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Turktan I, Erdeve O, Kostekci E, Okulu E, Atasay B, Arsan S. Comparison between INTERGROWTH-21ST and Fenton charts for extrauterine growth in very low birth weigth infants. Ital J Pediatr 2025; 51:176. [PMID: 40483534 PMCID: PMC12145624 DOI: 10.1186/s13052-025-01939-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 03/09/2025] [Indexed: 06/11/2025] Open
Abstract
BACKGROUND The growth of premature infants is expected to be equivalent to healthy fetal growth, but this is rarely achieved in practice. It is predicted that many premature infants, especially severe premature infants, will be discharged with growth restriction. Extrauterine growth retardation (EUGR) is defined as growth below the 10th percentile of the growth curve at discharge at corrected 36th/40th week of gestation, or a difference between birth and discharge z-score > 1 SD. The aim of our study is to determine the differences between the INTERGROWTH-21ST and the Fenton chart in the assessment of extrauterine growth. METHODS Infants < 1500 g born or transferred in the first 24 h at Ankara University NICU between January 1, 2015 and December 31, 2019 were included. Infants with major congenital anomalies, unknown gestational age, chromosomal anomalies, hydrops fetalis, TORCH infection, infants born to substance abusing mothers, and infants who died during hospitalization were excluded. RESULTS According to the Fenton, the rate of EUGR at discharge was 66.3%. There was no significant difference between the groups EUGR and non-EUGR in gender, gestational diabetes, maternal smoking during pregnancy, placental abruption, magnesium sulphate prophylaxis, development of respiratory distress, and need for intubation in the first 3 days after birth. When patients were grouped according to birth weight, the highest rate of EUGR according to the Fenton was found in the group with a birth weight ≤ 1000 g (78.8%) (p = 0.036). The proportion of patients defined as SGA by INTERGROWTH-21ST was significantly higher than by Fenton (p < 0.001). Comparing the mean z scores for body weight, height and head circumference at birth and discharge calculated from the Fenton and INTERGROWTH-21 charts, the z scores for body weight and height at birth and discharge were significantly lower in the INTERGROWTH-21 (p < 0.001). Head circumference z-scores at birth and discharge were found to be higher in the Fenton chart than in the INTERGROWTH-21ST (p < 0.001). When EUGR rates were evaluated by body weight in Fenton and INTERGROWTH-21ST, the EUGR rate was found to be higher in Fenton (p < 0.001). CONCLUSIONS The results show that when INTERGROWTH-21ST and Fenton are compared, INTERGROWTH-21ST is more sensitive in defining the SGA rate. The Fenton is more sensitive in defining EUGR at discharge. These differences between the charts make it difficult to monitor the growth of premature infants and to follow comorbidities. Therefore, the establishment of ideal growth curves is of great importance both during hospitalization and after discharge of premature infants.
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Affiliation(s)
- Ilkyaz Turktan
- Department of Pediatric Endocrinology, Ankara University School of Medicine, Ankara, Turkey.
| | - Omer Erdeve
- Division of Neonatology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Ezgi Kostekci
- Division of Neonatology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Emel Okulu
- Division of Neonatology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Begum Atasay
- Division of Neonatology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Saadet Arsan
- Division of Neonatology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
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Kakatsaki I, Anagnostatou NH, Roumeliotaki T, Panteris E, Liapikos T, Papanikolaou S, Hatzidaki E. Evaluating Prevalence of Preterm Postnatal Growth Faltering Using Fenton 2013 and INTERGROWTH-21st Growth Charts with Logistic and Machine Learning Models. Nutrients 2025; 17:1726. [PMID: 40431467 PMCID: PMC12114127 DOI: 10.3390/nu17101726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2025] [Revised: 05/14/2025] [Accepted: 05/16/2025] [Indexed: 05/29/2025] Open
Abstract
Background/Objectives: Postnatal growth faltering (PGF) significantly affects premature neonates, leading to compromised neurodevelopment and an increased risk of long-term health complications. Methods: This retrospective study at a level III NICU of a tertiary hospital analyzed 650 preterm neonates born before 33 weeks. Postnatal growth was evaluated using the Fenton2013 and INTERGROWTH-21st growth charts, with changes in weight z-scores from birth to discharge classified as normal growth (ΔZ ≥ -1), non-severe PGF (-2 ≤ ΔZ < -1), and severe PGF (ΔZ < -2). Results: Mean gestational and postmenstrual age at discharge was 30 weeks (SD 1.9) and 37.1 weeks (SD 2.7), respectively. Fenton2013 growth curves revealed a higher prevalence of non-severe and severe PGF (43% and 14.6%) compared to INTERGROWTH-21st (24.5% and 10.3%). A more rapid establishment of full enteral feeds was strongly associated with reduced severe PGF prevalence in both growth charts (p < 0.001), as was shorter hospitalization. Late-onset sepsis was associated with an increased risk of severe PGF, while being small for gestational age (SGA) was protective against severe PGF across both growth charts (p < 0.001). A trend of decreasing PGF prevalence was noted over the study years, most probably attributed to the implementation of updated nutritional guidelines. Interestingly, when machine learning classification models were evaluated in our Greek cohort, a notable decline in predictive accuracy depending on the growth standard applied was observed. Conclusions: Our study highlights the need for standardizing PGF definition in an attempt to enhance nutritional management and further investigate the long-term impacts of nutritional interventions on growth, neurodevelopment, and overall health outcomes.
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Affiliation(s)
- Ioanna Kakatsaki
- Department of Neonatology and NICU, University General Hospital of Heraklion, School of Medicine, University of Crete, 70013 Crete, Greece; (I.K.); (N.H.A.); (E.P.); (S.P.)
| | - Nicolina Hilda Anagnostatou
- Department of Neonatology and NICU, University General Hospital of Heraklion, School of Medicine, University of Crete, 70013 Crete, Greece; (I.K.); (N.H.A.); (E.P.); (S.P.)
| | - Theano Roumeliotaki
- Clinic of Preventive Medicine and Nutrition, Division of Social Medicine, School of Medicine, University of Crete, 70013 Crete, Greece;
| | - Eleftherios Panteris
- Department of Neonatology and NICU, University General Hospital of Heraklion, School of Medicine, University of Crete, 70013 Crete, Greece; (I.K.); (N.H.A.); (E.P.); (S.P.)
| | - Theodoros Liapikos
- Department of Chemistry, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Styliani Papanikolaou
- Department of Neonatology and NICU, University General Hospital of Heraklion, School of Medicine, University of Crete, 70013 Crete, Greece; (I.K.); (N.H.A.); (E.P.); (S.P.)
| | - Eleftheria Hatzidaki
- Department of Neonatology and NICU, University General Hospital of Heraklion, School of Medicine, University of Crete, 70013 Crete, Greece; (I.K.); (N.H.A.); (E.P.); (S.P.)
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Cohen AJ, Chidester WR, Wray DT, Jessen N, Jones A, Bitsui C, Zhao J, Maschek JA, Cox JE, Martin CR, Joss-Moore LA. Docosahexaenoic Acid Supplementation in Postnatal Growth Restricted Rats Does Not Normalize Lung Function or PPARγ Activity. Biomolecules 2025; 15:551. [PMID: 40305361 PMCID: PMC12024927 DOI: 10.3390/biom15040551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2025] [Revised: 04/02/2025] [Accepted: 04/04/2025] [Indexed: 05/02/2025] Open
Abstract
The development of BPD in preterm neonates is increased by poor growth and nutritional deficits. The involvement of the fatty acid DHA in the development of BPD has been a focus for over a decade. However, recent clinical trials show that isolated DHA supplementation may increase BPD in subgroups of preterm neonates. One explanation for poor lung outcomes in DHA-supplemented neonates is a disruption of global fatty acid profiles and increased expression of a dominant-negative splice variant of a key driver of lung development, PPARγ. We previously developed a rat model of postnatal growth restriction (PGR) in which pups have impaired lung function and altered PPARγ activity. Here, we use our PGR rat model to assess the effects of DHA supplementation on lung outcomes. We hypothesize that the PPARγ splice variant, PPARγΔ5, will be expressed in the rat lung, and that DHA supplementation of PGR rat pups will alter circulating lipid profiles, lung mechanics, and PPARγ variant expression. Our findings demonstrate that PPARγΔ5 is expressed in the developing rat lung and that DHA supplementation of PGR rat pups alters global circulating fatty-acid profiles and does not normalize PGR-induced impaired lung mechanics or PPARγ activity.
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Affiliation(s)
- Adrienne J. Cohen
- Department of Pediatrics, University of Utah, Salt Lake City, UT 84108, USA (W.R.C.)
| | - Wesley R. Chidester
- Department of Pediatrics, University of Utah, Salt Lake City, UT 84108, USA (W.R.C.)
| | - Daniel T. Wray
- Department of Pediatrics, University of Utah, Salt Lake City, UT 84108, USA (W.R.C.)
| | - Nicolette Jessen
- Department of Pediatrics, University of Utah, Salt Lake City, UT 84108, USA (W.R.C.)
| | - Aimee Jones
- Department of Pediatrics, University of Utah, Salt Lake City, UT 84108, USA (W.R.C.)
| | - Cheylah Bitsui
- Department of Pediatrics, University of Utah, Salt Lake City, UT 84108, USA (W.R.C.)
| | - James Zhao
- Department of Pediatrics, University of Utah, Salt Lake City, UT 84108, USA (W.R.C.)
| | - J. Alan Maschek
- Health Science Center Cores, University of Utah Health Sciences Center, Salt Lake City, UT 84108, USA
- Department of Biochemistry, University of Utah, Salt Lake City, UT 84108, USA
| | - James E. Cox
- Health Science Center Cores, University of Utah Health Sciences Center, Salt Lake City, UT 84108, USA
- Department of Biochemistry, University of Utah, Salt Lake City, UT 84108, USA
| | - Camilia R. Martin
- Division of Neonatology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Lisa A. Joss-Moore
- Department of Pediatrics, University of Utah, Salt Lake City, UT 84108, USA (W.R.C.)
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Yang L, Hui Y, Sangild PT, Kot WP, Aunsholt L, Zachariassen G, Jiang PP, Nielsen DS. Gut microbiota development in very preterm infants following fortification of human milk. mSystems 2025; 10:e0091624. [PMID: 39982063 PMCID: PMC11915873 DOI: 10.1128/msystems.00916-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Accepted: 01/22/2025] [Indexed: 02/22/2025] Open
Abstract
Very preterm infants (VPIs) are born with an immature gut and predisposed to gut microbiota dysbiosis-related diseases, for example, necrotizing enterocolitis. Although fortification of human milk is required for these infants, the optimal fortifier remains uncertain. Bovine colostrum (BC), rich in protein and bioactive components, could serve as an alternative to conventional fortifiers (CF). The gut microbiota (GM) of 225 VPIs fed human milk fortified with either BC or CF (FortiColos study, NCT03537365) was profiled by 16S rRNA gene amplicon sequencing of fecal samples collected before, and after 1 and 2 weeks of fortification. Birth mode exhibited transient effects on the microbial community structure shortly after birth, with cesarean section-born VPIs dominated by Firmicutes, whereas vaginally born VPIs were dominated by Proteobacteria. This birth mode-derived difference diminished with age and disappeared around 1 month after birth. Fortifier type affected the microbial community structure to a modest extent, but no specific taxa significantly differed between the BC and CF groups. Fecal pH, increased by BC, was positively correlated with Staphylococcus and Corynebacterium and negatively with Bifidobacterium abundance. Change in the relative abundance of Staphylococcus was negatively correlated with body weight gain. Collectively, fortification of human milk with BC or CF does influence the GM of VPIs but only to a modest extent during early life. Birth mode appears to have a significant, but temporary influence on the GM during this period.IMPORTANCEEarly life is a key period for gut microbiota (GM) establishment, where enteral feeding plays a significant role. This is also the case for infants born preterm, who, due to their immature gut, are at a high risk of developing GM dysbiosis-related diseases. Human milk is the optimal feed for preterm infants, but it requires fortification to reach adequate levels of especially protein. Only a few studies have investigated the impact of fortifiers on GM development in preterm infants. Here, we demonstrate that two different bovine milk-based fortifiers, bovine colostrum and a conventional fortifier based on mature bovine milk, exhibit limited effects on the microbial community structure of very preterm infants. These findings suggest that although great care in terms of optimally maturing the preterm infant GM should be taken, the choice of fortifier only has limited impact. In clinical practice, the choice of fortifier can thus be fully focussed on optimizing preterm infant nutrition.CLINICAL TRIALSThis study is registered with ClinicalTrials.gov as NCT03537365.
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Affiliation(s)
- Lin Yang
- Section for Comparative Paediatrics and Nutrition, Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Yan Hui
- Department of Food Science, University of Copenhagen, Frederiksberg, Denmark
| | - Per Torp Sangild
- Section for Comparative Paediatrics and Nutrition, Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark
- Department of Neonatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Neonatology, Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Witold Piotr Kot
- Department of Plant and Environmental Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Lise Aunsholt
- Section for Comparative Paediatrics and Nutrition, Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark
- Department of Neonatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Gitte Zachariassen
- Department of Neonatology, Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Ping-Ping Jiang
- Section for Comparative Paediatrics and Nutrition, Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark
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Izquierdo Renau M, García González E, Balcells-Esponera C, Del Rey Hurtado de Mendoza B, Inarejos Clemente EJ, Iglesias-Platas I. Clinical and ultrasound assessment of body composition in preterm infants at discharge: an observational study. BMJ Paediatr Open 2025; 9:e002774. [PMID: 39773975 PMCID: PMC11749038 DOI: 10.1136/bmjpo-2024-002774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 12/04/2024] [Indexed: 01/11/2025] Open
Abstract
OBJECTIVES While the target of growth of very preterm infants (VPIs) during Neonatal Intensive care unit (NICU) admission is still controversial, the most accepted objective is that they should follow their intrauterine trajectory in terms of growth and body composition (BC). BC is difficult to measure in clinical daily routine but proxies like body ratios and skinfolds have been used. Prenatal and postnatal factors can influence the growth and BC of VPIs in the NICU. DESIGN, SETTING AND PATIENTS We conducted a case-control study, including preterm infants born before 32 weeks gestational age at term-corrected age (TCA) and healthy late preterm or term infants as controls and also a retrospective cohort analysis of factors influencing VPI's BC at discharge. Patients had an anthropometric evaluation at discharge including weight, length, head circumference, body circumferences (waist, arm), skinfolds and abdominal ultrasound (US). RESULTS 191 VPIs were eligible for discharge visits, but only 83 had a complete evaluation and we collected 26 controls. VPIs at TCA were smaller in weight, length and head circumference but had greater ratios (arm fat-to-circumference and waist-to-length). Abdominal fat assessed by US was smaller in VPIs compared with term infants. Intrauterine growth restriction-VPI remained smaller at TCA but experienced less weight z-score loss. Sex did not seem to influence growth and BC proxies at TCA. Higher nutritional support during the first 2 weeks of life was related to a lower loss of length z-scores, and exclusive human milk feeding correlates with arm fat-to-circumference ratio. CONCLUSIONS Growth and BC of VPIs can be approached using simpler measures in clinical practice. Arm skinfolds and arm circumferences point to a greater adiposity of VPIs at TCA compared with term infants, while US does not show a greater visceral adiposity. Nutritional factors played a small effect in BC at the time of discharge.
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Affiliation(s)
- Montserrat Izquierdo Renau
- Neonatology, Hospital Sant Joan de Deu, Esplugues de Llobregat, Catalunya, Spain
- Institut de Recerca Sant Joan de Déu, Barcelona, Catalunya, Spain
| | - Elsa García González
- Neonatology, Hospital Universitario Virgen de la Candelaria, Santa Cruz de Tenerife, Canarias, Spain
| | - Carla Balcells-Esponera
- Institut de Recerca Sant Joan de Déu, Barcelona, Catalunya, Spain
- Hospital Sant Joan de Deu, Barcelona, Catalunya, Spain
| | - Beatriz Del Rey Hurtado de Mendoza
- Institut de Recerca Sant Joan de Déu, Barcelona, Catalunya, Spain
- Neonatology Department, Hospital Sant Joan de Deu, Barcelona, Catalunya, Spain
| | | | - Isabel Iglesias-Platas
- Institut de Recerca Sant Joan de Déu, Barcelona, Catalunya, Spain
- Neonatology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
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González López C, Solís Sánchez G, Fernández Colomer B, Mantecón Fernández L, Lareu Vidal S, Arias Llorente RP, Ibáñez Fernández A, González García LG, Suárez Rodríguez M. Extrauterine growth restriction in very-low-birthweight infants: prevalence and concordance according to Fenton, Olsen, and INTERGROWTH-21st growth charts in a multicenter Spanish cohort. Eur J Pediatr 2024; 183:4073-4083. [PMID: 38960906 PMCID: PMC11322293 DOI: 10.1007/s00431-024-05673-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 06/14/2024] [Accepted: 06/27/2024] [Indexed: 07/05/2024]
Abstract
Multiple criteria and growth references have been proposed for extrauterine growth restriction (EUGR). We hypothesized that these may impact the diagnosis of EUGR. The objective was to evaluate the prevalence of EUGR with its different definitions and the concordance according to Fenton, Olsen, and INTERGROWTH-21st in very-low-birthweight (VLBW) infants. This is an observational, retrospective, and multicenter study including VLBW infants from the Spanish SEN1500 Network from 2011 to 2020. Patients with major congenital anomalies, embryopathies, and gestational age less than 24 weeks were excluded. EUGR prevalence was calculated at discharge with cross-sectional, longitudinal, "true" cross-sectional, and "true" longitudinal definitions. Concordance was assessed with Fleiss' kappa coefficient. 23582 VLBW infants from 77 NICUs were included. In total, 50.4% were men with a median of gestational age of 29 (4) weeks. The prevalence of EUGR (cross-sectional, longitudinal, and "true") was variable for weight, length, and head circumference. Overall, the prevalence was higher with Fenton and lower with Olsen (cross-sectional and "true" cross-sectional) and INTERGROWTH-21st (longitudinal and "true" longitudinal). Agreement among the charts by weight was good only for cross-sectional EUGR and moderate for longitudinal, "true" cross-sectional, and "true" longitudinal. Concordance was good or very good for EUGR by length and head circumference.Conclusions: The prevalence of EUGR with the most commonly used definitions was variable in the cohort. Agreement among growth charts was moderate for all the definitions of EUGR by weight except cross-sectional and good or very good for length and head circumference. The choice of reference chart can impact the establishment of the diagnosis of EUGR. What is known: • EUGR has been defined in the literature and daily practice considering weight, length and head circumference with multiple criteria (cross-sectional, longitudinal, and "true" definition) • Different growth charts have been used for EUGR diagnosis What is new: • Prevalence of EUGR is variable depending on the definition and growth chart used in our cohort of VLBW infants • For the most frequently EUGR criteria used, traditionally considering weight, concordance among Fenton, Olsen and INTERGROWTH-21st growth charts is only moderate for all the definitions of EUGR by weight except cross-sectional definition. Concordance among the charts is good or very good for the different criteria of EUGR by head circumference and length.
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Affiliation(s)
- Clara González López
- Servicio de Neonatología, Área de Gestión Clínica de La Infancia y Adolescencia, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Gonzalo Solís Sánchez
- Servicio de Neonatología, Área de Gestión Clínica de La Infancia y Adolescencia, Hospital Universitario Central de Asturias, Oviedo, Spain.
- Instituto Investigación Sanitaria Principado de Asturias, ISPA, Oviedo, Spain.
- Departamento de Medicina, Universidad de Oviedo, Oviedo, Spain.
| | - Belén Fernández Colomer
- Servicio de Neonatología, Área de Gestión Clínica de La Infancia y Adolescencia, Hospital Universitario Central de Asturias, Oviedo, Spain
- Instituto Investigación Sanitaria Principado de Asturias, ISPA, Oviedo, Spain
| | - Laura Mantecón Fernández
- Servicio de Neonatología, Área de Gestión Clínica de La Infancia y Adolescencia, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Sonia Lareu Vidal
- Servicio de Neonatología, Área de Gestión Clínica de La Infancia y Adolescencia, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Rosa Patricia Arias Llorente
- Servicio de Neonatología, Área de Gestión Clínica de La Infancia y Adolescencia, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Aleida Ibáñez Fernández
- Servicio de Neonatología, Área de Gestión Clínica de La Infancia y Adolescencia, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Marta Suárez Rodríguez
- Servicio de Neonatología, Área de Gestión Clínica de La Infancia y Adolescencia, Hospital Universitario Central de Asturias, Oviedo, Spain
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González López C, Solís Sánchez G, Fernández Colomer B, Mantecón Fernández L, Lareu Vidal S, Fernández Castiñeira S, Rubio Granda A, Pérez Pérez A, Suárez Rodríguez M. Impact of the Choice of Diagnostic Criteria and Growth Reference on the Prevalence of Extrauterine Growth Restriction in Extremely-Low-Birthweight Infants. CHILDREN (BASEL, SWITZERLAND) 2024; 11:934. [PMID: 39201869 PMCID: PMC11352271 DOI: 10.3390/children11080934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Revised: 07/28/2024] [Accepted: 07/29/2024] [Indexed: 09/03/2024]
Abstract
BACKGROUND AND OBJECTIVES Variable diagnostic criteria and growth charts have been used for extrauterine growth restriction (EUGR). The objective was to assess the prevalence and concordance of EUGR in extremely-low-birthweight (ELBW) infants with the most frequent diagnostic criteria and growth charts. MATERIALS AND METHODS An observational, retrospective and multicenter study was conducted from 2011 to 2020 including ELBW infants from the Spanish SEN1500 Network. EUGR prevalence was calculated at discharge using different definitions: cross-sectional (anthropometry less than the 10th centile), longitudinal (decrease of more than 1 SD from birth to discharge), "true" cross-sectional and "true" longitudinal (using the criteria previously described, excluding infants small for gestational age at birth). Concordance among Fenton, Olsen and INTERGROWTH-21st was assessed with Fleiss' Kappa coefficient. RESULTS The prevalence of EUGR was variable with the different definitions and growth references studied in the 7914 ELBW infants included. Overall, it was higher with Fenton for all the EUGR criteria studied by weight and length. The agreement among growth charts was substantial (κ > 0.6) for all the definitions except for longitudinal EUGR by weight (moderate, κ = 0.578). CONCLUSIONS The prevalence of EUGR was variable in our cohort with the different diagnostic criteria and growth charts. The agreement among charts was good for all the definitions of EUGR except longitudinal EUGR by weight.
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Affiliation(s)
- Clara González López
- Servicio de Neonatología, Área de Gestión Clínica de la Infancia y Adolescencia, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Gonzalo Solís Sánchez
- Servicio de Neonatología, Área de Gestión Clínica de la Infancia y Adolescencia, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
- Instituto Investigación Sanitaria Principado de Asturias, ISPA, 33011 Oviedo, Spain
- Departamento de Medicina, Universidad de Oviedo, 33003 Oviedo, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS), Instituto de Salud Carlos III, RD21/0012/0020, 28028 Madrid, Spain
| | - Belén Fernández Colomer
- Servicio de Neonatología, Área de Gestión Clínica de la Infancia y Adolescencia, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
- Instituto Investigación Sanitaria Principado de Asturias, ISPA, 33011 Oviedo, Spain
| | - Laura Mantecón Fernández
- Servicio de Neonatología, Área de Gestión Clínica de la Infancia y Adolescencia, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Sonia Lareu Vidal
- Servicio de Neonatología, Área de Gestión Clínica de la Infancia y Adolescencia, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Sara Fernández Castiñeira
- Servicio de Neonatología, Área de Gestión Clínica de la Infancia y Adolescencia, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Ana Rubio Granda
- Servicio de Neonatología, Área de Gestión Clínica de la Infancia y Adolescencia, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Alicia Pérez Pérez
- Área de Gestión Clínica de la Infancia y Adolescencia, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Marta Suárez Rodríguez
- Servicio de Neonatología, Área de Gestión Clínica de la Infancia y Adolescencia, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
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Gao L, Shen W, Wu F, Mao J, Liu L, Chang YM, Zhang R, Ye XZ, Qiu YP, Ma L, Cheng R, Wu H, Chen DM, Chen L, Xu P, Mei H, Wang SN, Xu FL, Ju R, Zheng Z, Lin XZ, Tong XM. Real-time predictive model of extrauterine growth retardation in preterm infants with gestational age less than 32 weeks. Sci Rep 2024; 14:12884. [PMID: 38839838 PMCID: PMC11153599 DOI: 10.1038/s41598-024-63593-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 05/30/2024] [Indexed: 06/07/2024] Open
Abstract
The aim of this study was to develop a real-time risk prediction model for extrauterine growth retardation (EUGR). A total of 2514 very preterm infants were allocated into a training set and an external validation set. The most appropriate independent variables were screened using univariate analysis and Lasso regression with tenfold cross-validation, while the prediction model was designed using binary multivariate logistic regression. A visualization of the risk variables was created using a nomogram, while the calibration plot and receiver operating characteristic (ROC) curves were used to calibrate the prediction model. Clinical efficacy was assessed using the decision curve analysis (DCA) curves. Eight optimal predictors that namely birth weight, small for gestation age (SGA), hypertensive disease complicating pregnancy (HDCP), gestational diabetes mellitus (GDM), multiple births, cumulative duration of fasting, growth velocity and postnatal corticosteroids were introduced into the logistic regression equation to construct the EUGR prediction model. The area under the ROC curve of the training set and the external verification set was 83.1% and 84.6%, respectively. The calibration curve indicate that the model fits well. The DCA curve shows that the risk threshold for clinical application is 0-95% in both set. Introducing Birth weight, SGA, HDCP, GDM, Multiple births, Cumulative duration of fasting, Growth velocity and Postnatal corticosteroids into the nomogram increased its usefulness for predicting EUGR risk in very preterm infants.
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Affiliation(s)
- Liang Gao
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, 361000, Fujian, China
| | - Wei Shen
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, 361000, Fujian, China
| | - Fan Wu
- Department of Neonatology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510000, China
| | - Jian Mao
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, 110000, China
| | - Ling Liu
- Department of Neonatology, Guiyang Maternal and Child Health Hospital and Guiyang Children's Hospital, Guiyang, 550000, China
| | - Yan-Mei Chang
- Department of Pediatrics, Peking University Third Hospital, Beijing, 100000, China
| | - Rong Zhang
- Department of Neonatology, Pediatric Hospital of Fudan University, Shanghai, 200001, China
| | - Xiu-Zhen Ye
- Department of Neonatology, Guangdong Province Maternal and Children's Hospital, Guangzhou, 510000, China
| | - Yin-Ping Qiu
- Department of Neonatology, General Hospital of Ningxia Medical University, Yinchuan, 750000, China
| | - Li Ma
- Department of Neonatology, Children's Hospital of Hebei Province, Shijiazhuang, 050000, China
| | - Rui Cheng
- Department of Neonatology, Children's Hospital of Nanjing Medical University, Nanjing, 210000, China
| | - Hui Wu
- Department of Neonatology, The First Hospital of Jilin University, Changchun, 130000, China
| | - Dong-Mei Chen
- Department of Neonatology, Quanzhou Maternity and Children's Hospital, Fujian, 362000, Quanzhou, China
| | - Ling Chen
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, Hubei, China
| | - Ping Xu
- Department of Neonatology, Liaocheng People's Hospital, Liaocheng, 252000, Shandong, China
| | - Hua Mei
- Department of Neonatology, The Affiliate Hospital of Inner Mongolia Medical University, Hohhot, 010010, Inner Mongolia, China
| | - San-Nan Wang
- Department of Neonatology, Suzhou Municipal Hospital, Suzhou, 215002, Jiangsu, China
| | - Fa-Lin Xu
- Department of Neonatology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Rong Ju
- Department of Neonatology, School of Medicine, Chengdu Women' and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, Sichuan, China
| | - Zhi Zheng
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, 361000, Fujian, China
| | - Xin-Zhu Lin
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, 361000, Fujian, China.
| | - Xiao-Mei Tong
- Department of Pediatrics, Peking University Third Hospital, Beijing, 100000, China.
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9
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Palomino-Fernández L, Pastor-Villaescusa B, Velasco I, Rico MDLC, Roa J, Gil Á, Gil-Campos M. Metabolic and Low-Grade Inflammation Risk in Young Adults with a History of Extrauterine Growth Restriction. Nutrients 2024; 16:1608. [PMID: 38892541 PMCID: PMC11174372 DOI: 10.3390/nu16111608] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/17/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
Children with a history of extrauterine growth restriction (EUGR), later at prepubertal age, exhibit an increased metabolic risk including risen insulin resistance and low-grade inflammation. However, the progression of such metabolic changes after puberty and the lasting health implications have not yet been investigated. The objective of this study was to ascertain whether young adults with a history of EUGR faced increased vulnerability to metabolic disorders. A study was conducted comparing a group of adults with a history of EUGR with a healthy reference group. A total of 110 young adults (36 from the EUGR group and 74 from the control group) were included. Anthropometric variables, blood pressure (BP), general biochemical parameters, plasma inflammatory biomarkers, and adipokines were assessed. Compared to the reference group, the EUGR group had a shorter height and body weight with higher lean mass and waist circumference, as well as a greater percentage of individuals with high BP. In addition, EUGR patients had higher values of insulin, HOMA-IR, nerve growth factor, and leptin, and lower levels of adiponectin and resistin. The present study suggests that young adults with a history of EUGR present increased metabolic risk factors therefore, clinical follow-up should be considered.
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Affiliation(s)
- Laura Palomino-Fernández
- Metabolism and Investigation Unit, Reina Sofia University Hospital, Maimonides Institute of Biomedicine Research of Cordoba (IMIBIC), University of Cordoba, 14004 Cordoba, Spain; (L.P.-F.); (B.P.-V.); (M.G.-C.)
| | - Belén Pastor-Villaescusa
- Metabolism and Investigation Unit, Reina Sofia University Hospital, Maimonides Institute of Biomedicine Research of Cordoba (IMIBIC), University of Cordoba, 14004 Cordoba, Spain; (L.P.-F.); (B.P.-V.); (M.G.-C.)
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS), RD21/0012/0008, Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Inmaculada Velasco
- Department of Cell Biology, Physiology and Immunology, Reina Sofia University Hospital, Maimonides Institute of Biomedicine Research of Cordoba (IMIBIC), University of Cordoba, 14004 Cordoba, Spain;
| | - María de la Cruz Rico
- Department of Biochemistry and Molecular Biology II, School of Pharmacy, “José Mataix Verdú” Institute of Nutrition and Food Technology (INYTA), University of Granada, 18016 Granada, Spain; (M.d.l.C.R.); (Á.G.)
- Center of Biomedical Research, Instituto de Investigación Biosanitaria (IBS.Granada), University of Granada, 18016 Granada, Spain
| | - Juan Roa
- Department of Cell Biology, Physiology and Immunology, Reina Sofia University Hospital, Maimonides Institute of Biomedicine Research of Cordoba (IMIBIC), University of Cordoba, 14004 Cordoba, Spain;
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Ángel Gil
- Department of Biochemistry and Molecular Biology II, School of Pharmacy, “José Mataix Verdú” Institute of Nutrition and Food Technology (INYTA), University of Granada, 18016 Granada, Spain; (M.d.l.C.R.); (Á.G.)
- Center of Biomedical Research, Instituto de Investigación Biosanitaria (IBS.Granada), University of Granada, 18016 Granada, Spain
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Mercedes Gil-Campos
- Metabolism and Investigation Unit, Reina Sofia University Hospital, Maimonides Institute of Biomedicine Research of Cordoba (IMIBIC), University of Cordoba, 14004 Cordoba, Spain; (L.P.-F.); (B.P.-V.); (M.G.-C.)
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
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10
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Figueras-Aloy J, Izquierdo Renau M, Herranz Barbero A, Urquía Martí L, García-Muñoz Rodrigo F, Iriondo-Sanz M, García Algar Ó. Comparative analysis of foetal and neonatal growth curves. An Pediatr (Barc) 2024; 100:333-341. [PMID: 38653671 DOI: 10.1016/j.anpede.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/22/2024] [Indexed: 04/25/2024] Open
Abstract
INTRODUCTION Our aim was to determine which foetal or neonatal growth curves discriminate the probability of dying of newborns with low birth weight for their gestational age (small for gestational age, SGA) and sex (weight < 10th percentile) and to establish the curves that are presumably most useful for monitoring growth through age 10 years. MATERIAL AND METHODS The analysis included every neonate (15 122) managed in our hospital (2013-2022) and all neonates born preterm before 32 weeks (6913) registered in the SEN1500 database (2019-2022). We considered most useful those curves with the highest likelihood ratio (LR) for dying with or without a history of SGA in each subgroup of gestational ages. Theoretically, the optimal curves for monitoring growth would be those with a higher R2 in the quantile regression formulas for the 50th percentile. RESULTS The growth curves exhibiting the strongest association between SGA and hospital mortality are the Intergrowth fetal curves and the Fenton neonatal curves in infants born preterm before 32 weeks. However, the optimal curves for premature babies and neonates overall were those of Olsen and Intergrowth. The most useful curves to monitor anthropometric values alone until age 10 years of age are the longitudinal Intergrowth curves followed by the WHO standards, but if a single reference is desired from birth through age 10 years, the best option is the Fenton curves followed by the WHO standards. CONCLUSIONS The Intergrowth reference provides the most discriminating foetal growth curves. In neonatal clinical practice, the optimal references are the Fenton followed by the WHO charts.
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Affiliation(s)
- Josep Figueras-Aloy
- Servicio de Neonatología, ICGON, IDIBAPS, Hospital Clínic-Maternitat, BCNatal, Barcelona, Spain.
| | | | - Ana Herranz Barbero
- Servicio de Neonatología, ICGON, IDIBAPS, Hospital Clínic-Maternitat, BCNatal, Barcelona, Spain
| | - Lourdes Urquía Martí
- Servicio de Neonatología, Hospital Universitario Materno-Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Fermín García-Muñoz Rodrigo
- Servicio de Neonatología, Hospital Universitario Materno-Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Martín Iriondo-Sanz
- Servicio de Neonatología, Hospital Sant Joan de Déu, BCNatal, Esplugues de Llobregat, Barcelona, Spain
| | - Óscar García Algar
- Servicio de Neonatología, ICGON, IDIBAPS, Hospital Clínic-Maternitat, BCNatal, Barcelona, Spain
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11
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González-López C, Solís-Sánchez G, Lareu-Vidal S, Mantecón-Fernández L, Ibáñez-Fernández A, Rubio-Granda A, Suárez-Rodríguez M. Variability in Definitions and Criteria of Extrauterine Growth Restriction and Its Association with Neurodevelopmental Outcomes in Preterm Infants: A Narrative Review. Nutrients 2024; 16:968. [PMID: 38613002 PMCID: PMC11013404 DOI: 10.3390/nu16070968] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
Extrauterine growth restriction (EUGR) has been used in the literature and clinical practice to describe inadequate growth in preterm infants. Significant variability is seen in the criteria for EUGR, with no standard definition reached to date. Moreover, no consensus on the optimal timing for assessment or the ideal growth monitoring tool has been achieved, and an ongoing debate persists on the appropriate terminology to express poor postnatal growth. To ensure an adequate understanding of growth and early intervention in preterm infants at higher risk, it is critical to relate the diagnostic criteria of EUGR to the ability to predict adverse outcomes, such as neurodevelopmental outcomes. This narrative review was conducted to present evidence that evaluates neurodevelopmental outcomes in preterm infants with EUGR, comparing separately the different definitions of this concept by weight (cross-sectional, longitudinal and "true" EUGR). In this article, we highlight the challenges of comparing various published studies on the subject, even when subclassifying by the definition of EUGR, due to the significant variability on the criteria used for each definition and for the evaluation of neurodevelopmental outcomes in different papers. This heterogeneity compromises the obtention of a single firm conclusion on the relation between different definitions of EUGR and adverse neurodevelopmental outcomes.
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Affiliation(s)
- Clara González-López
- Unidad de Neonatología, Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.G.-L.); (S.L.-V.); (L.M.-F.); (A.I.-F.); (A.R.-G.); (M.S.-R.)
| | - Gonzalo Solís-Sánchez
- Unidad de Neonatología, Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.G.-L.); (S.L.-V.); (L.M.-F.); (A.I.-F.); (A.R.-G.); (M.S.-R.)
- Instituto Investigación Sanitaria Principado de Asturias, ISPA, 33011 Oviedo, Spain
- Medical Department, University of Oviedo, 33003 Oviedo, Spain
| | - Sonia Lareu-Vidal
- Unidad de Neonatología, Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.G.-L.); (S.L.-V.); (L.M.-F.); (A.I.-F.); (A.R.-G.); (M.S.-R.)
- Instituto Investigación Sanitaria Principado de Asturias, ISPA, 33011 Oviedo, Spain
| | - Laura Mantecón-Fernández
- Unidad de Neonatología, Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.G.-L.); (S.L.-V.); (L.M.-F.); (A.I.-F.); (A.R.-G.); (M.S.-R.)
- Instituto Investigación Sanitaria Principado de Asturias, ISPA, 33011 Oviedo, Spain
| | - Aleida Ibáñez-Fernández
- Unidad de Neonatología, Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.G.-L.); (S.L.-V.); (L.M.-F.); (A.I.-F.); (A.R.-G.); (M.S.-R.)
| | - Ana Rubio-Granda
- Unidad de Neonatología, Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.G.-L.); (S.L.-V.); (L.M.-F.); (A.I.-F.); (A.R.-G.); (M.S.-R.)
| | - Marta Suárez-Rodríguez
- Unidad de Neonatología, Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.G.-L.); (S.L.-V.); (L.M.-F.); (A.I.-F.); (A.R.-G.); (M.S.-R.)
- Instituto Investigación Sanitaria Principado de Asturias, ISPA, 33011 Oviedo, Spain
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12
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Meneghelli M, Toniazzo S, Priante E, Cavicchiolo ME, De Terlizzi F, Gaio P, Spinella P, Verlato G. Complementary feeding in infants born preterm: Aspects needing improvement. JPGN REPORTS 2024; 5:43-49. [PMID: 38545275 PMCID: PMC10964340 DOI: 10.1002/jpr3.12032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/09/2023] [Accepted: 11/04/2023] [Indexed: 11/10/2024]
Abstract
Objective The aim of our study was to collect data on complementary feeding (CF) in preterm infants (PIs). Methods We enrolled PI ≤ 34 weeks of gestational age discharged from the neonatal intensive care unit (NICU) of the University Hospital of Padova. At 12 months of corrected age (CA), CF was investigated with questionnaires to the parents and a 24-h dietary recall. In a subgroup of newborns, we also evaluated bone status at a CA of 12 months using quantitative ultrasound. Results We studied 167 ex PI at 1 year of CA. CF was introduced in 67.1% of them between 5 and 8 months of chronological age, with fruit as the first food (81%, n = 136). Sweet drinks were consumed by 17.4% of our sample, and salt was added in 33.5% of cases. PIs, at 1 year CA, introduced extra energy compared to the theoretical requirement (121 ± 31 kcal/kg/day) and higher protein intake than recommended (39 ± 11 g/day), while the intake of both total lipids and carbohydrates was slightly lower. Vitamins and minerals were adequate, except vitamin D. Regarding bone status, we found a correlation between vitamin D intakes from the diet and bone parameters (metacarpus-bone transmission time: r = 0.36, p = 0.01) at 1 year of CA. Conclusions Our population of PIs started CF in agreement with current suggestions though with a notable heterogeneity and with some mistakes. Vitamin D intake was correlated with bone status at 1 year of CA.
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Affiliation(s)
- Marta Meneghelli
- Neonatal Intensive Care Unit—Paediatric Nutrition Service, Department of Women's and Children's HealthUniversity Hospital of PadovaPadovaItaly
| | - Silvia Toniazzo
- Department of Medicine, Clinical Nutrition UnitUniversity of PadovaPadovaItaly
| | - Elena Priante
- Neonatal Intensive Care Unit—Paediatric Nutrition Service, Department of Women's and Children's HealthUniversity Hospital of PadovaPadovaItaly
| | - Maria Elena Cavicchiolo
- Neonatal Intensive Care Unit—Paediatric Nutrition Service, Department of Women's and Children's HealthUniversity Hospital of PadovaPadovaItaly
| | | | - Paola Gaio
- Unit of Pediatric Gastroenterology, Digestive Endoscopy, Hepatology and Care of the Child with Liver Transplantation, Department of Women's and Children's HealthUniversity Hospital of PadovaPadovaItaly
| | - Paolo Spinella
- Department of Medicine, Clinical Nutrition UnitUniversity of PadovaPadovaItaly
| | - Giovanna Verlato
- Neonatal Intensive Care Unit—Paediatric Nutrition Service, Department of Women's and Children's HealthUniversity Hospital of PadovaPadovaItaly
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13
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Yoon SJ, Kim D, Park SH, Han JH, Lim J, Shin JE, Eun HS, Lee SM, Park MS. Prediction of Postnatal Growth Failure in Very Low Birth Weight Infants Using a Machine Learning Model. Diagnostics (Basel) 2023; 13:3627. [PMID: 38132211 PMCID: PMC10743090 DOI: 10.3390/diagnostics13243627] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
Accurate prediction of postnatal growth failure (PGF) can be beneficial for early intervention and prevention. We aimed to develop a machine learning model to predict PGF at discharge among very low birth weight (VLBW) infants using extreme gradient boosting. A total of 729 VLBW infants, born between 2013 and 2017 in four hospitals, were included. PGF was defined as a decrease in z-score between birth and discharge that was greater than 1.28. Feature selection and addition were performed to improve the accuracy of prediction at four different time points, including 0, 7, 14, and 28 days after birth. A total of 12 features with high contribution at all time points by feature importance were decided upon, and good performance was shown as an area under the receiver operating characteristic curve (AUROC) of 0.78 at 7 days. After adding weight change to the 12 features-which included sex, gestational age, birth weight, small for gestational age, maternal hypertension, respiratory distress syndrome, duration of invasive ventilation, duration of non-invasive ventilation, patent ductus arteriosus, sepsis, use of parenteral nutrition, and reach at full enteral nutrition-the AUROC at 7 days after birth was shown as 0.84. Our prediction model for PGF performed well at early detection. Its potential clinical application as a supplemental tool could be helpful for reducing PGF and improving child health.
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Affiliation(s)
- So Jin Yoon
- Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.J.Y.)
| | - Donghyun Kim
- Department of Advanced General Dentistry, Yonsei University College of Dentistry, Seoul 03722, Republic of Korea
- InVisionLab Inc., Seoul 05854, Republic of Korea
| | - Sook Hyun Park
- Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.J.Y.)
| | - Jung Ho Han
- Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.J.Y.)
| | - Joohee Lim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.J.Y.)
| | - Jeong Eun Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.J.Y.)
| | - Ho Seon Eun
- Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.J.Y.)
| | - Soon Min Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.J.Y.)
| | - Min Soo Park
- Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.J.Y.)
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14
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Huang XR, Shen W, Wu F, Mao J, Liu L, Chang YM, Zhang R, Ye XZ, Qiu YP, Ma L, Cheng R, Wu H, Chen DM, Chen L, Xu P, Mei H, Wang SN, Xu FL, Ju R, Zheng Z, Lin XZ, Tong XM. Real-world evidence regarding the growth of very premature infants with small for gestational age after birth: a multicenter survey in China. BMC Pediatr 2023; 23:437. [PMID: 37653371 PMCID: PMC10468850 DOI: 10.1186/s12887-023-04245-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 08/11/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND To analyze the real-world growth pattern of very premature infants (VPI) with small for gestational age (SGA) after birth by using the ΔZ value of weight at discharge. METHODS The clinical data were collected from 28 hospitals in China from September 2019 to December 2020. They were divided into the EUGR(Extrauterine Growth Restriction) and the non-EUGR group according to the criterion of ΔZ value of weight at discharge < -1.28. RESULTS This study included 133 eligible VPI with SGA. Following the criterion of ΔZ value, the incidence of EUGR was 36.84% (49/133). The birth weight, the 5-min Apgar score, and the proportion of male infants in the EUGR group were lower (P < 0.05). The average invasive ventilation time, cumulative duration of the administration of antibiotics, blood transfusion time, blood transfusion ratio, and total days of hospitalization were significantly higher in the EUGR group (P < 0.05). In the EUGR group, several factors exhibited higher values (P < 0.05), including the initiation of enteral feeding, the volume of milk supplemented with human milk fortifier (HMF), the duration to achieve complete fortification, the cumulative duration of fasting, the duration to achieve full enteral feeding, the length of parenteral nutrition (PN), the number of days required to attain the desired total calorie intake and oral calorie intake, as well as the age at which birth weight was regained. The average weight growth velocity (GV) was significantly lower in the EUGR group (P < 0.001). The incidences of patent ductus arteriosus with hemodynamic changes (hsPDA), neonatal necrotizing enterocolitis (NEC) stage≥ 2, late-onset sepsis (LOS), and feeding intolerance (FI) in the EUGR group were higher (P < 0.05). Multivariate logistic regression analysis showed that birth weight, male, and GV were the protective factors, while a long time to achieve full-dose fortification, slow recovery of birth weight, and NEC stage ≥2 were the independent risk factors. CONCLUSION SGA in VPI can reflect the occurrence of EUGR more accurately by using the ΔZ value of weight at discharge. Enhancing enteral nutrition support, achieving prompt and complete fortification of breast milk, promoting greater GV, reducing the duration of birth weight recovery, and minimizing the risk of NEC can contribute to a decreased occurrence of EUGR. TRIAL REGISTRATION CHICTR, ChiCTR1900023418. Registered 26/05/2019, http://www.chictr.org.cn .
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Affiliation(s)
- Xue-Rong Huang
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, 361003, Fujian, China
- Xiamen Key Laboratory of Perinatal-Neonatal Infection, Xiamen, 361003, Fujian, China
| | - Wei Shen
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, 361003, Fujian, China
- Xiamen Key Laboratory of Perinatal-Neonatal Infection, Xiamen, 361003, Fujian, China
| | - Fan Wu
- Department of Neonatology, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, Guangdong, China
| | - Jian Mao
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, 110000, China
| | - Ling Liu
- Department of Neonatology, Guiyang Maternal, and Child Health Hospital Guiyang Children's Hospital, Guiyang, Guizhou, 550002, China
| | - Yan-Mei Chang
- Department of Pediatrics, Peking University Third Hospital, Beijing, 100191, China
| | - Rong Zhang
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Xiu-Zhen Ye
- Department of Neonatology, Guangdong Province Maternal and Children's Hospital, Guangzhou, 510030, Guangdong, China
| | - Yin-Ping Qiu
- Department of Neonatology, General Hospital of Ningxia Medical University, Yinchuan, 750001, Ningxia, China
| | - Li Ma
- Department of Neonatology, Children's Hospital of Hebei Province, Shijiazhuang, 050031, Hebei, China
| | - Rui Cheng
- Department of Neonatology, Children' Hospital of Nanjing Medical University, Nanjing, 210000, Jiangsu, China
| | - Hui Wu
- Department of Neonatology, the First Hospital of Jilin University, Changchun, Jilin, 130000, China
| | - Dong-Mei Chen
- Department of Neonatology, Quanzhou Maternity and Children's Hospital, Quanzhou, 362000, Fujian, China
| | - Ling Chen
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, Hubei, China
| | - Ping Xu
- Department of Neonatology, Liaocheng People's Hospital, Liaocheng, 252000, Shandong, China
| | - Hua Mei
- Department of Neonatology, the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, 010010, Inner Mongolia, China
| | - San-Nan Wang
- Department of Neonatology, Suzhou Municipal Hospital, Suzhou, 215002, Jiangsu, China
| | - Fa-Lin Xu
- Department of Neonatology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Rong Ju
- Department of Neonatology, Chengdu Women' and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, Sichuan, China
| | - Zhi Zheng
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, 361003, Fujian, China
- Xiamen Key Laboratory of Perinatal-Neonatal Infection, Xiamen, 361003, Fujian, China
| | - Xin-Zhu Lin
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, 361003, Fujian, China.
- Xiamen Key Laboratory of Perinatal-Neonatal Infection, Xiamen, 361003, Fujian, China.
| | - Xiao-Mei Tong
- Department of Pediatrics, Peking University Third Hospital, Beijing, 100191, China.
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15
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Angelika D, Etika R, Utomo MT, Ladydi L, Sampurna MTA, Handayani KD, Ugrasena IDG, Sauer PJJ. The incidence of and risk factors for hyperglycemia and hypoglycemia in preterm infants receiving early-aggressive parenteral nutrition. Heliyon 2023; 9:e18966. [PMID: 37609391 PMCID: PMC10440514 DOI: 10.1016/j.heliyon.2023.e18966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 07/11/2023] [Accepted: 08/03/2023] [Indexed: 08/24/2023] Open
Abstract
Introduction Optimizing nutritional support helps prevent extra uterine growth restriction and adverse long-term outcomes in preterm infants. Objectives This study aimed to analyze the incidence of and risk factors for hyperglycemia and hypoglycemia in preterm infants receiving early-aggressive parenteral nutrition (PN). Methods This prospective observational study included preterm infants receiving PN at the Neonatal Intensive Care Unit of Dr. Soetomo General Hospital between April 2018 and May 2019. Potential risk factors analyzed included asphyxia, sepsis, respiratory distress syndrome, multiple congenital anomalies, mortality, necrotizing enterocolitis, retinopathy of prematurity, the postoperative period, inotropic administration, glucose infusion rate (GIR) > 10-12 mg/kg/min, GIR 4-<5.5 mg/kg/min, and increase in GIR <1 mg/kg/min. Results Of the 105 preterm infants included, hyperglycemia and hypoglycemia were found in 14 (13.3%) and 26 (24.8%) infants, respectively, with most incidents occurring in the first week (hyperglycemia: 85.7%; hypoglycemia: 88.5%). Sepsis was an independent risk factor for hyperglycemia (odds ratio [OR]: 8.743, 95% confidence interval [CI]: 2.392-31.959; P = 0.001). Hypoglycemia independent risk factors included the postoperative period (OR: 4.425, 95% CI: 1.218-16.073; P = 0.024) and use of GIR 4-<5.5 mg/kg/min (OR: 2.950, 95% CI: 1.035-8.405; P = 0.043). Conclusion Hyperglycemia and hypoglycemia can occur in preterm infants receiving early-aggressive PN; most cases occur within the first week of life. Hypoglycemia correlated with low glucose intake, and hyperglycemia correlated with sepsis. Monitoring blood glucose levels in preterm infants receiving PN, especially in the first weeks of life, may decrease morbidity associated with hyperglycemia or hypoglycemia.
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Affiliation(s)
- Dina Angelika
- Department of Pediatrics, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, East Java, Indonesia
| | - Risa Etika
- Department of Pediatrics, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, East Java, Indonesia
| | - Martono Tri Utomo
- Department of Pediatrics, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, East Java, Indonesia
| | - Loysa Ladydi
- Department of Pediatrics, Bakti Timah Hospital, Pangkalpinang, Bangka Belitung, Indonesia
| | | | - Kartika Darma Handayani
- Department of Pediatrics, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, East Java, Indonesia
| | - I Dewa Gede Ugrasena
- Department of Pediatrics, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, East Java, Indonesia
| | - Pieter JJ. Sauer
- Department of Pediatrics, University of Groningen, Beatrix Children's Hospital/UMCG, Groningen, Netherlands
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16
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Wang N, Zhang J, Wang B, Yu Z, Zhang J, Qu L, Tang B. Relationship between nutrient intakes in the transition phase and postnatal growth of preterm infants: a systematic review. Ital J Pediatr 2023; 49:13. [PMID: 36670430 PMCID: PMC9862863 DOI: 10.1186/s13052-022-01406-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 12/29/2022] [Indexed: 01/22/2023] Open
Abstract
Nutrition practices for preterm infants include phases of parenteral nutrition, gradually interrupted parenteral nutrition (transition phase), and full enteral nutrition. However, nutrition management during the transition phase is frequently overlooked. This review examined the relationship between nutrient intake during the transition phase and preterm infant growth. PubMed, Embase, Web of Science, Cochrane, Chinese National Knowledge Infrastructure Database, Wanfang Database, and Chinese Science and Technique Journals Database were searched for studies examining the relationship between nutrient intake during the transition phase and postnatal growth of preterm infants from each database's earliest inception through February 28, 2022. The quality of the studies was assessed using the Newcastle-Ottawa scale. A total of three studies conducted in the USA, Italy and China met the inclusion criteria. The growth indicators were extrauterine growth restriction (weight < 10th percentile for post-menstrual age) or inadequate weight growth velocity (growth velocity < 15 g/kg/d) at discharge or the end of the transition phase. The transition phase was divided into two periods in two studies: the early period (parenteral energy intake > 50% of total energy intake) and the late period (enteral energy intake > 50% of the total energy intake). The cumulative protein intake in the transition phase was generally lower in preterm infants with extrauterine growth restriction or inadequate weight growth velocity, especially in the early transition phase. The deficiency of energy and protein intake during the transition phase cannot be explicitly determined due to differences in growth indicators and definitions of the transition phase. However, enteral protein intake should be closely monitored in the early transition phase to ensure a better growth rate for preterm infants. To elucidate potential associations, further well-designed research will be required.
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Affiliation(s)
- Na Wang
- Department of Pediatric, the Affiliated Suqian First People's Hospital of Nanjing Medical University, Jiangsu, China
| | - Jia Zhang
- Department of Pediatric, the Affiliated Suqian First People's Hospital of Nanjing Medical University, Jiangsu, China
| | - Bo Wang
- Department of Pediatric, the Affiliated Suqian First People's Hospital of Nanjing Medical University, Jiangsu, China
| | - Zhangbin Yu
- Department of Neonatology, The Second Clinical MedicalCollege, Shenzhen People's HospitalJinan UniversityThe First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China.
| | - Jun Zhang
- Department of Pediatric, the Affiliated Suqian First People's Hospital of Nanjing Medical University, Jiangsu, China
| | - Linlin Qu
- Department of Pediatric, the Affiliated Suqian First People's Hospital of Nanjing Medical University, Jiangsu, China
| | - Bin Tang
- Department of Pediatric, the Affiliated Suqian First People's Hospital of Nanjing Medical University, Jiangsu, China
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17
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Belyaeva IA, Bombardirova EP, Prihodko EA, Kruglyakov AY, Mikheeva AA, Larina AR. Clinical Phenotypes of Malnutrition in Young Children: Differential Nutritional Correction. CURRENT PEDIATRICS 2023. [DOI: 10.15690/vsp.v21i6.2495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This review article summarizes current data on malnutrition etiology and pathogenesis in infants. Topical requirements for revealing this condition, its diagnosis and severity assessment via centile metrics are presented. The characteristics of the most common clinical phenotypes of postnatal growth insufficiency in infants (premature infants with different degree of maturation, including patients with bronchopulmonary dysplasia) are described. Differential approaches for malnutrition nutritional correction in these children are presented. The final section of the article describes special nutritional needs for children with congenital heart defects in terms of hemodynamic disorders nature and severity. Modern nutritional strategies for preparation of these patients to surgery and for their postoperative period are presented. The use of high-calorie/high-protein product for malnutrition correction in the most vulnerable patients with described in this review phenotypes is worth noticing.
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Affiliation(s)
- I. A. Belyaeva
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery; Pirogov Russian National Research Medical University; Morozovskaya Children’s City Hospital
| | - E. P. Bombardirova
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery
| | | | | | - A. A. Mikheeva
- Research Institute for Healthcare Organization and Medical Management
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18
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Yazici A, Buyuktiryaki M, Sari FN, Akin MS, Ertekin O, Alyamac Dizdar E. Comparison of different growth curves in the assessment of extrauterine growth restriction in very low birth weight preterm infants. Arch Pediatr 2023; 30:31-35. [PMID: 36462987 DOI: 10.1016/j.arcped.2022.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/25/2022] [Accepted: 11/11/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Preterm infants are at risk of extrauterine growth restriction (EUGR) and associated complications in the long term. Growth curves are important in assessing postnatal growth in these infants. The aim of this study was to determine the prevalence of EUGR in preterm infants and the factors associated with EUGR using two different growth curves. METHODS We retrospectively evaluated 596 preterm infants with birth weight ≤1500 g. Small for gestational age (SGA) was defined as birth weight <10th percentile for gestational age. EUGR was defined as discharge weight z score <-2. All z scores were determined using both the Fenton 2013 and Intergrowth-21st (IG-21) growth curves. RESULTS The infants' median gestational age was 28 weeks (27-29) and median birth weight was 1080 g (900-1243). The prevalence of SGA was 9.2% with IG-21 curves and 5% with Fenton curves (p < 0.001). The median discharge weight was 2060 g (1860-2363). The prevalence of EUGR was significantly higher with the Fenton curves than with the IG-21 curves (38% vs. 31.7%, p < 0.001). The mean discharge weight z score was -1.82±1.29 with Fenton and -1.44±1.49 with IG-21 curves. In multivariate analysis, significant risk factors for EUGR according to the Fenton curves were SGA (odds ratio [OR]: 19.15, 95% confidence interval [CI]: 4.4-82.59), respiratory distress syndrome (RDS) (OR 1.64, 95% CI 1.12-2.4), late neonatal sepsis (LNS) (OR: 2.27, 95% CI: 1.5-3.44), and >16 days to full enteral feeding (OR: 1.8, 95% CI: 1.22-2.68). Similarly, independent risk factors for EUGR according to the IG-21 curve were SGA (OR: 16.3, 95% CI: 7.23-36.9), RDS (OR: 1.81, 95% CI: 1.16-2.83), LNS (OR: 2.29, 95% CI: 1.43-3.68), and >16 days to full enteral feeding (OR: 2.11, 95% CI: 1.38-3.23). CONCLUSION The growth curves used for diagnosis may lead to differences in EUGR rates in intensive care units and the factors identified as associated with EUGR. At-risk infants should be evaluated for EUGR and their weight and nutritional support should be monitored carefully. Comparisons of long-term outcomes are needed to assess the suitability of growth curves used for EUGR follow-up.
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Affiliation(s)
- Aybuke Yazici
- University of Health Sciences, Ankara City Hospital.
| | | | | | | | - Omer Ertekin
- University of Health Sciences, Ankara City Hospital
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19
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González-García L, Mantecón-Fernández L, Suárez-Rodríguez M, Arias-Llorente R, Lareu-Vidal S, Ibáñez-Fernández A, Caunedo-Jiménez M, González-López C, Fernández-Morán E, Fernández-Colomer B, Solís-Sánchez G. Postnatal Growth Faltering: Growth and Height Improvement at Two Years in Children with Very Low Birth Weight between 2002-2017. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121800. [PMID: 36553245 PMCID: PMC9777192 DOI: 10.3390/children9121800] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/08/2022] [Accepted: 11/22/2022] [Indexed: 11/25/2022]
Abstract
The prevalence of postnatal growth faltering (PGF) in preterm infants with very low birth weight (VLBW) (<1500 g) is a universal problem. Growth improvement is expected as neonatal care is optimized. Objectives: To determine if there has been a decrease in the prevalence of PGF and an improvement in height at 2 years in appropriate for gestational age VLBW children in the last two decades. Methods: Clinical descriptive retrospective analysis of neonatal somatometry at birth and at two-year corrected age in VLBW preterm infants. Small for gestational age were excluded. Two cohorts (2002−2006, n = 112; and 2013−2017, n = 92) were compared. Results. In the second five-year period, a decrease in prevalence of PGF was observed (36.6% vs. 22.8%, p = 0.033), an increase in growth rate in the first 28 days (5.22 (4.35−6.09) g/kg/day vs. 11.38 (10.61−12.15) g/kg/day, p < 0.0001) and an increase in height standard deviation (SD) at 2 years (−1.12 (−1.35−−0.91) vs. −0.74 (−0.99−−0.49) p = 0.023). Probability of short stature at 2 years was directly related to daily weight gain in the first 28 days. Conclusions: when comparing two five-year periods in the last two decades, growth in VLBW preterm infants has improved, both during neonatal period and at two years of age.
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Affiliation(s)
| | - Laura Mantecón-Fernández
- Pediatrics Department, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
- Instituto Investigación Sanitaria Principado de Asturias, ISPA, 33011 Oviedo, Spain
| | - Marta Suárez-Rodríguez
- Pediatrics Department, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
- Instituto Investigación Sanitaria Principado de Asturias, ISPA, 33011 Oviedo, Spain
| | - Rosa Arias-Llorente
- Pediatrics Department, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Sonia Lareu-Vidal
- Pediatrics Department, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | | | - María Caunedo-Jiménez
- Pediatrics Department, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Clara González-López
- Pediatrics Department, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Eva Fernández-Morán
- Pediatrics Department, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Belén Fernández-Colomer
- Pediatrics Department, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
- Instituto Investigación Sanitaria Principado de Asturias, ISPA, 33011 Oviedo, Spain
| | - Gonzalo Solís-Sánchez
- Pediatrics Department, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
- Instituto Investigación Sanitaria Principado de Asturias, ISPA, 33011 Oviedo, Spain
- Medical Department, University of Oviedo, 33003 Oviedo, Spain
- Correspondence:
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20
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Wang YS, Shen W, Wu F, Mao J, Liu L, Chang YM, Zhang R, Ye XZ, Qiu YP, Ma L, Cheng R, Wu H, Chen DM, Zheng Z, Lin XZ, Tong XM. Factors influencing extrauterine growth retardation in singleton-non-small for gestational age infants in China: A prospective multicenter study. Pediatr Neonatol 2022; 63:590-598. [PMID: 36241604 DOI: 10.1016/j.pedneo.2022.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/23/2022] [Accepted: 04/12/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The incidence of extrauterine growth retardation (EUGR) varies considerably in different countries due to the distinct definitions and inclusion criteria of individual studies. Most studies included small for gestational age (SGA) very preterm infants (VPIs), resulting in a higher incidence of EUGR. Experts have suggested the accurate definition of "EUGR" in SGA infants is not "true EUGR". The postnatal growth curve of multiple premature births also differs from that of singletons. As far as we know, there is no study about relationship between singleton-non-SGA preterm infants and EUGR. OBJECTIVES To analyze the factors influencing EUGR among VPIs who were singleton-non-SGA in China. METHODS A prospective-multicenter study was conducted in 28 hospitals distributed through China from September 2019 to December 2020. The clinical data on singleton-non-SGA among VPIs were divided into EUGR group (n = 692) and non-EUGR group (n = 912). RESULTS Compared to non-EUGR group, the mean gestational age (GA), mean birth weight (BW) and percentage of BW in Fenton curve in EUGR group were lower (P < 0.001 for all). The incidence of EUGR among distinct GA groups (classifications of GA < 28weeks, 28-28+6 weeks, 29-29+6 weeks, 30-30+6 weeks and 31-31+6 weeks) and distinct BW groups (classifications of BW<1000 g, 1000-1249 g, 1250-1499 g, 1500-1999g and 2000-2500 g) were statistically significant (P = 0.004 and P <.001). Logistic regression analysis indicated that later addition of human milk fortifier (HMF), later attainment of HMF sufficient fortification, later return to BW, more accumulative days of fasting, longer duration of parenteral nutrition, total duration of oxygen support and moderate/severe bronchopulmonary dysplasia (BPD) were risk factors for the development of EUGR in singleton-non-SGA VPIs (P < 0.001, P = 0.002, P < 0.001, P = 0.002, P = 0.017, P = 0.003 and P = 0.002, respectively). The use of full-course antenatal steroids, greater BW as a percentile of the Fenton curve, breastfeeding initiation and faster average velocity of weight growth effectively protected against EUGR (P = 0.008, P < 0.001, P < 0.001 and P < 0.001, respectively). CONCLUSIONS The overall incidence of EUGR was 43.1% among singleton-non-SGA VPIs in China. Raising the full-course antenatal steroids usage, reducing the incidence of moderate and severe BPD, attaching importance to the management of enteral nutrition in VPIs and increasing the weight growth velocity can reduce the incidence of EUGR.
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Affiliation(s)
- Ya-Sen Wang
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China; Xiamen Key Laboratory of Perinatal-Neonatal Infection, Xiamen, China
| | - Wei Shen
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China; Xiamen Key Laboratory of Perinatal-Neonatal Infection, Xiamen, China
| | - Fan Wu
- Department of Neonatology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jian Mao
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ling Liu
- Department of Neonatology, Guiyang Maternal and Child Health Hospital·Guiyang Children' s Hospital, Guiyang, China
| | - Yan-Mei Chang
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Rong Zhang
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Xiu-Zhen Ye
- Department of Neonatology, Guangdong Province Maternal and Children's Hospital, Guangzhou, China
| | - Yin-Ping Qiu
- Department of Neonatology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Li Ma
- Department of Neonatology, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Rui Cheng
- Department of Neonatology, Children' Hospital of Nanjing Medical University, Nanjing, China
| | - Hui Wu
- Department of Neonatology, The First Hospital of Jilin University, Changchun, China
| | - Dong-Mei Chen
- Department of Neonatology, Quanzhou Maternity and Children's Hospital, Quanzhou, China
| | - Zhi Zheng
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China; Xiamen Key Laboratory of Perinatal-Neonatal Infection, Xiamen, China
| | - Xin-Zhu Lin
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China; Xiamen Key Laboratory of Perinatal-Neonatal Infection, Xiamen, China.
| | - Xiao-Mei Tong
- Department of Pediatrics, Peking University Third Hospital, Beijing, China.
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21
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Lucaccioni L, Iughetti L, Berardi A, Predieri B. Challenges in the growth and development of newborns with extra-uterine growth restriction. Expert Rev Endocrinol Metab 2022; 17:415-423. [PMID: 35941822 DOI: 10.1080/17446651.2022.2110468] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 08/03/2022] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Extra-uterine growth restriction (EUGR) is a condition caused by the failure of very preterm infants to reach their potential growth during the NICU hospital stay. Despite enormous improvements in nutritional support and strategies, the growth pattern of preterm infants is still far from the one expected. AREAS COVERED This review focuses on what EUGR is, highlighting controversial aspects of this topic. EUGR is still missing a univocal definition, and the international debate is also open on what is the best growth chart to use. Moreover, professionals in NICU may not be trained on how to perform anthropometric measurements, increasing the risk of over- or underestimation, especially for length assessment. EUGR has recently been described as one of the main comorbidities in NICU, influencing growth, metabolism, and neurodevelopment later in life. EXPERT OPINION There is still much to investigate about what the best growth pattern in the NICU should be. What is known so far is that the majority of preterm neonates develop EUGR, and this leads to several short- and long-term consequences. It is imperative that neonatologists and pediatric endocrinologists work together, to modulate growth in the NICU.
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Affiliation(s)
- Laura Lucaccioni
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Lorenzo Iughetti
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Alberto Berardi
- Neonatology Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Barbara Predieri
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
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22
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Jeon GW, Lee JH, Oh M, Chang YS. Serial Long-Term Growth and Neurodevelopment of Very-Low-Birth-Weight Infants: 2022 Update on the Korean Neonatal Network. J Korean Med Sci 2022; 37:e263. [PMID: 36038959 PMCID: PMC9424698 DOI: 10.3346/jkms.2022.37.e263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 07/27/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND We aimed to evaluate the long-term growth and neurodevelopmental outcomes of very-low-birth-weight infants (VLBWIs, birth weight < 1,500 g) born between 2013, the establishment of the Korean Neonatal Network (KNN), and 2018, both at 18-24 months of corrected age and three years of age, using a nationwide large cohort, and to evaluate whether these outcomes have improved over time since 2013. METHODS This study used data from the annual reports of the KNN for 18-24 months of corrected age (follow-up 1) and three years of age (follow-up 2). Follow-up 1 data were collected from 10,065 eligible VLBWIs born between January 1, 2013, and December 31, 2018. Follow-up 2 data were collected from 8,156 eligible VLBWIs born between January 1, 2013, and December 31, 2017. RESULTS The overall follow-up rates of VLBWIs at follow-ups 1 and 2 were 74.6% (7,512/10,065) and 57.7% (4,702/8,156), respectively. The overall mortality rate between discharge from the neonatal intensive care unit and follow-up 1 was 1% (104/10,065). The overall mortality rate between follow-ups 1 and 2 was 0.049% (4/8,156). Growth restrictions decreased over time, especially weight growth restrictions, which significantly decreased according to era (17% in infants born in 2013-2014 and 13% in infants born in 2017-2018). Fewer infants were re-hospitalized and required rehabilitative support according to era at follow-up 1. More infants had language developmental delays and required language support according to era, both at follow-ups 1 and 2. The incidence of cerebral palsy has significantly decreased over time, from 6% in infants born in 2013-2014 to 4% in infants born in 2017-2018 at follow-up 1, and from 8% in infants born in 2013-2014 to 5% in infants born in 2017 at follow-up 2. CONCLUSION Long-term outcomes of VLBWIs regarding weight growth and cerebral palsy, the most common motor disability in childhood, have improved serially according to era since 2013. However, the rate of infants with language delays requiring language support has increased according to era. Further studies are required on the increased trends of language delay and language support while improving motor outcomes.
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Affiliation(s)
- Ga Won Jeon
- Department of Pediatrics, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Jang Hoon Lee
- Department of Pediatrics, Ajou University School of Medicin, Suwon, Korea
| | - Minkyung Oh
- Department of Pharmacology, Inje University College of Medicine, Busan, Korea
| | - Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Samsung Medical Center, Seoul, Korea.
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23
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Preterm birth and subsequent timing of pubertal growth, menarche, and voice break. Pediatr Res 2022; 92:199-205. [PMID: 34429512 PMCID: PMC9411060 DOI: 10.1038/s41390-021-01690-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/10/2021] [Accepted: 07/19/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND We evaluated pubertal growth and pubertal timing of participants born preterm compared to those born at term. METHODS In the ESTER Preterm Birth Study, we collected growth data and measured final height of men/women born very or moderately preterm (<34 gestational weeks, n = 52/55), late preterm (34-<37 weeks, 94/106), and term (≥37 weeks, 131/151), resulting in median 9 measurements at ≥6 years. Timing of menarche or voice break was self-reported. Peak height velocity (PHV, cm/year) and age at PHV (years) were compared with SuperImposition by Translation And Rotation (SITAR) model (sexes separately). RESULTS Age at PHV (years) and PHV (cm/year) were similar in all gestational age groups. Compared to term controls, insignificant differences in age at PHV were 0.1 (95% CI: -0.2 to 0.4) years/0.2 (-0.1 to 0.4) for very or moderately/late preterm born men and -0.0 (-0.3 to 0.3)/-0.0 (-0.3 to 0.2) for women, respectively. Being born small for gestational age was not associated with pubertal growth. Age at menarche or voice break was similar in all the gestational age groups. CONCLUSIONS Timing of pubertal growth and age at menarche or voice break were similar in participants born preterm and at term. IMPACT Pubertal growth and pubertal timing were similar in preterm and term participants in a relatively large cohort with a wide range of gestational ages. Previous literature indicates that small for gestational age is a risk for early puberty in term born children. This was not shown in preterm children. While our study had limited power for children born very preterm, all children born preterm were not at increased risk for early puberty.
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Wang L, Lin XZ, Shen W, Wu F, Mao J, Liu L, Chang YM, Zhang R, Ye XZ, Qiu YP, Ma L, Cheng R, Wu H, Chen DM, Chen L, Xu P, Mei H, Wang SN, Xu FL, Ju R, Zheng Z, Tong XM. Risk factors of extrauterine growth restriction in very preterm infants with bronchopulmonary dysplasia: a multi-center study in China. BMC Pediatr 2022; 22:363. [PMID: 35751057 PMCID: PMC9229749 DOI: 10.1186/s12887-022-03405-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/07/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Nutritional deficiency soon after birth is a risk factor of chronic lung disease (bronchopulmonary dysplasia, BPD). Afflicted infants are further prone to inadequate growth during hospitalization (extrauterine growth restriction, EUGR). This multi-center retrospective study investigated risk factors of EUGR, specifically in very preterm infants with BPD. METHOD Data of infants with BPD who were born less than 32 weeks gestation (n = 1010) were collected from 7 regions of China. All infants were non-small for gestational age at birth. Infants were characterized as EUGR or non-EUGR at 36 weeks gestation or discharge, or stratified by gestational age or birthweight. Logistic regression analysis was applied. RESULTS In 65.5% of the population, the BPD was mild. Infants with severe BPD (8.3%) had the highest rate of EUGR (72.6%, P < 0.001). Groups stratified by gestational age did not differ in rates of EUGR, but the birthweight of the EUGR group was significantly lower than that of the non-EUGR (P < 0.001). Birthweights of < 1000, 1000-1499, and ≥ 1500 g showed EUGR rates of 65.9%, 43.4%, and 23.8%, respectively (P < 0.001). Overall, the independent risk factors of EUGR were: moderate-to-severe BPD, gestational hypertension, cesarean section, cumulative fasting time, time required to achieve 110 kcal/kg/d, and hemodynamically significant patent ductus arteriosus (hsPDA). CONCLUSION In very preterm infants with BPD, the lower the birthweight or the more severe the BPD, the greater the risk of EUGR. In those with hsPDA, or moderate-to-severe BPD, it is especially important to prevent EUGR through perinatal management, enteral nutrition, and nutritional strategies.
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Affiliation(s)
- Lian Wang
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Perinatal-Neonatal Infection, Xiamen, China
| | - Xin-Zhu Lin
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Perinatal-Neonatal Infection, Xiamen, China
| | - Wei Shen
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Perinatal-Neonatal Infection, Xiamen, China
| | - Fan Wu
- Department of Neonatology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jian Mao
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ling Liu
- Department of Neonatology, Guiyang Maternal and Child Health Hospital·Guiyang Children's Hospital, Guiyang, China
| | - Yan-Mei Chang
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Rong Zhang
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Xiu-Zhen Ye
- Department of Neonatology, Guangdong Province Maternal and Children's Hospital, Guangzhou, China
| | - Yin-Ping Qiu
- Department of Neonatology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Li Ma
- Department of Neonatology, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Rui Cheng
- Department of Neonatology, Children' Hospital of Nanjing Medical University, Nanjing, China
| | - Hui Wu
- Department of Neonatology, The First Hospital of Jilin University, Changchun, China
| | - Dong-Mei Chen
- Department of Neonatology, Quanzhou Maternity and Children's Hospital, Quanzhou, China
| | - Ling Chen
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ping Xu
- Department of Neonatology, Liaocheng People's Hospital, Liaocheng, China
| | - Hua Mei
- Department of Neonatology, the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, China
| | - San-Nan Wang
- Department of Neonatology, Suzhou Municipal Hospital, Suzhou, China
| | - Fa-Lin Xu
- Department of Neonatology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Rong Ju
- Department of Neonatology, Chengdu Women' and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Zhi Zheng
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Perinatal-Neonatal Infection, Xiamen, China
| | - Xiao-Mei Tong
- Department of Pediatrics, Peking University Third Hospital, Beijing, China.
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Lund AM, Domellöf M, Pivodic A, Hellström A, Stoltz Sjöström E, Hansen-Pupp I. Mother's Own Milk and Its Relationship to Growth and Morbidity in a Population-based Cohort of Extremely Preterm Infants. J Pediatr Gastroenterol Nutr 2022; 74:292-300. [PMID: 34759238 PMCID: PMC8788942 DOI: 10.1097/mpg.0000000000003352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 10/27/2021] [Indexed: 12/10/2022]
Abstract
OBJECTIVES The aim of the study was to evaluate the relationships between intake of mother's own milk (MOM), compared with intake of pasteurized donor milk (DM), and postnatal growth, incidence of retinopathy of prematurity (ROP) and bronchopulmonary dysplasia (BPD), in extremely preterm infants. METHODS Swedish population-based cohort of surviving extremely preterm infants born 2004 to 2007. Exposure to MOM and DM was investigated from birth until 32 weeks postmenstrual age (PMA) in 453 infants. Primary outcome variables were change in z-score (Δ) from birth to 32 weeks PMA for weight, length, and head circumference (HC). Secondary outcomes were incidence of ROP and BPD. Mixed models adjusting for confounders were used to investigate the association between exposures and outcomes. RESULTS Infants' mean gestational age (GA) was 25.4 weeks. Unadjusted, MOM (per 10 mL · kg-1 · day-1) was associated with Δweight and ΔHC with beta estimates of 0.03 z-score units (95% CI, 0.02-0.04, P < 0.001) and 0.03 z-score units (95% CI, 0.01-0.05, P = 0.003), respectively. After adjustment for predefined confounders, the association remained significant for Δweight and ΔHC. A similar pattern was found between Δweight and each 10% increase of MOM. Unadjusted, a higher intake of MOM (mL · kg-1 · day-1) was significantly associated to a lower probability of any ROP and severe ROP; however, these associations did not remain in the adjusted analyses. No associations were found between MOM (mL · kg-1 · day-1) and BPD. Moreover, no associations were found between DM and growth or morbidity outcomes. CONCLUSIONS An increased intake of MOM, as opposed to DM (and not formula feeding), was associated with improved postnatal weight gain and HC growth from birth until 32 weeks PMA in extremely preterm infants. Interventions aiming at increasing early intake of unpasteurized MOM for extremely preterm infants should be encouraged.
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Affiliation(s)
- Anna-My Lund
- Division of Paediatrics, Department of Clinical Sciences, Lund, Lund University and Skåne University Hospital
| | - Magnus Domellöf
- Division of Paediatrics, Department of Clinical Sciences, Umeå University
| | - Aldina Pivodic
- Section for Ophthalmology, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg
| | - Ann Hellström
- Section for Ophthalmology, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg
| | | | - Ingrid Hansen-Pupp
- Division of Paediatrics, Department of Clinical Sciences, Lund, Lund University and Skåne University Hospital
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26
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Shen W, Wu F, Mao J, Liu L, Chang YM, Zhang R, Zheng Z, Ye XZ, Qiu YP, Ma L, Cheng R, Wu H, Chen DM, Chen L, Xu P, Mei H, Wang SN, Xu FL, Ju R, Chen C, Tong XM, Lin XZ. Analysis of "true extrauterine growth retardation" and related factors in very preterm infants-A multicenter prospective study in China. Front Pediatr 2022; 10:876310. [PMID: 36210927 PMCID: PMC9534122 DOI: 10.3389/fped.2022.876310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To investigate the incidence and related factors of extrauterine growth retardation (EUGR) and "true EUGR" in very preterm infants (VPI) from different regions of China. MATERIALS AND METHODS Clinical data of VPI were prospectively collected from 28 hospitals in seven different regions of China from September 2019 to December 2020. The infants were divided into a small for gestational age (SGA) group or non-SGA group at birth, with non-SGA infants at 36 weeks of gestation or at discharge being further divided into a EUGR group or a non-EUGR group. Infants in the EUGR and non-SGA group were defined as "true EUGR." The general information of VPI, such as maternal complications during pregnancy, use of enteral nutrition and parenteral nutrition, and complications during hospitalization were compared between the groups. RESULTS Among the 2,514 VPI included in this study, 47.3, 41.5, and 33.3% of VPI were below the 10th percentile, and 22.6, 22.4, and 16.0% of VPI were below the 3rd percentile for weight, height, and head circumference at 36 weeks of gestation or at discharge, respectively, by the percentile on the 2013 Fenton curve. The incidences of EUGR and "true EUGR" evaluated by weight were 47.3 and 44.5%, respectively. Univariate analysis showed that there were statistically significant differences in the aspects of perinatal and nutritional characteristics, treatment, and complications between the groups. Multivariate analysis showed that in non-SGA infants, the cumulative caloric intake during the first week was a protective factor for "true EUGR," while days to reach total enteral nutrition, late initiation of human milk fortifier, and moderate to severe bronchopulmonary dysplasia were independent risk factors for "true EUGR." CONCLUSION More attention should be paid to the nutritional management of VPI to prevent "true EUGR." Cumulative caloric intake should be ensured and increased during the first week, total enteral nutrition should be achieved as early as possible, human milk fortifier should be added early, and moderate to severe bronchopulmonary dysplasia should be prevented. These strategies are very important for reducing the incidence of "true EUGR" in VPI.
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Affiliation(s)
- Wei Shen
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China.,Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Fan Wu
- Department of Neonatology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jian Mao
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ling Liu
- Department of Neonatology, Guiyang Maternal and Child Health Hospital (Guiyang Children's Hospital), Guiyang, Guizhou, China
| | - Yan-Mei Chang
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Rong Zhang
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Zhi Zheng
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Xiu-Zhen Ye
- Department of Neonatology, Guangdong Province Maternal and Children's Hospital, Guangzhou, Guangdong, China
| | - Yin-Ping Qiu
- Department of Neonatology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Li Ma
- Department of Neonatology, Children's Hospital of Hebei Province, Shijiazhuang, Hebei, China
| | - Rui Cheng
- Department of Neonatology, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Hui Wu
- Department of Neonatology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Dong-Mei Chen
- Department of Neonatology, Quanzhou Maternity and Children's Hospital, Quanzhou, Fujian, China
| | - Ling Chen
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ping Xu
- Department of Neonatology, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Hua Mei
- Department of Neonatology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - San-Nan Wang
- Department of Neonatology, Suzhou Municipal Hospital, Suzhou, Jiangsu, China
| | - Fa-Lin Xu
- Department of Neonatology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Rong Ju
- Department of Neonatology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Chao Chen
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Xiao-Mei Tong
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Xin-Zhu Lin
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China.,Xiamen Key Laboratory of Perinatal-Neonatal Infection, Xiamen, Fujian, China
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Lan S, Fu H, Zhang R, Zhong G, Pan L, Bei F, Hong L. Extrauterine growth restriction in preterm infants: Postnatal growth pattern and physical development outcomes at age 3-6 years. Front Pediatr 2022; 10:945422. [PMID: 35967552 PMCID: PMC9372328 DOI: 10.3389/fped.2022.945422] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/07/2022] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To investigate the postnatal growth trajectories of preterm infants and evaluate the association between extrauterine growth restriction (EUGR) at discharge and adverse physical growth outcomes at age 3-6 years. METHODS Premature infants admitted to Shanghai Children's Medical Center within 24 h after birth from 1 January 2016 to 31 December 2018 were enrolled. Neonatal complications, nutrition support, and anthropometric data were collected and analyzed to diagnose EUGR on different definitions at discharge. The weight and the height of each subject were collected by telephone investigation from 1 September 2021 to 31 November 2021 to access the incidences of overweight/obesity, short stature, and thinness at age 3-6 years. RESULTS A total of 527 preterm infants were included in the final sample. The overall mean weight and height Z-scores were -0.37 ± 0.97 SD and -0.29 ± 1.18 SD at birth, and increased to -0.03 ± 1.11 SD and 0.13 ± 1.2 SD at follow-up, respectively. The logistic regression analysis indicated longitudinal EUGR on head circumference as the risk factor of overweight or obesity, cross-sectional EUGR on height as the risk factor of short stature, and delayed EN as the risk factor of thinness. CONCLUSION The growth trajectories of the preterm newborns tended toward the normal direction. Longitudinal EUGR on the head circumference and cross-sectional EUGR on height at discharge were associated with adverse physical growth outcomes at age 3-6 years.
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Affiliation(s)
- Siyuan Lan
- Department of Clinical Nutrition, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Huanhuan Fu
- Department of Clinical Nutrition, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Rui Zhang
- Department of Pediatrics, Fujian Provincial Maternity and Children's Hospital, Fujian Medical University, Fujian, China
| | - Guimei Zhong
- Department of Neonatal Intensive Care Unit, Quanzhou First Hospital, Fujian, China
| | - Liya Pan
- Department of Clinical Nutrition, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Fei Bei
- Department of Neonatology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Li Hong
- Department of Clinical Nutrition, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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An Interdisciplinary Approach to Reducing NEC While Optimizing Growth: A 20-Year Journey. Adv Neonatal Care 2021; 21:433-442. [PMID: 34510070 DOI: 10.1097/anc.0000000000000929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Necrotizing enterocolitis (NEC) and postnatal growth restriction are significant clinical dilemmas that contribute to short- and long-term morbidities for the most premature infants. PURPOSE After a rise in NEC rates in a regional neonatal intensive care unit (NICU), improvement practices were implemented by an interdisciplinary quality improvement (QI) work group whose focus was initially on nutrition and growth. QI work was refocused to address both NEC and growth concurrently. METHODS Through various QI initiatives and with evolving understanding of NEC and nutrition, the work group identified and implemented multiple practices changes over 2-decade time span. A standardized tool was used to review each case of NEC and outcomes were continually tracked to guide QI initiatives. LOCAL FINDINGS Focused QI work contributed to a significant reduction in NEC rates from 16.2% in 2007 to 0% in 2018 for inborn infants. Exclusive human milk diet was a critical part of the success. Postnatal growth outcomes initially declined after initial NEC improvement work. Improvement work that focused jointly on NEC and nutrition resulted in improved growth outcomes without impacting NEC. IMPLICATIONS FOR PRACTICE Use of historical perspective along with evolving scientific understanding can guide local improvement initiatives. Work must continue to optimize lactation during NICU hospitalization. More research is needed to determine impact of care practices on gastrointestinal inflammation including medication osmolality, probiotics, and noninvasive respiratory support.
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29
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Energy Expenditure, Protein Oxidation and Body Composition in a Cohort of Very Low Birth Weight Infants. Nutrients 2021; 13:nu13113962. [PMID: 34836218 PMCID: PMC8620881 DOI: 10.3390/nu13113962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/19/2021] [Accepted: 11/03/2021] [Indexed: 11/24/2022] Open
Abstract
The nutritional management of preterm infants is a critical point of care, especially because of the increased risk of developing extrauterine growth restriction (EUGR), which is associated with worsened health outcomes. Energy requirements in preterm infants are simply estimated, so the measurement of resting energy expenditure (REE) should be a key point in the nutritional evaluation of preterm infants. Although predictive formulae are available, it is well known that they are imprecise. The aim of our study was the evaluation of REE and protein oxidation (Ox) in very low birth weight infants (VLBWI) and the association with the mode of feeding and with body composition at term corrected age. Methods: Indirect calorimetry and body composition were performed at term corrected age in stable very low birth weight infants. Urinary nitrogen was measured in spot urine samples to calculate Ox. Infants were categorized as prevalent human milk (HMF) or prevalent formula diet (PFF). Results: Fifty VLBWI (HMF: 23, PFF: 27) were evaluated at 36.48 ± 0.85 post-conceptional weeks. No significant differences were found in basic characteristics or nutritional intake in the groups at birth and at the assessment. No differences were found in the REE of HMF vs. PFF (59.69 ± 9.8 kcal/kg/day vs. 59.27 ± 13.15 kcal/kg/day, respectively). We found statistical differences in the protein-Ox of HMF vs. PFF (1.7 ± 0.92 g/kg/day vs. 2.8 ± 1.65 g/kg/day, respectively, p < 0.01), and HMF infants had a higher fat-free mass (kg) than PFF infants (2.05 ± 0.26 kg vs. 1.82 ± 0.35 kg, respectively, p < 0.01), measured with air displacement plethysmography. Conclusion: REE is similar in infants with a prevalent human milk diet and in infants fed with formula. The HMF infants showed a lower oxidation rate of proteins for energy purposes and a better quality of growth. A greater amount of protein in HMF is probably used for anabolism and fat-free mass deposition. Further studies are needed to confirm our hypothesis.
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Neuropsychological Development and New Criteria for Extrauterine Growth Restriction in Very Low-Birth-Weight Children. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8110955. [PMID: 34828668 PMCID: PMC8619507 DOI: 10.3390/children8110955] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/01/2021] [Accepted: 10/22/2021] [Indexed: 01/23/2023]
Abstract
Background: Controversy between short-term neonatal growth of very low birth-weight preterm (VLBW) and neurodevelopment may be affected by criteria changes of extrauterine growth restriction (EUGR). Objective: to determine if new EUGR criteria imply modifications in the relationship between old criteria and results of neuropsychological tests in preterm children. Patients and methods: 87 VLBW at 5–7 years of age were studied. Neuropsychological assessment included RIST test (Reynolds Intellectual Sctreening Test) and NEPSY-II (NE neuro, PSY psycolgy assessment) tests. The relationships between these tests and the different growth parameters were analyzed. Results: RIST index was correlated with z-score Fenton’s weight (p = 0.004) and length (p = 0.003) and with z-score IGW-21’s (INTERGRWTH-21 Project) weight (p = 0.004) and length (p = 0.003) at neonatal discharge, but not with z-score difference between birth and neonatal discharge in weight, length, and HC for both. We did not find a statistically significant correlation between Fenton or IGW-21 z-scores and scalar data of NEPSY-II subtasks. Conclusion: In our series, neonatal growth influence on neuropsychological tests at the beginning of primary school does not seem robust, except for RIST test. New EUGR criteria do not improve the predictive ability of the old ones.
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Patel DV, Upadhyay V, Phatak AG, Thakker B, Nimbalkar SM. Comparison of Fenton Versus Intergrowth-21 Growth Charts for Preterm Neonates. JOURNAL OF NEONATOLOGY 2021; 35:131-137. [DOI: 10.1177/09732179211041960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
Background: Fenton charts from developed world are commonly used for growth assessment of preterm newborns. Recently prescribed Intergrowth-21 (IG-21) charts look more promising as they include mixed population from economically diverse nations. Objective: We compared IG-21 with Fenton charts for birth size classification and extrauterine growth in preterm infants. Study design: A prospective collection of growth parameters. Participants: Preterm newborns (<37 weeks). Intervention: Weight (W), length (L), and head circumference (HC) were collected at weekly interval during the stay as well as follow-up. Outcomes: Growth of preterm newborns at birth and last follow-up was assessed using Fenton and IG-21 charts. Agreement between Fenton and IG-21 for percentiles and z-scores of growth parameters was assessed using Bland-Altman plot. Results: A total of 301 preterm newborns were enrolled in the study. Mean (standard deviation [SD]) gestational age at birth was 34.08 (1.84) weeks, while at last follow-up (N = 296) it was 37.62 (1.85) weeks. The mean (SD) of birth W, L, and HC were 1889.24 (418.9) g, 44.69 (3.03) cm, and 30.6 (1.84) cm, respectively, while for last follow-up, they were 2114.76 (397.7) g, 47.64 (2.97) cm, and 32.65 (1.7) cm, respectively. The agreement of z-score/percentile between the 2 growth charts was not good for all the anthropometric parameters. Overall, Fenton reported more intrauterine (42.9% vs 36.9%) and extrauterine (92.9% vs 73%) growth restriction as compared to IG-21. Conclusion: The agreement between the 2 charts was poor. More proportions of the preterm population were growth restricted using Fenton charts.
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Affiliation(s)
- Dipen Vasudev Patel
- Department of Neonatology, Shree Krishna Hospital, Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India
| | - Vaishali Upadhyay
- Department of Pediatrics, Shree Krishna Hospital, Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India
| | - Ajay G. Phatak
- Central Research Services, Shree Krishna Hospital, Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India
| | - Biraj Thakker
- Department of Neonatology, Akanksha Hospital and Research Institute, Anand, Gujarat, India
| | - Somashekhar M. Nimbalkar
- Department of Neonatology, Shree Krishna Hospital, Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India
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32
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Wang N, Zhang J, Yu Z, Tang B, Zhang L, Yin Y, Wang Z, Li S, Jiang S, Hou W, Gao Y, Wang H, Chen X, Deng X, Lu Y, Zhu L, Bo L, Han S. Evaluation of nutrition status of very preterm infants in neonatal intensive care units using different growth indicators. Nutr Clin Pract 2021; 36:1312-1319. [PMID: 34339517 DOI: 10.1002/ncp.10741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 06/06/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Nutrition status of very preterm infants in the neonatal intensive care unit (NICU) is strongly associated with postnatal growth. This study aimed to develop indicators of nutrition status using growth data of very preterm infants during hospitalization. METHODS The data of 596 newborns from eight NICUs were retrospectively analyzed. Inclusion criteria were birth at <32 weeks' gestation, NICU admission ≤24 h after delivery, and length of hospital stay ≥28 days. Three indicators were evaluated: (indicator I) prevalence of extrauterine growth restriction (EUGR); (indicator II) z-score for change in weight from birth to discharge, adjusted for birth weight z-score and gestational age; and (indicator III) change in weight z-score from birth to discharge, adjusted for birth weight z-score, gestational age, and time to regain birth weight. Using data from NICU 1 as the reference for the latter two indicators, we established linear regression models of the adjusted change in weight z-score from birth to discharge. The difference between the observed value and the baseline value (calculated by the two models) served as the nutrition indices. RESULTS The prevalence of EUGR differed significantly between the eight NICUs (P = .009). Statistically significant differences were found between the mean indices calculated by the other two models (all P < .05). CONCLUSIONS Indicator III, change in weight z-score from birth to discharge (adjusted for birth weight z-score, gestational age, and time to regain birth weight), appears to be the most accurate for evaluating the quality of nutrition in the NICU.
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Affiliation(s)
- Na Wang
- The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, Jiangsu, China
| | - Jia Zhang
- The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, Jiangsu, China
| | - Zhangbin Yu
- Nanjing Maternity and Child Health Care Hospital, Women's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Bin Tang
- The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, Jiangsu, China
| | - Lin Zhang
- Changzhou Maternity and Child Health Care Hospital, Changzhou, Jiangsu, China
| | - Yujie Yin
- Jiangsu Province Hospital, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zengqin Wang
- Xuzhou Maternity and Child Health Care Hospital, Xuzhou, Jiangsu, China
| | - Shuangshuang Li
- Nantong Maternity and Child Health Care Hospital, Nantong, Jiangsu, China
| | - Shanyu Jiang
- Wuxi Maternity and Child Health Care Hospital, Wuxi, Jiangsu, China
| | - Weiwei Hou
- Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
| | - Yan Gao
- Lianyungang Maternity and Child Health Care Hospital, Lianyungang, Jiangsu, China
| | - Huaiyan Wang
- Changzhou Maternity and Child Health Care Hospital, Changzhou, Jiangsu, China
| | - Xiaoqing Chen
- Jiangsu Province Hospital, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaoyi Deng
- Xuzhou Maternity and Child Health Care Hospital, Xuzhou, Jiangsu, China
| | - Yi Lu
- Nantong Maternity and Child Health Care Hospital, Nantong, Jiangsu, China
| | - Lingling Zhu
- Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
| | - Lin Bo
- Lianyungang Maternity and Child Health Care Hospital, Lianyungang, Jiangsu, China
| | - Shuping Han
- Nanjing Maternity and Child Health Care Hospital, Women's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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33
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Malnutrition, poor post-natal growth, intestinal dysbiosis and the developing lung. J Perinatol 2021; 41:1797-1810. [PMID: 33057133 DOI: 10.1038/s41372-020-00858-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/07/2020] [Accepted: 09/26/2020] [Indexed: 01/31/2023]
Abstract
In extremely preterm infants, poor post-natal growth, intestinal dysbiosis and bronchopulmonary dysplasia are common, and each is associated with long-term complications. The central hypothesis that this review will address is that these three common conditions are interrelated. Challenges to studying this hypothesis include the understanding that malnutrition and poor post-natal growth are not synonymous and that there is not agreement on what constitutes a normal intestinal microbiota in this evolutionarily new population. If this hypothesis is supported, further study of whether "correcting" intestinal dysbiosis in extremely preterm infants reduces postnatal growth restriction and/or bronchopulmonary dysplasia is indicated.
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Perrone M, Mallardi D, Tabasso C, Bracco B, Menis C, Piemontese P, Amato O, Liotto N, Roggero P, Mosca F. The indirect calorimetry in very low birth weight preterm infants: An easier and reliable procedure. Nutrition 2021; 86:111180. [PMID: 33676329 DOI: 10.1016/j.nut.2021.111180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Preterm infants are at increased risk of developing extrauterine growth restriction, which is associated with worse health outcomes. The energy needs are not well known, as the measurement of resting energy expenditure (REE) using indirect calorimetry has critical issues when applied to infants. One of the main issues is the time required to obtain reliable data owing to the difficulty in keeping infants quiet during the entire examination. Thus, the aim of this study was to define the minimum duration of calorimetry to obtain reliable data. METHODS The volume of oxygen consumption (VO2) and the volume of carbon dioxide production (VCO2) were recorded for a mean duration of 90 consecutive minutes. REE was calculated using a neonatal prototype calculator. We extracted data regarding VO2, VCO2, and REE at 10(T1), 20(T2), 30(T3), 40(T4), and 50(T5) minutes of steady state and compared these data to those of entire steady state period. RESULTS Twenty-six very low birth weight preterm infants were evaluated at 36.58 ± 0.99 wk corrected age. Infants were appropriate for gestational age and clinically stable without comorbidities. There were no significant differences between mean VO2 and REE at T1 (8.26 ± 1.45 mL/kg to 57.80 ± 10.51 kcal/kg), T2 (8.15 ± 1.41 mL/kg to 56.87 ± 10.05 kcal/kg), T3 (8.04 ± 1.41 mL/kg to 56.32 ± 9.73 kcal/kg), T4 (8.05 ± 1.41 mL/kg to 56.07 ± 10.28 kcal/kg), and T5 (8.06 ± 1.55 mL/kg to 57.17 ± 11.62 kcal/kg), respectively, compared to steady state (8.13 ± 1.33 mL/kg to 56.77 ± 9.34 kcal/kg). The median values of VCO2 were significantly different only when T1 data were compared with other time slots (7.02 ± 1.02 mL/kg at steady state; 7.26 ± 1.23 mL/kg at T1; 7.13 ± 1.20 mL/kg at T2; 7.02 ± 1.19 mL/kg at T3; 6.85 ± 1.16 mL/kg at T4; 6.91 ± 1.24 mL/kg at T5). CONCLUSION Twenty consecutive minutes in steady state condition are sufficient to obtain reliable data on REE in stable, very low birth weight infants.
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Affiliation(s)
- Michela Perrone
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Domenica Mallardi
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Tabasso
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Beatrice Bracco
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Camilla Menis
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Pasqua Piemontese
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Orsola Amato
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nadia Liotto
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Roggero
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Bæk O, Cilieborg MS, Nguyen DN, Bering SB, Thymann T, Sangild PT. Sex-Specific Survival, Growth, Immunity and Organ Development in Preterm Pigs as Models for Immature Newborns. Front Pediatr 2021; 9:626101. [PMID: 33643975 PMCID: PMC7905020 DOI: 10.3389/fped.2021.626101] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/21/2021] [Indexed: 12/18/2022] Open
Abstract
Background: After very preterm birth, male infants show higher mortality than females, with higher incidence of lung immaturity, neurological deficits, infections, and growth failure. In modern pig production, piglets dying in the perinatal period (up to 20%) often show signs of immature organs, but sex-specific effects are not clear. Using preterm pigs as model for immature infants and piglets, we hypothesized that neonatal survival and initial growth and immune development depend on sex. Methods: Using data from a series of previous intervention trials with similar delivery and rearing procedures, we established three cohorts of preterm pigs (90% gestation), reared for 5, 9, or 19 days before sample collection (total n = 1,938 piglets from 109 litters). Partly overlapping endpoints among experiments allowed for multiple comparisons between males and females for data on mortality, body and organ growth, gut, immunity, and brain function. Results: Within the first 2 days, males showed higher mortality than females (18 vs. 8%, P < 0.001), but less severe immune response to gram-positive infection. No effect of sex was observed for thermoregulation or plasma cortisol. Later, infection resistance did not differ between sexes, but growth rate was reduced for body (up to -40%) and kidneys (-6%) in males, with higher leucocyte counts (+15%) and lower CD4 T cell fraction (-5%) on day 9 and lower monocyte counts (-18%, day 19, all P < 0.05). Gut structure, function and necrotizing enterocolitis (NEC) incidence were similar between groups, but intestinal weight (-3%) and brush-border enzyme activities were reduced at day 5 (lactase, DPP IV, -8%) in males. Remaining values for blood biochemistry, hematology, bone density, regional brain weights, and visual memory (tested in a T maze) were similar. Conclusion: Following preterm birth, male pigs show higher mortality and slower growth than females, despite limited differences in organ growth, gut, immune, and brain functions. Neonatal intensive care procedures may be particularly important for compromised newborns of the male sex. Preterm pigs can serve as good models to study the interactions of sex- and maturation-specific survival and physiological adaptation in mammals.
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Affiliation(s)
- Ole Bæk
- Comparative Pediatrics and Nutrition, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Malene Skovsted Cilieborg
- Comparative Pediatrics and Nutrition, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Duc Ninh Nguyen
- Comparative Pediatrics and Nutrition, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Stine Brandt Bering
- Comparative Pediatrics and Nutrition, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Thomas Thymann
- Comparative Pediatrics and Nutrition, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Per Torp Sangild
- Comparative Pediatrics and Nutrition, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark.,Department of Neonatology, Rigshospitalet, Copenhagen, Denmark.,Department of Pediatrics, Odense University Hospital, Odense, Denmark
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36
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González-García L, García-López E, Fernández-Colomer B, Mantecón-Fernández L, Lareu-Vidal S, Suárez-Rodríguez M, Arias-Llorente RP, Solís-Sánchez G. Extrauterine Growth Restriction in Very Low Birth Weight Infants: Concordance Between Fenton 2013 and INTERGROWTH-21 st Growth Charts. Front Pediatr 2021; 9:690788. [PMID: 34235126 PMCID: PMC8255477 DOI: 10.3389/fped.2021.690788] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 05/20/2021] [Indexed: 11/25/2022] Open
Abstract
Postnatal growth restriction has high prevalence in very low birth weight (VLBW) preterm neonates, and this could affect their long-term prognosis. Nowadays, there is no consensus on how to monitor growth in these neonates. Objective: This study aimed to compare prevalence of intra- and extrauterine growth restriction (IUGR and EUGR) in a sample of VLBW infants according to the Fenton 2013 charts and INTERGROWTH-21st (IW-21) standards and to analyze concordance between both in the different EUGR definitions criteria (cross-sectional, dynamic, and true). Patients and Methods: An observational retrospective study of 635 VLBW preterm was performed. The study was carried out in Central University Hospital of Asturias. Body measurements (weight, length, and head circumference) were collected at birth and at hospital discharge and expressed in z-scores for the two references (Fenton 2010 and IW-21). Kappa concordance was calculated. Results: Kappa concordance between Fenton and IW-21 was 0.887 for IUGR and 0.580 for static EUGR. Prevalence was higher according to Fenton in IUGR (36.5 vs. 35.1%), in static EUGR (73.8 vs. 59.3%), and in dynamic EUGR (44.3 vs. 29.3%). Despite observing low prevalence of EUGR when IW-21 was used to define EUGR, a statistical association between neonatal morbidity and diagnosis of EUGR was observed. Conclusion: The Fenton and IW-21 concordance for IUGR is good. IW-21 is more restrictive than Fenton in EUGR. Patients diagnosed by IW-21 as EUGR are more likely to have neonatal morbidity, especially if we use EUGR dynamic definition. In our study, we cannot conclude that one graph is better than the other.
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37
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Khasawneh W, Khassawneh M, Mazin M, Al-Theiabat M, Alquraan T. Clinical and Nutritional Determinants of Extrauterine Growth Restriction Among Very Low Birth Weight Infants. Int J Gen Med 2020; 13:1193-1200. [PMID: 33239903 PMCID: PMC7682780 DOI: 10.2147/ijgm.s284943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/28/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose To identify the clinical and nutritional factors associated with extrauterine growth restriction (EUGR) among very low birth weight infants (VLBW) in a tertiary hospital in Jordan. Patients and Methods We conducted a retrospective analysis of all VLBW infants admitted at King Abdullah University Hospital between July 2015 and June 2020. Clinical factors, nutritional intake, and growth parameters were collected and analyzed. A multilogistic regression model was applied to identify factors associated with EUGR. Results Of the 247 VLBW infants included in analysis, 112 (45%) were males, 30 (12%) were below 1000 g, and 72 (29%) were small for gestational age (SGA). EUGR was diagnosed in 198 (80%) at discharge. The rates of EUGR among SGA and non-SGA infants were 97% and 73%, respectively. The EUGR infants had a higher gestational age (30.7 vs 29.8 weeks, p=0.04), a lower birth weight (1209 vs 1300 g, p=0.005), a longer ventilatory support (5.7 vs 2.2 days, p=0.03), a higher incidence of sepsis (23% vs 10%, p=0.05), and a longer hospitalization (46 vs 38 days, p=0.03). With multilogistic regression model, the factors associated with EUGR include small-for-gestational age (AOR 9, 95% C.I. 2, 50), >3-day delay in feeding initiation (AOR 3.8, 95% C.I. 1.2,10), >14-day delay in achieving full feeds (AOR 3.3, 95% C.I. 1.2, 8), <3 g/kg of protein intake on the 8th day (AOR 2.1, 95% C.I. 1.1, 4.1), <100 kcal/kg of total caloric intake on the 15th day (AOR 3.8, 95% C.I. 1.6, 8.9), and occurrence of sepsis (AOR 3, 95% C.I. 1.1, 9). Conclusion The rate of EUGR in our unit is high. In addition to being SGA at birth, sepsis and suboptimal protein and caloric intake in the first two weeks of life were significantly associated with this complication. A more aggressive enteral and parenteral nutritional approach is needed to minimize postnatal growth delay.
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Affiliation(s)
- Wasim Khasawneh
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad Khassawneh
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mai Mazin
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Muath Al-Theiabat
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Tuka Alquraan
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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38
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Plasma Adipokines Profile in Prepubertal Children with a History of Prematurity or Extrauterine Growth Restriction. Nutrients 2020; 12:nu12041201. [PMID: 32344627 PMCID: PMC7231070 DOI: 10.3390/nu12041201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/15/2020] [Accepted: 04/22/2020] [Indexed: 12/27/2022] Open
Abstract
Adipose tissue programming could be developed in very preterm infants with extrauterine growth restriction (EUGR), with an adverse impact on long-term metabolic status, as was studied in intrauterine growth restriction patterns. The aim of this cohort study was to evaluate the difference in levels of plasma adipokines in children with a history of EUGR. A total of 211 school age prepubertal children were examined: 38 with a history of prematurity and EUGR (EUGR), 50 with a history of prematurity with adequate growth (PREM), and 123 healthy children born at term. Anthropometric parameters, blood pressure, metabolic markers and adipokines (adiponectin, resistin, leptin) were measured. Children with a history of EUGR showed lower values of adiponectin (μg/mL) compared with the other two groups: (EUGR: 10.6 vs. PREM: 17.7, p < 0.001; vs. CONTROL: 25.7, p = 0.004) and higher levels of resistin (ng/mL) (EUGR: 19.2 vs. PREM: 16.3, p =0.007; vs. CONTROL: 7.1, p < 0.001. The PREM group showed the highest values of leptin (ng/mL), compared with the others: PREM: 4.9 vs. EUGR: 2.1, p = 0.048; vs. CONTROL: 3.2, p = 0.029). In conclusion, EUGR in premature children could lead to a distinctive adipokines profile, likely associated with an early programming of the adipose tissue, and likely to increase the risk of adverse health outcomes later in life.
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Ordóñez-Díaz MD, Pérez-Navero JL, Flores-Rojas K, Olza-Meneses J, Muñoz-Villanueva MC, Aguilera-García CM, Gil-Campos M. Prematurity With Extrauterine Growth Restriction Increases the Risk of Higher Levels of Glucose, Low-Grade of Inflammation and Hypertension in Prepubertal Children. Front Pediatr 2020; 8:180. [PMID: 32373566 PMCID: PMC7186313 DOI: 10.3389/fped.2020.00180] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 03/30/2020] [Indexed: 12/31/2022] Open
Abstract
Introduction: An adipose tissue programming mechanism could be implicated in the extrauterine growth restriction (EUGR) of very preterm infants with morbidity in the cardiometabolic status later in life, as has been reported in intrauterine growth restriction. The aim of this study was to assess whether children with a history of prematurity and EUGR, but also with an adequate growth, showed alterations in the metabolic and inflammatory status. Methods: This was a case-control study. A total of 88 prepubertal children with prematurity antecedents were selected: 38 with EUGR and 50 with an adequate growth pattern (PREM group). They were compared with 123 healthy children born at term. Anthropometry, metabolic parameters, blood pressure (BP), C-reactive protein, hepatocyte growth factor (HGF), interleukin-6 (IL-6), IL-8, monocyte chemotactic protein type 1 (MCP-1), neural growth factor, tumour necrosis factor-alpha (TNF-α) and plasminogen activator inhibitor type-1 were analysed at the prepubertal age. Results: EUGR children exhibited higher BP levels and a higher prevalence of hypertension (46%) compared with both PREM (10%) and control (2.5%) groups. Moreover, there was a positive relationship between BP levels and values for glucose, insulin and HOMA-IR only in children with a EUGR history. The EUGR group showed higher concentrations of most of the cytokines analysed, markedly higher TNF-α, HGF and MCP-1 levels compared with the other two groups. Conclusion: EUGR status leads to cardiometabolic changes and a low-grade inflammatory status in children with a history of prematurity, and that could be related with cardiovascular risk later in life.
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Affiliation(s)
- Maria D Ordóñez-Díaz
- Department of Paediatrics, Maimónides Biomedical Research Institute, Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain
| | - Juan L Pérez-Navero
- Department of Paediatrics, Maimónides Biomedical Research Institute, Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain.,Centre for Biomedical Research on Rare Diseases (CIBERER-ISCIII), Madrid, Spain
| | - Katherine Flores-Rojas
- Unit of Metabolism and Paediatric Research, Maimónides Biomedical Research Institute, Reina Sofia University Hospital, University of Córdoba, Córdoba, Spain
| | - Josune Olza-Meneses
- Laboratory 123, Department of Biochemistry and Molecular Biology II, Centre of Biomedical Research, Institute of Nutrition and Food Technology, University of Granada, Granada, Spain
| | - Maria C Muñoz-Villanueva
- Unit of Methodological Support to Research, Maimónides Biomedical Research Institute, Córdoba, Spain
| | - Concepción M Aguilera-García
- Laboratory 123, Department of Biochemistry and Molecular Biology II, Centre of Biomedical Research, Institute of Nutrition and Food Technology, University of Granada, Granada, Spain
| | - Mercedes Gil-Campos
- Unit of Metabolism and Paediatric Research, Maimónides Biomedical Research Institute, Reina Sofia University Hospital, University of Córdoba, Córdoba, Spain
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