[Risk factors for malnutrition at two years of corrected age in preterm infants under 32 weeks]

Post-discharge nutrition of preterm newborns must avoid excessive or insufficient weight gain and optimal length and head circumference growth. In Chile, premature infants less than 32 wee ks at birth receive fortified formulas during the first year, unless they are exclusively breastfed.

OBJECTIVE

To describe growth and identify the risk of malnutrition at 24 months.

PATIENTS AND METHOD

Retrospective cohort study that analyzes growth from birth to 2 years of corrected age in preterm patients < 32 weeks of gestational age. Z-score of weight, length, head circumference, and Body Mass Index (BMI) were analyzed. Factors related to Z BMI at 24 months were analyzed as follows: Eutrophic: Z BMI between -1 and +1; Overweight: Z BMI > +1; Underweight: Z BMI < -1.

RESULTS

996 preterm infants were included, 559 completed check-ups at 24 months. 64.5% were eutrophic, 18.4% overweight, and 17.1% underweight. Multivariate analysis showed that risk of overweight was associated with birth weight > 1460 g: OR 5.77 (2.11-15.77) and Z BMI > 1.6 at 6 months: OR 2.67 (1.91-3.74); underweight risk was associated with birth weight < 1000g: OR 3.1 (1.1-8.8) and Z BMI < -0.75 at 6 months: OR 8.2 (4.3-16.3).

CONCLUSIONS

The greater risk of overweight and underweight can be anticipated in premature infants under 32 weeks with birth weight or Z BMI at 6 months of corrected age.

[Colostrum protocol evaluation for very low birth weight preterm infants]

INTRODUCTION

Early administration of oral colostrum has been recommended in very-low-birth-weight (VLBW) preterm infant care.

OBJECTIVE

To evaluate the clinical effect of early colostrum administration on in-hospital outcome and lactation of VLBW preterm infants compared with historical control in an Intensive Care Unit.

SUBJECTS AND METHOD

descriptive cohort study with historical control of VLBW preterm infants who did or did not receive early oral colostrum, born 1.6 years before and 1.4 years after this protocol, with information collected from the database of infants under 1500 grams at birth and in the colostrum protocol registry. Children born to HIV+ mothers, with hepatitis, chemothe rapy, and those born with malformations incompatible with life were excluded. The main perinatal, morbidity, nutritional, and breastfeeding data at discharge were compared.

RESULTS

94 patients were born pre-colostrum and 64 in the protocol period (post-colostrum). The groups were comparable in perinatal history. No difference was observed in infectious, respiratory, or gastrointestinal morbidity, progress in enteral feeding, days of parenteral nutrition, and length of hospital stay. There were signi ficant differences in the percentage breastfeeding at discharge (52 vs. 69%, p < 0.037) and in average breast milk volume at discharge (70 vs. 102 ml/k/day, p < 0.012) in the post-colostrum group. Con clusions: Early colostrum administration to preterm infants was associated with a higher volume of maternal milk at discharge, being a good benefit in VLBW preterm infant care.

[Growth until 24 months in preterm of very low birth weight, with or without intrauterine or postnatal growth restriction]

INTRODUCTION

The growth of preterm newborns can be affected during the fetal period, hospitalization, and post discharge.

OBJECTIVE

to describe the anthropometric development of preterm newborns with or without intrauterine and postnatal growth restriction, and with or without recovery at 40 weeks from birth to 24 months of age.

PATIENTS AND METHOD

Retrospective, descriptive study with Z-scores (Fen ton and WHO) of weight, length, head circumference, and weight/length of preterm infants of less than 32 weeks of gestational age at birth up to 24 months of corrected age. 4 groups were defined ac cording to prenatal, postnatal, post-discharge growth as follows: Group AAA: newborns born AGA, with no postnatal growth restriction; Group APA: newborns born AGA, with postnatal growth res triction, weight < p10 at discharge, and weight > p10 at 40 weeks; Group APP: newborns born AGA, with postnatal growth restriction, weight < p10 at discharge and at 40w; and Group PPP: newborns born with intrauterine growth restriction and who maintained postnatal growth restriction (< p10 at birth, at discharge, and at 40w). We used descriptive statistics with ANOVA, Chi-squared, and linear mixed model analysis.

RESULTS

710 preterm newborns were included, birth weight 1272 grams (SD 360) and gestational age 29 weeks (SD 1.9). Group AAA had weight, length, and head circumference Z-scores close to the median until 2 years of age. AGA preterm newborns and with postnatal growth restriction can evolve in two ways: one group presents recovery at 40 weeks (Group APA) while the other group presents weight Z-score < -1 up to 6 months (Group APP). Group PPP (with intraute rine and postnatal growth restriction) presents slow weight and length Z-score recovery, weight Z- score -2.3 at discharge, and slow improvement to < -1 at 2 years of age. All groups had weight/height Z-scores above the median in the first 2 months of corrected age.

CONCLUSION

Preterm newborns with good fetal growth but restricted postnatal growth, may recover at 40 weeks, with subsequent normal development or recover at 6 months.

[Hypomagnesemia in newborns with hypoxic ischemic encephalopathy and whole-body hypothermia]

INTRODUCTION

In newborns with the diagnosis of hypoxic-ischemic encephalopathy (HIE) treated with hypother mia, metabolic alterations are observed, which are associated with neurological prognosis. Hypo magnesemia has been reported frequently in the literature in these patients, but it is not measured or corrected in all neonatal healthcare centers.

OBJECTIVE

To evaluate the frequency of hypomag nesemia and hypocalcemia in newborns with HIE treated with whole-body hypothermia and to evaluate the response to the magnesium sulfate administration.

PATIENTS AND METHOD

Prospective, observational and descriptive study in hospitalized newborns with the diagnosis of HIE and trea ted with whole-body hypothermia between the years 2016 and 2017. Serial blood measurement of magnesemia (Mg) and calcemia (Ca) was performed. When presenting an Mg level < 1.8 mg/dl, supplementation with magnesium sulfate was administered to maintain levels between 1.9 and 2.8 mg/dl. The frecuency of hypomagnesemia, hypocalcemia and clinical evolution was registered. A descriptive statistical analysis was performed, with central tendency measures.

RESULTS

Sixteen ca ses were included, 13 of them presented hypomagnesemia (81.3%), with early-onset (6-36 hours of life), which was normalized with magnesium sulfate treatment, receiving a second dose 4 patients. Six of 16 patients presented hypocalcemia (37.5 %).

CONCLUSIONS

Hypomagnesemia is frequent (80%), similar to that described in the literature, and should be controlled and corrected early, given its physiological role, in the same way that calcium is controlled.

[Severe hyperbilirubinemia in newborns, risk factors and neurological outcomes]

INTRODUCTION

Hyperbilirubinemia is highly prevalent in newborns, with risk of neurological invol vement with bilirubinemia higher than 20 to 25 mg/dl. This progression is preventable with early de tection and treatment.

OBJECTIVE

To describe the incidence and associated factors in hospitalized pa tients with hyperbilirubinemia higher than 20 mg/dl, and the follow-up of symptomatic cases during hospitalization.

PATIENTS AND METHOD

Retrospective study of patients with severe hyperbilirubine mia, between 2013 and 2016. Risk factors were evaluated, stratifying by bilirubin level, admission age, and gestational age. The data were compared with Fisher's exact test, chi-square test, and relative risk (RR) in an Excel database, with an alpha error of p <0.05. The data were obtained from the electronic discharge summary and the medical record of secondary level follow-up.

RESULTS

During the studied period, out of 25,288 live newborns (NB), 593 were hospitalized due to hyperbilirubinemia higher than 20 mg/dl, one per each 42 live NB; and 59 with bilirubinemia higher than 25 mg/dl, one per each 428 live NB. Hyperbilirubinemia was more frequent in males, with RR 1.22 (95% CI 1.04-1.44), and in late preterm newborns, with RR 2.39 (95% CI 1.96-2.93) compared with term NB. In those admitted with more than four days, the main associated factor was excessive weight loss, whereas in the first three days was classic group incompatibility. Three of ten cases with acute encephalopathy persisted with neurological involvement, which means 11.8 per 100,000 live births.

CONCLUSIONS

The main risk factors for developing severe hyperbilirubinemia were prematurity, excessive weight loss, classic group incompatibility, and male sex. These findings allow to focus attention on risk groups and decrease the probability of neurological damage.

[Nutritional factors on retinopathy of prematurity]

Retinopathy of prematurity is a complication affecting very low birth weight infants; it is produced by numerous factors. We review nutritional and growth aspects associated with larger or lesser incidence and severity of retinopathy. This information would allow a better prediction of risk and, a clinical management to minimize visual damage.