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Holzapfel LF, Unger JP, Gordon P, Yang H, Cluette-Brown JE, Gollins LA, Hair AB, Martin CR. Fatty acid concentrations in preterm infants fed the exclusive human milk diet: a prospective cohort study. J Perinatol 2024; 44:680-686. [PMID: 38082071 PMCID: PMC11090710 DOI: 10.1038/s41372-023-01841-y] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 11/03/2023] [Accepted: 11/23/2023] [Indexed: 02/01/2024]
Abstract
OBJECTIVE Quantify blood fatty acids and growth outcomes in preterm infants fed the exclusive human milk diet. METHODS A prospective cohort study of 30 infants 24-34 weeks gestation and ≤1250 g fed the exclusive human milk diet. Blood fatty acids were quantified at two time points. Comparisons were made using two-sample t-tests and Wilcoxon rank sum. RESULTS Donor human milk-fed (n = 12) compared to mother's own milk-fed infants (n = 18) from birth to after 28 days of life, had an increased interval change of linoleic to docosahexaenoic acid ratio (5.5 vs. -1.1 mole percent ratio, p = 0.034). Docosahexaenoic and eicosapentaenoic acid interval changes were similar between groups. The arachidonic acid change was similar between groups (-2.3 vs. -0.9 mole percent, p = 0.37), however, both experienced a negative change across time. At 36 weeks postmenstrual age, growth velocities were similar for groups. CONCLUSION An exclusive human milk diet maintains birth docosahexaenoic and eicosapentaenoic acid concentrations. However, the postnatal deficit in arachidonic acid was not prevented.
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Affiliation(s)
- Lindsay F Holzapfel
- Department of Pediatrics, Division of Neonatology, McGovern Medical School at the University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, TX, USA.
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
| | - Jana P Unger
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Pam Gordon
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
- Clinical Research Nutrition Center, Texas Children's Hospital, Houston, TX, USA
| | - Heeju Yang
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Joanne E Cluette-Brown
- Department of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Laura A Gollins
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Amy B Hair
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Camilia R Martin
- Division of Neonatology, Weill Cornell Medicine, New York, NY, USA
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2
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Sizemore N, Oliphant K, Zheng R, Martin CR, Claud EC, Chattopadhyay I. A digital twin of the infant microbiome to predict neurodevelopmental deficits. Sci Adv 2024; 10:eadj0400. [PMID: 38598636 PMCID: PMC11006218 DOI: 10.1126/sciadv.adj0400] [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] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 03/06/2024] [Indexed: 04/12/2024]
Abstract
Despite the recognized gut-brain axis link, natural variations in microbial profiles between patients hinder definition of normal abundance ranges, confounding the impact of dysbiosis on infant neurodevelopment. We infer a digital twin of the infant microbiome, forecasting ecosystem trajectories from a few initial observations. Using 16S ribosomal RNA profiles from 88 preterm infants (398 fecal samples and 32,942 abundance estimates for 91 microbial classes), the model (Q-net) predicts abundance dynamics with R2 = 0.69. Contrasting the fit to Q-nets of typical versus suboptimal development, we can reliably estimate individual deficit risk (Mδ) and identify infants achieving poor future head circumference growth with ≈76% area under the receiver operator characteristic curve, 95% ± 1.8% positive predictive value at 98% specificity at 30 weeks postmenstrual age. We find that early transplantation might mitigate risk for ≈45.2% of the cohort, with potentially negative effects from incorrect supplementation. Q-nets are generative artificial intelligence models for ecosystem dynamics, with broad potential applications.
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Affiliation(s)
- Nicholas Sizemore
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA
| | - Kaitlyn Oliphant
- Department of Pediatrics, University of Chicago, Chicago, IL 60637, USA
| | - Ruolin Zheng
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA
| | - Camilia R. Martin
- Division of Neonatology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Erika C. Claud
- Department of Pediatrics, University of Chicago, Chicago, IL 60637, USA
- Neonatology Research, University of Chicago, Chicago, IL 60637, USA
| | - Ishanu Chattopadhyay
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA
- Committee on Quantitative Methods in Social, Behavioral, and Health Sciences, University of Chicago, Chicago, IL 60637, USA
- Committee on Genetics, Genomics and Systems Biology, University of Chicago, Chicago, IL 60637, USA
- Center for Health Statistics, University of Chicago, Chicago, IL 60637, USA
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3
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Nair J, Martin CR. Context of time on intestinal injury in preterm infants. Pediatr Res 2024; 95:873-874. [PMID: 37875727 DOI: 10.1038/s41390-023-02844-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 08/30/2023] [Accepted: 09/02/2023] [Indexed: 10/26/2023]
Affiliation(s)
- Jayasree Nair
- Division of Neonatology, Weill Cornell Medicine, New York, NY, USA
| | - Camilia R Martin
- Division of Neonatology, Weill Cornell Medicine, New York, NY, USA.
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4
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Sharma P, Luo G, Wang C, Brodsky D, Martin CR, Beam A, Beam K. Assessment of the clinical knowledge of ChatGPT-4 in neonatal-perinatal medicine: a comparative analysis with ChatGPT-3.5. J Perinatol 2024:10.1038/s41372-024-01912-8. [PMID: 38402349 DOI: 10.1038/s41372-024-01912-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/08/2024] [Accepted: 02/15/2024] [Indexed: 02/26/2024]
Affiliation(s)
- Puneet Sharma
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA.
| | - Guangze Luo
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Cambridge, MA, USA
| | - Cindy Wang
- Department of Statistics, Harvard University, Cambridge, MA, USA
| | - Dara Brodsky
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Camilia R Martin
- Division of Neonatology, Weill Cornell Medicine, New York City, NY, USA
| | - Andrew Beam
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Cambridge, MA, USA
| | - Kristyn Beam
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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5
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Ahmed S, Odumade OA, van Zalm P, Fatou B, Hansen R, Martin CR, Angelidou A, Steen H. Proteomics-Based Mapping of Bronchopulmonary Dysplasia-Associated Changes in Noninvasively Accessible Oral Secretions. J Pediatr 2023; 270:113774. [PMID: 37839510 PMCID: PMC11014893 DOI: 10.1016/j.jpeds.2023.113774] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/18/2023] [Accepted: 10/09/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE To determine if oral secretions (OS) can be used as a noninvasively collected body fluid, in lieu of tracheal aspirates (TA), to track respiratory status and predict bronchopulmonary dysplasia (BPD) development in infants born <32 weeks. STUDY DESIGN This was a retrospective, single center cohort study that included data and convenience samples from week-of-life (WoL) 3 from 2 independent preterm infant cohorts. Using previously banked samples, we applied our sample-sparing, high-throughput proteomics technology to compare OS and TA proteomes in infants born <32 weeks admitted to the Neonatal Intensive Care Unit (NICU) (Cohort 1; n = 23 infants). In a separate similar cohort, we mapped the BPD-associated changes in the OS proteome (Cohort 2; n = 17 infants including 8 with BPD). RESULTS In samples collected during the first month of life, we identified 607 proteins unique to OS, 327 proteins unique to TA, and 687 overlapping proteins belonging to pathways involved in immune effector processes, neutrophil degranulation, leukocyte mediated immunity, and metabolic processes. Furthermore, we identified 37 OS proteins that showed significantly differential abundance between BPD cases and controls: 13 were associated with metabolic and immune dysregulation, 10 of which (eg, SERPINC1, CSTA, BPI) have been linked to BPD or other prematurity-related lung disease based on blood or TA investigations, but not OS. CONCLUSIONS OS are a noninvasive, easily accessible alternative to TA and amenable to high-throughput proteomic analysis in preterm newborns. OS samples hold promise to yield actionable biomarkers of BPD development, particularly for prospective categorization and timely tailored treatment of at-risk infants with novel therapies.
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Affiliation(s)
- Saima Ahmed
- Department of Pathology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Oludare A Odumade
- Harvard Medical School, Boston, MA; Division of Neonatology, Boston Children's Hospital and Harvard Medical School, Boston, MA; Precision Vaccines Program, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Patrick van Zalm
- Department of Pathology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Benoit Fatou
- Department of Pathology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA; Precision Vaccines Program, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Rachel Hansen
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA
| | | | - Asimenia Angelidou
- Harvard Medical School, Boston, MA; Precision Vaccines Program, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA; Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Hanno Steen
- Department of Pathology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA; Precision Vaccines Program, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA.
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6
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Heras A, Chambers R, Solomon Z, Blatt L, Martin CR. Nutrition-based implications and therapeutics in the development and recovery of bronchopulmonary dysplasia. Semin Perinatol 2023; 47:151818. [PMID: 37775366 DOI: 10.1016/j.semperi.2023.151818] [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] [Indexed: 10/01/2023]
Abstract
Premature births account for over 10% of live births worldwide. Bronchopulmonary dysplasia (BPD) represents a severe sequela in neonates born very prematurely and remains the most common chronic neonatal lung disease, often leading to serious adverse consequences in adulthood. Nutrition plays a crucial role in lung development and repair. Ongoing research has primarily focused on the pathogenesis and prevention of BPD in preterm birth. However, infants with established BPD need specialist medical care that persists throughout their hospitalization and continues after discharge. This manuscript aims to highlight the impact of growth and nutrition on BPD and highlight research gaps to provide direction for future studies. Protective practices include ensuring adequate early energy delivery through parenteral nutrition and enteral feedings while carefully monitoring total fluid intake and the use of breast milk over formula. These nutritional strategies remain the same for infants with established BPD with the addition of limiting the use of diuretics and steroids; but if employed, monitoring carefully without compromising total energy delivery. Functional nutrient supplements with a potential protective role against BPD are revisited, despite the limited evidence of their efficacy, including vitamins, trace elements, zinc, lipids, and sphingolipids. Planning post-intensive care and outpatient longitudinal nutrition support is critical in caring for an infant with established BPD.
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Affiliation(s)
- Andrea Heras
- Department of Pediatrics, Division of Pediatric Pulmonology, Weill Cornell Medicine, Komansky Children's Hospital, New York, NY, United States
| | - Rachel Chambers
- NewYork-Presbyterian Food& Nutrition Services, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, NY, United States
| | - Zenna Solomon
- Department of Pediatrics, Division of Pediatric Pulmonology, Weill Cornell Medicine, Komansky Children's Hospital, New York, NY, United States
| | - Lauren Blatt
- Department of Pediatrics, Division of Neonatology, Weill Cornell Medicine, Komansky Children's Hospital, New York, NY, United States
| | - Camilia R Martin
- Department of Pediatrics, Division of Neonatology, Weill Cornell Medicine, Komansky Children's Hospital, New York, NY, United States.
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7
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Frost B, Martin CR, Calkins KL. Dilemmas in the delivery of intravenous lipid emulsions and approach to hypertriglyceridemia in very preterm and low birth weight infants. J Perinatol 2023; 43:1189-1193. [PMID: 37031340 DOI: 10.1038/s41372-023-01637-0] [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: 11/16/2022] [Revised: 02/10/2023] [Accepted: 02/22/2023] [Indexed: 04/10/2023]
Abstract
Intravenous lipid emulsions (ILEs) are an essential component of parenteral nutrition for very preterm and very low birth weight infants (VLBWs). This article offers a perspective on advancements and controversies on ILE use in this population. ILEs prescribed after birth at a dose of 1.5-2 g/kg/day and advanced to 3 g/kg/day enhance growth. Growth appears to be similar for infants who receive an ILE composed of 100% soybean oil or a multi-oil ILE with 15% fish oil. 100% fish oil is the preferred ILE for the management of parenteral nutrition associated cholestasis and intestinal failure associated liver disease. Research is warranted to help determine how we can optimize ILEs to improve neurodevelopment and prematurity complications. Last, we lack a universal definition of hypertriglyceridemia (HTG) and consensus on triglyceride surveillance and HTG management. Investigation is required to determine the health impact of specific triglyceride ranges in very preterm infants and VLBWs.
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Affiliation(s)
- Brandy Frost
- Department of Pediatrics, Division of Neonatology, NorthShore University HealthSystem, Pritzker School of Medicine, University of Chicago, Evanston, IL, USA
| | - Camilia R Martin
- Department of Pediatrics, Division of Neonatology, Weill Cornell Medicine, New York, NY, USA
| | - Kara L Calkins
- Department of Pediatrics, Division of Neonatology & Developmental Biology, Neonatal Research Center of the UCLA Children's Discovery and Innovation Institute, David Geffen School of Medicine UCLA, Los Angeles, CA, USA.
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8
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Blanco CL, Smith V, Ramel SE, Martin CR. Dilemmas in parenteral glucose delivery and approach to glucose monitoring and interpretation in the neonate. J Perinatol 2023; 43:1200-1205. [PMID: 36964206 DOI: 10.1038/s41372-023-01640-5] [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: 07/20/2022] [Revised: 12/16/2022] [Accepted: 02/23/2023] [Indexed: 03/26/2023]
Abstract
Glucose control continues to be challenging for intensivists, in particular in high-risk neonates. Many factors play a role in glucose regulation including intrinsic and extrinsic factors. Optimal targets for euglycemia are debatable with uncertain short and long-term effects. Glucose measurement technology has continued to advance over the past decade; unfortunately, the availability of these advanced devices outside of research continues to be problematic. Treatment approaches should be individualized depending on etiology, symptoms, and neonatal conditions. Glucose infusions should be titrated based upon variations in organ glucose uptake, co-morbidities and postnatal development. In this article we summarize the most common dilemmas encountered in the NICU: ranges for euglycemia, physiological differences, approach for glucose measurements, monitoring and best strategies to control parenteral glucose delivery.
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Affiliation(s)
- Cynthia L Blanco
- Department of Pediatrics, University of Texas Health Science Center San Antonio, San Antonio, TX, USA.
| | - Victor Smith
- Department of Pediatrics, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Sara E Ramel
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Camilia R Martin
- Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA
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9
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Chan AP, Rostas S, Rogers S, Martin CR, Calkins KL. Parenteral Nutrition in the Neonatal Intensive Care Unit: Intravenous Lipid Emulsions. Clin Perinatol 2023; 50:575-589. [PMID: 37536765 DOI: 10.1016/j.clp.2023.04.012] [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] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Intravenous lipid emulsions (ILEs) are a source of nonprotein calories and fatty acids and help promote growth in preterm infants and infants with intestinal failure. An ILE dose and oil source determines its fatty acid, phytosterol, and vitamin E delivery. These factors play a role in the infant's risk for essential fatty acid deficiency and cholestasis, and help modulate inflammation, immunity, and organ development. This article reviews different ILEs and their constituents and their relationship with neonatal health.
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Affiliation(s)
- Alvin P Chan
- Division of Gastroenterology, Department of Pediatrics, David Geffen School of Medicine UCLA, 10833 Le Conte Avenue, MDCC 12-383, Los Angeles, CA 90095, USA
| | - Sara Rostas
- New York-Presbyterian Department of Pharmacy, New York-Presbyterian Hospital/Komansky Children's Hospital, 1283 York Avenue, FL15, New York, NY 10065, USA
| | - Samantha Rogers
- New York-Presbyterian Food & Nutrition Services, New York-Presbyterian Hospital/Weill Cornell Medical Center, 1283 York Avenue, FL15, New York, NY 10065, USA
| | - Camilia R Martin
- Division of Neonatology, Department of Pediatrics, Weill Cornell Medicine, 1283 York Avenue, FL15, New York, NY 10065, USA
| | - Kara L Calkins
- Division of Neonatology & Developmental Biology, Department of Pediatrics, Neonatal Research Center of the UCLA Children's Discovery and Innovation Institute, David Geffen School of Medicine UCLA, 1088 Le Conte Avenue, Room B2-375 MDCC, Los Angeles, CA 90095, USA.
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10
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Beam K, Sharma P, Kumar B, Wang C, Brodsky D, Martin CR, Beam A. Performance of a Large Language Model on Practice Questions for the Neonatal Board Examination. JAMA Pediatr 2023; 177:977-979. [PMID: 37459084 PMCID: PMC10352922 DOI: 10.1001/jamapediatrics.2023.2373] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 03/30/2023] [Accepted: 04/28/2023] [Indexed: 07/20/2023]
Abstract
This Diagnostic/Prognostic Study evaluates the performance of a large language model in generating answers to practice questions for the neonatal-perinatal board examination.
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Affiliation(s)
- Kristyn Beam
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Puneet Sharma
- Division of Newborn Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Bhawesh Kumar
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Cindy Wang
- Department of Statistics, Harvard University, Cambridge, Massachusetts
| | - Dara Brodsky
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Andrew Beam
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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11
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Martin CR. Fatty acid supplementation and health outcomes in preterm infants: Hand-waving or true biological impact? Am J Clin Nutr 2023; 117:839-841. [PMID: 37137612 DOI: 10.1016/j.ajcnut.2023.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 05/05/2023] Open
Affiliation(s)
- Camilia R Martin
- Division of Neonatology, Weill Cornell Medicine, New York, NY, USA.
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12
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Ramiro-Cortijo D, Herranz Carrillo G, Singh P, Rebollo-Hernanz M, Rodríguez-Rodríguez P, Ruvira S, Martín-Trueba M, Martin CR, Arribas SM. Maternal and Neonatal Factors Modulating Breast Milk Cytokines in the First Month of Lactation. Antioxidants (Basel) 2023; 12:antiox12050996. [PMID: 37237863 DOI: 10.3390/antiox12050996] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023] Open
Abstract
Breast milk (BM) cytokines support and modulate infant immunity, being particularly relevant in premature neonates with adverse outcomes (NAO). This study aimed to examine, in a cohort of Spanish breastfeeding women, changes in BM cytokines in the first month of lactation, their modulation by neonatal factors (sex, gestational age, and NAO), maternal factors (obstetric complications, C-section, and diet), and their relationship with oxidative status. Sixty-three mother-neonate dyads were studied at days 7 and 28 of lactation. Dietary habits were assessed by a 72-h dietary recall, and the maternal dietary inflammatory index (mDII) was calculated. BM cytokines (IL-10, IL-13, IL-8, MCP-1, and TNFα) were assessed by ultra-sensitive chemiluminescence. Total antioxidant capacity was assessed by the ABTS method and lipid peroxidation by the MDA+HNE kit. From days 7 to 28 of lactation, the levels of IL-10 and TNFα remained stable, while IL-13 increased (β = 0.85 ± 0.12, p < 0.001) and IL-8 and MCP-1 levels decreased (β = -0.64 ± 0.27, p = 0.019; β = -0.98 ± 0.22, p < 0.001; respectively). Antioxidant capacity and lipid peroxidation also decrease during lactation. Neonatal sex did not influence any of the cytokines, but BM from mothers with male infants had a higher antioxidant capacity. Gestational age was associated with male sex and NAO, being inversely correlated with the BM proinflammatory cytokines IL-8, MCP-1, and TNFα. From days 7 to 28 of lactation, BM from women with NAO infants increased MCP-1 levels and had a larger drop in antioxidant capacity, with the opposite trend in lipid peroxidation. MCP-1 was also significantly higher in women undergoing C-section; this cytokine declined in women who decreased mDII during lactation, while IL-10 increased. Linear mixed regression models evidenced that the most important factors modulating BM cytokines were lactation period and gestational age. In conclusion, during the first month of lactation, BM cytokines shift towards an anti-inflammatory profile, influenced mainly by prematurity. BM MCP-1 is associated with maternal and neonatal inflammatory processes.
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Affiliation(s)
- David Ramiro-Cortijo
- Department of Physiology, Faculty of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
- Instituto Universitario de Estudios de la Mujer (IUEM), Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - Gloria Herranz Carrillo
- Division of Neonatology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Pratibha Singh
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Miguel Rebollo-Hernanz
- Department of Agricultural Chemistry and Food Science, Institute of Food Science Research CIAL (UAM-CSIC), Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | | | - Santiago Ruvira
- Department of Physiology, Faculty of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain
| | - María Martín-Trueba
- Department of Agricultural Chemistry and Food Science, Institute of Food Science Research CIAL (UAM-CSIC), Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - Camilia R Martin
- Department of Neonatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
- Division of Translational Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Silvia M Arribas
- Department of Physiology, Faculty of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain
- Instituto Universitario de Estudios de la Mujer (IUEM), Universidad Autónoma de Madrid, 28049 Madrid, Spain
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13
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Holzapfel LF, Hair AB, Preidis GA, Halder T, Yang H, Unger JP, Freedman S, Martin CR. Fecal Elastase in Preterm Infants to Predict Growth Outcomes. J Pediatr Gastroenterol Nutr 2023; 76:206-212. [PMID: 36705701 PMCID: PMC9886337 DOI: 10.1097/mpg.0000000000003672] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Preterm infants are born functionally pancreatic insufficient with decreased pancreatic production of lipase and proteases. Developmental pancreatic insufficiency (PI) may contribute to reduced nutrient absorption and growth failure. We sought to determine longitudinal fecal elastase (ELA1) levels in a cohort of preterm infants and whether levels are associated with growth outcomes. METHODS Prospective observational study of 30 infants 24-34 weeks gestational age and birth weight ≤1250 g fed the exclusive human milk diet, consisting of human milk with human milk-based fortifier. ELA1 was quantified by ELISA during the first 2 weeks of life [Early; 7.5 ± 1.8 days of life (DOL)] and after attainment of full, fortified feedings (Late; 63.6 ± 24.1 DOL). RESULTS Early ELA1 levels were 192.2 ± 96.4 µg/g, and Late ELA1 levels were 268.0 ± 80.3 µg/g, 39.4% higher (P = 0.01). Infants with early PI (ELA1 < 200 µg/g) were more likely male and of lower gestational age, weight, length, and head circumference at birth. These variables, but not PI status, independently predicted somatic growth. CONCLUSIONS Fecal ELA1 in preterm infants fed exclusive human milk diet increases with postnatal age. Although pancreatic function in preterm infants may serve as a biological contributor to early postnatal growth failure, additional studies using fecal ELA1 as a predictive biomarker for growth failure are needed in larger cohorts.
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Affiliation(s)
- Lindsay F Holzapfel
- From the Department of Pediatrics, Division of Neonatology, University of Texas at Houston Health Science Center, Houston, TX
- the Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Amy B Hair
- the Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Geoffrey A Preidis
- the Division of Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Tripti Halder
- the Division of Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Heeju Yang
- the Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Jana P Unger
- the Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
- the Clinical Nutrition Services, Texas Children's Hospital, Houston, TX
| | - Steven Freedman
- the Department of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
- Division of Translational Research, Beth Israel Deaconess Medical Center, Boston, MA
| | - Camilia R Martin
- the Division of Neonatology, Weill Cornell Medicine, New York, NY
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14
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Lu J, Martin CR, Claud EC. Neurodevelopmental outcome of infants who develop necrotizing enterocolitis: The gut-brain axis. Semin Perinatol 2023; 47:151694. [PMID: 36572620 PMCID: PMC9974904 DOI: 10.1016/j.semperi.2022.151694] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Necrotizing enterocolitis (NEC) poses a significant risk for neurodevelopmental impairment in extremely preterm infants. The gut microbiota shapes the development of the gut, immune system, and the brain; and dysbiosis drive neonatal morbidities including NEC. In this chapter, we delineate a gut-brain axis linking gut microbiota to the adverse neurological outcomes in NEC patients. We propose that in NEC, immaturity of the microbiome along with aberrant gut microbiota-driven immaturity of the gut barrier and immune system can lead to effects including systemic inflammation and circulating microbial mediators. This nexus of gut microbiota-driven systemic effects further interacts with a likewise underdeveloped blood-brain barrier to regulate neuroinflammation and neurodevelopment. Targeting deviant gut-brain axis signaling presents an opportunity to improve the neurodevelopmental outcomes of NEC patients.
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Affiliation(s)
- Jing Lu
- Department of Pediatrics, Division of Biological Sciences, University of Chicago, Pritzker School of Medicine, Chicago, Illinois 60637, United States
| | - Camilia R Martin
- Department of Pediatrics, Division of Newborn Medicine, Weill Cornell Medicine, New York, New York 10021, United States
| | - Erika C Claud
- Department of Pediatrics, Division of Biological Sciences, University of Chicago, Pritzker School of Medicine, Chicago, Illinois 60637, United States.
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15
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Ramiro-Cortijo D, Singh P, Herranz Carrillo G, Gila-Díaz A, Martín-Cabrejas MA, Martin CR, Arribas SM. Association of maternal body composition and diet on breast milk hormones and neonatal growth during the first month of lactation. Front Endocrinol (Lausanne) 2023; 14:1090499. [PMID: 36936154 PMCID: PMC10018215 DOI: 10.3389/fendo.2023.1090499] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 02/17/2023] [Indexed: 03/06/2023] Open
Abstract
INTRODUCTION Preterm birth is associated with altered growth patterns and an increased risk of cardiometabolic diseases, with breast milk (BM) being a counteracting factor. Preterm infants also show alterations in adipokines and gut hormones influencing appetite and metabolism. Since these hormones are present in BM, it is possible that their levels may equilibrate deficiencies improving infant growth. We aimed to assess 1) the BM levels of ghrelin, resistin, leptin, insulin, peptide YY, and the gastrointestinal peptide in women with preterm and term labor; 2) the relationship between BM hormones and neonatal growth; and 3) the influence of maternal body composition and diet on these BM hormones. METHODS BM from 48 women (30 term and 18 preterm labor) was collected at days 7, 14, and 28 of lactation. Maternal body composition was evaluated by bioimpedance, and neonate anthropometric parameters were collected from medical records. The maternal dietary pattern was assessed by a 72-h dietary recall at days 7 and 28 of lactation. BM hormones were analyzed by the U-Plex Ultra-sensitive method. Data were analyzed using linear regression models. BM from women with preterm labor had lower ghrelin levels, with the other hormones being significantly higher compared to women with term delivery. RESULTS In premature infants, growth was positively associated with BM ghrelin, while, in term infants, it was positively associated with insulin and negatively with peptide YY. In the first week of lactation, women with preterm labor had higher body fat compared to women with term labor. In this group, ghrelin levels were positively associated with maternal body fat and with fiber and protein intake. In women with term labor, no associations between anthropometric parameters and BM hormones were found, and fiber intake was negatively associated with peptide YY. DISCUSSION Preterm labor is a factor influencing the levels of BM adipokines and gut hormones, with BM ghrelin being a relevant hormone for premature infant growth. Since ghrelin is lower in BM from women with preterm labor and the levels are associated with maternal fat storage and some dietary components, our data support the importance to monitor diet and body composition in women who gave birth prematurely to improve the BM hormonal status.
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Affiliation(s)
- David Ramiro-Cortijo
- Department of Physiology, Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
- Instituto Universitario de Estudios de la Mujer (IUEM), Universidad Autónoma de Madrid, Madrid, Spain
| | - Pratibha Singh
- Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Gloria Herranz Carrillo
- Division of Neonatology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Andrea Gila-Díaz
- Department of Physiology, Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - María A. Martín-Cabrejas
- Department of Agricultural Chemistry and Food Science, Institute of Food Science Research (CIAL), Universidad Autónoma de Madrid, Consejo Superior de Investigación Científica (CSIC), Madrid, Spain
| | - Camilia R. Martin
- Department of Neonatology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
- Division of Translational Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Silvia M. Arribas
- Department of Physiology, Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Instituto Universitario de Estudios de la Mujer (IUEM), Universidad Autónoma de Madrid, Madrid, Spain
- *Correspondence: Silvia M. Arribas,
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16
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Ramiro-Cortijo D, Herranz Carrillo G, Gila-Diaz A, Ruvira S, Singh P, Braojos C, Martin CR, Arribas SM. Association between Adherence to the Healthy Food Pyramid and Breast Milk Fatty Acids in the First Month of Lactation. Nutrients 2022; 14:nu14245280. [PMID: 36558439 PMCID: PMC9780987 DOI: 10.3390/nu14245280] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/13/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
In lactating women, breast milk (BM) fatty acids may come from the diet or stored adipose tissue. Our objective was to evaluate the influence of the adherence to the healthy food pyramid (HFP), the dietary pattern in the Mediterranean region, and the maternal body composition on the BM fatty acids pattern. Fifty breastfeeding women answered a socioeconomic survey and the adherence to the HFP questionnaire (AP-Q). In addition, they provided a BM sample at 7 ± 1, 14 ± 1, and 28 ± 1 days postpartum. The body's composition was analyzed at days 7 and 28 by bioimpedance. The BM fatty acids were analyzed by gas chromatography-mass spectroscopy. We found a negative association between the consumption of olive oil and the BM palmitic acid levels (β = -3.19 ± 1.40; p = 0.030), and the intake of cereals and legumes was positively associated with the BM saturated fatty acids (β = 11.48 ± 3.87; p = 0.005). The intake of proteins and vegetables was positively associated with the omega-3 fatty acids and negatively with the omega-6:omega-3 ratio in BM. A negative association between the maternal age (β = -0.43 ± 0.11; p = 0.001) and the α-linolenic acid (ALA) levels was observed, being overall AP-Q positively associated with the ALA levels (β = 0.39 ± 0.15; p = 0.016). Physical activity reduced both the omega-3 and omega-6 fatty acids in BM. Diet had a larger influence than the maternal body's composition on BM fatty acids during the first month of lactation, demonstrating a better adherence to the HFP and positively impacting on the omega-3 content in BM, a fact that is modulated by one's maternal age.
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Affiliation(s)
- David Ramiro-Cortijo
- Department of Physiology, Faculty of Medicine, Universidad Autónoma de Madrid, C/ Arzobispo Morcillo 2, 28029 Madrid, Spain
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Gloria Herranz Carrillo
- Division of Neonatology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), C/ del Profesor Martin Lagos, S/N, 28040 Madrid, Spain
| | - Andrea Gila-Diaz
- Department of Physiology, Faculty of Medicine, Universidad Autónoma de Madrid, C/ Arzobispo Morcillo 2, 28029 Madrid, Spain
| | - Santiago Ruvira
- Department of Physiology, Faculty of Medicine, Universidad Autónoma de Madrid, C/ Arzobispo Morcillo 2, 28029 Madrid, Spain
| | - Pratibha Singh
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Cheyenne Braojos
- Department of Agricultural Chemistry and Food Science, Faculty of Science, Institute of Food Science Research (CIAL, UAM-CSIC), Universidad Autónoma de Madrid, C/ Nicolas Cabrera 9, 28049 Madrid, Spain
| | - Camilia R. Martin
- Department of Neonatology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Silvia M. Arribas
- Department of Physiology, Faculty of Medicine, Universidad Autónoma de Madrid, C/ Arzobispo Morcillo 2, 28029 Madrid, Spain
- Correspondence:
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17
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Affiliation(s)
- Camilia R Martin
- From the Division of Neonatology, Weill Cornell Medicine, New York
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18
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Bozzetti V, Martin CR. [Práctica de la nutrición enteral en lactantes de muy bajo y extremadamente bajo peso al nacer]. World Rev Nutr Diet 2022; 122:284-301. [PMID: 36174520 DOI: 10.1159/000526523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Valentina Bozzetti
- Neonatal Intensive Care Unit, MBBM Foundation, San Gerardo Hospital, Monza, Italy
| | - Camilia R Martin
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.,Division of Translational Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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19
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Frazer LC, Gura KM, Bines JE, Puder M, Martin CR. [Prevención y manejo de la colestasis asociada a la nutrición parenteral y la enfermedad hepática asociada a la insuficiencia intestinal en los lactantes críticamente enfermos]. World Rev Nutr Diet 2022; 122:408-430. [PMID: 36174529 DOI: 10.1159/000526555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Lauren C Frazer
- Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Kathleen M Gura
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.,Department of Pharmacy, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Julie E Bines
- Department of Paediatrics, University of Melbourne, Enteric Diseases Group, Murdoch Children's Research Institute, Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Mark Puder
- Department of Surgery and the Vascular Biology Program, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Camilia R Martin
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.,Division of Translational Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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20
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Frazer LC, Yakah W, Martin CR. Decreased Acetic Acid in the Stool of Preterm Infants Is Associated with an Increased Risk of Bronchopulmonary Dysplasia. Nutrients 2022; 14:nu14122412. [PMID: 35745141 PMCID: PMC9230097 DOI: 10.3390/nu14122412] [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] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 05/26/2022] [Accepted: 06/02/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Short-chain fatty acids (SCFAs), microbial metabolites, have been minimally studied in neonatal pathophysiology but have been associated with disease outcomes in adults. The objective of this manuscript was to determine if SCFA levels in maternal breastmilk (BM) and stool from preterm neonates impacted the risk of neonatal morbidities. Methods: SCFA levels were quantified by liquid chromatography with tandem mass spectrometry on maternal BM and neonatal stool for preterm infants < 28 weeks’ gestation (N = 72) on postnatal days 14 and 28. SCFA levels in BM and stool of infants with and without bronchopulmonary disease (BPD) and retinopathy of prematurity (ROP) were compared. Logistic regression was applied to determine the association between stool acetic acid levels and disease. Results: Acetic, propionic, isobutyric, 2-methylbutyric, and isovaleric acid levels increased in BM and neonatal stool between days 14 and 28. Logistic regression demonstrated an inverse relationship between the quartile of fecal acetic acid level and the odds of BPD but not ROP on days 14 and 28. For each quartile increase in fecal acetic acid, the odds ratio (95% CI) of BPD was 0.41 (0.18, 0.83) for day 14 and 0.28 (0.09, 0.64) for day 28. Conclusions: Low acetic acid levels in the stool of preterm infants are associated with increased odds of BPD. These findings support a relationship between intestinal and pulmonary health in preterm infants.
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Affiliation(s)
- Lauren C. Frazer
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
| | - William Yakah
- Institute of Human Nutrition, Columbia University Medical Center, New York, NY 10032, USA;
| | - Camilia R. Martin
- Division of Newborn Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY 10065, USA
- Correspondence: ; Tel.: +1-646-697-6428
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21
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Santoro KL, Yakah W, Singh P, Ramiro-Cortijo D, Medina-Morales E, Freedman SD, Martin CR. Acetaminophen and Xenobiotic Metabolites in Human Milk and the Development of Bronchopulmonary Dysplasia and Retinopathy of Prematurity in a Cohort of Extremely Preterm Infants. J Pediatr 2022; 244:224-229.e3. [PMID: 35093319 PMCID: PMC9152735 DOI: 10.1016/j.jpeds.2022.01.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 10/06/2021] [Revised: 12/22/2021] [Accepted: 01/18/2022] [Indexed: 12/14/2022]
Abstract
This retrospective cohort study sought to identify the association between certain xenobiotic metabolites in maternal breast milk and the diagnoses of bronchopulmonary dysplasia and retinopathy of prematurity in extremely preterm infants. Several acetaminophen metabolites were associated with a 3- to 6-fold increased odds of these disorders, and metabolites of certain food products, benzoate, and caffeine were associated with decreased odds.
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Affiliation(s)
- Kristin L. Santoro
- Division of Newborn Medicine, Boston Children’s Hospital, Harvard Medical School, Boston MA 02115, USA
| | - William Yakah
- Department of Neonatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA 02215, USA
| | - Pratibha Singh
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA 02215, USA
| | - David Ramiro-Cortijo
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA 02215, USA
| | - Esli Medina-Morales
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA 02215, USA
| | - Steven D. Freedman
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA 02215, USA;,Division of Translational Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA 02215, USA
| | - Camilia R. Martin
- Department of Neonatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA 02215, USA;,Division of Translational Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA 02215, USA
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22
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Heard BJ, Barton KI, Abubacker S, Chung M, Martin CR, Schmidt TA, Shrive NG, Hart DA. Synovial and cartilage responsiveness to peri-operative hyaluronic acid ± dexamethasone administration following a limited injury to the rabbit stifle joint. J Orthop Res 2022; 40:838-845. [PMID: 34061360 DOI: 10.1002/jor.25108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 12/21/2020] [Revised: 04/03/2021] [Accepted: 05/25/2021] [Indexed: 02/04/2023]
Abstract
Posttraumatic osteoarthritis (PTOA) can develop after an injury to the knee. Previous studies have indicated that an intra-articular (IA) injection of the potent glucocorticoid dexamethasone (DEX) may significantly prevent induction of PTOA. The aim of the present study was to investigate the effectiveness of a single IA injection of hyaluronic acid (HA), alone and in combination with DEX following a localized intra-articular injury as a PTOA-preventing treatment option. An established rabbit model of surgical injury consisting of dual intra-articular (IA) drill holes in a non-cartilaginous area of the femoral notch near the origin of the anterior cruciate ligament (ACL) to allow for bleeding into the joint space was used. Immediately following surgery, subjects were treated with HA, HA + DEX, or received no treatment. An uninjured control group was used for comparison (N = 5/group). Rabbits were sacrificed and investigated at 9 weeks post-injury. At 9 weeks post-injury, there was a significant protective capacity of the single IA treatment of DEX + HA on the histological grade of the synovial tissue, and some variable location-specific effects of HA alone and HA + DEX interactions on cartilage damage. Thus, it is possible that co-treatment with HA may interfere with the effectiveness of the DEX. In vitro friction testing indicated that DEX did not interfere with the lubricating ability of HA or synovial fluid on cartilage. These results suggest that a single IA administration of HA in combination with DEX following an IA injury is not recommended for inhibition of PTOA progression in this model.
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Affiliation(s)
- B J Heard
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.,Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - K I Barton
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.,Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - S Abubacker
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.,Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - M Chung
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - C R Martin
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.,Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - T A Schmidt
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.,Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Sculich School of Engineering, University of Calgary, Calgary, Alberta, Canada
| | - N G Shrive
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.,Sculich School of Engineering, University of Calgary, Calgary, Alberta, Canada
| | - D A Hart
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.,Department of Surgery, University of Calgary, Calgary, Alberta, Canada.,Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Bone & Joint Health Strategic Clinical Network, Edmonton, Alberta, Canada
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Abstract
Despite abundant research comparing postdischarge hospital diets for preterm infants, the ideal clinical approach has not been determined. Dilemmas persist because randomized controlled trials of preterm versus term infant formula have yielded equivocal results and because the predominant postdischarge diet for preterm infants has shifted from formula-based to a combination that includes maternal milk and increasingly includes a plan for breastfeeding. As the investigation of the influence of the post-hospital discharge diet on preterm infant outcomes evolves, factors to consider include the infant's oral feeding ability and the maternal lactation goal. The maturation of the preterm infant's oral feeding skills may at least partially explain why increased nutrient density appears to most benefit growth outcomes when given during the first 3 to 4 months after hospital discharge. At some point in maturation, the preterm infant may develop the ability to vary intake as needed to obtain sufficient nutrition no matter the density of the diet. In addition, attention to the maternal lactation goal is critical as intake of maternal milk likely influences neurodevelopmental outcomes as much or even to a greater extent than growth trajectory.
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Affiliation(s)
- Sarah N Taylor
- Department of Pediatrics, Yale School of Medicine, New Haven, CT
| | - Camilia R Martin
- Department of Neonatology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA
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24
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Lewis AN, de la Cruz D, Wynn JL, Frazer LC, Yakah W, Martin CR, Yang H, Itriago E, Unger J, Hair AB, Miele J, Sullivan BA, Husain A, Good M. Evaluation of the Neonatal Sequential Organ Failure Assessment and Mortality Risk in Preterm Infants with Necrotizing Enterocolitis. Neonatology 2022; 119:334-344. [PMID: 35313308 PMCID: PMC9117503 DOI: 10.1159/000522560] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 02/10/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The neonatal sequential organ failure assessment (nSOFA) score is a tool for calculating mortality risk of infants in the neonatal intensive care unit. The utility of the nSOFA in determining the risk of mortality or the association with surgical intervention among infants with necrotizing enterocolitis (NEC) has not been investigated. METHODS We performed a retrospective, cohort study of preterm (<37 weeks) infants with NEC Bell's stage ≥ IIA at six hospitals from 2008 to 2020. An nSOFA score (range 0-15) was assigned to each patient at nine time points from 48 h before or after clinical illness was suspected. RESULTS Of the 259 infants, nSOFA scores for infants who died (n = 39) or had the composite outcome of surgery or death (n = 114) were significantly higher (p < 0.05) early in the NEC course compared to nSOFA scores for infants who survived medical NEC. Twelve hours after evaluation, the area under the receiver operating characteristic curve was 0.87 (95% confidence interval [CI], 0.80-0.93) to discriminate for mortality and 0.84 (95% CI, 0.79-0.90) for surgery or death (p < 0.001). A maximum nSOFA score of ≥4 at -6, 0, 6, or 12 h following evaluation was associated with a 20-fold increase in mortality and 19-fold increase in surgery or death compared with a score of <4 (p < 0.001). CONCLUSION In this multicenter cohort, the nSOFA score was able to discriminate well for death as well as surgery or death among infants with NEC. The nSOFA is a clinical research tool that may be used in infants with NEC to improve classification by objective quantification of organ dysfunction.
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Affiliation(s)
- Angela N. Lewis
- Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis Children’s Hospital, 660 South Euclid, St. Louis, MO 63110, USA
| | - Diomel de la Cruz
- Division of Neonatology, Department of Pediatrics, University of Florida College of Medicine, UF Health Shands Children’s Hospital, 1600 SW Archer Rd, Gainesville, FL 32610, USA
| | - James L. Wynn
- Division of Neonatology, Department of Pediatrics, University of Florida College of Medicine, UF Health Shands Children’s Hospital, 1600 SW Archer Rd, Gainesville, FL 32610, USA
| | - Lauren C. Frazer
- Division of Newborn Medicine, Department of Pediatrics, Harvard Medical School, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - William Yakah
- Division of Newborn Medicine, Department of Pediatrics, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA
| | - Camilia R. Martin
- Division of Newborn Medicine, Department of Pediatrics, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA
- Division of Newborn Medicine, Department of Pediatrics, Harvard Medical School, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Heeju Yang
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Elena Itriago
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Jana Unger
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Amy B. Hair
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Jessica Miele
- University of Virginia School of Medicine, UVA Children’s Hospital, 200 Jeanette Lancaster Way, Charlottesville, VA 22903, USA
| | - Brynne A. Sullivan
- Division of Neonatology, Department of Pediatrics, University of Virginia School of Medicine, UVA Children’s Hospital, 200 Jeanette Lancaster Way, Charlottesville, VA 22903, USA
| | - Ameena Husain
- Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis Children’s Hospital, 660 South Euclid, St. Louis, MO 63110, USA
| | - Misty Good
- Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis Children’s Hospital, 660 South Euclid, St. Louis, MO 63110, USA
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25
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Belfort MB, Ramel SE, Martin CR, Fichorova R, Kuban KCK, Heeren T, Fry RC, O’Shea TM. Systemic Inflammation in the First 2 Weeks after Birth as a Determinant of Physical Growth Outcomes in Hospitalized Infants with Extremely Low Gestational Age. J Pediatr 2022; 240:37-43.e1. [PMID: 34508750 PMCID: PMC8712377 DOI: 10.1016/j.jpeds.2021.09.006] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/31/2021] [Accepted: 09/03/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To examine associations of systemic inflammation with growth outcomes at neonatal intensive care unit discharge or transfer among infants with extremely low gestational ages. STUDY DESIGN We studied 850 infants at born at 23-27 weeks of gestation. We defined inflammatory protein elevation as the highest quartile of C-reactive protein (CRP), Interleukin (IL)-6, tumor necrosis factor-∝, or IL-8 on postnatal days 1, 7, and 14. We compared z-scores of weight, length, and head circumference at neonatal intensive care unit discharge or transfer between infants with vs without inflammatory protein elevation, adjusting in linear regression for birth size z-score, sex, gestational age, diet, comorbidities, medications, and length of hospitalization. RESULTS The mean gestational age was 25 weeks (range, 23-27 weeks) and birth weight z-score 0.14 (range, -2.73 to 3.28). Infants with a high CRP on day 7 had lower weights at discharge or transfer (-0.17 z-score; 95% CI, -0.27 to -0.06) than infants without CRP elevation, with similar results on day 14. Infants with CRP elevation on day 14 were also shorter (-0.21 length z-scores; 95% CI, -0.38 to -0.04), and had smaller head circumferences (-0.18 z-scores; 95% CI, -0.33 to -0.04) at discharge or transfer. IL-6 elevation on day 14 was associated with lower weight (-0.12; 95% CI, -0.22 to -0.02); IL-6 elevation on day 7 was associated with shorter length (-0.27; 95% CI, -0.43 to -0.12). Tumor necrosis factor-∝ and IL-8 elevation on day 14 were associated with a lower weight at discharge or transfer. CONCLUSIONS Postnatal systemic inflammation may contribute to impaired nutrient accretion during a critical period in development in infants with extremely low gestational ages.
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Affiliation(s)
- Mandy B. Belfort
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Sara E. Ramel
- University of Minnesota School of Medicine, Minneapolis, MN
| | - Camilia R. Martin
- Harvard Medical School, Boston, MA,Beth Israel Deaconess Medical Center, Boston, MA
| | - Raina Fichorova
- Harvard Medical School, Boston, MA,Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, MA
| | | | | | - Rebecca C. Fry
- Department of Environmental Sciences and Engineering, University of North Carolina School of Medicine, Chapel Hill, NC
| | - T. Michael O’Shea
- Division of Neonatal-Perinatal Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
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26
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Good M, Martin CR. A Promising Genetic Target for a Deadly Disease: Single Immunoglobulin Interleukin 1 (SIGIRR) Mutations in Necrotizing Enterocolitis. Cell Mol Gastroenterol Hepatol 2021; 13:674-675. [PMID: 34740617 PMCID: PMC8776998 DOI: 10.1016/j.jcmgh.2021.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 10/19/2021] [Indexed: 12/10/2022]
Affiliation(s)
- Misty Good
- Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Camilia R Martin
- Department of Neonatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
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27
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Fenton TR, Groh-Wargo S, Gura K, Martin CR, Taylor SN, Griffin IJ, Rozga M, Moloney L. Effect of Enteral Protein Amount on Growth and Health Outcomes in Very-Low-Birth-Weight Preterm Infants: Phase II of the Pre-B Project and an Evidence Analysis Center Systematic Review. J Acad Nutr Diet 2021; 121:2287-2300.e12. [DOI: 10.1016/j.jand.2020.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 10/08/2020] [Accepted: 11/03/2020] [Indexed: 01/05/2023]
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28
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Frazer LC, Martin CR. Parenteral lipid emulsions in the preterm infant: current issues and controversies. Arch Dis Child Fetal Neonatal Ed 2021; 106:676-681. [PMID: 33514630 PMCID: PMC8319211 DOI: 10.1136/archdischild-2020-319108] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 06/15/2020] [Revised: 12/24/2020] [Accepted: 01/14/2021] [Indexed: 12/14/2022]
Abstract
Parenteral lipid emulsions are a necessary component of nutrition for extremely low gestational age newborns until adequate levels of enteral intake are established. Historically, Intralipid, a 100% soybean oil emulsion, has filled this role. Newer multicomponent lipid emulsions containing a mixture of other oils, including olive oil and fish oil, are now available as options, although the regulatory approval for use in neonates varies worldwide. When dosed at currently published recommendations, each of these lipid emulsions meets total fat and energy requirements without a risk of essential fatty acid deficiency. Thus, when choosing which lipid emulsion to provide, the answer must be based on the metabolic differences induced as a result of these fatty acid-rich emulsions and whether the emulsions provide a health advantage or pose a health risk. The questions of induced fatty acid profiles, health benefit and health risk are discussed sequentially for multicomponent lipid emulsions. Despite the growing acceptance of multicomponent lipid emulsions, there is concern regarding changes in blood fatty acid levels and potential health risk without strong evidence of benefit. There remains no ideal parenteral lipid emulsion option for the preterm infant. Standardising future animal and human studies in lipid delivery with the inclusion of lipid metabolism data will iteratively provide answers to inform the optimal lipid emulsion for the preterm infant.
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Affiliation(s)
- Lauren C Frazer
- Division of Newborn Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Camilia R Martin
- Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA .,Division of Translational Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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29
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Frazer LC, Martin CR. Reply to 'Parenteral nutrition for preterm infants: correcting for arachidonic and docosahexaenoic acid may not suffice'. Arch Dis Child Fetal Neonatal Ed 2021; 106:683-684. [PMID: 34131040 DOI: 10.1136/archdischild-2021-322370] [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: 05/24/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Lauren C Frazer
- Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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30
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Enstad S, Cheema S, Thomas R, Fichorova R, Martin CR, O'Tierney-Ginn P, Wagner CL, Sen S. Response to messaging and methodological considerations when researching breastfeeding and obesity. Eur J Clin Nutr 2021; 75:1526-1527. [PMID: 33893448 DOI: 10.1038/s41430-021-00900-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/03/2021] [Accepted: 03/02/2021] [Indexed: 01/30/2023]
Affiliation(s)
- Samantha Enstad
- Department of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA.
| | - Sukhinder Cheema
- Department of Biochemistry, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Raymond Thomas
- School of Science and the Environment/Boreal Ecosystem Research Initiative, Grenfell Campus, Memorial University of Newfoundland, Corner Brooke, NL, Canada
| | - Raina Fichorova
- Laboratory of Genital Tract Biology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Camilia R Martin
- Harvard Medical School, Boston, MA, USA.,Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Carol L Wagner
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, SC, USA
| | - Sarbattama Sen
- Harvard Medical School, Boston, MA, USA.,Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
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31
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Frazer LC, Gura KM, Bines JE, Puder M, Martin CR. Prevention and Management of Parenteral Nutrition-Associated Cholestasis and Intestinal Failure-Associated Liver Disease in the Critically Ill Infant. World Rev Nutr Diet 2021; 122:379-399. [PMID: 34352771 DOI: 10.1159/000514763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 12/06/2020] [Indexed: 03/18/2023]
Affiliation(s)
- Lauren C Frazer
- Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Kathleen M Gura
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.,Department of Pharmacy, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Julie E Bines
- Department of Paediatrics, University of Melbourne, Enteric Diseases Group, Murdoch Children's Research Institute, Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Mark Puder
- Department of Surgery and the Vascular Biology Program, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Camilia R Martin
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.,Division of Translational Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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32
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Bozzetti V, Martin CR. The Practice of Enteral Nutrition in Very Low and Extremely Low Birth Weight Infants. World Rev Nutr Diet 2021; 122:265-280. [PMID: 34352759 DOI: 10.1159/000514743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 01/05/2021] [Indexed: 12/13/2022]
Affiliation(s)
- Valentina Bozzetti
- Neonatal Intensive Care Unit, MBBM Foundation, San Gerardo Hospital, Monza, Italy
| | - Camilia R Martin
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.,Division of Translational Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Abstract
Interest in fear of childbirth has grown exponentially since the 1980s, but the landscape of birth has shifted considerably since then, with evolving feminism; moving from a patriarchal environment in a biomedical model of care to a holistic model which recognizes the birth and sexuality rights of women and birthing people. Distinguishing the spectrum of fear from low to high and severe is important rather than aggregating all individuals with fear of childbirth. However, the terms 'fear of childbirth' and 'tocophobia' have been used interchangeably. In this paper we urge clinicians to use the term 'tocophobia' with caution since it may be construed negatively and there is a limited understanding of the underpinning aetiology of tocophobia. Furthermore, using the label may be disempowering for women and birthing people making decisions about their birth. Further research is warranted to better understand the experience, refine and define the issue and meet the individual needs of people with fear of childbirth and tocophobia.
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Affiliation(s)
- M A O'Connell
- Midwifery, School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Wales, UK.
| | - C R Martin
- Institute for Clinical and Applied Health Research, University of Hull, Hull, UK.
| | - J Jomeen
- Midwifery, Faculty of Health, Southern Cross University, Australia.
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34
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Medina-Morales E, Singh P, Ramiro-Cortijo D, Ndjamen HF, Liu Y, Pan K, Brown J, Yakah W, Leone K, Freedman SD, Martin CR. Impact of Long-chain Polyunsaturated Fatty Acids on Hyperoxia-Induced Lung Injury in Neonatal Murine Model. Curr Dev Nutr 2021. [DOI: 10.1093/cdn/nzab046_081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
Reduced levels of long chain-polyunsaturated fatty acids (LCPUFAs) in preterm infants are associated with several neonatal morbidities, including bronchopulmonary dysplasia (BPD). We hypothesized that LCPUFA supplementation would attenuate hyperoxia-induced lung injury in a neonatal mouse model, and we tested our hypothesis in 40%O2-induced-lung injury in neonatal murine model.
Methods
C57BL/6 WT dams were allowed to deliver naturally, and pups were randomized within 12 hours of birth to either hyperoxia (H, 40% O2) or room air (RA) for 10 days. To study the effect of LCPUFAs on hyperoxia-induced lung injury, the pups were randomized to the following groups: 1) RA (vehicle), 2) H (vehicle), 3) H + AA (120mg/kg/day), 4) H + DHA (60mg/kg/day), and 5) H + AA: DHA at 120mg/kg/day and 60mg/kg/day, respectively, maintaining a 2:1 ratio. Mice were gavage fed once daily 50 ul/g body weight from day 1–9. On day 10, the mice were sacrificed, and the lungs were removed for morphometric analyses. Mean Linear Intercept (MLI), Mean Septal Thickness (MST), and Radial Alveolar Count (RAC) were quantified and analyzed using R software and data was shown as mean ± SD.
Results
Compared to RA group, mice in hyperoxia groups showed a significant increase in MLI intercept (RA vs H = 47.75 ± 2.02 vs 56.24 ± 5.54, p < 0.01) and MST (RA vs H = 7.33 ± 0.45 vs 7.88 ± 0.70, p < 0.01), and a significant decrease in RAC (RA vs H = 12.93 ± 0.82 vs 10.26 ± 1, p < 0.01). Compared to H alone, AA: DHA resulted in a significant reduction in hyperoxia-induced MST (H vs H + AA: DHA = 8.70 ± 0.44 vs 6.94 ± 0.74, p < 0.001) and improved hyperoxia-induced reduction in RAC (H vs H + AA: DHA = 9.7 ± 0.9 vs 12.0 ± 1.4, p < 0.001). Noteworthy, while AA decreased hyperoxia-induced MST (H vs H + AA = 8.7 ± 0.4 vs 6.9 ± 0.6, p < 0.001), it significantly increased MLI (H vs H + AA = 58.76 ± 5.9 vs 71.19 ± 6.1, p < 0.001).
Conclusions
We reproduced lung injury in a neonatal murine model using 40% O2 and showed a significant increase in MLI, MST, and decreased RAC. The data also demonstrate that LCPUFAs acts distinctively, and specific fatty acids alone or in combination have contrasting effects. Whether the observed changes are also associated with the inflammatory response needs to be investigated further to better understand the impact of LCPUFAs in hyperoxia-induced lung injury and inflammation.
Funding Sources
Charles H. and Judy H. Family Infant Health Research Program.
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Affiliation(s)
- Esli Medina-Morales
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Pratibha Singh
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - David Ramiro-Cortijo
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School
| | | | - Yan Liu
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Karin Pan
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Joanne Brown
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - William Yakah
- Department of Neonatology, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Kristin Leone
- Department of Neonatology, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Steven D Freedman
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Camilia R Martin
- Department of Neonatology, Beth Israel Deaconess Medical Center, Harvard Medical School
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35
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Joung KE, Martin CR, Cherkerzian S, Kellogg M, Belfort MB. Human Milk Hormone Intake in the First Month of Life and Physical Growth Outcomes in Preterm Infants. J Clin Endocrinol Metab 2021; 106:1793-1803. [PMID: 33544860 DOI: 10.1210/clinem/dgab001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 02/18/2020] [Indexed: 12/31/2022]
Abstract
CONTEXT Human milk contains hormones that regulate metabolism. Extrauterine growth restriction remains common among preterm infants, but the effect of ingesting milk hormones on preterm infant growth is poorly understood. OBJECTIVE To quantify associations of longitudinal exposure to leptin, adiponectin, and insulin in milk with physical growth of preterm infants. DESIGN/METHODS In 50 preterm neonates (median gestational age 29.4 weeks), we sampled maternal milk on day-of-life 7, 14, 21, and 28 and measured hormone levels in whole milk by ELISA. Milk leptin levels were available for a subset of 18 infants. We calculated milk hormone doses by multiplying the hormone level by the milk volume ingested on each day and estimated the area under the curve (AUC) to reflect longitudinal exposure. We analyzed associations of milk hormone exposure with growth outcomes in generalized estimated equations. MAIN OUTCOME MEASURES Weight gain velocity and z-scores in weight, length, head circumference, and body mass index at 36 weeks' postmenstrual age (PMA). RESULTS Higher leptin intake was associated with greater weight gain (2.17g/kg/day [95% CI, 1.31, 3.02]) and weight z-score at 36 weeks' PMA (0.30 [0.08, 0.53] higher z-score per tertile). Higher adiponectin intake was associated with greater length z-score (0.41 [0.13, 0.69]), however, this association was nullified after adjustment of protein and calorie intake. Higher adiponectin was associated with smaller head circumference z-score (-0.36 [-0.64, -0.07]). Insulin was not associated with growth outcomes. CONCLUSIONS Milk leptin and adiponectin exposures may affect growth of preterm infants. The long-term effects of milk hormones warrant further investigation.
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Affiliation(s)
- Kyoung Eun Joung
- Division of Neonatology and Newborn Medicine, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Camilia R Martin
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Sara Cherkerzian
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Mark Kellogg
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Mandy Brown Belfort
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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36
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Fenton TR, Griffin IJ, Groh-Wargo S, Gura K, Martin CR, Taylor SN, Rozga M, Moloney L. Very Low Birthweight Preterm Infants: A 2020 Evidence Analysis Center Evidence-Based Nutrition Practice Guideline. J Acad Nutr Diet 2021; 122:182-206. [PMID: 33820749 DOI: 10.1016/j.jand.2021.02.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/24/2021] [Indexed: 12/20/2022]
Affiliation(s)
- Tanis R Fenton
- Community Health Sciences, Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB; Canada Nutrition Services, Alberta Health Services, Calgary, AB; Community Health Sciences, Nutrition Services, Alberta Health Services, Calgary, Canada
| | - Ian J Griffin
- Clinical and Translational Research, Biomedical Research Institute of New Jersey, Cedar Knolls, NJ; Department of Pediatrics, Morristown Medical Center, Morristown, NJ
| | - Sharon Groh-Wargo
- Departments of Nutrition and Pediatrics, Case Western Reserve University at MetroHealth Medical Center, Cleveland, OH
| | - Kathleen Gura
- Clinical Research Program, Department of Pharmacy, Boston Children's Hospital, Boston, MA
| | - Camilia R Martin
- Department of Neonatology, Director for Cross-Disciplinary Research Partnerships, Division of Translational Research, Beth Israel Deaconess Medical Center, Boston, MA
| | - Sarah N Taylor
- Department of Pediatrics, Yale School of Medicine, 430 Congress Avenue, New Haven, CT
| | - Mary Rozga
- Academy of Nutrition and Dietetics, Evidence Analysis Center, Chicago, IL
| | - Lisa Moloney
- Academy of Nutrition and Dietetics, Evidence Analysis Center, Chicago, IL.
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37
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Rao C, Coyte KZ, Bainter W, Geha RS, Martin CR, Rakoff-Nahoum S. Multi-kingdom ecological drivers of microbiota assembly in preterm infants. Nature 2021; 591:633-638. [PMID: 33627867 PMCID: PMC7990694 DOI: 10.1038/s41586-021-03241-8] [Citation(s) in RCA: 132] [Impact Index Per Article: 44.0] [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: 03/18/2020] [Accepted: 01/14/2021] [Indexed: 01/31/2023]
Abstract
The gut microbiota of preterm infants develops predictably1-7, with pioneer species colonizing the gut after birth, followed by an ordered succession of microorganisms. The gut microbiota is vital to the health of preterm infants8,9, but the forces that shape these predictable dynamics of microbiome assembly are unknown. The environment, the host and interactions between microorganisms all potentially shape the dynamics of the microbiota, but in such a complex ecosystem, identifying the specific role of any individual factor is challenging10-14. Here we use multi-kingdom absolute abundance quantification, ecological modelling and experimental validation to address this challenge. We quantify the absolute dynamics of bacteria, fungi and archaea in a longitudinal cohort of 178 preterm infants. We uncover microbial blooms and extinctions, and show that there is an inverse correlation between bacterial and fungal loads in the infant gut. We infer computationally and demonstrate experimentally in vitro and in vivo that predictable assembly dynamics may be driven by directed, context-dependent interactions between specific microorganisms. Mirroring the dynamics of macroscopic ecosystems15-17, a late-arriving member of the microbiome, Klebsiella, exploits the pioneer microorganism, Staphylococcus, to gain a foothold within the gut. Notably, we find that interactions between different kingdoms can influence assembly, with a single fungal species-Candida albicans-inhibiting multiple dominant genera of gut bacteria. Our work reveals the centrality of simple microbe-microbe interactions in shaping host-associated microbiota, which is critical both for our understanding of microbiota ecology and for targeted microbiota interventions.
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Affiliation(s)
- Chitong Rao
- Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Katharine Z Coyte
- Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA.
- Division of Evolution and Genomic Sciences, School of Biological Sciences, University of Manchester, Manchester, UK.
| | - Wayne Bainter
- Division of Immunology, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Raif S Geha
- Division of Immunology, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Camilia R Martin
- Department of Neonatology and Division of Translational Research, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Seth Rakoff-Nahoum
- Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA.
- Division of Gastroenterology, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA.
- Department of Microbiology, Harvard Medical School, Boston, MA, USA.
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.
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38
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Fleiss N, Coggins SA, Lewis AN, Zeigler A, Cooksey KE, Walker LA, Husain AN, de Jong BS, Wallman-Stokes A, Alrifai MW, Visser DH, Good M, Sullivan B, Polin RA, Martin CR, Wynn JL. Evaluation of the Neonatal Sequential Organ Failure Assessment and Mortality Risk in Preterm Infants With Late-Onset Infection. JAMA Netw Open 2021; 4:e2036518. [PMID: 33538825 PMCID: PMC7862993 DOI: 10.1001/jamanetworkopen.2020.36518] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
IMPORTANCE Infection in neonates remains a substantial problem. Advances for this population are hindered by the absence of a consensus definition for sepsis. In adults, the Sequential Organ Failure Assessment (SOFA) operationalizes mortality risk with infection and defines sepsis. The generalizability of the neonatal SOFA (nSOFA) for neonatal late-onset infection-related mortality remains unknown. OBJECTIVE To determine the generalizability of the nSOFA for neonatal late-onset infection-related mortality across multiple sites. DESIGN, SETTING, AND PARTICIPANTS A multicenter retrospective cohort study was conducted at 7 academic neonatal intensive care units between January 1, 2010, and December 31, 2019. Participants included 653 preterm (<33 weeks) very low-birth-weight infants. EXPOSURES Late-onset (>72 hours of life) infection including bacteremia, fungemia, or surgical peritonitis. MAIN OUTCOMES AND MEASURES The primary outcome was late-onset infection episode mortality. The nSOFA scores from survivors and nonsurvivors with confirmed late-onset infection were compared at 9 time points (T) preceding and following event onset. RESULTS In the 653 infants who met inclusion criteria, median gestational age was 25.5 weeks (interquartile range, 24-27 weeks) and median birth weight was 780 g (interquartile range, 638-960 g). A total of 366 infants (56%) were male. Late-onset infection episode mortality occurred in 97 infants (15%). Area under the receiver operating characteristic curves for mortality in the total cohort ranged across study centers from 0.71 to 0.95 (T0 hours), 0.77 to 0.96 (T6 hours), and 0.78 to 0.96 (T12 hours), with utility noted at all centers and in aggregate. Using the maximum nSOFA score at T0 or T6, the area under the receiver operating characteristic curve for mortality was 0.88 (95% CI, 0.84-0.91). Analyses stratified by sex or Gram-stain identification of pathogen class or restricted to infants born at less than 25 weeks' completed gestation did not reduce the association of the nSOFA score with infection-related mortality. CONCLUSIONS AND RELEVANCE The nSOFA score was associated with late-onset infection mortality in preterm infants at the time of evaluation both in aggregate and in each center. These findings suggest that the nSOFA may serve as the foundation for a consensus definition of sepsis in this population.
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Affiliation(s)
- Noa Fleiss
- Department of Pediatrics, Columbia University School of Medicine, New York, New York
| | - Sarah A. Coggins
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Angela N. Lewis
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Angela Zeigler
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville
| | - Krista E. Cooksey
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - L. Anne Walker
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Ameena N. Husain
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Brenda S. de Jong
- Department of Neonatology, Amsterdam UMC University of Amsterdam, Vrije Universiteit, Emma Children’s Hospital, Amsterdam, the Netherlands
| | - Aaron Wallman-Stokes
- Department of Pediatrics, Columbia University School of Medicine, New York, New York
| | - Mhd Wael Alrifai
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Douwe H. Visser
- Department of Neonatology, Amsterdam UMC University of Amsterdam, Vrije Universiteit, Emma Children’s Hospital, Amsterdam, the Netherlands
| | - Misty Good
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Brynne Sullivan
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville
| | - Richard A. Polin
- Department of Pediatrics, Columbia University School of Medicine, New York, New York
| | - Camilia R. Martin
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - James L. Wynn
- Department of Pediatrics, University of Florida School of Medicine, Gainesville
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Yakah W, Singh P, Brown J, Stoll B, Burrin D, Premkumar MH, Otu HH, Gu X, Dillon ST, Libermann TA, Freedman SD, Martin CR. Parenteral lipid emulsions induce unique ileal fatty acid and metabolomic profiles but do not increase the risk of necrotizing enterocolitis in preterm pigs. Am J Physiol Gastrointest Liver Physiol 2021; 320:G227-G239. [PMID: 33236951 PMCID: PMC7948117 DOI: 10.1152/ajpgi.00311.2020] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Necrotizing enterocolitis (NEC) is a manifestation of maladaptive intestinal responses in preterm infants centrally medicated by unattenuated inflammation. Early in the postnatal period, preterm infants develop a deficit in arachidonic and docosahexaenoic acid, both potent regulators of inflammation. We hypothesized that the fatty acid composition of parenteral lipid emulsions uniquely induces blood and intestinal fatty acid profiles which, in turn, modifies the risk of NEC development. Forty-two preterm pigs were randomized to receive one of three lipid emulsions containing 100% soybean oil (SO), 15% fish oil (MO15), or 100% fish oil (FO100) with enteral feedings over an 8-day protocol. Blood and distal ileum tissue were collected for fatty acid analysis. The distal ileum underwent histologic, proteomic, and metabolomic analyses. Eight pigs [3/14 SO (21%), 3/14 MO15 (21%), and 2/14 FO100 (14%)] developed NEC. No differences in NEC risk were evident between groups despite differences in induced fatty acid profiles in blood and ileal tissue. Metabolomic analysis of NEC versus no NEC tissue revealed differences in tryptophan metabolism and arachidonic acid-containing glycerophospholipids. Proteomic analysis demonstrated no differences by lipid group; however, 15 proteins differentiated NEC versus no NEC in the domains of tissue injury, glucose uptake, and chemokine signaling. Exposure to parenteral lipid emulsions induces unique intestinal fatty acid and metabolomic profiles; however, these profiles are not linked to a difference in NEC development. Metabolomic and proteomic analyses of NEC versus no NEC intestinal tissue provide mechanistic insights into the pathogenesis of NEC in preterm infants.NEW & NOTEWORTHY Exposure to parenteral lipid emulsions induces unique intestinal fatty acid and metabolomic profiles; however, these profiles are not linked to a difference in NEC risk in preterm pigs. Metabolomic and proteomic analyses provide mechanistic insights into NEC pathogenesis. Compared with healthy ileal tissue, metabolites in tryptophan metabolism and arachidonic acid-containing glycerophospholipids are increased in NEC tissue. Proteomic analysis differentiates NEC versus no NEC in the domains of tissue injury, glucose uptake, and chemokine signaling.
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Affiliation(s)
- William Yakah
- 1Department of Neonatology Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Pratibha Singh
- 2Division of Gastroenterology Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Joanne Brown
- 2Division of Gastroenterology Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Barbara Stoll
- 3United States Department of Agriculture-Agricultural Research Service, Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Doug Burrin
- 3United States Department of Agriculture-Agricultural Research Service, Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Muralidhar H. Premkumar
- 4Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Hasan H. Otu
- 5Department of Electrical and Computer Engineering, University of Nebraska-Lincoln, Lincoln, Nebraska
| | - Xuesong Gu
- 6Genomics, Proteomics, Bioinformatics and Systems Biology Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Simon T. Dillon
- 6Genomics, Proteomics, Bioinformatics and Systems Biology Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Towia A. Libermann
- 6Genomics, Proteomics, Bioinformatics and Systems Biology Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Steven D. Freedman
- 2Division of Gastroenterology Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts,7Division of Translational Research Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Camilia R. Martin
- 1Department of Neonatology Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts,7Division of Translational Research Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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40
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Taylor SN, Fenton TR, Groh-Wargo S, Gura K, Martin CR, Griffin IJ, Rozga M, Moloney L. Exclusive Maternal Milk Compared With Exclusive Formula on Growth and Health Outcomes in Very-Low-Birthweight Preterm Infants: Phase II of the Pre-B Project and an Evidence Analysis Center Systematic Review. Front Pediatr 2021; 9:793311. [PMID: 35280446 PMCID: PMC8913886 DOI: 10.3389/fped.2021.793311] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED As part of the Pre-B Project, a systematic review was conducted to evaluate associations between exclusive maternal milk (≥75%) intake and exclusive formula intake and growth and health outcomes in very-low-birthweight (VLBW) preterm infants. The protocols from the Academy of Nutrition and Dietetics' Evidence Analysis Center and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist were followed. Thirteen observational studies were included; 11 studies reported data that could be synthesized in a pooled analysis. The evidence is very uncertain (very low quality) about the effect of exclusive maternal milk on all outcomes due to observational study designs and risk of selection, performance, detection, and reporting bias in most of the included studies. Very-low-quality evidence suggested that providing VLBW preterm infants with exclusive maternal milk was not associated with mortality, risk of necrotizing enterocolitis, sepsis, or developing bronchopulmonary dysplasia, as compared with exclusive preterm formula, but exclusive maternal milk was associated with a lower risk of retinopathy of prematurity (very low certainty). Results may change when additional studies are conducted. There was no difference in weight, length, and head circumference gain between infants fed fortified exclusive maternal milk and infants receiving exclusive preterm formula; however, weight and length gain were lower in infants fed non-fortified exclusive maternal milk. Given the observational nature of human milk research, cause-and-effect evidence was lacking for VLBW preterm infants. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=86829, PROSPERO ID: CRD42018086829.
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Affiliation(s)
- Sarah N Taylor
- Division of Neonatology, Department of Pediatrics, Yale School of Medicine, New Haven, CT, United States
| | - Tanis R Fenton
- Community Health Sciences, Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Nutrition Services, Alberta Health Services, Calgary, AB, Canada.,Nutrition Services, Alberta Health Services, Calgary, AB, Canada
| | - Sharon Groh-Wargo
- Departments of Nutrition and Pediatrics, Case Western Reserve University at MetroHealth Medical Center, Cleveland, OH, United States
| | - Kathleen Gura
- Clinical Research Program, Department of Pharmacy, Boston Children's Hospital, Boston, MA, United States
| | - Camilia R Martin
- Division of Translational Research, Department of Neonatology, Harvard Medical School, Neonatal Intensive Care Unit (NICU), Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Ian J Griffin
- Biomedical Research Institute of New Jersey, Cedar Knolls, NJ, United States.,Department of Pediatrics, Morristown Medical Center, Morristown, NJ, United States
| | - Mary Rozga
- Academy of Nutrition and Dietetics, Evidence Analysis Center, Chicago, IL, United States
| | - Lisa Moloney
- Academy of Nutrition and Dietetics, Evidence Analysis Center, Chicago, IL, United States
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Affiliation(s)
- D B Whelan
- University of Toronto, St. Michaels Hospital 55 Queen St. E. Suite 800. Toronto, Ontario, Canada M5C 1R6
| | - C R Martin
- University of Calgary, 0490 McCaig Tower, Foothills Hospital, 3134 Hospital Drive NW Calgary, Alberta, Canada T2N 5A1
| | - R E Buckley
- University of Calgary, 0490 McCaig Tower, Foothills Hospital, 3134 Hospital Drive NW Calgary, Alberta, Canada T2N 5A1.
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Jomeen J, Martin CR, Jones C, Marshall C, Ayers S, Burt K, Frodsham L, Horsch A, Midwinter D, O'Connell M, Shakespeare J, Sheen K, Thomson G. Tokophobia and fear of birth: a workshop consensus statement on current issues and recommendations for future research. J Reprod Infant Psychol 2020; 39:2-15. [PMID: 33206580 DOI: 10.1080/02646838.2020.1843908] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective: To discuss and develop a statement on the current state of the evidence and opinion in Fear of Childbirth (FoC) and Tokophobia (Tocophobia), and to provide recommendations. Background: A group met in 2019 to discuss the state of clinical and academic knowledge relating to FoC/Tokophobia. Five key areas were agreed as the focus of the meeting. Methods: 12 internationally acknowledged experts, in this or a closely related area (e.g. PTSD) met to discuss their understanding of the evidence for FoC/ Tokophobia and current practice. The consensus described in this paper constitutes the expression of the general opinion of the participants and does not necessarily imply unanimity. Keys points: Work focussed on tokophobia is recent and there remains a wide range of issues, which were addressed in the workshop including complexity in defining prevalence, a theoretical lack of understanding, which creates challenge for robust assessment and the identification of risk factors. An improved aetiological and developmental understanding of the tokophobia is required to underpin appropriate, effective and evidence-based interventions. Evaluation of pathways of care and relevant interventions, should be a focus of future research. Conclusion: Significant gaps remain within the FoC/tokophobia knowledge base. Further research is necessary.
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Affiliation(s)
- J Jomeen
- School of Health & Human Sciences, Southern Cross University , Bilinga, Australia.,Institute for Clinical and Applied Health Research (ICAHR), University of Hull , Hull, UK
| | - C R Martin
- School of Health & Human Sciences, Southern Cross University , Bilinga, Australia.,Institute for Clinical and Applied Health Research (ICAHR), University of Hull , Hull, UK.,School of Nursing and Allied Health, Buckinghamshire New University , High Wycombe, UK
| | - C Jones
- Institute for Clinical and Applied Health Research (ICAHR), University of Hull , Hull, UK
| | - C Marshall
- Perinatal Mental Health Team, Humber Teaching NHS Foundation Trust , Hull, UK
| | - S Ayers
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London , London, UK
| | - K Burt
- Expert by Experience , UK
| | - L Frodsham
- Obstetric Medicine, Guy's and St Thomas' NHS Foundation Trust , London, UK
| | - A Horsch
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne , Lausanne, Switzerland.,Department Woman-Mother-Child, University Hospital , Lausanne, Switzerland
| | - D Midwinter
- Maternity and Midwifery Services, North Lincolnshire and Goole NHS Foundation Trust , Scunthorpe, UK
| | - M O'Connell
- School of Nursing and Midwifery, Royal College of Surgeons Ireland in Bahrain , Adliya, Bahrain
| | | | - K Sheen
- School of Psychology, Faculty of Health, Liverpool John Moores University , Liverpool, UK
| | - G Thomson
- Maternal and Infant Nutrition & Nurture Unit, School of Community Health & Midwifery, University of Central Lancashire , Lancashire, UK.,School of Education, Health and Social Studies, Dalarna University , Falun, Sweden
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43
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Singh P, Sanchez-Fernandez LL, Ramiro-Cortijo D, Ochoa-Allemant P, Perides G, Liu Y, Medina-Morales E, Yakah W, Freedman SD, Martin CR. Maltodextrin-induced intestinal injury in a neonatal mouse model. Dis Model Mech 2020; 13:dmm044776. [PMID: 32753526 PMCID: PMC7473650 DOI: 10.1242/dmm.044776] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 07/17/2020] [Indexed: 12/14/2022] Open
Abstract
Prematurity and enteral feedings are major risk factors for intestinal injury leading to necrotizing enterocolitis (NEC). An immature digestive system can lead to maldigestion of macronutrients and increased vulnerability to intestinal injury. The aim of this study was to test in neonatal mice the effect of maltodextrin, a complex carbohydrate, on the risk of intestinal injury. The goal was to develop a robust and highly reproducible murine model of intestinal injury that allows insight into the pathogenesis and therapeutic interventions of nutrient-driven intestinal injury. Five- to 6-day-old C57BL/6 mice were assigned to the following groups: dam fed (D); D+hypoxia+Klebsiella pneumoniae; maltodextrin-dominant human infant formula (M) only; M+hypoxia; and M+hypoxia+K. pneumoniae. The mice in all M groups were gavage fed five times a day for 4 days. Mice were exposed to hypoxia twice a day for 10 min prior to the first and last feedings, and K. pneumoniae was added to feedings as per group assignment. Mice in all M groups demonstrated reduced body weight, increased small intestinal dilatation and increased intestinal injury scores. Maltodextrin-dominant infant formula with hypoxia led to intestinal injury in neonatal mice accompanied by loss of villi, increased MUC2 production, altered expression of tight junction proteins, enhanced intestinal permeability, increased cell death and higher levels of intestinal inflammatory mediators. This robust and highly reproducible model allows for further interrogation of the effects of nutrients on pathogenic factors leading to intestinal injury and NEC in preterm infants.This article has an associated First Person interview with the first author of the paper.
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MESH Headings
- Animals
- Animals, Newborn
- Cytokines/metabolism
- Disease Models, Animal
- Enterocolitis, Necrotizing/chemically induced
- Enterocolitis, Necrotizing/metabolism
- Enterocolitis, Necrotizing/microbiology
- Enterocolitis, Necrotizing/pathology
- Goblet Cells/metabolism
- Goblet Cells/microbiology
- Goblet Cells/pathology
- Hypoxia/complications
- Inflammation Mediators/metabolism
- Intestinal Mucosa/metabolism
- Intestinal Mucosa/microbiology
- Intestinal Mucosa/pathology
- Intestine, Small/metabolism
- Intestine, Small/microbiology
- Intestine, Small/pathology
- Klebsiella pneumoniae/pathogenicity
- Mice, Inbred C57BL
- Microvilli/pathology
- Mucin-2/metabolism
- Permeability
- Polysaccharides
- Tight Junction Proteins/metabolism
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Affiliation(s)
- Pratibha Singh
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA
| | - Lady Leidy Sanchez-Fernandez
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA
| | - David Ramiro-Cortijo
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA
| | - Pedro Ochoa-Allemant
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA
| | - George Perides
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA
| | - Yan Liu
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA
| | - Esli Medina-Morales
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA
| | - William Yakah
- Division of Translational Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA
| | - Steven D Freedman
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA
- Division of Translational Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA
| | - Camilia R Martin
- Division of Translational Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA
- Department of Neonatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA
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44
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Enstad S, Cheema S, Thomas R, Fichorova RN, Martin CR, O'Tierney-Ginn P, Wagner CL, Sen S. The impact of maternal obesity and breast milk inflammation on developmental programming of infant growth. Eur J Clin Nutr 2020; 75:180-188. [PMID: 32814855 PMCID: PMC7855210 DOI: 10.1038/s41430-020-00720-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/22/2020] [Accepted: 08/04/2020] [Indexed: 02/07/2023]
Abstract
Background: Little is known about how maternal obesity impacts breast milk (BM) composition and how BM composition may impact growth. We sought to determine the role of maternal body mass index (BMI) on BM inflammatory and oxidative stress markers and to delineate the role of these BM markers on infant growth. Methods: This was a secondary analysis of 40 mother-infant dyads. We first assessed the association between maternal BMI and BM marker (omega-6:omega-3 polyunsaturated fatty acid ratio (n-6:n-3 PUFA), leptin, interleukin (IL)-8, IL-6, IL-1β and malondialdehyde (MDA)) concentration at one (V1) and four (V4) months postpartum. We then examined the association between BM markers on infant growth trajectory from birth to seven months. Results: Higher maternal BMI was associated with higher BM n-6:n-3 PUFA (V1 β=0.12, 95% CI 0.01, 0.2; V4 β=0.13, 95% CI 0.01, 0.3) and leptin (V1 β=107, 95% CI 29, 184; V4 β=254, 95% CI 105, 403) concentrations. Infants exposed to high BM n-6:n-3 PUFA had higher BMI z-scores over time (p=0.01). Higher BM leptin was associated with lower infant percent fat mass at V4 (β=−9, 95% CI −17, −0.6). Infants exposed to high BM IL-8, IL-6, or IL-1β had higher weight z-scores over time (IL-8 p<0.001; IL-6 p<0.001; IL-1β p=0.02). There was no association between BM MDA and maternal BMI or infant growth. Conclusions: Higher maternal BMI is associated with higher BM n-6:n-3 PUFA and leptin concentrations. In addition, higher BM n-6:n-3 PUFA and inflammatory cytokines were associated with accelerated weight gain in infancy.
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Affiliation(s)
- Samantha Enstad
- Department of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA.
| | - Sukhinder Cheema
- Department of Biochemistry, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Raymond Thomas
- School of Science and the Environment/Boreal Ecosystem Research Initiative, Grenfell Campus, Memorial University of Newfoundland, Corner Brook, NL, Canada
| | - Raina N Fichorova
- Laboratory of Genital Tract Biology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Camilia R Martin
- Harvard Medical School, Boston, MA, USA.,Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Carol L Wagner
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, SC, USA
| | - Sarbattama Sen
- Harvard Medical School, Boston, MA, USA.,Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
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45
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Ramiro-Cortijo D, Singh P, Liu Y, Medina-Morales E, Yakah W, Freedman SD, Martin CR. Breast Milk Lipids and Fatty Acids in Regulating Neonatal Intestinal Development and Protecting against Intestinal Injury. Nutrients 2020; 12:nu12020534. [PMID: 32092925 PMCID: PMC7071444 DOI: 10.3390/nu12020534] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [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] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/14/2020] [Accepted: 02/16/2020] [Indexed: 12/13/2022] Open
Abstract
Human breast milk is the optimal source of nutrition for infant growth and development. Breast milk fats and their downstream derivatives of fatty acids and fatty acid-derived terminal mediators not only provide an energy source but also are important regulators of development, immune function, and metabolism. The composition of the lipids and fatty acids determines the nutritional and physicochemical properties of human milk fat. Essential fatty acids, including long-chain polyunsaturated fatty acids (LCPUFAs) and specialized pro-resolving mediators, are critical for growth, organogenesis, and regulation of inflammation. Combined data including in vitro, in vivo, and human cohort studies support the beneficial effects of human breast milk in intestinal development and in reducing the risk of intestinal injury. Human milk has been shown to reduce the occurrence of necrotizing enterocolitis (NEC), a common gastrointestinal disease in preterm infants. Preterm infants fed human breast milk are less likely to develop NEC compared to preterm infants receiving infant formula. Intestinal development and its physiological functions are highly adaptive to changes in nutritional status influencing the susceptibility towards intestinal injury in response to pathological challenges. In this review, we focus on lipids and fatty acids present in breast milk and their impact on neonatal gut development and the risk of disease.
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Affiliation(s)
- David Ramiro-Cortijo
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA; (D.R.-C.); (P.S.); (Y.L.); (E.M.-M.); (S.D.F.)
| | - Pratibha Singh
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA; (D.R.-C.); (P.S.); (Y.L.); (E.M.-M.); (S.D.F.)
| | - Yan Liu
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA; (D.R.-C.); (P.S.); (Y.L.); (E.M.-M.); (S.D.F.)
| | - Esli Medina-Morales
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA; (D.R.-C.); (P.S.); (Y.L.); (E.M.-M.); (S.D.F.)
| | - William Yakah
- Department of Neonatology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA;
| | - Steven D. Freedman
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA; (D.R.-C.); (P.S.); (Y.L.); (E.M.-M.); (S.D.F.)
- Division of Translational Research, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Camilia R. Martin
- Department of Neonatology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA;
- Division of Translational Research, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
- Correspondence:
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Koletzko B, Bergmann K, Brenna JT, Calder PC, Campoy C, Clandinin MT, Colombo J, Daly M, Decsi T, Demmelmair H, Domellöf M, FidlerMis N, Gonzalez-Casanova I, van Goudoever JB, Hadjipanayis A, Hernell O, Lapillonne A, Mader S, Martin CR, Matthäus V, Ramakrishan U, Smuts CM, Strain SJJ, Tanjung C, Tounian P, Carlson SE. Should formula for infants provide arachidonic acid along with DHA? A position paper of the European Academy of Paediatrics and the Child Health Foundation. Am J Clin Nutr 2020; 111:10-16. [PMID: 31665201 DOI: 10.1093/ajcn/nqz252] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [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: 07/16/2019] [Accepted: 09/09/2019] [Indexed: 01/08/2023] Open
Abstract
Recently adopted regulatory standards on infant and follow-on formula for the European Union stipulate that from February 2020 onwards, all such products marketed in the European Union must contain 20-50 mg omega-3 DHA (22:6n-3) per 100 kcal, which is equivalent to about 0.5-1% of fatty acids (FAs) and thus higher than typically found in human milk and current infant formula products, without the need to also include ω-6 arachidonic acid (AA; 20:4n-6). This novel concept of infant formula composition has given rise to concern and controversy because there is no accountable evidence on its suitability and safety in healthy infants. Therefore, international experts in the field of infant nutrition were invited to review the state of scientific research on DHA and AA, and to discuss the questions arising from the new European regulatory standards. Based on the available information, we recommend that infant and follow-on formula should provide both DHA and AA. The DHA should equal at least the mean content in human milk globally (0.3% of FAs) but preferably reach 0.5% of FAs. Although optimal AA intake amounts remain to be defined, we strongly recommend that AA should be provided along with DHA. At amounts of DHA in infant formula up to ∼0.64%, AA contents should at least equal the DHA contents. Further well-designed clinical studies should evaluate the optimal intakes of DHA and AA in infants at different ages based on relevant outcomes.
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Affiliation(s)
- Berthold Koletzko
- Ludwig-Maximilians-Universität Munich, Dr von Hauner Children's Hospital, University of Munich Medical Center, Munich, Germany.,Stiftung Kindergesundheit (Child Health Foundation), c/o Dr von Hauner Children's Hospital, University of Munich Medical Center, Munich, Germany
| | - Karin Bergmann
- Stiftung Kindergesundheit (Child Health Foundation), c/o Dr von Hauner Children's Hospital, University of Munich Medical Center, Munich, Germany
| | - J Thomas Brenna
- Dell Pediatric Research Institute, Departments of Pediatrics, Chemistry, and Nutrition, University of Texas at Austin, Austin, TX, USA.,Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Philip C Calder
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,National Institute for Health Research Southampton Biomedical Research Centre, University Hospital Southampton, National Health Service Foundation Trust and University of Southampton, Southampton, United Kingdom
| | - Cristina Campoy
- Department of Pediatrics, University of Granada, Granada, Spain
| | - M Tom Clandinin
- Departments of Agriculture, Food and Nutritional Science and of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - John Colombo
- Department of Psychology and Schiefelbusch Institute for Life Span Studies, University of Kansas, Lawrence, KS, USA
| | - Mandy Daly
- Irish Neonatal Health Alliance, Bray, Ireland
| | - Tamás Decsi
- Department of Paediatrics, University of Pécs, Pécs, Hungary
| | - Hans Demmelmair
- Ludwig-Maximilians-Universität Munich, Dr von Hauner Children's Hospital, University of Munich Medical Center, Munich, Germany
| | - Magnus Domellöf
- Pediatrics Unit, Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Nataša FidlerMis
- Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital, University Medical Centre, Ljubljana, Slovenia
| | | | - Johannes B van Goudoever
- Amsterdam Academic Medical Center, University of Amsterdam, Vrije Universiteit, Emma Children's Hospital, Amsterdam, Netherlands
| | - Adamos Hadjipanayis
- Pediatric Department, Larnaca General Hospital, Larnaca, Cyprus.,School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Olle Hernell
- Pediatrics Unit, Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Alexandre Lapillonne
- Paris Descartes University, APHP Necker-Enfants Malades Hospital, Paris, France.,Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
| | - Silke Mader
- European Foundation for the Care of Newborn Infants, Munich, Germany
| | - Camilia R Martin
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Valerie Matthäus
- European Foundation for the Care of Newborn Infants, Munich, Germany
| | - Usha Ramakrishan
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA
| | - Cornelius M Smuts
- Centre of Excellence for Nutrition, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Sean J J Strain
- Northern Ireland Centre for Food and Health, Ulster University, Coleraine, United Kingdom
| | | | - Patrick Tounian
- Pediatric Nutrition and Gastroenterology Department, Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | - Susan E Carlson
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS, USA
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47
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Yakah W, Singh P, Perides G, Brown J, Freedman SD, Martin CR. Developmental Accretion of Docosahexaenoic Acid Is Independent of Fatty Acid Transporter Expression in Brain and Lung Tissues of C57BL/6 and Fat1 Mice. J Nutr 2019; 149:1724-1731. [PMID: 31179494 PMCID: PMC6768804 DOI: 10.1093/jn/nxz074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 08/08/2018] [Revised: 09/21/2018] [Accepted: 03/26/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Developmental expression of fatty acid transporters and their role in polyunsaturated fatty acid concentrations in the postnatal period have not been evaluated. OBJECTIVE We hypothesized that transporter expression is developmentally regulated, tissue-specific, and that expression can modulate fatty acid accretion independently of diet. METHODS Brain and lung transporter expression were quantified in C57BL/6 wild-type (WT) and Fat1 mice. Pups were dam-fed until day 21. Dams were fed AIN-76A 10% corn oil to represent a typical North American/European diet. After weaning, mice were fed the same diet as dams. Gene expression of Fatp1, Fatp4, Fabp5, and Fat/cd36 was quantified by quantitative reverse transcriptase-polymerase chain reaction. Fatty acid concentrations were measured by GC-MS. RESULTS Brain docosahexaenoic acid (DHA) concentrations increased from day 3 to day 28 in both genotypes, with higher concentrations at days 3 and 14 in Fat1 than in WT mice [median (IQR)]: 10.7 (10.6-11.2) mol% compared with 6.6 (6.4-7.2) mol% and 12.5 (12.4-12.9) mol% compared with 8.9 (8.7-9.1) mol%, respectively; P < 0.05). During DHA accrual, transporter expression decreased. Fold changes in brain Fatp4, Fabp5, and Fat/cd36 were inversely correlated with fold changes in brain DHA concentrations in Fat1 relative to WT mice (ρ = -0.85, -0.75, and -0.78, respectively; P ≤ 0.001). Lung DHA concentrations were unchanged across the 3 time points for both genotypes. Despite unchanging DHA concentrations, there was increased expression of Fatp1 at days 14 and 28 (5-fold), Fatp4 at day 14 (2.3-fold), and Fabp5 at day 14 (3.8-fold) relative to day 3 in Fat1 mice. In WT mice, Fatp1 increased almost 5-fold at day 28 relative to day 3. There was no correlation between lung transporters and DHA concentrations in Fat1 relative to WT mice. CONCLUSIONS Development of fatty acid transporter expression in C57BL/6 WT and Fat1 mice is genotype and tissue specific. Further, postnatal accretion of brain DHA appears independent of transporter status, with tissue concentrations representing dietary contributions.
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Affiliation(s)
- William Yakah
- Department of Neuroscience, Michigan State University, East Lansing, MI
| | | | | | | | - Steven D Freedman
- Division of Gastroenterology, Boston, MA,Division of Translational Research, Boston, MA
| | - Camilia R Martin
- Division of Translational Research, Boston, MA,Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA,Address correspondence to CRM (e-mail: )
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48
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Akinsulire O, Perides G, Anez-Bustillos L, Cluette-Brown J, Nedder A, Pollack E, Singh P, Liu Y, Sanchez-Fernandez LL, Obregon E, Bicak E, Kiefer S, Yakah W, Gutierrez HV, Dao DT, Vurma M, Ehling S, Gordon D, DeMichele S, Freedman SD, Martin CR. Early Enteral Administration of a Complex Lipid Emulsion Supplement Prevents Postnatal Deficits in Docosahexaenoic and Arachidonic Acids and Increases Tissue Accretion of Lipophilic Nutrients in Preterm Piglets. JPEN J Parenter Enteral Nutr 2019; 44:69-79. [PMID: 31441521 DOI: 10.1002/jpen.1697] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 07/10/2019] [Accepted: 08/03/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Preterm delivery and current nutrition strategies result in deficiencies of critical long-chain fatty acids (FAs) and lipophilic nutrients, increasing the risk of preterm morbidities. We sought to determine the efficacy of preventing postnatal deficits in FAs and lipophilic nutrients using an enteral concentrated lipid supplement in preterm piglets. METHODS Preterm piglets were fed a baseline diet devoid of arachidonic acid (AA) and docosahexaenoic acid (DHA) and randomized to enteral supplementation as follows: (1) Intralipid (IL), (2) complex lipid supplement 1 (CLS1) with an AA:DHA ratio of 0.25, or (3) CLS2 with an AA:DHA ratio of 1.2. On day 8, plasma and tissue levels of FAs and lipophilic nutrients were measured and ileum histology performed. RESULTS Plasma DHA levels decreased in the IL group by day 2. In contrast, DHA increased by day 2 compared with birth levels in both CLS1 and CLS2 groups. The IL and CLS1 groups demonstrated a continued decline in AA levels during the 8-day protocol, whereas AA levels in the CLS2 group on day 8 were comparable to birth levels. Preserving AA levels in the CLS2 group was associated with greater ileal villus height and muscular layer thickness. Lipophilic nutrients were effectively absorbed in plasma and tissues. CONCLUSIONS Enteral administration of CLS1 and CLS2 demonstrated similar increases in DHA levels compared with birth levels. Only CLS2 maintained AA birth levels. Providing a concentrated complex lipid emulsion with an AA:DHA ratio > 1 is important in preventing postnatal AA deficits.
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Affiliation(s)
- Olajumoke Akinsulire
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - George Perides
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Joanne Cluette-Brown
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Arthur Nedder
- Animal Resources Children's Hospital, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Elizabeth Pollack
- Animal Resources Children's Hospital, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Pratibha Singh
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Yan Liu
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Evelyn Obregon
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Ece Bicak
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Savanna Kiefer
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - William Yakah
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Hilda V Gutierrez
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Duy T Dao
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Mustafa Vurma
- Abbott Nutrition Research and Development, Abbott Laboratories, Abbott Park, Illinois, USA
| | - Stefan Ehling
- Abbott Nutrition Research and Development, Abbott Laboratories, Abbott Park, Illinois, USA
| | - Douglas Gordon
- Abbott Nutrition Research and Development, Abbott Laboratories, Abbott Park, Illinois, USA
| | - Stephen DeMichele
- Abbott Nutrition Research and Development, Abbott Laboratories, Abbott Park, Illinois, USA
| | - Steven D Freedman
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Division of Translational Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Camilia R Martin
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Division of Translational Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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49
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Affiliation(s)
- Camilia R Martin
- Department of Neonatology, Beth Israel Deaconess Medical Center, Harvard Medical School Boston, Boston, Massachusetts
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50
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Singh P, Ochoa Allemant P, Brown J, Perides G, Freedman SD, Martin CR. Effect of polyunsaturated fatty acids on postnatal ileum development using the fat-1 transgenic mouse model. Pediatr Res 2019; 85:556-565. [PMID: 30653193 PMCID: PMC6397682 DOI: 10.1038/s41390-019-0284-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 12/05/2018] [Accepted: 12/18/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Long-chain polyunsaturated fatty acids (LCPUFAs) play a critical role in neonatal health. We hypothesized that LCPUFAs play an essential role in priming postnatal gut development. We studied the effect of LCPUFAs on postnatal gut development using fat-1 transgenic mice, which are capable of converting n-6 to n-3 LCPUFAs, and wild-type (WT) C57BL/6 mice. METHODS Distal ileum sections were collected from fat-1 and WT mice on days 3, 14, and 28. Fatty acid analyses, histology, RT-qPCR and intestinal permeability were performed. RESULTS Fat-1 mice, relative to WT mice, showed increased n-3 LCPUFAs levels (α-linolenic acid, docosahexaenoic acid, and eicosapentaenoic acid, p < 0.05) and decreased arachidonic acid levels (p < 0.05) in the ileum. Preweaning fat-1 mice, compared to WT, showed >50% reduced muc2, Tff3, TLR9, and Camp expression (p < 0.05), markers of the innate immune response. There was a >two-fold increased expression of Fzd5 and EphB2, markers of cell differentiation (p < 0.05), and Fabp2 and 6, regulators of fatty acid transport and metabolism (p < 0.05). Despite reduced expression of tight junction genes, intestinal permeability in fat-1 was comparable to WT mice. CONCLUSIONS Our data support the hypothesis that fatty acid profiles early in development modulate intestinal gene expression in formative domains, such as cell differentiation, tight junctions, other innate host defenses, and lipid metabolism.
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Affiliation(s)
- Pratibha Singh
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, MA,,Harvard Medical School, Boston, MA
| | - Pedro Ochoa Allemant
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, MA,,Harvard Medical School, Boston, MA
| | - Joanne Brown
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, MA,,Harvard Medical School, Boston, MA
| | - George Perides
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, MA,,Harvard Medical School, Boston, MA
| | - Steven D. Freedman
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, MA,,Division of Translational Research, Beth Israel Deaconess Medical Center, MA,,Harvard Medical School, Boston, MA
| | - Camilia R Martin
- Department of Neonatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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