Medicine (S.A.M.), Flinders University, Adelaide, SA, the Newborn Research Centre, Royal Women's Hospital (P.G.D., M.T.), University of Melbourne (P.G.D., M.T.), Murdoch Children's Research Institute (M.T.), the Department of Paediatrics, Mercy Hospital for Women (G.F.O., J.H.), the Department of Paediatrics, Monash University and Monash Newborn, Monash Children's Hospital (K.T.), Melbourne, VIC, the Clinical Trials Centre, University of Sydney (K.S.), School of Women's and Children's Health, University of New South Wales (K.L., J.S.), and Newborn Care, Royal Hospital for Women (S.B.), Sydney, the Neonatal Intensive Care Unit, John Hunter Children's Hospital and School of Medicine and Public Health, University of Newcastle, Newcastle, NSW (J.T.), the Neonatal Intensive Care Unit, Liverpool Hospital, Liverpool, NSW (J.S., I.R.C.), the Department of Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth (K.S.), and Newborn Services, Mater Misericordiae, and Mater Research Institute, University of Queensland, Brisbane (H.G.L.) - all in Australia; the Department of Paediatrics and Child Health, University of Otago, Wellington (M.J.B.), the Newborn Intensive Care Unit, Waikato Hospital, Hamilton (D.L.H.), and Liggins Institute, University of Auckland, Auckland (D.L.H.) - all in New Zealand; and the Department of Neonatology, KK Women's and Children's Hospital (V.S.R., M.-C.C., P.A.J.), Yong Loo Lin School of Medicine, National University of Singapore (V.S.R., M.-C.C.), and Duke-National University of Singapore Medical School (V.S.R., M.-C.C.) - all in Singapore
| | - Andrew J McPhee
- From Healthy Mothers, Babies, and Children, South Australian Health and Medical Research Institute (C.T.C., M.M., A.J.M., R.A.G.), the Schools of Medicine (C.T.C., M.M., A.J.M., M.J.S.), Public Health (T.R.S.), and Agriculture, Food, and Wine (R.A.G.) and the Robinson Research Institute (M.J.S.), University of Adelaide, the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M., M.J.S.), and the School of Medicine (S.A.M.), Flinders University, Adelaide, SA, the Newborn Research Centre, Royal Women's Hospital (P.G.D., M.T.), University of Melbourne (P.G.D., M.T.), Murdoch Children's Research Institute (M.T.), the Department of Paediatrics, Mercy Hospital for Women (G.F.O., J.H.), the Department of Paediatrics, Monash University and Monash Newborn, Monash Children's Hospital (K.T.), Melbourne, VIC, the Clinical Trials Centre, University of Sydney (K.S.), School of Women's and Children's Health, University of New South Wales (K.L., J.S.), and Newborn Care, Royal Hospital for Women (S.B.), Sydney, the Neonatal Intensive Care Unit, John Hunter Children's Hospital and School of Medicine and Public Health, University of Newcastle, Newcastle, NSW (J.T.), the Neonatal Intensive Care Unit, Liverpool Hospital, Liverpool, NSW (J.S., I.R.C.), the Department of Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth (K.S.), and Newborn Services, Mater Misericordiae, and Mater Research Institute, University of Queensland, Brisbane (H.G.L.) - all in Australia; the Department of Paediatrics and Child Health, University of Otago, Wellington (M.J.B.), the Newborn Intensive Care Unit, Waikato Hospital, Hamilton (D.L.H.), and Liggins Institute, University of Auckland, Auckland (D.L.H.) - all in New Zealand; and the Department of Neonatology, KK Women's and Children's Hospital (V.S.R., M.-C.C., P.A.J.), Yong Loo Lin School of Medicine, National University of Singapore (V.S.R., M.-C.C.), and Duke-National University of Singapore Medical School (V.S.R., M.-C.C.) - all in Singapore
| | - Thomas R Sullivan
- From Healthy Mothers, Babies, and Children, South Australian Health and Medical Research Institute (C.T.C., M.M., A.J.M., R.A.G.), the Schools of Medicine (C.T.C., M.M., A.J.M., M.J.S.), Public Health (T.R.S.), and Agriculture, Food, and Wine (R.A.G.) and the Robinson Research Institute (M.J.S.), University of Adelaide, the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M., M.J.S.), and the School of Medicine (S.A.M.), Flinders University, Adelaide, SA, the Newborn Research Centre, Royal Women's Hospital (P.G.D., M.T.), University of Melbourne (P.G.D., M.T.), Murdoch Children's Research Institute (M.T.), the Department of Paediatrics, Mercy Hospital for Women (G.F.O., J.H.), the Department of Paediatrics, Monash University and Monash Newborn, Monash Children's Hospital (K.T.), Melbourne, VIC, the Clinical Trials Centre, University of Sydney (K.S.), School of Women's and Children's Health, University of New South Wales (K.L., J.S.), and Newborn Care, Royal Hospital for Women (S.B.), Sydney, the Neonatal Intensive Care Unit, John Hunter Children's Hospital and School of Medicine and Public Health, University of Newcastle, Newcastle, NSW (J.T.), the Neonatal Intensive Care Unit, Liverpool Hospital, Liverpool, NSW (J.S., I.R.C.), the Department of Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth (K.S.), and Newborn Services, Mater Misericordiae, and Mater Research Institute, University of Queensland, Brisbane (H.G.L.) - all in Australia; the Department of Paediatrics and Child Health, University of Otago, Wellington (M.J.B.), the Newborn Intensive Care Unit, Waikato Hospital, Hamilton (D.L.H.), and Liggins Institute, University of Auckland, Auckland (D.L.H.) - all in New Zealand; and the Department of Neonatology, KK Women's and Children's Hospital (V.S.R., M.-C.C., P.A.J.), Yong Loo Lin School of Medicine, National University of Singapore (V.S.R., M.-C.C.), and Duke-National University of Singapore Medical School (V.S.R., M.-C.C.) - all in Singapore
| | - Peter G Davis
- From Healthy Mothers, Babies, and Children, South Australian Health and Medical Research Institute (C.T.C., M.M., A.J.M., R.A.G.), the Schools of Medicine (C.T.C., M.M., A.J.M., M.J.S.), Public Health (T.R.S.), and Agriculture, Food, and Wine (R.A.G.) and the Robinson Research Institute (M.J.S.), University of Adelaide, the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M., M.J.S.), and the School of Medicine (S.A.M.), Flinders University, Adelaide, SA, the Newborn Research Centre, Royal Women's Hospital (P.G.D., M.T.), University of Melbourne (P.G.D., M.T.), Murdoch Children's Research Institute (M.T.), the Department of Paediatrics, Mercy Hospital for Women (G.F.O., J.H.), the Department of Paediatrics, Monash University and Monash Newborn, Monash Children's Hospital (K.T.), Melbourne, VIC, the Clinical Trials Centre, University of Sydney (K.S.), School of Women's and Children's Health, University of New South Wales (K.L., J.S.), and Newborn Care, Royal Hospital for Women (S.B.), Sydney, the Neonatal Intensive Care Unit, John Hunter Children's Hospital and School of Medicine and Public Health, University of Newcastle, Newcastle, NSW (J.T.), the Neonatal Intensive Care Unit, Liverpool Hospital, Liverpool, NSW (J.S., I.R.C.), the Department of Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth (K.S.), and Newborn Services, Mater Misericordiae, and Mater Research Institute, University of Queensland, Brisbane (H.G.L.) - all in Australia; the Department of Paediatrics and Child Health, University of Otago, Wellington (M.J.B.), the Newborn Intensive Care Unit, Waikato Hospital, Hamilton (D.L.H.), and Liggins Institute, University of Auckland, Auckland (D.L.H.) - all in New Zealand; and the Department of Neonatology, KK Women's and Children's Hospital (V.S.R., M.-C.C., P.A.J.), Yong Loo Lin School of Medicine, National University of Singapore (V.S.R., M.-C.C.), and Duke-National University of Singapore Medical School (V.S.R., M.-C.C.) - all in Singapore
| | - Marta Thio
- From Healthy Mothers, Babies, and Children, South Australian Health and Medical Research Institute (C.T.C., M.M., A.J.M., R.A.G.), the Schools of Medicine (C.T.C., M.M., A.J.M., M.J.S.), Public Health (T.R.S.), and Agriculture, Food, and Wine (R.A.G.) and the Robinson Research Institute (M.J.S.), University of Adelaide, the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M., M.J.S.), and the School of Medicine (S.A.M.), Flinders University, Adelaide, SA, the Newborn Research Centre, Royal Women's Hospital (P.G.D., M.T.), University of Melbourne (P.G.D., M.T.), Murdoch Children's Research Institute (M.T.), the Department of Paediatrics, Mercy Hospital for Women (G.F.O., J.H.), the Department of Paediatrics, Monash University and Monash Newborn, Monash Children's Hospital (K.T.), Melbourne, VIC, the Clinical Trials Centre, University of Sydney (K.S.), School of Women's and Children's Health, University of New South Wales (K.L., J.S.), and Newborn Care, Royal Hospital for Women (S.B.), Sydney, the Neonatal Intensive Care Unit, John Hunter Children's Hospital and School of Medicine and Public Health, University of Newcastle, Newcastle, NSW (J.T.), the Neonatal Intensive Care Unit, Liverpool Hospital, Liverpool, NSW (J.S., I.R.C.), the Department of Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth (K.S.), and Newborn Services, Mater Misericordiae, and Mater Research Institute, University of Queensland, Brisbane (H.G.L.) - all in Australia; the Department of Paediatrics and Child Health, University of Otago, Wellington (M.J.B.), the Newborn Intensive Care Unit, Waikato Hospital, Hamilton (D.L.H.), and Liggins Institute, University of Auckland, Auckland (D.L.H.) - all in New Zealand; and the Department of Neonatology, KK Women's and Children's Hospital (V.S.R., M.-C.C., P.A.J.), Yong Loo Lin School of Medicine, National University of Singapore (V.S.R., M.-C.C.), and Duke-National University of Singapore Medical School (V.S.R., M.-C.C.) - all in Singapore
| | - Karen Simmer
- From Healthy Mothers, Babies, and Children, South Australian Health and Medical Research Institute (C.T.C., M.M., A.J.M., R.A.G.), the Schools of Medicine (C.T.C., M.M., A.J.M., M.J.S.), Public Health (T.R.S.), and Agriculture, Food, and Wine (R.A.G.) and the Robinson Research Institute (M.J.S.), University of Adelaide, the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M., M.J.S.), and the School of Medicine (S.A.M.), Flinders University, Adelaide, SA, the Newborn Research Centre, Royal Women's Hospital (P.G.D., M.T.), University of Melbourne (P.G.D., M.T.), Murdoch Children's Research Institute (M.T.), the Department of Paediatrics, Mercy Hospital for Women (G.F.O., J.H.), the Department of Paediatrics, Monash University and Monash Newborn, Monash Children's Hospital (K.T.), Melbourne, VIC, the Clinical Trials Centre, University of Sydney (K.S.), School of Women's and Children's Health, University of New South Wales (K.L., J.S.), and Newborn Care, Royal Hospital for Women (S.B.), Sydney, the Neonatal Intensive Care Unit, John Hunter Children's Hospital and School of Medicine and Public Health, University of Newcastle, Newcastle, NSW (J.T.), the Neonatal Intensive Care Unit, Liverpool Hospital, Liverpool, NSW (J.S., I.R.C.), the Department of Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth (K.S.), and Newborn Services, Mater Misericordiae, and Mater Research Institute, University of Queensland, Brisbane (H.G.L.) - all in Australia; the Department of Paediatrics and Child Health, University of Otago, Wellington (M.J.B.), the Newborn Intensive Care Unit, Waikato Hospital, Hamilton (D.L.H.), and Liggins Institute, University of Auckland, Auckland (D.L.H.) - all in New Zealand; and the Department of Neonatology, KK Women's and Children's Hospital (V.S.R., M.-C.C., P.A.J.), Yong Loo Lin School of Medicine, National University of Singapore (V.S.R., M.-C.C.), and Duke-National University of Singapore Medical School (V.S.R., M.-C.C.) - all in Singapore
| | - Victor S Rajadurai
- From Healthy Mothers, Babies, and Children, South Australian Health and Medical Research Institute (C.T.C., M.M., A.J.M., R.A.G.), the Schools of Medicine (C.T.C., M.M., A.J.M., M.J.S.), Public Health (T.R.S.), and Agriculture, Food, and Wine (R.A.G.) and the Robinson Research Institute (M.J.S.), University of Adelaide, the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M., M.J.S.), and the School of Medicine (S.A.M.), Flinders University, Adelaide, SA, the Newborn Research Centre, Royal Women's Hospital (P.G.D., M.T.), University of Melbourne (P.G.D., M.T.), Murdoch Children's Research Institute (M.T.), the Department of Paediatrics, Mercy Hospital for Women (G.F.O., J.H.), the Department of Paediatrics, Monash University and Monash Newborn, Monash Children's Hospital (K.T.), Melbourne, VIC, the Clinical Trials Centre, University of Sydney (K.S.), School of Women's and Children's Health, University of New South Wales (K.L., J.S.), and Newborn Care, Royal Hospital for Women (S.B.), Sydney, the Neonatal Intensive Care Unit, John Hunter Children's Hospital and School of Medicine and Public Health, University of Newcastle, Newcastle, NSW (J.T.), the Neonatal Intensive Care Unit, Liverpool Hospital, Liverpool, NSW (J.S., I.R.C.), the Department of Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth (K.S.), and Newborn Services, Mater Misericordiae, and Mater Research Institute, University of Queensland, Brisbane (H.G.L.) - all in Australia; the Department of Paediatrics and Child Health, University of Otago, Wellington (M.J.B.), the Newborn Intensive Care Unit, Waikato Hospital, Hamilton (D.L.H.), and Liggins Institute, University of Auckland, Auckland (D.L.H.) - all in New Zealand; and the Department of Neonatology, KK Women's and Children's Hospital (V.S.R., M.-C.C., P.A.J.), Yong Loo Lin School of Medicine, National University of Singapore (V.S.R., M.-C.C.), and Duke-National University of Singapore Medical School (V.S.R., M.-C.C.) - all in Singapore
| | - Javeed Travadi
- From Healthy Mothers, Babies, and Children, South Australian Health and Medical Research Institute (C.T.C., M.M., A.J.M., R.A.G.), the Schools of Medicine (C.T.C., M.M., A.J.M., M.J.S.), Public Health (T.R.S.), and Agriculture, Food, and Wine (R.A.G.) and the Robinson Research Institute (M.J.S.), University of Adelaide, the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M., M.J.S.), and the School of Medicine (S.A.M.), Flinders University, Adelaide, SA, the Newborn Research Centre, Royal Women's Hospital (P.G.D., M.T.), University of Melbourne (P.G.D., M.T.), Murdoch Children's Research Institute (M.T.), the Department of Paediatrics, Mercy Hospital for Women (G.F.O., J.H.), the Department of Paediatrics, Monash University and Monash Newborn, Monash Children's Hospital (K.T.), Melbourne, VIC, the Clinical Trials Centre, University of Sydney (K.S.), School of Women's and Children's Health, University of New South Wales (K.L., J.S.), and Newborn Care, Royal Hospital for Women (S.B.), Sydney, the Neonatal Intensive Care Unit, John Hunter Children's Hospital and School of Medicine and Public Health, University of Newcastle, Newcastle, NSW (J.T.), the Neonatal Intensive Care Unit, Liverpool Hospital, Liverpool, NSW (J.S., I.R.C.), the Department of Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth (K.S.), and Newborn Services, Mater Misericordiae, and Mater Research Institute, University of Queensland, Brisbane (H.G.L.) - all in Australia; the Department of Paediatrics and Child Health, University of Otago, Wellington (M.J.B.), the Newborn Intensive Care Unit, Waikato Hospital, Hamilton (D.L.H.), and Liggins Institute, University of Auckland, Auckland (D.L.H.) - all in New Zealand; and the Department of Neonatology, KK Women's and Children's Hospital (V.S.R., M.-C.C., P.A.J.), Yong Loo Lin School of Medicine, National University of Singapore (V.S.R., M.-C.C.), and Duke-National University of Singapore Medical School (V.S.R., M.-C.C.) - all in Singapore
| | - Mary J Berry
- From Healthy Mothers, Babies, and Children, South Australian Health and Medical Research Institute (C.T.C., M.M., A.J.M., R.A.G.), the Schools of Medicine (C.T.C., M.M., A.J.M., M.J.S.), Public Health (T.R.S.), and Agriculture, Food, and Wine (R.A.G.) and the Robinson Research Institute (M.J.S.), University of Adelaide, the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M., M.J.S.), and the School of Medicine (S.A.M.), Flinders University, Adelaide, SA, the Newborn Research Centre, Royal Women's Hospital (P.G.D., M.T.), University of Melbourne (P.G.D., M.T.), Murdoch Children's Research Institute (M.T.), the Department of Paediatrics, Mercy Hospital for Women (G.F.O., J.H.), the Department of Paediatrics, Monash University and Monash Newborn, Monash Children's Hospital (K.T.), Melbourne, VIC, the Clinical Trials Centre, University of Sydney (K.S.), School of Women's and Children's Health, University of New South Wales (K.L., J.S.), and Newborn Care, Royal Hospital for Women (S.B.), Sydney, the Neonatal Intensive Care Unit, John Hunter Children's Hospital and School of Medicine and Public Health, University of Newcastle, Newcastle, NSW (J.T.), the Neonatal Intensive Care Unit, Liverpool Hospital, Liverpool, NSW (J.S., I.R.C.), the Department of Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth (K.S.), and Newborn Services, Mater Misericordiae, and Mater Research Institute, University of Queensland, Brisbane (H.G.L.) - all in Australia; the Department of Paediatrics and Child Health, University of Otago, Wellington (M.J.B.), the Newborn Intensive Care Unit, Waikato Hospital, Hamilton (D.L.H.), and Liggins Institute, University of Auckland, Auckland (D.L.H.) - all in New Zealand; and the Department of Neonatology, KK Women's and Children's Hospital (V.S.R., M.-C.C., P.A.J.), Yong Loo Lin School of Medicine, National University of Singapore (V.S.R., M.-C.C.), and Duke-National University of Singapore Medical School (V.S.R., M.-C.C.) - all in Singapore
| | - Helen G Liley
- From Healthy Mothers, Babies, and Children, South Australian Health and Medical Research Institute (C.T.C., M.M., A.J.M., R.A.G.), the Schools of Medicine (C.T.C., M.M., A.J.M., M.J.S.), Public Health (T.R.S.), and Agriculture, Food, and Wine (R.A.G.) and the Robinson Research Institute (M.J.S.), University of Adelaide, the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M., M.J.S.), and the School of Medicine (S.A.M.), Flinders University, Adelaide, SA, the Newborn Research Centre, Royal Women's Hospital (P.G.D., M.T.), University of Melbourne (P.G.D., M.T.), Murdoch Children's Research Institute (M.T.), the Department of Paediatrics, Mercy Hospital for Women (G.F.O., J.H.), the Department of Paediatrics, Monash University and Monash Newborn, Monash Children's Hospital (K.T.), Melbourne, VIC, the Clinical Trials Centre, University of Sydney (K.S.), School of Women's and Children's Health, University of New South Wales (K.L., J.S.), and Newborn Care, Royal Hospital for Women (S.B.), Sydney, the Neonatal Intensive Care Unit, John Hunter Children's Hospital and School of Medicine and Public Health, University of Newcastle, Newcastle, NSW (J.T.), the Neonatal Intensive Care Unit, Liverpool Hospital, Liverpool, NSW (J.S., I.R.C.), the Department of Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth (K.S.), and Newborn Services, Mater Misericordiae, and Mater Research Institute, University of Queensland, Brisbane (H.G.L.) - all in Australia; the Department of Paediatrics and Child Health, University of Otago, Wellington (M.J.B.), the Newborn Intensive Care Unit, Waikato Hospital, Hamilton (D.L.H.), and Liggins Institute, University of Auckland, Auckland (D.L.H.) - all in New Zealand; and the Department of Neonatology, KK Women's and Children's Hospital (V.S.R., M.-C.C., P.A.J.), Yong Loo Lin School of Medicine, National University of Singapore (V.S.R., M.-C.C.), and Duke-National University of Singapore Medical School (V.S.R., M.-C.C.) - all in Singapore
| | - Gillian F Opie
- From Healthy Mothers, Babies, and Children, South Australian Health and Medical Research Institute (C.T.C., M.M., A.J.M., R.A.G.), the Schools of Medicine (C.T.C., M.M., A.J.M., M.J.S.), Public Health (T.R.S.), and Agriculture, Food, and Wine (R.A.G.) and the Robinson Research Institute (M.J.S.), University of Adelaide, the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M., M.J.S.), and the School of Medicine (S.A.M.), Flinders University, Adelaide, SA, the Newborn Research Centre, Royal Women's Hospital (P.G.D., M.T.), University of Melbourne (P.G.D., M.T.), Murdoch Children's Research Institute (M.T.), the Department of Paediatrics, Mercy Hospital for Women (G.F.O., J.H.), the Department of Paediatrics, Monash University and Monash Newborn, Monash Children's Hospital (K.T.), Melbourne, VIC, the Clinical Trials Centre, University of Sydney (K.S.), School of Women's and Children's Health, University of New South Wales (K.L., J.S.), and Newborn Care, Royal Hospital for Women (S.B.), Sydney, the Neonatal Intensive Care Unit, John Hunter Children's Hospital and School of Medicine and Public Health, University of Newcastle, Newcastle, NSW (J.T.), the Neonatal Intensive Care Unit, Liverpool Hospital, Liverpool, NSW (J.S., I.R.C.), the Department of Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth (K.S.), and Newborn Services, Mater Misericordiae, and Mater Research Institute, University of Queensland, Brisbane (H.G.L.) - all in Australia; the Department of Paediatrics and Child Health, University of Otago, Wellington (M.J.B.), the Newborn Intensive Care Unit, Waikato Hospital, Hamilton (D.L.H.), and Liggins Institute, University of Auckland, Auckland (D.L.H.) - all in New Zealand; and the Department of Neonatology, KK Women's and Children's Hospital (V.S.R., M.-C.C., P.A.J.), Yong Loo Lin School of Medicine, National University of Singapore (V.S.R., M.-C.C.), and Duke-National University of Singapore Medical School (V.S.R., M.-C.C.) - all in Singapore
| | - Kenneth Tan
- From Healthy Mothers, Babies, and Children, South Australian Health and Medical Research Institute (C.T.C., M.M., A.J.M., R.A.G.), the Schools of Medicine (C.T.C., M.M., A.J.M., M.J.S.), Public Health (T.R.S.), and Agriculture, Food, and Wine (R.A.G.) and the Robinson Research Institute (M.J.S.), University of Adelaide, the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M., M.J.S.), and the School of Medicine (S.A.M.), Flinders University, Adelaide, SA, the Newborn Research Centre, Royal Women's Hospital (P.G.D., M.T.), University of Melbourne (P.G.D., M.T.), Murdoch Children's Research Institute (M.T.), the Department of Paediatrics, Mercy Hospital for Women (G.F.O., J.H.), the Department of Paediatrics, Monash University and Monash Newborn, Monash Children's Hospital (K.T.), Melbourne, VIC, the Clinical Trials Centre, University of Sydney (K.S.), School of Women's and Children's Health, University of New South Wales (K.L., J.S.), and Newborn Care, Royal Hospital for Women (S.B.), Sydney, the Neonatal Intensive Care Unit, John Hunter Children's Hospital and School of Medicine and Public Health, University of Newcastle, Newcastle, NSW (J.T.), the Neonatal Intensive Care Unit, Liverpool Hospital, Liverpool, NSW (J.S., I.R.C.), the Department of Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth (K.S.), and Newborn Services, Mater Misericordiae, and Mater Research Institute, University of Queensland, Brisbane (H.G.L.) - all in Australia; the Department of Paediatrics and Child Health, University of Otago, Wellington (M.J.B.), the Newborn Intensive Care Unit, Waikato Hospital, Hamilton (D.L.H.), and Liggins Institute, University of Auckland, Auckland (D.L.H.) - all in New Zealand; and the Department of Neonatology, KK Women's and Children's Hospital (V.S.R., M.-C.C., P.A.J.), Yong Loo Lin School of Medicine, National University of Singapore (V.S.R., M.-C.C.), and Duke-National University of Singapore Medical School (V.S.R., M.-C.C.) - all in Singapore
| | - Kei Lui
- From Healthy Mothers, Babies, and Children, South Australian Health and Medical Research Institute (C.T.C., M.M., A.J.M., R.A.G.), the Schools of Medicine (C.T.C., M.M., A.J.M., M.J.S.), Public Health (T.R.S.), and Agriculture, Food, and Wine (R.A.G.) and the Robinson Research Institute (M.J.S.), University of Adelaide, the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M., M.J.S.), and the School of Medicine (S.A.M.), Flinders University, Adelaide, SA, the Newborn Research Centre, Royal Women's Hospital (P.G.D., M.T.), University of Melbourne (P.G.D., M.T.), Murdoch Children's Research Institute (M.T.), the Department of Paediatrics, Mercy Hospital for Women (G.F.O., J.H.), the Department of Paediatrics, Monash University and Monash Newborn, Monash Children's Hospital (K.T.), Melbourne, VIC, the Clinical Trials Centre, University of Sydney (K.S.), School of Women's and Children's Health, University of New South Wales (K.L., J.S.), and Newborn Care, Royal Hospital for Women (S.B.), Sydney, the Neonatal Intensive Care Unit, John Hunter Children's Hospital and School of Medicine and Public Health, University of Newcastle, Newcastle, NSW (J.T.), the Neonatal Intensive Care Unit, Liverpool Hospital, Liverpool, NSW (J.S., I.R.C.), the Department of Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth (K.S.), and Newborn Services, Mater Misericordiae, and Mater Research Institute, University of Queensland, Brisbane (H.G.L.) - all in Australia; the Department of Paediatrics and Child Health, University of Otago, Wellington (M.J.B.), the Newborn Intensive Care Unit, Waikato Hospital, Hamilton (D.L.H.), and Liggins Institute, University of Auckland, Auckland (D.L.H.) - all in New Zealand; and the Department of Neonatology, KK Women's and Children's Hospital (V.S.R., M.-C.C., P.A.J.), Yong Loo Lin School of Medicine, National University of Singapore (V.S.R., M.-C.C.), and Duke-National University of Singapore Medical School (V.S.R., M.-C.C.) - all in Singapore
| | - Scott A Morris
- From Healthy Mothers, Babies, and Children, South Australian Health and Medical Research Institute (C.T.C., M.M., A.J.M., R.A.G.), the Schools of Medicine (C.T.C., M.M., A.J.M., M.J.S.), Public Health (T.R.S.), and Agriculture, Food, and Wine (R.A.G.) and the Robinson Research Institute (M.J.S.), University of Adelaide, the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M., M.J.S.), and the School of Medicine (S.A.M.), Flinders University, Adelaide, SA, the Newborn Research Centre, Royal Women's Hospital (P.G.D., M.T.), University of Melbourne (P.G.D., M.T.), Murdoch Children's Research Institute (M.T.), the Department of Paediatrics, Mercy Hospital for Women (G.F.O., J.H.), the Department of Paediatrics, Monash University and Monash Newborn, Monash Children's Hospital (K.T.), Melbourne, VIC, the Clinical Trials Centre, University of Sydney (K.S.), School of Women's and Children's Health, University of New South Wales (K.L., J.S.), and Newborn Care, Royal Hospital for Women (S.B.), Sydney, the Neonatal Intensive Care Unit, John Hunter Children's Hospital and School of Medicine and Public Health, University of Newcastle, Newcastle, NSW (J.T.), the Neonatal Intensive Care Unit, Liverpool Hospital, Liverpool, NSW (J.S., I.R.C.), the Department of Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth (K.S.), and Newborn Services, Mater Misericordiae, and Mater Research Institute, University of Queensland, Brisbane (H.G.L.) - all in Australia; the Department of Paediatrics and Child Health, University of Otago, Wellington (M.J.B.), the Newborn Intensive Care Unit, Waikato Hospital, Hamilton (D.L.H.), and Liggins Institute, University of Auckland, Auckland (D.L.H.) - all in New Zealand; and the Department of Neonatology, KK Women's and Children's Hospital (V.S.R., M.-C.C., P.A.J.), Yong Loo Lin School of Medicine, National University of Singapore (V.S.R., M.-C.C.), and Duke-National University of Singapore Medical School (V.S.R., M.-C.C.) - all in Singapore
| | - Jacqueline Stack
- From Healthy Mothers, Babies, and Children, South Australian Health and Medical Research Institute (C.T.C., M.M., A.J.M., R.A.G.), the Schools of Medicine (C.T.C., M.M., A.J.M., M.J.S.), Public Health (T.R.S.), and Agriculture, Food, and Wine (R.A.G.) and the Robinson Research Institute (M.J.S.), University of Adelaide, the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M., M.J.S.), and the School of Medicine (S.A.M.), Flinders University, Adelaide, SA, the Newborn Research Centre, Royal Women's Hospital (P.G.D., M.T.), University of Melbourne (P.G.D., M.T.), Murdoch Children's Research Institute (M.T.), the Department of Paediatrics, Mercy Hospital for Women (G.F.O., J.H.), the Department of Paediatrics, Monash University and Monash Newborn, Monash Children's Hospital (K.T.), Melbourne, VIC, the Clinical Trials Centre, University of Sydney (K.S.), School of Women's and Children's Health, University of New South Wales (K.L., J.S.), and Newborn Care, Royal Hospital for Women (S.B.), Sydney, the Neonatal Intensive Care Unit, John Hunter Children's Hospital and School of Medicine and Public Health, University of Newcastle, Newcastle, NSW (J.T.), the Neonatal Intensive Care Unit, Liverpool Hospital, Liverpool, NSW (J.S., I.R.C.), the Department of Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth (K.S.), and Newborn Services, Mater Misericordiae, and Mater Research Institute, University of Queensland, Brisbane (H.G.L.) - all in Australia; the Department of Paediatrics and Child Health, University of Otago, Wellington (M.J.B.), the Newborn Intensive Care Unit, Waikato Hospital, Hamilton (D.L.H.), and Liggins Institute, University of Auckland, Auckland (D.L.H.) - all in New Zealand; and the Department of Neonatology, KK Women's and Children's Hospital (V.S.R., M.-C.C., P.A.J.), Yong Loo Lin School of Medicine, National University of Singapore (V.S.R., M.-C.C.), and Duke-National University of Singapore Medical School (V.S.R., M.-C.C.) - all in Singapore
| | - Michael J Stark
- From Healthy Mothers, Babies, and Children, South Australian Health and Medical Research Institute (C.T.C., M.M., A.J.M., R.A.G.), the Schools of Medicine (C.T.C., M.M., A.J.M., M.J.S.), Public Health (T.R.S.), and Agriculture, Food, and Wine (R.A.G.) and the Robinson Research Institute (M.J.S.), University of Adelaide, the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M., M.J.S.), and the School of Medicine (S.A.M.), Flinders University, Adelaide, SA, the Newborn Research Centre, Royal Women's Hospital (P.G.D., M.T.), University of Melbourne (P.G.D., M.T.), Murdoch Children's Research Institute (M.T.), the Department of Paediatrics, Mercy Hospital for Women (G.F.O., J.H.), the Department of Paediatrics, Monash University and Monash Newborn, Monash Children's Hospital (K.T.), Melbourne, VIC, the Clinical Trials Centre, University of Sydney (K.S.), School of Women's and Children's Health, University of New South Wales (K.L., J.S.), and Newborn Care, Royal Hospital for Women (S.B.), Sydney, the Neonatal Intensive Care Unit, John Hunter Children's Hospital and School of Medicine and Public Health, University of Newcastle, Newcastle, NSW (J.T.), the Neonatal Intensive Care Unit, Liverpool Hospital, Liverpool, NSW (J.S., I.R.C.), the Department of Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth (K.S.), and Newborn Services, Mater Misericordiae, and Mater Research Institute, University of Queensland, Brisbane (H.G.L.) - all in Australia; the Department of Paediatrics and Child Health, University of Otago, Wellington (M.J.B.), the Newborn Intensive Care Unit, Waikato Hospital, Hamilton (D.L.H.), and Liggins Institute, University of Auckland, Auckland (D.L.H.) - all in New Zealand; and the Department of Neonatology, KK Women's and Children's Hospital (V.S.R., M.-C.C., P.A.J.), Yong Loo Lin School of Medicine, National University of Singapore (V.S.R., M.-C.C.), and Duke-National University of Singapore Medical School (V.S.R., M.-C.C.) - all in Singapore
| | - Mei-Chien Chua
- From Healthy Mothers, Babies, and Children, South Australian Health and Medical Research Institute (C.T.C., M.M., A.J.M., R.A.G.), the Schools of Medicine (C.T.C., M.M., A.J.M., M.J.S.), Public Health (T.R.S.), and Agriculture, Food, and Wine (R.A.G.) and the Robinson Research Institute (M.J.S.), University of Adelaide, the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M., M.J.S.), and the School of Medicine (S.A.M.), Flinders University, Adelaide, SA, the Newborn Research Centre, Royal Women's Hospital (P.G.D., M.T.), University of Melbourne (P.G.D., M.T.), Murdoch Children's Research Institute (M.T.), the Department of Paediatrics, Mercy Hospital for Women (G.F.O., J.H.), the Department of Paediatrics, Monash University and Monash Newborn, Monash Children's Hospital (K.T.), Melbourne, VIC, the Clinical Trials Centre, University of Sydney (K.S.), School of Women's and Children's Health, University of New South Wales (K.L., J.S.), and Newborn Care, Royal Hospital for Women (S.B.), Sydney, the Neonatal Intensive Care Unit, John Hunter Children's Hospital and School of Medicine and Public Health, University of Newcastle, Newcastle, NSW (J.T.), the Neonatal Intensive Care Unit, Liverpool Hospital, Liverpool, NSW (J.S., I.R.C.), the Department of Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth (K.S.), and Newborn Services, Mater Misericordiae, and Mater Research Institute, University of Queensland, Brisbane (H.G.L.) - all in Australia; the Department of Paediatrics and Child Health, University of Otago, Wellington (M.J.B.), the Newborn Intensive Care Unit, Waikato Hospital, Hamilton (D.L.H.), and Liggins Institute, University of Auckland, Auckland (D.L.H.) - all in New Zealand; and the Department of Neonatology, KK Women's and Children's Hospital (V.S.R., M.-C.C., P.A.J.), Yong Loo Lin School of Medicine, National University of Singapore (V.S.R., M.-C.C.), and Duke-National University of Singapore Medical School (V.S.R., M.-C.C.) - all in Singapore
| | - Pooja A Jayagobi
- From Healthy Mothers, Babies, and Children, South Australian Health and Medical Research Institute (C.T.C., M.M., A.J.M., R.A.G.), the Schools of Medicine (C.T.C., M.M., A.J.M., M.J.S.), Public Health (T.R.S.), and Agriculture, Food, and Wine (R.A.G.) and the Robinson Research Institute (M.J.S.), University of Adelaide, the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M., M.J.S.), and the School of Medicine (S.A.M.), Flinders University, Adelaide, SA, the Newborn Research Centre, Royal Women's Hospital (P.G.D., M.T.), University of Melbourne (P.G.D., M.T.), Murdoch Children's Research Institute (M.T.), the Department of Paediatrics, Mercy Hospital for Women (G.F.O., J.H.), the Department of Paediatrics, Monash University and Monash Newborn, Monash Children's Hospital (K.T.), Melbourne, VIC, the Clinical Trials Centre, University of Sydney (K.S.), School of Women's and Children's Health, University of New South Wales (K.L., J.S.), and Newborn Care, Royal Hospital for Women (S.B.), Sydney, the Neonatal Intensive Care Unit, John Hunter Children's Hospital and School of Medicine and Public Health, University of Newcastle, Newcastle, NSW (J.T.), the Neonatal Intensive Care Unit, Liverpool Hospital, Liverpool, NSW (J.S., I.R.C.), the Department of Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth (K.S.), and Newborn Services, Mater Misericordiae, and Mater Research Institute, University of Queensland, Brisbane (H.G.L.) - all in Australia; the Department of Paediatrics and Child Health, University of Otago, Wellington (M.J.B.), the Newborn Intensive Care Unit, Waikato Hospital, Hamilton (D.L.H.), and Liggins Institute, University of Auckland, Auckland (D.L.H.) - all in New Zealand; and the Department of Neonatology, KK Women's and Children's Hospital (V.S.R., M.-C.C., P.A.J.), Yong Loo Lin School of Medicine, National University of Singapore (V.S.R., M.-C.C.), and Duke-National University of Singapore Medical School (V.S.R., M.-C.C.) - all in Singapore
| | - James Holberton
- From Healthy Mothers, Babies, and Children, South Australian Health and Medical Research Institute (C.T.C., M.M., A.J.M., R.A.G.), the Schools of Medicine (C.T.C., M.M., A.J.M., M.J.S.), Public Health (T.R.S.), and Agriculture, Food, and Wine (R.A.G.) and the Robinson Research Institute (M.J.S.), University of Adelaide, the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M., M.J.S.), and the School of Medicine (S.A.M.), Flinders University, Adelaide, SA, the Newborn Research Centre, Royal Women's Hospital (P.G.D., M.T.), University of Melbourne (P.G.D., M.T.), Murdoch Children's Research Institute (M.T.), the Department of Paediatrics, Mercy Hospital for Women (G.F.O., J.H.), the Department of Paediatrics, Monash University and Monash Newborn, Monash Children's Hospital (K.T.), Melbourne, VIC, the Clinical Trials Centre, University of Sydney (K.S.), School of Women's and Children's Health, University of New South Wales (K.L., J.S.), and Newborn Care, Royal Hospital for Women (S.B.), Sydney, the Neonatal Intensive Care Unit, John Hunter Children's Hospital and School of Medicine and Public Health, University of Newcastle, Newcastle, NSW (J.T.), the Neonatal Intensive Care Unit, Liverpool Hospital, Liverpool, NSW (J.S., I.R.C.), the Department of Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth (K.S.), and Newborn Services, Mater Misericordiae, and Mater Research Institute, University of Queensland, Brisbane (H.G.L.) - all in Australia; the Department of Paediatrics and Child Health, University of Otago, Wellington (M.J.B.), the Newborn Intensive Care Unit, Waikato Hospital, Hamilton (D.L.H.), and Liggins Institute, University of Auckland, Auckland (D.L.H.) - all in New Zealand; and the Department of Neonatology, KK Women's and Children's Hospital (V.S.R., M.-C.C., P.A.J.), Yong Loo Lin School of Medicine, National University of Singapore (V.S.R., M.-C.C.), and Duke-National University of Singapore Medical School (V.S.R., M.-C.C.) - all in Singapore
| | - Srinivas Bolisetty
- From Healthy Mothers, Babies, and Children, South Australian Health and Medical Research Institute (C.T.C., M.M., A.J.M., R.A.G.), the Schools of Medicine (C.T.C., M.M., A.J.M., M.J.S.), Public Health (T.R.S.), and Agriculture, Food, and Wine (R.A.G.) and the Robinson Research Institute (M.J.S.), University of Adelaide, the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M., M.J.S.), and the School of Medicine (S.A.M.), Flinders University, Adelaide, SA, the Newborn Research Centre, Royal Women's Hospital (P.G.D., M.T.), University of Melbourne (P.G.D., M.T.), Murdoch Children's Research Institute (M.T.), the Department of Paediatrics, Mercy Hospital for Women (G.F.O., J.H.), the Department of Paediatrics, Monash University and Monash Newborn, Monash Children's Hospital (K.T.), Melbourne, VIC, the Clinical Trials Centre, University of Sydney (K.S.), School of Women's and Children's Health, University of New South Wales (K.L., J.S.), and Newborn Care, Royal Hospital for Women (S.B.), Sydney, the Neonatal Intensive Care Unit, John Hunter Children's Hospital and School of Medicine and Public Health, University of Newcastle, Newcastle, NSW (J.T.), the Neonatal Intensive Care Unit, Liverpool Hospital, Liverpool, NSW (J.S., I.R.C.), the Department of Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth (K.S.), and Newborn Services, Mater Misericordiae, and Mater Research Institute, University of Queensland, Brisbane (H.G.L.) - all in Australia; the Department of Paediatrics and Child Health, University of Otago, Wellington (M.J.B.), the Newborn Intensive Care Unit, Waikato Hospital, Hamilton (D.L.H.), and Liggins Institute, University of Auckland, Auckland (D.L.H.) - all in New Zealand; and the Department of Neonatology, KK Women's and Children's Hospital (V.S.R., M.-C.C., P.A.J.), Yong Loo Lin School of Medicine, National University of Singapore (V.S.R., M.-C.C.), and Duke-National University of Singapore Medical School (V.S.R., M.-C.C.) - all in Singapore
| | - Ian R Callander
- From Healthy Mothers, Babies, and Children, South Australian Health and Medical Research Institute (C.T.C., M.M., A.J.M., R.A.G.), the Schools of Medicine (C.T.C., M.M., A.J.M., M.J.S.), Public Health (T.R.S.), and Agriculture, Food, and Wine (R.A.G.) and the Robinson Research Institute (M.J.S.), University of Adelaide, the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M., M.J.S.), and the School of Medicine (S.A.M.), Flinders University, Adelaide, SA, the Newborn Research Centre, Royal Women's Hospital (P.G.D., M.T.), University of Melbourne (P.G.D., M.T.), Murdoch Children's Research Institute (M.T.), the Department of Paediatrics, Mercy Hospital for Women (G.F.O., J.H.), the Department of Paediatrics, Monash University and Monash Newborn, Monash Children's Hospital (K.T.), Melbourne, VIC, the Clinical Trials Centre, University of Sydney (K.S.), School of Women's and Children's Health, University of New South Wales (K.L., J.S.), and Newborn Care, Royal Hospital for Women (S.B.), Sydney, the Neonatal Intensive Care Unit, John Hunter Children's Hospital and School of Medicine and Public Health, University of Newcastle, Newcastle, NSW (J.T.), the Neonatal Intensive Care Unit, Liverpool Hospital, Liverpool, NSW (J.S., I.R.C.), the Department of Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth (K.S.), and Newborn Services, Mater Misericordiae, and Mater Research Institute, University of Queensland, Brisbane (H.G.L.) - all in Australia; the Department of Paediatrics and Child Health, University of Otago, Wellington (M.J.B.), the Newborn Intensive Care Unit, Waikato Hospital, Hamilton (D.L.H.), and Liggins Institute, University of Auckland, Auckland (D.L.H.) - all in New Zealand; and the Department of Neonatology, KK Women's and Children's Hospital (V.S.R., M.-C.C., P.A.J.), Yong Loo Lin School of Medicine, National University of Singapore (V.S.R., M.-C.C.), and Duke-National University of Singapore Medical School (V.S.R., M.-C.C.) - all in Singapore
| | - Deborah L Harris
- From Healthy Mothers, Babies, and Children, South Australian Health and Medical Research Institute (C.T.C., M.M., A.J.M., R.A.G.), the Schools of Medicine (C.T.C., M.M., A.J.M., M.J.S.), Public Health (T.R.S.), and Agriculture, Food, and Wine (R.A.G.) and the Robinson Research Institute (M.J.S.), University of Adelaide, the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M., M.J.S.), and the School of Medicine (S.A.M.), Flinders University, Adelaide, SA, the Newborn Research Centre, Royal Women's Hospital (P.G.D., M.T.), University of Melbourne (P.G.D., M.T.), Murdoch Children's Research Institute (M.T.), the Department of Paediatrics, Mercy Hospital for Women (G.F.O., J.H.), the Department of Paediatrics, Monash University and Monash Newborn, Monash Children's Hospital (K.T.), Melbourne, VIC, the Clinical Trials Centre, University of Sydney (K.S.), School of Women's and Children's Health, University of New South Wales (K.L., J.S.), and Newborn Care, Royal Hospital for Women (S.B.), Sydney, the Neonatal Intensive Care Unit, John Hunter Children's Hospital and School of Medicine and Public Health, University of Newcastle, Newcastle, NSW (J.T.), the Neonatal Intensive Care Unit, Liverpool Hospital, Liverpool, NSW (J.S., I.R.C.), the Department of Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth (K.S.), and Newborn Services, Mater Misericordiae, and Mater Research Institute, University of Queensland, Brisbane (H.G.L.) - all in Australia; the Department of Paediatrics and Child Health, University of Otago, Wellington (M.J.B.), the Newborn Intensive Care Unit, Waikato Hospital, Hamilton (D.L.H.), and Liggins Institute, University of Auckland, Auckland (D.L.H.) - all in New Zealand; and the Department of Neonatology, KK Women's and Children's Hospital (V.S.R., M.-C.C., P.A.J.), Yong Loo Lin School of Medicine, National University of Singapore (V.S.R., M.-C.C.), and Duke-National University of Singapore Medical School (V.S.R., M.-C.C.) - all in Singapore
| | - Robert A Gibson
- From Healthy Mothers, Babies, and Children, South Australian Health and Medical Research Institute (C.T.C., M.M., A.J.M., R.A.G.), the Schools of Medicine (C.T.C., M.M., A.J.M., M.J.S.), Public Health (T.R.S.), and Agriculture, Food, and Wine (R.A.G.) and the Robinson Research Institute (M.J.S.), University of Adelaide, the Department of Neonatal Medicine, Women's and Children's Hospital (A.J.M., M.J.S.), and the School of Medicine (S.A.M.), Flinders University, Adelaide, SA, the Newborn Research Centre, Royal Women's Hospital (P.G.D., M.T.), University of Melbourne (P.G.D., M.T.), Murdoch Children's Research Institute (M.T.), the Department of Paediatrics, Mercy Hospital for Women (G.F.O., J.H.), the Department of Paediatrics, Monash University and Monash Newborn, Monash Children's Hospital (K.T.), Melbourne, VIC, the Clinical Trials Centre, University of Sydney (K.S.), School of Women's and Children's Health, University of New South Wales (K.L., J.S.), and Newborn Care, Royal Hospital for Women (S.B.), Sydney, the Neonatal Intensive Care Unit, John Hunter Children's Hospital and School of Medicine and Public Health, University of Newcastle, Newcastle, NSW (J.T.), the Neonatal Intensive Care Unit, Liverpool Hospital, Liverpool, NSW (J.S., I.R.C.), the Department of Newborn Medicine, Centre for Neonatal Research and Education, University of Western Australia, Perth (K.S.), and Newborn Services, Mater Misericordiae, and Mater Research Institute, University of Queensland, Brisbane (H.G.L.) - all in Australia; the Department of Paediatrics and Child Health, University of Otago, Wellington (M.J.B.), the Newborn Intensive Care Unit, Waikato Hospital, Hamilton (D.L.H.), and Liggins Institute, University of Auckland, Auckland (D.L.H.) - all in New Zealand; and the Department of Neonatology, KK Women's and Children's Hospital (V.S.R., M.-C.C., P.A.J.), Yong Loo Lin School of Medicine, National University of Singapore (V.S.R., M.-C.C.), and Duke-National University of Singapore Medical School (V.S.R., M.-C.C.) - all in Singapore
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36
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Gould JF, Treyvaud K, Yelland LN, Anderson PJ, Smithers LG, McPhee AJ, Makrides M. Seven-Year Follow-up of Children Born to Women in a Randomized Trial of Prenatal DHA Supplementation. JAMA 2017; 317:1173-1175. [PMID: 28324081 DOI: 10.1001/jama.2016.21303] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jacqueline F Gould
- Child Nutrition Research Centre, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Karli Treyvaud
- Department of Psychology and Counselling, La Trobe University, Melbourne, Australia
| | - Lisa N Yelland
- School of Public Health, University of Adelaide, Adelaide, Australia
| | - Peter J Anderson
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia
| | - Lisa G Smithers
- School of Public Health, University of Adelaide, Adelaide, Australia
| | - Andrew J McPhee
- Neonatal Services, Women's and Children's Hospital, Adelaide, Australia
| | - Maria Makrides
- Child Nutrition Research Centre, South Australian Health and Medical Research Institute, Adelaide, Australia
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37
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Abstract
BACKGROUND Preterm infants start milk feeds by gavage tube. As they mature, sucking feeds are gradually introduced. Women who choose to breast feed their preterm infant are not always able to be in hospital with their baby and need an alternative approach to feeding. Most commonly, milk (expressed breast milk or formula) is given by bottle. Whether using bottles during establishment of breast feeds is detrimental to breast feeding success is a topic of ongoing debate. OBJECTIVES To identify the effects of avoidance of bottle feeds during establishment of breast feeding on the likelihood of successful breast feeding, and to assess the safety of alternatives to bottle feeds. SEARCH METHODS We used the standard search strategy of the Cochrane Neonatal Review Group to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 2), MEDLINE via PubMed (1966 to July 2016), Embase (1980 to July 2016) and CINAHL (1982 to July 2016). We also searched databases of clinical trials and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. SELECTION CRITERIA Randomised and quasi-randomised controlled trials comparing avoidance of bottles with use of bottles in women who have chosen to breast feed their preterm infant. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. When appropriate, we contacted study authors for additional information. Review authors used standard methods of The Cochrane Collaboration and the Cochrane Neonatal Review Group. MAIN RESULTS We included seven trials with 1152 preterm infants. Five studies used a cup feeding strategy, one used a tube feeding strategy and one used a novel teat when supplements to breast feeds were needed. We included the novel teat study in this review, as the teat was designed to more closely mimic the sucking action of breast feeding. The trials were of small to moderate size, and two had high risk of attrition bias. Adherence with cup feeding was poor in one of the studies, indicating dissatisfaction with this method by staff and/or parents; the remaining four cup feeding studies provided no such reports of dissatisfaction or low adherence. Meta-analyses provided evidence of low to moderate quality indicating that avoiding bottles increases the extent of breast feeding on discharge home (full breast feeding typical risk ratio (RR) 1.47, 95% confidence interval (CI) 1.19 to 1.80; any breast feeding RR 1.11, 95% CI 1.06 to 1.16). Limited available evidence for three months and six months post discharge shows that avoiding bottles increases the occurrence of full breast feeding and any breast feeding at discharge and at six months post discharge, and of full (but not any) breast feeding at three months post discharge. This effect was evident at all time points for the tube alone strategy and for all except any breast feeding at three months post discharge for cup feeding. Investigators reported no clear benefit when the novel teat was used. No other benefits or harms were evident, including, in contrast to the previous (2008) review, length of hospital stay. AUTHORS' CONCLUSIONS Evidence of low to moderate quality suggests that supplementing breast feeds by cup increases the extent and duration of breast feeding. Current insufficient evidence provides no basis for recommendations for a tube alone approach to supplementing breast feeds.
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Affiliation(s)
- Carmel T Collins
- South Australian Health and Medical Research InstituteHealthy Mothers, Babies and Children72 King William RoadNorth AdelaideSouth AustraliaAustralia5006
| | - Jennifer Gillis
- Women's and Children's HospitalSpecial Care Baby Unit72 King William RoadNorth AdelaideSouth AustraliaAustralia5006
| | - Andrew J McPhee
- Women's and Children's HospitalNeonatal Medicine72 King William RoadNorth AdelaideSouth AustraliaAustralia5006
| | - Hiroki Suganuma
- Juntendo University School of MedicineDepartment of PediatricsTokyoJapan
| | - Maria Makrides
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research InstituteC/‐ WCHRI72 King William RoadAdelaideSAAustralia5006
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38
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Abstract
BACKGROUND Preterm infants start milk feeds by gavage tube. As they mature, sucking feeds are gradually introduced. Women who choose to breast feed their preterm infant are not always able to be in hospital with their baby and need an alternative approach to feeding. Most commonly, milk (expressed breast milk or formula) is given by bottle. Whether using bottles during establishment of breast feeds is detrimental to breast feeding success is a topic of ongoing debate. OBJECTIVES To identify the effects of avoidance of bottle feeds during establishment of breast feeding on the likelihood of successful breast feeding, and to assess the safety of alternatives to bottle feeds. SEARCH METHODS We used the standard search strategy of the Cochrane Neonatal Review Group to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 2), MEDLINE via PubMed (1966 to July 2016), Embase (1980 to July 2016) and CINAHL (1982 to July 2016). We also searched databases of clinical trials and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. SELECTION CRITERIA Randomised and quasi-randomised controlled trials comparing avoidance of bottles with use of bottles in women who have chosen to breast feed their preterm infant. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. When appropriate, we contacted study authors for additional information. Review authors used standard methods of The Cochrane Collaboration and the Cochrane Neonatal Review Group. MAIN RESULTS We included seven trials with 1152 preterm infants. Five studies used a cup feeding strategy, one used a tube feeding strategy and one used a novel teat when supplements to breast feeds were needed. We included the novel teat study in this review, as the teat was designed to more closely mimic the sucking action of breast feeding. The trials were of small to moderate size, and two had high risk of attrition bias. Adherence with cup feeding was poor in one of the studies, indicating dissatisfaction with this method by staff and/or parents; the remaining four cup feeding studies provided no such reports of dissatisfaction or low adherence. Meta-analyses provided evidence of low to moderate quality indicating that avoiding bottles increases the extent of breast feeding on discharge home (full breast feeding typical risk ratio (RR) 1.47, 95% confidence interval (CI) 1.19 to 1.80; any breast feeding RR 1.11, 95% CI 1.06 to 1.16). Limited available evidence for three months and six months post discharge shows that avoiding bottles increases the occurrence of full breast feeding and any breast feeding at discharge and at six months post discharge, and of full (but not any) breast feeding at three months post discharge. This effect was evident at all time points for the tube alone strategy and for all except any breast feeding at three months post discharge for cup feeding. Investigators reported no clear benefit when the novel teat was used. No other benefits or harms were evident, including, in contrast to the previous (2008) review, length of hospital stay. AUTHORS' CONCLUSIONS Evidence of low to moderate quality suggests that supplementing breast feeds by cup increases the extent and duration of breast feeding. Current insufficient evidence provides no basis for recommendations for a tube alone approach to supplementing breast feeds.
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Affiliation(s)
- Carmel T Collins
- South Australian Health and Medical Research InstituteHealthy Mothers, Babies and Children72 King William RoadNorth AdelaideAustralia5006
| | - Jennifer Gillis
- Women's and Children's HospitalSpecial Care Baby Unit72 King William RoadNorth AdelaideAustralia5006
| | - Andrew J McPhee
- Women's and Children's HospitalNeonatal Medicine72 King William RoadNorth AdelaideAustralia5006
| | - Hiroki Suganuma
- Juntendo University School of MedicineDepartment of PediatricsTokyoJapan
| | - Maria Makrides
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research InstituteC/‐ WCHRI72 King William RoadNorth AdelaideAustralia5006
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39
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Barnett CP, Nataren NJ, Klingler-Hoffmann M, Schwarz Q, Chong CE, Lee YK, Bruno DL, Lipsett J, McPhee AJ, Schreiber AW, Feng J, Hahn CN, Scott HS. Cover Image, Volume 37, Issue 9. Hum Mutat 2016. [DOI: 10.1002/humu.23058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Barnett CP, Nataren NJ, Klingler-Hoffmann M, Schwarz Q, Chong CE, Lee YK, Bruno DL, Lipsett J, McPhee AJ, Schreiber AW, Feng J, Hahn CN, Scott HS. Ectrodactyly and Lethal Pulmonary Acinar Dysplasia Associated with Homozygous FGFR2 Mutations Identified by Exome Sequencing. Hum Mutat 2016; 37:955-63. [PMID: 27323706 DOI: 10.1002/humu.23032] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 05/31/2016] [Accepted: 06/04/2016] [Indexed: 12/26/2022]
Abstract
Ectrodactyly/split hand-foot malformation is genetically heterogeneous with more than 100 syndromic associations. Acinar dysplasia is a rare congenital lung lesion of unknown etiology, which is frequently lethal postnatally. To date, there have been no reports of combinations of these two phenotypes. Here, we present an infant from a consanguineous union with both ectrodactyly and autopsy confirmed acinar dysplasia. SNP array and whole-exome sequencing analyses of the affected infant identified a novel homozygous Fibroblast Growth Factor Receptor 2 (FGFR2) missense mutation (p.R255Q) in the IgIII domain (D3). Expression studies of Fgfr2 in development show localization to the affected limbs and organs. Molecular modeling and genetic and functional assays support that this mutation is at least a partial loss-of-function mutation, and contributes to ectrodactyly and acinar dysplasia only in homozygosity, unlike previously reported heterozygous activating FGFR2 mutations that cause Crouzon, Apert, and Pfeiffer syndromes. This is the first report of mutations in a human disease with ectrodactyly with pulmonary acinar dysplasia and, as such, homozygous loss-of-function FGFR2 mutations represent a unique syndrome.
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Affiliation(s)
- Christopher P Barnett
- SA Clinical Genetics, Women's and Children's Hospital/SA Pathology, North Adelaide, SA, Australia.,School of Biological Sciences, University of Adelaide, SA, Australia
| | - Nathalie J Nataren
- School of Biological Sciences, University of Adelaide, SA, Australia.,Department of Genetics and Molecular Pathology, Centre for Cancer Biology, SA Pathology, Adelaide, SA, Australia.,Centre for Cancer Biology, An Alliance between SA Pathology and the University of South Australia, SA, Australia
| | - Manuela Klingler-Hoffmann
- School of Biological Sciences, University of Adelaide, SA, Australia.,Department of Genetics and Molecular Pathology, Centre for Cancer Biology, SA Pathology, Adelaide, SA, Australia.,Centre for Cancer Biology, An Alliance between SA Pathology and the University of South Australia, SA, Australia
| | - Quenten Schwarz
- Centre for Cancer Biology, An Alliance between SA Pathology and the University of South Australia, SA, Australia
| | - Chan-Eng Chong
- Department of Genetics and Molecular Pathology, Centre for Cancer Biology, SA Pathology, Adelaide, SA, Australia
| | - Young K Lee
- Department of Genetics and Molecular Pathology, Centre for Cancer Biology, SA Pathology, Adelaide, SA, Australia
| | - Damien L Bruno
- Cytogenetics Laboratory, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia
| | - Jill Lipsett
- Department of Neonatal Medicine, Women's and Children's Hospital, North Adelaide, SA, Australia
| | - Andrew J McPhee
- School of Medicine, University of Adelaide, SA, Australia.,Department of Anatomical Pathology, Women's and Children's Hospital/SA Pathology, North Adelaide, SA, Australia
| | - Andreas W Schreiber
- School of Biological Sciences, University of Adelaide, SA, Australia.,Centre for Cancer Biology, An Alliance between SA Pathology and the University of South Australia, SA, Australia.,ACRF Cancer Genomics Facility, Centre for Cancer Biology, SA Pathology, SA, Australia
| | - Jinghua Feng
- School of Biological Sciences, University of Adelaide, SA, Australia.,Centre for Cancer Biology, An Alliance between SA Pathology and the University of South Australia, SA, Australia.,ACRF Cancer Genomics Facility, Centre for Cancer Biology, SA Pathology, SA, Australia
| | - Christopher N Hahn
- Department of Genetics and Molecular Pathology, Centre for Cancer Biology, SA Pathology, Adelaide, SA, Australia.,Centre for Cancer Biology, An Alliance between SA Pathology and the University of South Australia, SA, Australia.,School of Medicine, University of Adelaide, SA, Australia
| | - Hamish S Scott
- School of Biological Sciences, University of Adelaide, SA, Australia.,Department of Genetics and Molecular Pathology, Centre for Cancer Biology, SA Pathology, Adelaide, SA, Australia.,Centre for Cancer Biology, An Alliance between SA Pathology and the University of South Australia, SA, Australia.,School of Medicine, University of Adelaide, SA, Australia.,ACRF Cancer Genomics Facility, Centre for Cancer Biology, SA Pathology, SA, Australia
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41
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Dodd JM, Deussen AR, Mohamad I, Rifas-Shiman SL, Yelland LN, Louise J, McPhee AJ, Grivell RM, Owens JA, Gillman MW, Robinson JS. The effect of antenatal lifestyle advice for women who are overweight or obese on secondary measures of neonatal body composition: the LIMIT randomised trial. BJOG 2016; 123:244-53. [PMID: 26841217 DOI: 10.1111/1471-0528.13796] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the effect of providing antenatal dietary and lifestyle advice on neonatal anthropometry, and to determine the inter-observer variability in obtaining anthropometric measurements. DESIGN Randomised controlled trial. SETTING Public maternity hospitals across metropolitan Adelaide, South Australia. POPULATION Pregnant women with a singleton gestation between 10(+0) and 20(+0) weeks, and body mass index (BMI) ≥25 kg/m(2). METHODS Women were randomised to either Lifestyle Advice (comprehensive dietary and lifestyle intervention over the course of pregnancy including dietary, exercise and behavioural strategies, delivered by a research dietician and research assistants) or continued Standard Care. Analyses were conducted using intention-to-treat principles. MAIN OUTCOME MEASURES Secondary outcome measures for the trial included assessment of infant body composition using body circumference and skinfold thickness measurements (SFTM), percentage body fat, and bio-impedance analysis of fat-free mass. RESULTS Anthropometric measurements were obtained from 970 neonates (488 Lifestyle Advice Group, and 482 Standard Care Group). In 394 of these neonates (215 Lifestyle Advice Group, and 179 Standard Care Group) bio-impedance analysis was also obtained. There were no statistically significant differences identified between those neonates born to women receiving Lifestyle Advice and those receiving Standard Care, in terms of body circumference measures, SFTM, percentage body fat, fat mass, or fat-free mass. The intra-class correlation coefficient for SFTM was moderate to excellent (0.55-0.88). CONCLUSIONS Among neonates born to women who are overweight or obese, anthropometric measures of body composition were not modified by an antenatal dietary and lifestyle intervention.
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Affiliation(s)
- J M Dodd
- Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia.,Women's and Babies Division, Department of Perinatal Medicine, The Women's and Children's Hospital, North Adelaide, SA, Australia
| | - A R Deussen
- Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | - I Mohamad
- Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | - S L Rifas-Shiman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - L N Yelland
- Women's and Children's Health Research Institute, North Adelaide, SA, Australia.,School of Population Health, The University of Adelaide, Adelaide, SA, Australia
| | - J Louise
- School of Population Health, The University of Adelaide, Adelaide, SA, Australia
| | - A J McPhee
- Women's and Babies Division, Department of Neonatal Medicine, The Women's and Children's Hospital, Adelaide, SA, Australia
| | - R M Grivell
- Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia.,Women's and Babies Division, Department of Perinatal Medicine, The Women's and Children's Hospital, North Adelaide, SA, Australia
| | - J A Owens
- Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | - M W Gillman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - J S Robinson
- Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
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Collins CT, Gibson RA, Makrides M, McPhee AJ, Sullivan TR, Davis PG, Thio M, Simmer K, Rajadurai VS. The N3RO trial: a randomised controlled trial of docosahexaenoic acid to reduce bronchopulmonary dysplasia in preterm infants < 29 weeks' gestation. BMC Pediatr 2016; 16:72. [PMID: 27250120 PMCID: PMC4896378 DOI: 10.1186/s12887-016-0611-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 05/27/2016] [Indexed: 11/16/2022] Open
Abstract
Background Bronchopulmonary dysplasia (BPD) is a major cause of mortality and long-term respiratory and neurological morbidity in very preterm infants. While survival rates of very preterm infants have increased over the past two decades there has been no decrease in the rate of BPD in surviving infants. Evidence from animal and human studies has suggested potential benefits of docosahexaenoic acid (DHA), an n-3 long chain polyunsaturated fatty acid, in the prevention of chronic lung disease. This randomised controlled trial aims to determine the effectiveness of supplementary DHA in reducing the rate of BPD in infants less than 29 weeks’ gestation. Methods/design This is a multicentre, parallel group, randomised, blinded and controlled trial. Infants born less than 29 weeks’ gestation, within 3 days of first enteral feed and with parent informed consent are eligible to participate. Infants will be randomised to receive an enteral emulsion containing DHA or a control emulsion without DHA. The DHA emulsion will provide 60 mg/kg/day of DHA. The study emulsions will continue to 36 weeks’ postmenstrual age (PMA). The primary outcome is BPD as assessed by the requirement for supplemental oxygen and/or assisted ventilation at 36 weeks’ PMA. Secondary outcomes include the composite of death or BPD; duration of respiratory support and hospitalisation, major neonatal morbidities. The target sample size is 1244 infants (622 per group), which will provide 90 % power to detect a clinically meaningful absolute reduction of 10 % in the incidence of BPD between the DHA and control emulsion (two tailed α =0.05). Discussion DHA supplementation has the potential to reduce respiratory morbidity in very preterm infants. This multicentre trial will provide evidence on whether an enteral DHA supplement reduces BPD in very preterm infants. Trial registration Australia and New Zealand Clinical Trial Registry: ACTRN12612000503820. Registered 09 May 2012.
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Affiliation(s)
- Carmel T Collins
- Women's and Children's Health Research Institute, North Adelaide, South Australia, Australia. .,Healthy Mother's, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia. .,Discipline of Paediatrics, School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia.
| | - Robert A Gibson
- Healthy Mother's, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,School of Agriculture, Food and Wine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Maria Makrides
- Women's and Children's Health Research Institute, North Adelaide, South Australia, Australia.,Healthy Mother's, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Discipline of Paediatrics, School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Andrew J McPhee
- Healthy Mother's, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Neonatal Services, Women's and Children's Health Network, Adelaide, South Australia, Australia
| | - Thomas R Sullivan
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Peter G Davis
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, VIC, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia.,Clinical Sciences, The Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Marta Thio
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, VIC, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia.,Clinical Sciences, The Murdoch Children's Research Institute, Parkville, VIC, Australia.,PIPER-Neonatal Retrieval Service, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Karen Simmer
- Centre of Neonatal Research and Education, The University of Western Australia, Perth, WA, Australia.,King Edward Memorial Hospital and Princess Margaret Hospital for Children, Subiaco, WA, Australia
| | - Victor S Rajadurai
- Department Neonatology, KK Women's and Children's Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Gould JF, Treyvaud K, Yelland LN, Anderson PJ, Smithers LG, Gibson RA, McPhee AJ, Makrides M. Does n-3 LCPUFA supplementation during pregnancy increase the IQ of children at school age? Follow-up of a randomised controlled trial. BMJ Open 2016; 6:e011465. [PMID: 27188814 PMCID: PMC4874207 DOI: 10.1136/bmjopen-2016-011465] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Despite recommendations that pregnant women increase their docosahexaenoic acid (DHA) intake to support fetal brain development, a recent systematic review found a lack of high-quality data to support the long-term effects of DHA supplementation on children's neurodevelopment. METHODS AND ANALYSIS We will assess child neurodevelopment at 7 years of age in follow-up of a multicentre double-blind randomised controlled trial of DHA supplementation in pregnancy. In 2010-2012, n=2399 Australian women with a singleton pregnancy <21 weeks' gestation were randomised to receive 3 capsules daily containing a total dose of 800 mg DHA/day or a vegetable oil placebo until birth. N=726 children from Adelaide (all n=97 born preterm, random sample of n=630 born at term) were selected for neurodevelopmental follow-up and n=638 (preterm n=85) are still enrolled at 7 years of age. At the 7-year follow-up, a psychologist will assess the primary outcome, IQ, with the Wechsler Abbreviated Scale of Intelligence, Second Edition. Specific measures of executive functioning (Fruit Stroop and the Rey Complex Figure), attention (Test of Everyday Attention for Children), memory and learning (Rey Auditory Verbal Learning Test), language (Clinical Evaluation of Language Fundamentals, Fourth Edition) and basic educational skills (Wide Range Achievement Test, Fourth Edition) will also be administered. Caregivers will be asked to complete questionnaires measuring behaviour and executive functioning. Families, clinicians and research personnel are blinded to group assignment with the exception of families who requested unblinding prior to the follow-up. All analyses will be conducted according to the intention-to-treat principal. ETHICS AND DISSEMINATION All procedures will be approved by the relevant institutional ethics committees prior to start of the study. The results of this study will be disseminated in peer-reviewed journal publications and academic presentations. TRIAL REGISTRATION NUMBERS ACTRN12605000569606 and ACTRN12614000770662.
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Affiliation(s)
- Jacqueline F Gould
- Women's & Children's Health Research Institute, North Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Karli Treyvaud
- Victorian Infant Brain Studies (VIBeS), Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Lisa N Yelland
- Women's & Children's Health Research Institute, North Adelaide, South Australia, Australia
- School of Public Health, The University of Adelaide, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Peter J Anderson
- Victorian Infant Brain Studies (VIBeS), Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Lisa G Smithers
- School of Public Health, The University of Adelaide, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Robert A Gibson
- FOODplus Research Centre, School of Agriculture, Food and Wine, Discipline of Paediatrics, The University of Adelaide, Glen Osmond, South Australia, Australia
| | - Andrew J McPhee
- Neonatal Services, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Maria Makrides
- Women's & Children's Health Research Institute, North Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
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Yelland LN, Makrides M, McPhee AJ, Quinlivan J, Gibson RA. Importance of adequate sample sizes in fatty acid intervention trials. Prostaglandins Leukot Essent Fatty Acids 2016; 107:8-11. [PMID: 27033420 DOI: 10.1016/j.plefa.2016.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 12/11/2015] [Revised: 02/02/2016] [Accepted: 02/03/2016] [Indexed: 11/23/2022]
Abstract
Randomised controlled trials are the ideal way to assess the effects of interventions. Small trials are useful for generating pilot data to determine samples sizes for larger trials, but can produce unreliable or biased results if they are considered in their own right. We investigate the impact of small sample sizes due to either inadequate recruitment targets or high attrition rates on the results of fatty acid intervention trials. Data from our large trial of DHA supplementation during pregnancy with minimal attrition are used for illustration. Our findings demonstrate that recruiting fewer participants or neglecting to follow up difficult participants can lead to substantially different results and alter conclusions about the effectiveness of the intervention. Developing strategies for overcoming these inadequacies should be a top priority in fatty acid intervention trials.
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Affiliation(s)
- Lisa N Yelland
- Women׳s and Children׳s Health Research Institute, The University of Adelaide, Australia; School of Public Health, The University of Adelaide, Australia.
| | - Maria Makrides
- Women׳s and Children׳s Health Research Institute, The University of Adelaide, Australia; South Australian Health and Medical Research Institute, Australia; School of Paediatrics and Reproductive Health, The University of Adelaide, Australia
| | - Andrew J McPhee
- Neonatal Medicine, Women׳s and Children׳s Health Network, Australia
| | - Julie Quinlivan
- Institute for Health Research, University of Notre Dame, Australia
| | - Robert A Gibson
- School of Agriculture, Food and Wine, The University of Adelaide, Australia
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Dodd JM, Newman A, Moran LJ, Deussen AR, Grivell RM, Yelland LN, Crowther CA, McPhee AJ, Wittert G, Owens JA, Turnbull D, Robinson JS. The effect of antenatal dietary and lifestyle advice for women who are overweight or obese on emotional well-being: the LIMIT randomized trial. Acta Obstet Gynecol Scand 2015; 95:309-18. [PMID: 26618547 DOI: 10.1111/aogs.12832] [Citation(s) in RCA: 23] [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] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 11/24/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Our aim was to evaluate the effect of dietary and lifestyle advice given to women who were overweight or obese during pregnancy on maternal quality of life, anxiety and risk of depression, and satisfaction with care. MATERIAL AND METHODS We conducted a randomized trial, involving pregnant women with body mass index ≥25 kg/m(2) , recruited from maternity units in South Australia. Women were randomized to Lifestyle Advice or Standard Care, and completed questionnaires assessing risk of depression (Edinburgh Postnatal Depression Scale), anxiety (Spielberger State-Trait Anxiety Inventory), and quality of life (SF-36) at trial entry, 28 and 36 weeks' gestation, and 4 months postpartum. Secondary trial outcomes assessed for this analysis were risk of depression, anxiety, maternal quality of life, and satisfaction with care. RESULTS One or more questionnaires were completed by 976 of 1108 (90.8%) women receiving Lifestyle Advice and 957 of 1104 (89.7%) women receiving Standard Care. The risk of depression [adjusted risk ratio 1.01; 95% confidence interval (CI) 0.82-1.24; p = 0.95], anxiety (adjusted risk ratio 1.09; 95% CI 0.93-1.27; p = 0.31), and health-related quality of life were similar between the two groups. Women receiving Lifestyle Advice reported improved healthy food choice [Lifestyle Advice 404 (68.9%) vs. Standard Care 323 (51.8%); p < 0.0001], and exercise knowledge [Lifestyle Advice 444 (75.8%) vs. Standard Care 367 (58.8%); p < 0.0001], and reassurance about their health [Lifestyle Advice 499 (85.3%) vs. Standard Care 485 (77.9%); p = 0.0112], and health of their baby [Lifestyle Advice 527 (90.2%) vs. Standard Care 545 (87.6%); p = 0.0143]. CONCLUSION Lifestyle advice in pregnancy improved knowledge and provided reassurance without negatively impacting well-being.
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Affiliation(s)
- Jodie M Dodd
- Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.,Women's and Babies Division, Department of Perinatal Medicine, The Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Angela Newman
- Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Lisa J Moran
- Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Andrea R Deussen
- Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Rosalie M Grivell
- Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.,Women's and Babies Division, Department of Perinatal Medicine, The Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Lisa N Yelland
- Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.,Women's and Children's Health Research Institute, North Adelaide, South Australia, Australia.,School of Population Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Caroline A Crowther
- Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Andrew J McPhee
- Women's and Babies' Division, Department of Neonatal Medicine, The Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Gary Wittert
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Julie A Owens
- Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Deborah Turnbull
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Jeffrey S Robinson
- Discipline of Obstetrics and Gynaecology, The Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
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Collins CT, Sullivan TR, McPhee AJ, Stark MJ, Makrides M, Gibson RA. A dose response randomised controlled trial of docosahexaenoic acid (DHA) in preterm infants. Prostaglandins Leukot Essent Fatty Acids 2015; 99:1-6. [PMID: 25997653 DOI: 10.1016/j.plefa.2015.04.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [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: 11/28/2014] [Revised: 04/02/2015] [Accepted: 04/04/2015] [Indexed: 11/25/2022]
Abstract
Thirty one infants born less than 30 weeks׳ gestational age were randomised to receive either 40 (n=11), 80 (n=9) or 120 (n=11) mg/kg/day of docosahexaenoic acid (DHA) respectively as an emulsion, via the feeding tube, commenced within 4 days of the first enteral feed. Twenty three infants were enroled in non-randomised reference groups; n=11 who had no supplementary DHA and n=12 who had maternal DHA supplementation. All levels of DHA in the emulsion were well tolerated with no effect on number of days of interrupted feeds or days to full enteral feeds. DHA levels in diets were directly related to blood DHA levels but were unrelated to arachidonic acid (AA) levels. All randomised groups and the maternal supplementation reference group prevented the drop in DHA levels at study end that was evident in infants not receiving supplementation. Australian New Zealand Clinical Trials Registry: ACTRN12610000382077.
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Affiliation(s)
- C T Collins
- Child Nutrition and FOODplus Research Centres, Women׳s and Children׳s Health Research Institute, Flinders Medical Centre, Women׳s and Children׳s Hospital and The University of Adelaide, South Australia, Australia; Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; School of Paediatrics and Reproductive Health, The University of Adelaide, South Australia
| | - T R Sullivan
- School of Population Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - A J McPhee
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Neonatal Medicine, Women׳s and Children׳s Hospital, Adelaide, South Australia, Australia; The Robinson Research Institute, The University of Adelaide, South Australia, Australia
| | - M J Stark
- Neonatal Medicine, Women׳s and Children׳s Hospital, Adelaide, South Australia, Australia; The Robinson Research Institute, The University of Adelaide, South Australia, Australia
| | - M Makrides
- Child Nutrition and FOODplus Research Centres, Women׳s and Children׳s Health Research Institute, Flinders Medical Centre, Women׳s and Children׳s Hospital and The University of Adelaide, South Australia, Australia; Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; School of Paediatrics and Reproductive Health, The University of Adelaide, South Australia
| | - R A Gibson
- Child Nutrition and FOODplus Research Centres, Women׳s and Children׳s Health Research Institute, Flinders Medical Centre, Women׳s and Children׳s Hospital and The University of Adelaide, South Australia, Australia; Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; School of Agriculture, Food and Wine, The University of Adelaide, South Australia, Australia.
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Collins CT, Makrides M, McPhee AJ. Early discharge with home support of gavage feeding for stable preterm infants who have not established full oral feeds. Cochrane Database Syst Rev 2015; 2015:CD003743. [PMID: 26154426 PMCID: PMC7133780 DOI: 10.1002/14651858.cd003743.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Early discharge of stable preterm infants still requiring gavage feeds offers the benefits of uniting families sooner and reducing healthcare and family costs compared with discharge home when on full sucking feeds. Potential disadvantages of early discharge include increased care burden for the family and risk of complications related to gavage feeding. OBJECTIVES To determine the effects of a policy of early discharge of stable preterm infants with home support of gavage feeding compared with a policy of discharge of such infants when they have reached full sucking feeds.We planned subgroup analyses to determine whether safety and efficacy outcomes are altered by the type of support received (outpatient visits vs home support) or by the maturity of the infants discharged (gestational age ≤ 28 weeks at birth or birth weight ≤ 1000 grams). SEARCH METHODS We used the standard search strategy of the Cochrane Neonatal Review Group, together with searches of the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 3), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to March 2015), EMBASE (1980 to March 2015) and MEDLINE (1950 to March 2015). We found no new trials. SELECTION CRITERIA We included all randomised and quasi-randomised trials among infants born at < 37 weeks and requiring no intravenous nutrition at the point of discharge. Trials were required to compare early discharge home with gavage feeds and healthcare support versus later discharge home when full sucking feeds were attained. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. We conducted study authors for additional information. We performed data analysis in accordance with the standards of the Cochrane Neonatal Review Group. MAIN RESULTS We included in the review data from one quasi-randomised trial with 88 infants from 75 families. Infants in the early discharge programme with home gavage feeding had a mean hospital stay that was 9.3 days shorter (mean difference (MD) -9.3, 95% confidence interval (CI) -18.49 to -0.11) than that of infants in the control group. Infants in the early discharge programme also had lower risk of clinical infection during the home gavage period compared with those in the control group spending corresponding time in hospital (risk ratio 0.35, 95% CI 0.17 to 0.69). No significant differences were noted between groups in duration and extent of breast feeding, weight gain, re-admission within the first 12 months post discharge from the home gavage programme or from hospital, scores reflecting parental satisfaction or overall health service use. AUTHORS' CONCLUSIONS Experimental evidence on the benefits and risks for preterm infants of early discharge from hospital with home gavage feeding compared with later discharge upon attainment of full sucking feeds is limited to the results of one small quasi-randomised controlled trial. High-quality trials with concealed allocation, complete follow-up of all randomly assigned infants and adequate sample size are needed before practice recommendations can be made.
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Affiliation(s)
- Carmel T Collins
- Women's and Children's Hospital and Flinders Medical CentreChild Nutrition Research Centre, Women's and Children's Health Research Institute72 King William RoadAdelaideSouth AustraliaAustralia5006
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research InstituteAdelaideAustralia
| | - Maria Makrides
- Women's and Children's Hospital and Flinders Medical CentreChild Nutrition Research Centre, Women's and Children's Health Research Institute72 King William RoadAdelaideSouth AustraliaAustralia5006
- South Australian Health and Medical Research InstituteHealthy Mothers, Babies and ChildrenC/‐ WCHRI72 King William RoadAdelaideSAAustralia5006
| | - Andrew J McPhee
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research InstituteAdelaideAustralia
- Women's and Children's HospitalNeonatal Medicine72 King William RoadNorth AdelaideSouth AustraliaAustralia5006
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Collins CT, Gibson RA, Anderson PJ, McPhee AJ, Sullivan TR, Gould JF, Ryan P, Doyle LW, Davis PG, McMichael JE, French NP, Colditz PB, Simmer K, Morris SA, Makrides M. Neurodevelopmental outcomes at 7 years' corrected age in preterm infants who were fed high-dose docosahexaenoic acid to term equivalent: a follow-up of a randomised controlled trial. BMJ Open 2015; 5:e007314. [PMID: 25787990 PMCID: PMC4368907 DOI: 10.1136/bmjopen-2014-007314] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To determine if improvements in cognitive outcome detected at 18 months' corrected age (CA) in infants born <33 weeks' gestation receiving a high-docosahexaenoic acid (DHA) compared with standard-DHA diet were sustained in early childhood. DESIGN Follow-up of a multicentre randomised controlled trial. Randomisation was stratified for sex, birth weight (<1250 vs ≥1250 g) and hospital. SETTING Five Australian tertiary hospitals from 2008 to 2013. PARTICIPANTS 626 of the 657 participants randomised between 2001 and 2005 were eligible to participate. INTERVENTIONS High-DHA (≈1% total fatty acids) enteral feeds compared with standard-DHA (≈0.3% total fatty acids) from age 2-4 days until term CA. PRIMARY OUTCOME Full Scale IQ of the Wechsler Abbreviated Scale of Intelligence (WASI) at 7 years CA. Prespecified subgroup analyses based on the randomisation strata (sex, birth weight) were conducted. RESULTS 604 (92% of the 657 originally randomised) consented to participate (291 high-DHA, 313 standard-DHA). To address missing data in the 604 consenting participants (22 for primary outcome), multiple imputation was performed. The Full Scale IQ was not significantly different between groups (high-DHA 98.3, SD 14.0, standard-DHA 98.5, SD 14.9; mean difference adjusted for sex, birthweight strata and hospital -0.3, 95% CI -2.9 to 2.2; p=0.79). There were no significant differences in any secondary outcomes. In prespecified subgroup analyses, there was a significant sex by treatment interaction on measures of parent-reported executive function and behaviour. Scores were within the normal range but girls receiving the high-DHA diet scored significantly higher (poorer outcome) compared with girls receiving the standard-DHA diet. CONCLUSIONS Supplementing the diets of preterm infants with a DHA dose of approximately 1% total fatty acids from days 2-4 until term CA showed no evidence of benefit at 7 years' CA. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry: ACTRN12606000327583.
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Affiliation(s)
- Carmel T Collins
- Women's and Children's Health Research Institute, North Adelaide, South Australia, Australia
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, South Australia, Australia
- FOODplus Research Centre, The University of Adelaide, Adelaide, South Australia, Australia
| | - Robert A Gibson
- Women's and Children's Health Research Institute, North Adelaide, South Australia, Australia
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- FOODplus Research Centre, The University of Adelaide, Adelaide, South Australia, Australia
| | - Peter J Anderson
- Clinical Sciences, The Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Andrew J McPhee
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Neonatal Medicine, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Thomas R Sullivan
- School of Population Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jacqueline F Gould
- Women's and Children's Health Research Institute, North Adelaide, South Australia, Australia
- FOODplus Research Centre, The University of Adelaide, Adelaide, South Australia, Australia
| | - Philip Ryan
- School of Population Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Lex W Doyle
- Clinical Sciences, The Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Peter G Davis
- Clinical Sciences, The Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Judy E McMichael
- Centre of Neonatal Research and Education, The University of Western Australia, Perth, Western Australia, Australia
- King Edward Memorial Hospital and Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia
| | - Noel P French
- Centre of Neonatal Research and Education, The University of Western Australia, Perth, Western Australia, Australia
- King Edward Memorial Hospital and Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia
| | - Paul B Colditz
- Perinatal Research Centre, University of Queensland Centre for Clinical Research, The University of Queensland, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Karen Simmer
- Centre of Neonatal Research and Education, The University of Western Australia, Perth, Western Australia, Australia
- King Edward Memorial Hospital and Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia
| | - Scott A Morris
- Centre for Perinatal Medicine, Flinders Medical Centre and School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Maria Makrides
- Women's and Children's Health Research Institute, North Adelaide, South Australia, Australia
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, South Australia, Australia
- FOODplus Research Centre, The University of Adelaide, Adelaide, South Australia, Australia
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Dodd JM, Ahmed S, Karnon J, Umberger W, Deussen AR, Tran T, Grivell RM, Crowther CA, Turnbull D, McPhee AJ, Wittert G, Owens JA, Robinson JS. The cost-effectiveness of providing antenatal lifestyle advice for women who are overweight or obese: the LIMIT randomised trial. BMC Obes 2015. [PMID: 26217529 PMCID: PMC4511432 DOI: 10.1186/s40608-015-0046-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Overweight and obesity during pregnancy is common, although robust evidence about the economic implications of providing an antenatal dietary and lifestyle intervention for women who are overweight or obese is lacking. We conducted a health economic evaluation in parallel with the LIMIT randomised trial. Women with a singleton pregnancy, between 10+0-20+0 weeks, and BMI ≥25 kg/m2 were randomised to Lifestyle Advice (a comprehensive antenatal dietary and lifestyle intervention) or Standard Care. The economic evaluation took the perspective of the health care system and its patients, and compared costs encountered from the additional use of resources from time of randomisation until six weeks postpartum. Increments in health outcomes for both the woman and infant were considered in the cost-effectiveness analysis. Mean costs and effects in the treatment groups allocated at randomisation were compared, and incremental cost effectiveness ratios (ICERs) and confidence intervals (95%) calculated. Bootstrapping was used to confirm the estimated confidence intervals, and to generate acceptability curves representing the probability of the intervention being cost-effective at alternative monetary equivalent values for the outcomes avoiding high infant birth weight, and respiratory distress syndrome. Analyses utilised intention to treat principles. Results Overall, the increase in mean costs associated with providing the intervention was offset by savings associated with improved immediate neonatal outcomes, rendering the intervention cost neutral (Lifestyle Advice Group $11261.19±$14573.97 versus Standard Care Group $11306.70±$14562.02; p=0.094). Using a monetary value of $20,000 as a threshold value for avoiding an additional infant with birth weight above 4 kg, the probability that the antenatal intervention is cost-effective is 0.85, which increases to 0.95 when the threshold monetary value increases to $45,000. Conclusions Providing an antenatal dietary and lifestyle intervention for pregnant women who are overweight or obese is not associated with increased costs or cost savings, but is associated with a high probability of cost effectiveness. Ongoing participant follow-up into childhood is required to determine the medium to long-term impact of the observed, short-term endpoints, to more accurately estimate the value of the intervention on risk of obesity, and associated costs and health outcomes. Trials registration Australian and New Zealand Clinical Trials Registry (ACTRN12607000161426).
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Affiliation(s)
- Jodie M Dodd
- School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia ; Department of Perinatal Medicine, Women's and Babies Division, The Women's and Children's Hospital, North Adelaide, Australia
| | - Sharmina Ahmed
- Agricultural and Food Economics, Global Food Studies, Faculty of the Professions, The University of Adelaide, Adelaide, Australia ; Women's and Children's Health Research Institute, North Adelaide, Australia
| | - Jonathan Karnon
- School of Population Health, The University of Adelaide, Adelaide, Australia
| | - Wendy Umberger
- Agricultural and Food Economics, Global Food Studies, Faculty of the Professions, The University of Adelaide, Adelaide, Australia ; Women's and Children's Health Research Institute, North Adelaide, Australia
| | - Andrea R Deussen
- School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia
| | - Thach Tran
- School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia
| | - Rosalie M Grivell
- School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia ; Department of Perinatal Medicine, Women's and Babies Division, The Women's and Children's Hospital, North Adelaide, Australia
| | - Caroline A Crowther
- School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia ; Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Deborah Turnbull
- School of Psychology, The University of Adelaide, Adelaide, Australia
| | - Andrew J McPhee
- Department of Neonatal Medicine, Women's and Babies Division, The Women's and Children's Hospital, North Adelaide, Australia
| | - Gary Wittert
- School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Julie A Owens
- School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia
| | - Jeffrey S Robinson
- School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia
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Dodd JM, Cramp C, Sui Z, Yelland LN, Deussen AR, Grivell RM, Moran LJ, Crowther CA, Turnbull D, McPhee AJ, Wittert G, Owens JA, Robinson JS. The effects of antenatal dietary and lifestyle advice for women who are overweight or obese on maternal diet and physical activity: the LIMIT randomised trial. BMC Med 2014; 12:161. [PMID: 25315237 PMCID: PMC4194375 DOI: 10.1186/s12916-014-0161-y] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 08/26/2014] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Overweight and obesity is a significant health concern during pregnancy. Our aim was to investigate the effect of providing antenatal dietary and lifestyle advice to women who are overweight or obese on components of maternal diet and physical activity. METHODS We conducted a randomised controlled trial, in which pregnant women with a body mass index≥25 kg/m2, and singleton gestation between 10(+0) to 20(+0) weeks were recruited and randomised to Lifestyle Advice (involving a comprehensive dietary and lifestyle intervention over their pregnancy) or Standard Care. Within the intervention group, we conducted a nested randomised trial in which a subgroup of women were further randomised to receive access to supervised group walking sessions in addition to the standard information presented during the intervention contacts (the Walking group) or standard information only. The outcome measures were maternal dietary intake, (including food groups, macronutrient and micronutrient intake, diet quality (using the Healthy Eating Index; HEI), dietary glycaemic load, and glycaemic index) and maternal physical activity. Women completed the Harvard Semi-Structured Food Frequency Questionnaire, and the Short Questionnaire to Assess Health-enhancing Physical Activity (SQUASH), at trial entry, 28 and 36 weeks' gestational age, and 4 months postpartum. Analyses were performed on an intention-to-treat basis, using linear mixed effects models with adjustment for the stratification variables. RESULTS Women randomised to Lifestyle Advice demonstrated a statistically significant increase in the number of servings of fruit and vegetables consumed per day, as well as increased consumption of fibre, and reduced percentage energy intake from saturated fats (P<0.05 for all). Maternal HEI was significantly improved at both 28 (73.35±6.62 versus 71.86±7.01; adjusted difference in means 1.58; 95% CI 0.89 to 2.27; P<0.0001) and 36 (72.95±6.82 versus 71.17±7.69; adjusted difference in means 1.77; 95% CI 1.01 to 2.53; P<0.0001) weeks. There were no differences in dietary glycaemic index or glycaemic load. Women randomised to Lifestyle Advice also demonstrated greater total physical activity (adjusted difference in means 359.76 metabolic equivalent task units (MET) minutes/week; 95% CI 74.87 to 644.65; P=0.01) compared with women receiving Standard Care. The supervised walking group was poorly utilised. CONCLUSIONS For women who are overweight or obese, antenatal lifestyle advice improves maternal diet and physical activity during pregnancy. Please see related articles: http://www.biomedcentral.com/1741-7015/12/163 and http://www.biomedcentral.com/1741-7015/12/201. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ( ACTRN12607000161426).
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Affiliation(s)
- Jodie M Dodd
- School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia.
- Department of Perinatal Medicine, Women's and Babies Division, The Women's and Children's Hospital, North Adelaide, Australia.
| | - Courtney Cramp
- School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia.
| | - Zhixian Sui
- School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia.
| | - Lisa N Yelland
- School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia.
- Women's and Children's Health Research Institute, North Adelaide, Australia.
- School of Population Health, The University of Adelaide, Adelaide, Australia.
| | - Andrea R Deussen
- School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia.
| | - Rosalie M Grivell
- School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia.
- Department of Perinatal Medicine, Women's and Babies Division, The Women's and Children's Hospital, North Adelaide, Australia.
| | - Lisa J Moran
- School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia.
| | - Caroline A Crowther
- School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia.
- Liggins Institute, The University of Auckland, Auckland, New Zealand.
| | - Deborah Turnbull
- School of Psychology, The University of Adelaide, Adelaide, AUSTRALIA.
| | - Andrew J McPhee
- Department of Neonatal Medicine, Women's and Babies Division, The Women's and Children's Hospital, North Adelaide, Australia.
| | - Gary Wittert
- School of Medicine, The University of Adelaide, Adelaide, Australia.
| | - Julie A Owens
- School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia.
| | - Jeffrey S Robinson
- School of Paediatrics and Reproductive Health, and The Robinson Research Institute, The University of Adelaide, Adelaide, Australia.
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