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Zhang R, Ying E, Wu X, Qin H, Guo Y, Guo X, Yu Z, Chen J. A systematic review and meta-analysis of breastfeeding and neurodevelopmental outcomes in preterm infant. Front Public Health 2024; 12:1401250. [PMID: 39639909 PMCID: PMC11617369 DOI: 10.3389/fpubh.2024.1401250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 11/08/2024] [Indexed: 12/07/2024] Open
Abstract
Background Prematurity significantly impacts neonatal health worldwide, necessitating effective interventions to improve outcomes for these vulnerable infants. While breastfeeding has emerged as a cornerstone of preterm care, its precise impact on neurodevelopment remains a subject of ongoing inquiry and debate. This systematic review aims to investigate the existing evidence in this area. Methods On December 17, 2023, online databases including PubMed, The Cochrane Library, Embase, Web of Science, CNKI, VIP, CBM, and Wan Fang Data were searched. Comparisons were classified into several categories: never breastfeeding (Never-BF) versus exclusive breastfeeding, Never-BF versus any breastfeeding (Any-BF), predominant preterm formula (Pre-PTF) versus predominant breastfeeding (Pre-BF), and Pre-PTF versus predominant donor breast milk (Pre-DBM) groups. Randomized controlled trials and observational studies were analyzed separately through meta-analyses. Each study's risk of bias was assessed, and the GRADE system was utilized to evaluate the certainty of the findings. Results Sixteen studies met the inclusion criteria, comprising one RCT and 15 cohort studies. The key findings indicated that infants in the Any-BF groups demonstrated superior long-term cognitive scores compared to those in the Never-BF groups, particularly evident in infants assessed before 18 months in the Pre-BF groups versus Pre-PTF groups. A reduced risk of neurodevelopmental impairment was also observed in preterm infants in the Any-BF groups. Evidence regarding the effect of breastfeeding on motor development was inconclusive, except for potential motor improvement in extremely low birth weight infants in the Any-BF groups. Neither exclusive breastfeeding nor pre-DBM exhibited clear superiority over Pre-PTF in terms of neurodevelopmental outcomes for preterm infants. Caution is warranted due to potential publication bias impacting the assessment of breastfeeding's impact on motor skills. Conclusion Our systematic review supports current recommendations for breastfeeding in preterm infants, emphasizing its positive effects on cognitive abilities and reduced risk of neurodevelopmental disorders. Further studies are needed to clarify if DHM provides neurodevelopmental benefits comparable to maternal milk, as current evidence does not sufficiently address this question. Additionally, future investigations should prioritize refining our understanding of the influence of breastfeeding on motor development in this vulnerable population. Systematic review registration PROSPERO, identifier CRD42023492274, Available at: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023492274.
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Affiliation(s)
- Ruolin Zhang
- Department of Neonatology, Nanshan Maternity & Child Healthcare Hospital, Shenzhen, Guangdong, China
| | - Erya Ying
- Department of Neonatology, Nanshan Maternity & Child Healthcare Hospital, Shenzhen, Guangdong, China
| | - Xiujuan Wu
- Department of Neonatology, Nanshan Maternity & Child Healthcare Hospital, Shenzhen, Guangdong, China
| | - Han Qin
- Department of Neonatology, Nanshan Maternity & Child Healthcare Hospital, Shenzhen, Guangdong, China
| | - Yanping Guo
- Department of Pediatrics, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Xin Guo
- Department of Neonatology, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City, Longgang Maternity and Child Institute of Shantou University Medical College, Shenzhen, China
| | - Zhangbin Yu
- Department of Neonatology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Jun Chen
- Department of Neonatology, Nanshan Maternity & Child Healthcare Hospital, Shenzhen, Guangdong, China
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2
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Xu Y, Ma Y, Rahman Q. Childhood Gender Nonconformity and Parental Maltreatment as Mediators of Sexual Orientation Disparities in Childhood Emotional and Behavioral Difficulties. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1777-1791. [PMID: 38418716 DOI: 10.1007/s10508-024-02825-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 03/02/2024]
Abstract
The mechanisms underlying sexual orientation differences in psychopathology originating in childhood remain understudied since sexual orientation does not directly manifest in childhood. This study tested whether childhood gender nonconformity and parental maltreatment before age 6 years 9 months partly explained sexual orientation disparities in the developmental trajectories of emotional and behavioral difficulties from age 6 years 9 months to 11 years 8 months. The Avon Longitudinal Study of Parents and Children was used (2182 boys and 2422 girls, Mage = 15.5, 90% White). After controlling for early life factors, non-heterosexual boys and girls displayed significantly greater emotional and behavioral difficulties than their heterosexual counterparts at all three ages. There was a sex difference in the mediating effects. For girls, sexual orientation disparities in childhood emotional and behavioral difficulties were partially explained by childhood gender nonconformity. For boys, sexual orientation disparities in childhood emotional and behavioral difficulties were partially explained by a path through greater childhood gender nonconformity, leading to increased risk of being the targets of parental maltreatment. Childhood gender nonconformity, parental maltreatment, and other early life factors only partially explain sexual orientation disparities in childhood emotional and behavioral difficulties. The mediating effects of childhood gender nonconformity and parental maltreatment on the association between sexual orientation and childhood emotional and behavioral difficulties differ between the sexes.
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Affiliation(s)
- Yin Xu
- Department of Sociology & Psychology, School of Public Administration, Sichuan University, Chengdu, 610065, Sichuan, China.
| | - Yidan Ma
- Department of Psychology, Institute of Education Science, Leshan Normal University, Leshan, China
- Key Laboratory of Personality and Cognition, Leshan Normal University, Leshan, China
| | - Qazi Rahman
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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3
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Xu Y, Rahman Q. Sexual orientation disparities in the developmental trajectories of emotional and behavioral difficulties from childhood to early adolescence. J Child Psychol Psychiatry 2022; 63:1505-1512. [PMID: 35253224 DOI: 10.1111/jcpp.13603] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/18/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Lesbian, gay, bisexual, and asexual adolescents are at increased risk of poor mental health outcomes but it remains unknown whether this disparity emerges from early childhood and through to adolescence. This study tested sexual orientation disparities in the developmental trajectories of emotional and behavioral difficulties from ages 5 to 14 years, and the influence of early life adversities upon them. METHODS The Millennium Cohort Study, a British birth cohort, was used (4,838 boys and 5,016 girls). Parent-report emotional and behavioral difficulties at ages 5, 7, 11, and 14 were measured using the Strength and Difficulties Questionnaire. Sexual orientation was measured via sexual attraction at age 17. Early life adversities in the first 5 years of life, including parental age at birth, birthweight, duration of breastfeeding, parent-child relationship quality, and parental absence, were collected prospectively. RESULTS Latent growth modeling suggested that, for both sexes, sexual orientation disparities in emotional and behavioral difficulties increased from age 5 to 14 years. Homosexual and bisexual girls displayed significantly greater emotional and behavioral difficulties than heterosexual girls at ages 7, 11, and 14. Homosexual and bisexual boys displayed significantly greater emotional and behavioral difficulties than heterosexual boys at ages 11 and 14. Asexual boys and girls displayed significantly greater emotional and behavioral difficulties than their heterosexual counterparts at all four ages. For both sexes, sexual orientation disparities in emotional and behavioral difficulties only reduced slightly in magnitude after controlling for early life adversities. CONCLUSIONS Sexual minority disparities in emotional and behavioral difficulties increased from childhood to early adolescence, possibly due to the accumulation of susceptibility to minority-related stressors. Sex and early life adversity may contribute to these developmental disparities.
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Affiliation(s)
- Yin Xu
- Department of Sociology and Psychology, School of Public Administration, Sichuan University, Chengdu, China
| | - Qazi Rahman
- Department of Psychology, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
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4
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Strobel NA, Adams C, McAullay DR, Edmond KM. Mother's Own Milk Compared With Formula Milk for Feeding Preterm or Low Birth Weight Infants: Systematic Review and Meta-analysis. Pediatrics 2022; 150:188643. [PMID: 35921674 DOI: 10.1542/peds.2022-057092d] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We assessed the effect of feeding preterm or low birth weight infants with infant formula compared with mother's own milk on mortality, morbidity, growth, neurodevelopment, and disability. METHODS We searched Medline (Ovid), Embase (Ovid), and Cochrane Central Register of Controlled Studies to October 1, 2021. RESULTS Forty-two studies enrolling 89 638 infants fulfilled the inclusion criteria. We did not find evidence of an effect on mortality (odds ratio [OR] 1.26, 95% confidence interval [CI] 0.91-1.76), infection (OR 1.52, 95% CI 0.98-2.37), cognitive neurodevelopment (standardized mean difference -1.30, 95% CI -3.53 to 0.93), or on growth parameters. Formula milk feeding increased the risk of necrotizing enterocolitis (OR 2.99, 95% CI 1.75-5.11). The Grading of Recommendations Assessment, Development, and Evaluation certainty of evidence was low for mortality and necrotizing enterocolitis, and very low for neurodevelopment and growth outcomes. CONCLUSIONS In preterm and low birth weight infants, low to very low-certainty evidence indicates that feeding with infant formula compared with mother's own milk has little effect on all-cause mortality, infection, growth, or neurodevelopment, and a higher risk of developing necrotizing enterocolitis.
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5
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Buck CO, Montgomery AM. Long-Term Impact of Early Nutritional Management. Clin Perinatol 2022; 49:461-474. [PMID: 35659097 DOI: 10.1016/j.clp.2022.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Catherine O Buck
- Department of Pediatrics, Yale School of Medicine, PO Box 208064, 333 Cedar Street, New Haven, CT 06520, USA.
| | - Angela M Montgomery
- Department of Pediatrics, Yale School of Medicine, PO Box 208064, 333 Cedar Street, New Haven, CT 06520, USA. https://twitter.com/amontgom09
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Morton SU, Leyshon BJ, Tamilia E, Vyas R, Sisitsky M, Ladha I, Lasekan JB, Kuchan MJ, Grant PE, Ou Y. A Role for Data Science in Precision Nutrition and Early Brain Development. Front Psychiatry 2022; 13:892259. [PMID: 35815018 PMCID: PMC9259898 DOI: 10.3389/fpsyt.2022.892259] [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: 03/08/2022] [Accepted: 05/17/2022] [Indexed: 11/13/2022] Open
Abstract
Multimodal brain magnetic resonance imaging (MRI) can provide biomarkers of early influences on neurodevelopment such as nutrition, environmental and genetic factors. As the exposure to early influences can be separated from neurodevelopmental outcomes by many months or years, MRI markers can serve as an important intermediate outcome in multivariate analyses of neurodevelopmental determinants. Key to the success of such work are recent advances in data science as well as the growth of relevant data resources. Multimodal MRI assessment of neurodevelopment can be supplemented with other biomarkers of neurodevelopment such as electroencephalograms, magnetoencephalogram, and non-imaging biomarkers. This review focuses on how maternal nutrition impacts infant brain development, with three purposes: (1) to summarize the current knowledge about how nutrition in stages of pregnancy and breastfeeding impact infant brain development; (2) to discuss multimodal MRI and other measures of early neurodevelopment; and (3) to discuss potential opportunities for data science and artificial intelligence to advance precision nutrition. We hope this review can facilitate the collaborative march toward precision nutrition during pregnancy and the first year of life.
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Affiliation(s)
- Sarah U Morton
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, United States.,Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | | | - Eleonora Tamilia
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, United States.,Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Rutvi Vyas
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, United States.,Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, United States
| | - Michaela Sisitsky
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, United States.,Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, United States
| | - Imran Ladha
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, United States
| | | | | | - P Ellen Grant
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, United States.,Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States.,Department of Radiology, Boston Children's Hospital, Boston, MA, United States
| | - Yangming Ou
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, United States.,Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States.,Department of Radiology, Boston Children's Hospital, Boston, MA, United States
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7
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The Impact of Human Milk on Necrotizing Enterocolitis: A Systematic Review and Meta-Analysis. Nutrients 2020; 12:nu12051322. [PMID: 32384652 PMCID: PMC7284425 DOI: 10.3390/nu12051322] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/29/2020] [Accepted: 05/01/2020] [Indexed: 12/30/2022] Open
Abstract
Background. Premature infants receiving breastfeed have a lower incidence of NEC than those fed preterm formula. This study aimed: (1) to update a systematic review and meta-analyses to evaluate the relationship between feeding and necrotizing enterocolitis (NEC) in low weight premature infants; (2) to conduct meta-regression analyses by subgroups; (3) to describe geographical distribution of milk banks in the world. Methods. Papers included in the meta-analysis were updated as of June 2019. Relative risks were used as a measure of effect size. Random effect models were used to account for different sources of variation among studies. For milk banks, the data reviewed by the literature were integrated with the information collected from countries’ institutional sites and milk bank networks. Results. Thirty-two papers were included in meta-analysis: six randomized controlled trials (RCTs) and 26 observational studies (OS). The census has found 572 milk banks around in the world. Brazil has the most active milk banks. RCTs meta-analysis indicates a risk reduction of NEC using human milk respect to formula: Relative risk (RR) = 0.62 (0.42–0.93). Seven OS compared quantities lower than human milk or higher than the 50th quantile showing a risk reduction of NEC:RR = 0.51 (0.31–0.85); 3 OS that evaluated human milk versus mixed feeding showing that human milk has a protective role on the development of NEC:RR = 0.74 (0.63–0.91). Results of subgroups analysis show that the risk reduction is statistically significant only for studies in which premature infants are given both their own and donated breastmilk. Conclusions. The possibility of preserving human milk and promoting donations guarantees an improvement in the health of newborns.
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8
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Saarinen AIL, Keltikangas-Järvinen L, Honda Y, Oksman E, Raitakari O, Pulkki-Råback L, Hintsanen M. Breastfeeding and offspring's compassion and empathy in adulthood: A study with an over 30-year follow-up. Scand J Psychol 2019; 61:227-236. [PMID: 31823393 DOI: 10.1111/sjop.12600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 10/21/2019] [Indexed: 11/28/2022]
Abstract
This study investigated whether breastfeeding predicts offspring's dispositional compassion and empathy from early adulthood to middle age. The parents of the participants (N = 1,394) of the Young Finns study answered questions about breastfeeding in 1983, and the participants' compassion and empathy were evaluated in 1997-2012 (participants were aged 20-50 years). Breastfeeding did not predict the course of compassion or empathy in adulthood at the age of 20-50 years. The associations remained non-significant, when adjusted for age, gender, socioeconomic factors, and a wide range of characteristics of the family environment (including mother's gestational age; premature birth; birth weight; number of other children at home; parental mental disorder; parental relationship status; parental postnatal smoking; parental postnatal alcohol use; parenting behavior; and child's externalizing behavior). In conclusion, breastfeeding seems not to predict offspring's compassion or empathy in adulthood. The findings may present a hopeful perspective for children growing up with non-breastfeeding caregivers.
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Affiliation(s)
- Aino I L Saarinen
- Research Unit of Psychology, University of Oulu, Finland.,Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
| | | | - Yukiko Honda
- Global Cooperation Institute for Sustainable Cities, Yokohama City University, Japan.,Department of Global Health and Socio-epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Japan
| | - Elli Oksman
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
| | - Olli Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland.,Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Finland
| | - Laura Pulkki-Råback
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
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9
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San Mauro Martin I, Sanz Rojo S, Garicano Vilar E, González Cosano L, Conty de la Campa R, Blumenfeld Olivares JA. Lifestyle factors, diet and attention-deficit/hyperactivity disorder in Spanish children - an observational study. Nutr Neurosci 2019; 24:614-623. [PMID: 31479410 DOI: 10.1080/1028415x.2019.1660486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background: The aetiology of Attention Deficit Hyperactivity Disorder (ADHD) continues to be debated, although several contributing factors have been acknowledged.Objective: Assess the association between weight, birth attributes, exercise and sleep habits, dietary intake and adherence to a Mediterranean diet, and impulsive behaviour on Spanish ADHD children. Establish whether specific food groups (not just adherence to the Mediterranean diet) associate with impulsive behaviour.Methods: This observational cross-sectional study included 57 ADHD children from Madrid (Spain). Demographic, clinical data, sleep, exercise and technology-use habits were obtained. Anthropometric measurements included height and weight. Adherence to the Mediterranean diet was assessed using the KIDMED test. Barratt Impulsivity Scale version-11c was used to assess impulsivity. Subjects were divided into three groups for analysis, according to their age (6-10 years, children; 11-13 years, pre-adolescents; 14-16 years, adolescents).Results: There were clear associations between those who had higher BIS scores and who slept less at weekends (49.4 ± 10.16 vs. 43.8 ± 12.51), who adhered poorly to the Mediterranean diet (49.9 ± 11.72 vs. 41.6 ± 16.52), who used internet and technological devices for >3 h/day (45.5 ± 13.6 vs. 44.7 ± 12.11), who were born with >2.5 kg (46.1 ± 11.61 vs. 42.9 ± 15.29), who were delivered by caesarean (45.1 ± 12.78 vs. 44.7 ± 12.5) and who were not breastfed (45.0 ± 13.38 vs. 44.8 ± 12.39). Subjects exercising more than 3 days a week also scored slightly higher (45.4±14.02 vs. 44.6±11.85) in the BIS.Conclusion: There is a need to follow up the link between ADHD and sleep onset difficulties, dietary patterns, technological habits, perinatal factors, breastfeeding and birth delivery mode.
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10
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Volpe JJ. Dysmaturation of Premature Brain: Importance, Cellular Mechanisms, and Potential Interventions. Pediatr Neurol 2019; 95:42-66. [PMID: 30975474 DOI: 10.1016/j.pediatrneurol.2019.02.016] [Citation(s) in RCA: 208] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 02/12/2019] [Accepted: 02/19/2019] [Indexed: 02/07/2023]
Abstract
Prematurity, especially preterm birth (less than 32 weeks' gestation), is common and associated with high rates of both survival and neurodevelopmental disability, especially apparent in cognitive spheres. The neuropathological substrate of this disability is now recognized to be related to a variety of dysmaturational disturbances of the brain. These disturbances follow initial brain injury, particularly cerebral white matter injury, and involve many of the extraordinary array of developmental events active in cerebral white and gray matter structures during the premature period. This review delineates these developmental events and the dysmaturational disturbances that occur in premature infants. The cellular mechanisms involved in the genesis of the dysmaturation are emphasized, with particular focus on the preoligodendrocyte. A central role for the diffusely distributed activated microglia and reactive astrocytes in the dysmaturation is now apparent. As these dysmaturational cellular mechanisms appear to occur over a relatively long time window, interventions to prevent or ameliorate the dysmaturation, that is, neurorestorative interventions, seem possible. Such interventions include pharmacologic agents, especially erythropoietin, and particular attention has also been paid to such nutritional factors as quality and source of milk, breastfeeding, polyunsaturated fatty acids, iron, and zinc. Recent studies also suggest a potent role for interventions directed at various experiential factors in the neonatal period and infancy, i.e., provision of optimal auditory and visual exposures, minimization of pain and stress, and a variety of other means of environmental behavioral enrichment, in enhancing brain development.
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Affiliation(s)
- Joseph J Volpe
- Department of Neurology, Harvard Medical School, Boston, Massachusetts; Department of Pediatric Newborn Medicine, Harvard Medical School, Boston, Massachusetts.
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11
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Moloney L, Rozga M, Fenton TR. Nutrition Assessment, Exposures, and Interventions for Very-Low-Birth-Weight Preterm Infants: An Evidence Analysis Center Scoping Review. J Acad Nutr Diet 2019; 119:323-339. [PMID: 29871835 DOI: 10.1016/j.jand.2018.03.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 03/26/2018] [Indexed: 01/01/2023]
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12
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Lavallée A, De Clifford-Faugère G, Garcia C, Fernandez Oviedo AN, Héon M, Aita M. Part 1: Narrative overview of developmental care interventions for the preterm newborn. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.jnn.2018.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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13
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Miller J, Tonkin E, Damarell RA, McPhee AJ, Suganuma M, Suganuma H, Middleton PF, Makrides M, Collins CT. A Systematic Review and Meta-Analysis of Human Milk Feeding and Morbidity in Very Low Birth Weight Infants. Nutrients 2018; 10:nu10060707. [PMID: 29857555 PMCID: PMC6024377 DOI: 10.3390/nu10060707] [Citation(s) in RCA: 264] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 05/25/2018] [Accepted: 05/29/2018] [Indexed: 12/30/2022] Open
Abstract
This systematic review and meta-analysis synthesised the post-1990 literature examining the effect of human milk on morbidity, specifically necrotising enterocolitis (NEC), late onset sepsis (LOS), retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD) and neurodevelopment in infants born ≤28 weeks' gestation and/or publications with reported infant mean birth weight of ≤1500 g. Online databases including Medline, PubMed, CINAHL, Scopus, and the Cochrane Central Register of Controlled Trials were searched, and comparisons were grouped as follows: exclusive human milk (EHM) versus exclusive preterm formula (EPTF), any human milk (HM) versus EPTF, higher versus lower dose HM, and unpasteurised versus pasteurised HM. Experimental and observational studies were pooled separately in meta-analyses. Risk of bias was assessed for each individual study and the GRADE system used to judge the certainty of the findings. Forty-nine studies (with 56 reports) were included, of which 44 could be included in meta-analyses. HM provided a clear protective effect against NEC, with an approximate 4% reduction in incidence. HM also provided a possible reduction in LOS, severe ROP and severe NEC. Particularly for NEC, any volume of HM is better than EPTF, and the higher the dose the greater the protection. Evidence regarding pasteurisation is inconclusive, but it appears to have no effect on some outcomes. Improving the intake of mother's own milk (MOM) and/or donor HM results in small improvements in morbidity in this population.
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MESH Headings
- Enteral Nutrition
- Enterocolitis, Necrotizing/etiology
- Enterocolitis, Necrotizing/physiopathology
- Enterocolitis, Necrotizing/prevention & control
- Evidence-Based Medicine
- Humans
- Infant
- Infant Formula
- Infant Nutritional Physiological Phenomena
- Infant, Extremely Premature
- Infant, Newborn
- Infant, Premature, Diseases/etiology
- Infant, Premature, Diseases/physiopathology
- Infant, Premature, Diseases/prevention & control
- Infant, Very Low Birth Weight
- Milk, Human
- Neonatal Sepsis/etiology
- Neonatal Sepsis/physiopathology
- Neonatal Sepsis/prevention & control
- Neurodevelopmental Disorders/etiology
- Neurodevelopmental Disorders/physiopathology
- Neurodevelopmental Disorders/prevention & control
- Premature Birth/diet therapy
- Premature Birth/physiopathology
- Severity of Illness Index
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Affiliation(s)
- Jacqueline Miller
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, SA 5006, Australia.
- Nutrition and Dietetics, Flinders University, Adelaide, SA 5001, Australia.
| | - Emma Tonkin
- Nutrition and Dietetics, Flinders University, Adelaide, SA 5001, Australia.
| | - Raechel A Damarell
- Nutrition and Dietetics, Flinders University, Adelaide, SA 5001, Australia.
| | - Andrew J McPhee
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, SA 5006, Australia.
- Neonatal Medicine, Women's and Children's Hospital, Adelaide, SA 5006, Australia.
| | - Machiko Suganuma
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, SA 5006, Australia.
| | - Hiroki Suganuma
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, SA 5006, Australia.
| | - Philippa F Middleton
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, SA 5006, Australia.
- Adelaide Medical School, Discipline of Paediatrics, The University of Adelaide, Adelaide, SA 5006, Australia.
| | - Maria Makrides
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, SA 5006, Australia.
- Adelaide Medical School, Discipline of Paediatrics, The University of Adelaide, Adelaide, SA 5006, Australia.
| | - Carmel T Collins
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, SA 5006, Australia.
- Adelaide Medical School, Discipline of Paediatrics, The University of Adelaide, Adelaide, SA 5006, Australia.
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14
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Nutrition (Micronutrients) in Child Growth and Development: A Systematic Review on Current Evidence, Recommendations and Opportunities for Further Research. J Dev Behav Pediatr 2017; 38:665-679. [PMID: 28746059 DOI: 10.1097/dbp.0000000000000482] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE An important aspect of malnutrition is deficiency of different micronutrients during pregnancy or early childhood. We systematically reviewed the role of nutrition in child growth (weight or height gain) and development. METHODS A comprehensive literature search was done on PubMed/Cochrane Library browsing through 38,795 abstracts until December 31, 2016 to select systematic reviews/meta-analyses and individual randomized controlled trials (RCTs) of micronutrient supplementation. RESULTS Micronutrients studied included iron, iodine, folate, zinc, calcium, magnesium, selenium, vitamin D, vitamin A, vitamin B complex, and multiple micronutrients. We summarize evidence with details and results of RCTs, highlight strengths/weaknesses, and critically interpret findings. Effects of breastfeeding-promotion, food-supplementation (complementary and school feeding), conditional-cash-transfers, and integrated nutrition/psychosocial interventions are discussed. CONCLUSION Based on this evidence we make policy and programmatic recommendations for supplementation to mothers and children at high-risk of deficiency.
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Lechner BE, Vohr BR. Neurodevelopmental Outcomes of Preterm Infants Fed Human Milk: A Systematic Review. Clin Perinatol 2017; 44:69-83. [PMID: 28159210 DOI: 10.1016/j.clp.2016.11.004] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The neurodevelopmental benefits of breast milk feedings for preterm infants have been controversial. However, the effect on preterm infant neurodevelopment is sustained into childhood. The effects of breast milk feeding during the neonatal period and the duration of breastfeeding display effects on cognition into adolescence. The volume of breast milk received is a key factor in these effects. Additionally, emerging studies support the effects of human milk on structural brain development, such as increased white matter development and increased cortical thickness. The components of breast milk thought to mediate improved cognitive outcomes include long-chain polyunsaturated fatty acids and human milk oligosaccharides.
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Affiliation(s)
- Beatrice E Lechner
- Department of Pediatrics, Women and Infants Hospital of Rhode Island, 101 Dudley Street, Providence, RI 02905, USA; Department of Pediatrics, Alpert School of Medicine, Brown University, 222 Richmond Street, Providence, RI 02903, USA.
| | - Betty R Vohr
- Department of Pediatrics, Women and Infants Hospital of Rhode Island, 101 Dudley Street, Providence, RI 02905, USA; Department of Pediatrics, Alpert School of Medicine, Brown University, 222 Richmond Street, Providence, RI 02903, USA
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Schneider N, Garcia-Rodenas CL. Early Nutritional Interventions for Brain and Cognitive Development in Preterm Infants: A Review of the Literature. Nutrients 2017; 9:E187. [PMID: 28241501 PMCID: PMC5372850 DOI: 10.3390/nu9030187] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 02/17/2017] [Indexed: 01/15/2023] Open
Abstract
Adequate nutrition is important for neurodevelopmental outcomes in preterm-born infants. In this review, we aim to summarize the current knowledge on nutritional interventions initiated during the hospital stay targeting brain and cognitive development benefits in preterm human infants. Studies can broadly be split in general dietary intervention studies and studies investigating specific nutrients or nutritional supplements. In general, mother's breast milk was reported to be better for preterm infants' neurodevelopment compared to infant formula. The differences in methodologies make it difficult to conclude any effects of interventions with individual nutrients. Only protein and iron level studies showed some consistent findings regarding optimal doses; however, confirmatory studies are needed. This review does not support some widely accepted associations, such as that between long-chain polyunsaturated fatty acid supplementation and visual development. Clear nutritional recommendations cannot be made based on this review. However, the type of infant nutrition (i.e., breast milk versus formula or donor milk), the timing of the nutritional intervention, and the dose of the nutrient/supplement have been found to be relevant factors in determining the success of nutritional intervention studies in preterm infants.
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Affiliation(s)
- Nora Schneider
- Nestec Ltd., Nestlé Research Center, Vers-Chez-les Blanc, 1000 Lausanne 26, Switzerland.
| | - Clara L Garcia-Rodenas
- Nestec Ltd., Nestlé Research Center, Vers-Chez-les Blanc, 1000 Lausanne 26, Switzerland.
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Park SH. Clinical Trials for Preterm Infants' Neurodevelopment to the Norm: Erythropoietin and Nutritional Interventions. NEONATAL MEDICINE 2017. [DOI: 10.5385/nm.2017.24.3.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Sook-Hyun Park
- Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea
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Reduced growth during early infancy in very low birth weight children with autism spectrum disorder. Early Hum Dev 2016; 98:23-7. [PMID: 27367970 DOI: 10.1016/j.earlhumdev.2016.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 05/05/2016] [Accepted: 05/27/2016] [Indexed: 01/24/2023]
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Tam EW, Chau V, Barkovich AJ, Ferriero DM, Miller SP, Rogers EE, Grunau RE, Synnes AR, Xu D, Foong J, Brant R, Innis SM. Early postnatal docosahexaenoic acid levels and improved preterm brain development. Pediatr Res 2016; 79:723-30. [PMID: 26761122 PMCID: PMC4853254 DOI: 10.1038/pr.2016.11] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 11/12/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Preterm birth has a dramatic impact on polyunsaturated fatty acid exposures for the developing brain. This study examined the association between postnatal fatty acid levels and measures of brain injury and development, as well as outcomes. METHODS A cohort of 60 preterm newborns (24-32 wk gestational age) was assessed using early and near-term magnetic resonance imaging (MRI) studies. Red blood cell fatty acid composition was analyzed coordinated with each scan. Outcome at a mean of 33 mo corrected age was assessed using the Bayley Scales of Infant Development, 3rd edition. RESULTS Adjusting for confounders, a 1% increase in postnatal docosahexaenoic acid (DHA) levels at early MRI was associated with 4.3-fold decreased odds of intraventricular hemorrhage, but was not associated with white matter injury or cerebellar haemorrhage. Higher DHA and lower linoleic acid (LA) levels at early MRI were associated with lower diffusivity in white matter tracts and corresponding improved developmental scores in follow-up. CONCLUSION Higher DHA and lower LA levels in the first few weeks of life are associated with decreased intraventricular haemorrhage, improved microstructural brain development, and improved outcomes in preterm born children. Early and possibly antenatal interventions in high-risk pregnancies need to be studied for potential benefits in preterm developmental outcomes.
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Affiliation(s)
- Emily W.Y. Tam
- Department of Pediatrics, Hospital for Sick Children and University of Toronto, ON, Canada
| | - Vann Chau
- Department of Pediatrics, Hospital for Sick Children and University of Toronto, ON, Canada
| | - A. James Barkovich
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA,Department of Pediatrics, University of California San Francisco,Department of Radiology & Diagnostic Imaging, University of California San Francisco
| | - Donna M. Ferriero
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA,Department of Pediatrics, University of California San Francisco
| | - Steven P. Miller
- Department of Pediatrics, Hospital for Sick Children and University of Toronto, ON, Canada,Department of Pediatrics, University of British Columbia
| | | | - Ruth E. Grunau
- Department of Pediatrics, University of British Columbia
| | - Anne R. Synnes
- Department of Pediatrics, University of British Columbia
| | - Duan Xu
- Department of Radiology & Diagnostic Imaging, University of California San Francisco
| | - Justin Foong
- Department of Pediatrics, Hospital for Sick Children and University of Toronto, ON, Canada,Centre for Computational Medicine, Hospital for Sick Children
| | - Rollin Brant
- Department of Statistics, University of British Columbia, Vancouver, BC, Canada
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Breast milk supplementation and preterm infant development after hospital discharge: a randomized clinical trial. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2016. [DOI: 10.1016/j.jpedp.2015.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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da Cunha RDES, Lamy Filho F, Rafael EV, Lamy ZC, de Queiroz ALG. Breast milk supplementation and preterm infant development after hospital discharge: a randomized clinical trial. J Pediatr (Rio J) 2016; 92:136-42. [PMID: 26403703 DOI: 10.1016/j.jped.2015.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 03/25/2015] [Accepted: 05/06/2015] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES To assess the effect of maternal breast milk supplementation on the development of exclusively breast-fed very low birth weight preterm infants at 12 months of corrected age. METHODS A randomized clinical trial with 53 infants followed-up after discharge from the neonatal unit until a corrected gestational age of 12 months. Newborns in the intervention group were breastfed exclusively with maternal milk and received 2g of a multinutrient supplement (Pré-Nan(®), Nestlé, Vevey, Switzerland) added to expressed breast milk twice a day until a corrected age of 4-6 months. The control group was exclusively breastfed without supplementation. After monthly follow-up, developmental assessment was performed using the Bayley III Scale. RESULTS There was no statistically significant difference on the Bayley III Scale between the intervention and control groups in any of the assessed domains: motor, cognitive, and communication. However, scores in the three domains were always higher in the group that received the supplement. There were a similar number of cases of developmental delay in both groups: seven (28%) in the group that received the supplement and nine (33.3%) in the group that was exclusively breastfed. CONCLUSIONS The results failed to show an association between post-discharge multinutrient supplementation and development in the assessed infants.
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Affiliation(s)
| | - Fernando Lamy Filho
- Departamento de Medicina, Universidade Federal do Maranhão (UFMA), São Luís, MA, Brazil
| | - Eremita Val Rafael
- Hospital Universitário Materno-Infantil, São Luís, MA, Brazil; Universidade Federal do Maranhão (UFMA), São Luís, MA, Brazil
| | - Zeni Carvalho Lamy
- Departamento de Medicina, Universidade Federal do Maranhão (UFMA), São Luís, MA, Brazil
| | - André Luiz Guimarães de Queiroz
- Faculdade de Medicina, Universidade Federal do Maranhão (UFMA), São Luís, MA, Brazil; Institutional Program for Scientific Initiation Scholarships (PIBIC), Brazil
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The Association Between Breastfeeding Exposure and Duration, Neuropsychological Deficits, and Psychopathic Personality Traits in Offspring: The Moderating Role of 5HTTLPR. Psychiatr Q 2016; 87:107-27. [PMID: 25982080 DOI: 10.1007/s11126-015-9366-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
A wealth of research has revealed that a shorter duration of breastfeeding during infancy can increase the risk of various maladaptive traits, including neuropsychological deficits. Despite the number of studies that have been conducted on the topic, few studies have explored whether the effects of breastfeeding on neuropsychological functioning and personality features persist into adulthood. Furthermore, very little research to date has examined whether this relationship is moderated by specific indicators of genetic risk. The current study examines the direct and interactive effects of breastfeeding experiences and the serotonin transporter polymorphism (5HTTLPR) on neuropsychological deficits and psychopathic personality traits. Using data from the National Longitudinal study of Adolescent Health, we find that no exposure to breastfeeding and a shorter duration of breastfeeding significantly increase the risk of exhibiting neuropsychological deficits during adolescence and early adulthood as well as psychopathic personality traits during adulthood. The results also reveal a number of gene × environment interactions between 5HTTLPR, breastfeeding exposure and breastfeeding duration in the prediction of neuropsychological deficits, but not in the prediction of psychopathic personality traits.
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Delgado‐Noguera MF, Calvache JA, Bonfill Cosp X, Kotanidou EP, Galli‐Tsinopoulou A. Supplementation with long chain polyunsaturated fatty acids (LCPUFA) to breastfeeding mothers for improving child growth and development. Cochrane Database Syst Rev 2015; 2015:CD007901. [PMID: 26171898 PMCID: PMC9759098 DOI: 10.1002/14651858.cd007901.pub3] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Long chain polyunsaturated fatty acids (LCPUFA), especially docosahexaenoic acid (DHA), are the most abundant fatty acids in the brain and are necessary for growth and maturation of an infant's brain and retina. LCPUFAs are named "essential" because they cannot be synthesised efficiently by the human body and come from maternal diet. It remains controversial whether LCPUFA supplementation to breastfeeding mothers is beneficial for the development of their infants. OBJECTIVES To assess the effectiveness and safety of supplementation with LCPUFA in breastfeeding mothers in the cognitive and physical development of their infants as well as safety for the mother and infant. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (6 August 2014), CENTRAL (Cochrane Library 2014, Issue 8), PubMed (1966 to August 2014), EMBASE (1974 to August 2014), LILACS (1982 to August 2014), Google Scholar (August 2014) and reference lists of published narrative and systematic reviews. SELECTION CRITERIA Randomised controlled trials or cluster-randomised controlled trials evaluating the effects of LCPUFA supplementation on breastfeeding mothers (including the pregnancy period) and their infants. DATA COLLECTION AND ANALYSIS Two review authors independently assessed eligibility and trial quality, performed data extraction and evaluated data accuracy. MAIN RESULTS We included eight randomised controlled trials involving 1567 women. All the studies were performed in high-income countries. The longest follow-up was seven years.We report the results from the longest follow-up time point from included studies. Overall, there was moderate quality evidence as assessed using the GRADE approach from these studies for the following outcomes measured beyond 24 months age of children: language development and child weight. There was low-quality evidence for the outcomes: Intelligence or solving problems ability, psychomotor development, child attention, and child visual acuity.We found no significant difference in children's neurodevelopment at long-term follow-up beyond 24 months: language development (standardised mean difference (SMD) -0.27, 95% confidence interval (CI) -0.56 to 0.02; two trials, 187 participants); intelligence or problem-solving ability (three trials, 238 participants; SMD 0.00, 95% CI -0.36 to 0.36); psychomotor development (SMD -0.11, 95% CI -0.48 to 0.26; one trial, 113 participants); motor development (SMD -0.23, 95% CI -0.60 to 0.14; one trial, 115 participants), or in general movements (risk ratio, RR, 1.12, 95% CI 0.58 to 2.14; one trial, 77 participants; at 12 weeks of life). However, child attention scores were better at five years of age in the group of children whose mothers had received supplementation with fatty acids (mean difference (MD) 4.70, 95% CI 1.30 to 8.10; one study, 110 participants)). In working memory and inhibitory control, we found no significant difference (MD -0.02 95% CI -0.07 to 0.03 one trial, 63 participants); the neurological optimality score did not present any difference (P value: 0.55).For child visual acuity, there was no significant difference (SMD 0.33, 95% CI -0.04 to 0.71; one trial, 111 participants).For growth, there were no significant differences in length (MD -0.39 cm, 95% CI -1.37 to 0.60; four trials, 441 participants), weight (MD 0.13 kg, 95% CI -0.49 to 0.74; four trials, 441 participants), and head circumference (MD 0.15 cm, 95% CI -0.27 to 0.58; three trials, 298 participants). Child fat mass and fat mass distribution did not differ between the intervention and control group (MD 2.10, 95% CI -0.48 to 4.68; one trial, 115 participants, MD -0.50, 95% CI -1.69 to 0.69; one trial, 165 participants, respectively).One study (117 infants) reported a significant difference in infant allergy at short-term follow-up (risk ratio (RR) 0.13, 95% CI 0.02 to 0.95), but not at medium-term follow-up (RR 0.52, 95% CI 0.17 to 1.59).We found no significant difference in two trials evaluating postpartum depression. Data were not possible to be pooled due to differences in the describing of the outcome. One study (89 women) did not find any significant difference between the LCPUFA supplementation and the control group at four weeks postpartum (MD 1.00, 95%CI -1.72 to 3.72).No adverse effects were reported. AUTHORS' CONCLUSIONS Based on the available evidence, LCPUFA supplementation did not appear to improve children's neurodevelopment, visual acuity or growth. In child attention at five years of age, weak evidence was found (one study) favouring the supplementation. Currently, there is inconclusive evidence to support or refute the practice of giving LCPUFA supplementation to breastfeeding mothers in order to improve neurodevelopment or visual acuity.
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Affiliation(s)
- Mario F Delgado‐Noguera
- Facultad Ciencias de la Salud, Universidad del Cauca, ColombiaDepartamento de PediatriaHospital Universitario San JoseDepartamento de PediatríaPopayanCaucaColombiaNA
| | - Jose Andres Calvache
- Universidad del Cauca, Colombia. Erasmus University Medical Centre Rotterdam, The Netherlands.Departamento de Anestesiología, Universidad del Cauca, Colombia. Department of Anesthesiology, Erasmus University Medical Centre Rotterdam, The Netherlands.Cra 2 16N‐142, tercer pisoHospital Universitario San JosePopayanColombia
| | - Xavier Bonfill Cosp
- CIBER Epidemiología y Salud Pública (CIBERESP) ‐ Universitat Autònoma de BarcelonaIberoamerican Cochrane Centre ‐ Biomedical Research Institute Sant Pau (IIB Sant Pau)Sant Antoni Maria Claret, 167Pavilion 18 (D‐13)BarcelonaCataloniaSpain08025
| | - Eleni P Kotanidou
- Medical School, Aristotle University of Thessaloniki4th Department of PaediatricsPapageorgiou General Hospital, Ring Road Nea EfkarpiaThessalonikiGreeceGR56403
| | - Assimina Galli‐Tsinopoulou
- Medical School, Aristotle University of Thessaloniki4th Department of PaediatricsPapageorgiou General Hospital, Ring Road Nea EfkarpiaThessalonikiGreeceGR56403
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Beyond building better brains: bridging the docosahexaenoic acid (DHA) gap of prematurity. J Perinatol 2015; 35:1-7. [PMID: 25357095 PMCID: PMC4281288 DOI: 10.1038/jp.2014.195] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 08/23/2014] [Accepted: 08/26/2014] [Indexed: 12/12/2022]
Abstract
Long-chain polyunsaturated fatty acids (LCPUFA) including docosahexaenoic acid (DHA) are essential for normal vision and neurodevelopment. DHA accretion in utero occurs primarily in the last trimester of pregnancy to support rapid growth and brain development. Premature infants, born before this process is complete, are relatively deficient in this essential fatty acid. Very low birth weight (VLBW) infants remain deficient for a long period of time due to ineffective conversion from precursor fatty acids, lower fat stores and a limited nutritional provision of DHA after birth. In addition to long-term visual and neurodevelopmental risks, VLBW infants have significant morbidity and mortality from diseases specific to premature birth, including bronchopulmonary dysplasia, necrotizing enterocolitis, and retinopathy of prematurity. There is increasing evidence that DHA has protective benefits against these disease states. The aim of this article is to identify the unique needs of premature infants, review the current recommendations for LCPUFA provision in infants and discuss the caveats and innovative new ways to overcome the DHA deficiency through postnatal supplementation, with the long-term goal of improving morbidity and mortality in this at-risk population.
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Shim SY, Ahn HM, Cho SJ, Park EA. Early aggressive nutrition enhances language development in very low-birthweight infants. Pediatr Int 2014; 56:845-850. [PMID: 24750193 DOI: 10.1111/ped.12361] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Revised: 03/06/2014] [Accepted: 04/11/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Inadequate nutrition in very-low-birthweight (VLBW) infants is known to be associated with growth failure and poor neurological outcomes. We aimed to investigate the association of early aggressive protein and energy intakes with weight gain and 18-month neurodevelopmental outcomes in VLBW infants. METHODS A total of 90 infants among 129 infants who survived to discharge were included and divided into two groups (early aggressive nutrition [n = 52] vs conventional nutrition [n = 38]). Clinical findings were compared between the two groups and daily protein and energy intakes were collected for the first 4 weeks of life. Multiple regression analyses tested the association between weekly protein or energy intakes and the result of each category of the Denver Developmental Screening Test II at 18 months' corrected age or weight gain. RESULTS The early aggressive nutrition group had higher rates of normal language development and lower rates of growth failure (<10th percentile) at both 40 weeks' and 18 months' corrected age compared to the conventional nutrition group. After controlling for the confounding variables, higher first week protein and energy intakes each independently contributed to normal language development (odds ratio [95% confidence interval]; 9.4 [1.8-49.6] per 1 g/kg of protein increase and 1.7 [1.1-2.8] per 10 kcal/kg of energy increase). Higher first-week protein intake was associated with a higher weight at 40 weeks' corrected age (r = 0.41, P = 0.005). CONCLUSIONS This study demonstrates the importance of the protein and energy intakes in VLBW infants in the first week of life not only for growth but also for better language development.
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Affiliation(s)
- So-Yeon Shim
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hye Mi Ahn
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Su Jin Cho
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Eun Ae Park
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
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Koo W, Tank S, Martin S, Shi R. Human milk and neurodevelopment in children with very low birth weight: a systematic review. Nutr J 2014; 13:94. [PMID: 25231364 PMCID: PMC4176583 DOI: 10.1186/1475-2891-13-94] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 09/15/2014] [Indexed: 02/06/2023] Open
Abstract
Human milk (HM) contains critical nutrients and possibly other neurotrophic factors that could benefit the less developed brain of preterm infants, particularly those with very low birth weight (VLBW). This study aims to systematically review the original studies to determine whether there is a reproducible independent effect of HM feeding on neurodevelopment outcome in preterm VLBW infants. Search of seven databases (PubMed, Cochrane, CINAHL, Embase, Proquest Research Library, Google Scholar, and Web of Science) identified 24 original studies. Each study was evaluated by two authors independently for 8 non-nutritive (study design, target population, a priori power calculation, adjustment for baseline growth status, postnatal complication, other confounders, observer blinding to feeding status, effect size) and 5 nutritive (definition and duration of HM intake, use of HM fortifier, source of HM data, infant formula used) methodology parameters, and consistency and directness of outcome measures. Thirteen reports of preterm infants with wide ranges of birth weights were excluded as none provided sufficient data to delineate the effects of HM feeding on developmental outcome of subjects with VLBW. Eleven reports included only VLBW children and 7 studies were reviewed after elimination of preliminary data from same cohort or lack of appropriate standardized testing or control group. These 7 studies (n = 18 to 704, median 219) were performed at <3 years (3 studies) and at 5 to 11 years (4 studies). Six studies were secondary analysis of data from other studies. Each study met or only partially met 4 to 10 methodological parameters. VLBW children with no neurological impairment fed HM achieved normal or low normal range of test scores. Formula feeding using older formulations was associated with a lower subtest score in 4 studies. There is no randomized clinical trial comparing the neurodevelopment outcome of HM versus formula or minimal HM feeding that included only children with VLBW. The role of HM in the neurodevelopment and cognitive function of VLBW children needs reassessment with high quality studies in the context of current formulations of HM fortifier and preterm formula.
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Affiliation(s)
- Winston Koo
- Department of Pediatrics, Louisiana State University Health Sciences, 1501 Kings Hwy, Shreveport, LA, USA.
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Field SS. Interaction of genes and nutritional factors in the etiology of autism and attention deficit/hyperactivity disorders: a case control study. Med Hypotheses 2014; 82:654-61. [PMID: 24685108 DOI: 10.1016/j.mehy.2014.02.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 02/12/2014] [Accepted: 02/17/2014] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To compare risk factors of attention deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) to age/sex-matched controls with particular attention to family history, parental age and nutrition. METHOD 31 ASD and 81 ADHD patients were compared to 612 age/sex-matched controls by reviewing charts for parental age, sibling order, gestational age, and early feeding, and by parental interview for early feeding and family history of psychopathology on affected patients and 139 of those controls. FINDINGS Parental age affected ASD and ADHD females but not males. First-born males were at increased risk for both disorders even though their siblings had older parents and their parents were not more likely to stop having children. Breastfeeding in the absence of parental psychopathology reduced ADHD risk, but breastfeeding of first-born males by older mothers with psychopathology was a risk for ASD. Breastfeeding was only a risk for ADHD if the mother had psychopathology. Parent emigration from a place of high fish consumption was a significant ASD risk factor. RESULTING HYPOTHESES ADHD and ASD share risk factors due to shared genetic and nutritional interactions, likely revolving around deficiencies of omega-3 fatty acids (n3FAs) during brain development. Fatty acid metabolism genes are important in that process. The 4:1 male to female ratio for both disorders results from hormonally driven fat metabolism differences. Risk factors for both disorders including maternal smoking, prematurity, and gestational diabetes may also be attributed to their effect on n3FA supplies. Breastfeeding can be a risk factor when the mother's genes and/or age affect her milk quality. Parental age and gene defects may affect female more than male offspring. Childbirth with adequate spacing and breastfeeding can override maternal age and protect subsequent offspring. Genetic variations in fat metabolism can be influenced by cultural/geographic diet, causing deficiencies in offspring with migration-influenced diet changes. Interaction of n3FA deficient diets, delayed child-bearing, and breastfeeding by mothers with psychopathology may be important factors in the rising incidence of ASD and ADHD in recent decades. Partial prevention through diet and supplements may be possible.
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Affiliation(s)
- Scott S Field
- Huntsville Hospital, University of Alabama in Birmingham (Huntsville Campus), United States.
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Rodrigues MCCD, Mello RRD, Silva KSD, Carvalho MLD. Risk factors for cognitive impairment in school-age children born preterm: application of a hierarchical model. ARQUIVOS DE NEURO-PSIQUIATRIA 2013; 70:583-9. [PMID: 22899028 DOI: 10.1590/s0004-282x2012000800005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Accepted: 03/28/2012] [Indexed: 11/22/2022]
Abstract
The purpose was to analyze factors associated with cognitive impairment in very low birth weight (VLBW) children born preterm. A prospective cohort of 65 VLBW children was assessed at the age of eight years using the Wechsler Intelligence Scale for Children. A model for the relationship of variables with the cognitive impairment outcome attributed hierarchical levels: distal (socioeconomic variables), intermediate I and II (perinatal and neonatal variables, post-neonatal variables) and proximal (child health and psychosocial stimulation). A multivariate logistic regression was performed. In the multivariate hierarchical logistic regression, the maternal education (OR=0.77, 95%CI 0.63-0.94) and number of prenatal visits (OR=0.73, 95%CI 0.54-0.99) showed a protective association, but the male (OR=7.3, 95%CI 1.54-35.3) was associated with worse results. The VLBW children cognitive performance in the age of eight years benefits from more educated mothers, better prenatal care, and the baby gender as female.
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Affiliation(s)
- Maura Calixto Cecherelli de Rodrigues
- Doutora em Ciências pela Fundação Oswaldo Cruz (FIOCRUZ). Médica Pediatra coordenadora do Núcleo de Atenção Interdisciplinar ao Recém-nascido de Risco da Maternidade Leila Diniz-Hospital Municipal Lourenço Jorge, Rio de Janeiro RJ, Brazil
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Herba CM, Roza S, Govaert P, Hofman A, Jaddoe V, Verhulst FC, Tiemeier H. Breastfeeding and early brain development: the Generation R study. MATERNAL AND CHILD NUTRITION 2012; 9:332-49. [PMID: 23167730 DOI: 10.1111/mcn.12015] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Breastfeeding during infancy is associated with a range of short- and long-term health benefits. We examine whether breastfeeding in the first 2 months of life is associated with structural markers of brain development in infants from the general population. This study was embedded within the Generation R study. Cranial ultrasounds were obtained at approximately 7 weeks post-natal age. The diameter of the gangliothalamic ovoid, corpus callosum length, ventricular volume and head circumference were measured. Maternal reports of breastfeeding were obtained at 2 months of age. We examined associations in relation to current breastfeeding practices (exclusively breastfed, n = 318, breast- and bottle-fed, n = 119, and bottle-fed, n = 243). Analyses were adjusted for head size and relevant covariates. Secondary analyses were conducted for breastfeeding history (exclusively breastfed, n = 318, breast- and bottle-fed, n = 281, and never breastfed, n = 81). Exclusive breastfeeding was associated with more optimal brain development compared with babies who were bottle-fed or never breastfed. Results were most consistent for gangliothalamic ovoid diameter. Larger gangliothalamic ovoid diameters were evident in babies who were exclusively breastfed compared with bottle-fed babies [difference between means (95% confidence interval) = 0.21(0.02, 0.39), P = 0.02]. Smaller ventricular volume and larger head circumference were also found for exclusively breastfed babies. Breastfeeding was not significantly associated with corpus callosum length. Maternal reports of breastfeeding are associated with more mature brain development within the first 2 months of life. Results are most consistent for gangliothalamic ovoid diameter, a subcortical structure rich in docosahexaenoic acid. Findings also pointed to non-specific neural developmental advantage for exclusively breastfed babies.
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Affiliation(s)
- Catherine M Herba
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus University Medical Center, Rotterdam, the Netherlands
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Kremmyda LS, Tvrzicka E, Stankova B, Zak A. Fatty acids as biocompounds: their role in human metabolism, health and disease: a review. part 2: fatty acid physiological roles and applications in human health and disease. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2012; 155:195-218. [PMID: 22286806 DOI: 10.5507/bp.2011.052] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND This is the second of two review parts aiming at describing the major physiological roles of fatty acids, as well as their applications in specific conditions related to human health. RESULTS The review included the current literature published in Pubmed up to March 2011. In humans, fatty acids are a principle energy substrate and structural components of cell membranes (phospholipids) and second messengers. Fatty acids are also ligands of nuclear receptors affecting gene expression. Longer-chain (LC) polyunsaturated fatty acids (PUFA), including eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and arachidonic acid are precursors of lipid mediators such as eicosanoids (prostaglandins, leukotrienes, thromboxanes), resolvins and neuroprotectins. Lipid mediators produced by EPA and DHA (LC n-3 PUFA; mainly found in oily fish) are considered as inflammation-resolving, and thus, fish oil has been characterised as antiinflammatory. Recommendations for EPA plus DHA intake from oily fish vary between 250-450 mg/day. Dietary reference values for fat vary between nutrition bodies, but mainly agree on a low total and saturated fat intake. The existing literature supports the protective effects of LC n-3 PUFA (as opposed to n-6 PUFA and saturated fat) in maternal and offspring health, cardiovascular health, insulin sensitivity, the metabolic syndrome, cancer, critically ill patients, and immune system disorders. CONCLUSION Fatty acids are involved in multiple pathways and play a major role in health. Further investigation and a nutrigenomics approach to the effects of these biocompounds on health and disease development are imperative and highlight the importance of environmental modifications on disease outcome.
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Isaacs EB, Ross S, Kennedy K, Weaver LT, Lucas A, Fewtrell MS. 10-year cognition in preterms after random assignment to fatty acid supplementation in infancy. Pediatrics 2011; 128:e890-8. [PMID: 21930549 DOI: 10.1542/peds.2010-3153] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To test the hypothesis that long-chain polyunsaturated fatty acid (LCPUFA) supplementation in infancy would improve cognition into later childhood (after 9 years) at both general and specific levels. METHODS A comprehensive cognitive battery was completed by 107 formerly preterm infants (mean age: 128 months). As infants, they had been assigned randomly to receive LCPUFA-supplemented (N = 50) or control (N = 57) formula, between birth and 9 months; the docosahexaenoic acid level (DHA) in the supplemented formulas was 0.5%. In addition to randomized comparisons, we planned supplementary analyses to examine the effects of both gender and feeding group (those receiving some maternal breast milk versus those receiving none). RESULTS There were no significant differences between randomized diet groups on any cognitive measure. There was significant interaction between gender and supplementation; girls only showed beneficial effects of LCPUFAs on literacy. Significant interaction also occurred between feeding group and supplementation; increases of 0.7 SD in verbal IQ, full-scale IQ, and memory scores were found for the LCPUFA group, but only for infants who received only formula and no maternal breast milk. CONCLUSIONS The results of this post-9-year cognitive follow-up study in a randomized trial of LCPUFA-supplemented formula for preterm infants suggest no overall group effects but indicate that gender-specific and diet-specific effects may exist. The data provide some evidence that LCPUFAs are a key factor in the cognitive benefits of breast milk. Caution is advised in data interpretation because of the small groups used.
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Affiliation(s)
- Elizabeth B Isaacs
- Medical Research Council Childhood Nutrition Research Centre, University College London Institute of Child Health, London, England.
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Rodrigues MCCD, Mello RRD, Silva KSD, Carvalho MLD. Desenvolvimento cognitivo de prematuros à idade escolar: proposta de modelo hierarquizado para investigação dos fatores de risco. CAD SAUDE PUBLICA 2011; 27:1154-64. [DOI: 10.1590/s0102-311x2011000600012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Accepted: 04/11/2011] [Indexed: 11/22/2022] Open
Abstract
O déficit cognitivo é a sequela do neurodesenvolvimento mais prevalente na população de prematuros de muito baixo peso. Poucos são os trabalhos nacionais sobre o desenvolvimento desta população na idade escolar. Este estudo propõe uma discussão teórica sobre os fatores determinantes do desenvolvimento cognitivo na idade escolar de prematuros de muito baixo peso ao nascer, utilizando o modelo hierarquizado de análise. Neste modelo, fatores biológicos e ambientais se relacionariam em diversos níveis: distal, intermediário e proximal, resultando em alterações no desenvolvimento cognitivo. Pretende-se, desta forma, aprofundar a questão das mediações possíveis das variáveis e suas inter-relações e consequentes eventos que podem levar ao desfecho. Para a seleção dos fatores de risco foi realizada uma revisão da literatura sobre fatores associados a resultados cognitivos desfavoráveis. Pressupõe-se que o melhor conhecimento das inter-relações destes fatores auxiliaria na prevenção e intervenção mais adequada nesta população, aumentando suas chances de inclusão escolar e social.
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Delgado-Noguera MF, Calvache JA, Bonfill Cosp X. Supplementation with long chain polyunsaturated fatty acids (LCPUFA) to breastfeeding mothers for improving child growth and development. Cochrane Database Syst Rev 2010:CD007901. [PMID: 21154388 DOI: 10.1002/14651858.cd007901.pub2] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Long chain polyunsaturated fatty acids (LCPUFA), especially docosahexaenoic acid (DHA), are the most abundant fatty acids in the brain and are necessary for growth and maturation of the brain and retina. LCPUFA are named "essential" because they cannot be synthesised efficiently by the human body and come from maternal diet. It remains controversial whether LCPUFA supplementation to breastfeeding mothers is beneficial for the development of their infants. OBJECTIVES To assess the effectiveness and safety of supplementation with LCPUFA in breastfeeding mothers in the cognitive and physical development of their infants as well as safety for the mother and infant. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (November 2009), CENTRAL (2009, Issue 2), PubMed (1966 to July 2009), EMBASE (1974 to June 2009), CINAHL (1984 to June 2009), LILACS (1982 to June 2009), Google Scholar (June 2009) and reference lists of published narrative and systematic reviews. SELECTION CRITERIA Randomised controlled trials or cluster-randomised controlled trials evaluating the effects of LCPUFA supplementation on breastfeeding mothers and their infants. DATA COLLECTION AND ANALYSIS Two review authors independently assessed eligibility and trial quality and performed data extraction. MAIN RESULTS We included six randomised controlled trials involving 1280 women. We found no significant difference in children's neurodevelopment: language development (standardised mean difference (SMD) -0.14, 95% confidence interval (CI) -0.49 to 0.20; two trials, 349 participants); intelligence or problem-solving ability (two trials, 817 participants; SMD -0.22, 95% CI -0.23 to 0.66); psychomotor development (SMD 0.34, 95% CI -0.11 to 0.78; two trials, 279 participants); motor development (SMD 0.08, 95% CI -0.13 to 0.29; two trials, 349 participants); in child attention there was a significant difference (SMD 0.50, 95% CI 0.24 to 0.77; one study). For child visual acuity there was no significant difference (SMD -0.06, 95% CI -0.26 to 0.14; three trials, 401 participants). For growth, there were significant differences in length (MD -0.75 cm, 95% CI -1.38 to -0.12; two trials, 834 participants) and head circumference (MD 0.69 cm, 95% CI 0.35 to 1.02; one trial, 244 participants). One study reported a significant difference in infant allergy (risk ratio (RR) 0.12, 95% CI 0.02 to 0.95). We found no significant difference in one trial evaluating postpartum depression (SMD 0.15, 95% CI -0.11 to 0.41). AUTHORS' CONCLUSIONS Based on the limited evidence that we found, LCPUFA supplementation did not appear to improve children's neurodevelopment or visual acuity. In two studies, LCPUFA supplementation was associated with increased head circumference. Currently, there is insufficient evidence to support or refute the practice of giving LCPUFA supplementation to breastfeeding mothers in order to improve infant growth and development.
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Affiliation(s)
- Mario F Delgado-Noguera
- Departamento de Pediatría, Universidad del Cauca, Popayán, Colombia; Iberoamerican Cochrane Network, Barcelona, Spain
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Prenatal exposure to methylmercury and PCBs affects distinct stages of information processing: an event-related potential study with Inuit children. Neurotoxicology 2010; 31:373-84. [PMID: 20403381 DOI: 10.1016/j.neuro.2010.04.005] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Revised: 03/27/2010] [Accepted: 04/12/2010] [Indexed: 11/23/2022]
Abstract
Methylmercury (MeHg) and polychlorinated biphenyls (PCBs) are seafood contaminants known for their adverse effects on neurodevelopment. This study examines the relation of developmental exposure to these contaminants to information processing assessed with event-related potentials (ERPs) in school-aged Inuit children from Nunavik (Arctic Québec). In a prospective longitudinal study on child development, exposure to contaminants was measured at birth and 11 years of age. An auditory oddball protocol was administered at 11 years to measure ERP components N1 and P3b. Multiple regression analyses were performed to examine the associations of levels of the contaminants to auditory oddball performance (mean reaction time, omission errors and false alarms) and ERP parameters (latency and amplitude) after control for potential confounding variables. A total of 118 children provided useable ERP data. Prenatal MeHg exposure was associated with slower reaction times and fewer false alarms during the oddball task. Analyses of the ERP parameters revealed that prenatal MeHg exposure was related to greater amplitude and delayed latency of the N1 wave in the target condition but not to the P3b component. MeHg effects on the N1 were stronger after control for seafood nutrients. Prenatal PCB exposure was not related to any endpoint for sample as a whole but was associated with a decrease in P3b amplitude in the subgroup of children who had been breast-fed for less than 3 months. Body burdens of MeHg and PCBs at 11 years were not related to any of the behavioural or ERP measures. These data suggest that prenatal MeHg exposure alters attentional mechanisms modulating early processing of sensory information. By contrast, prenatal PCB exposure appears to affect information processing at later stages, when the information is being consciously evaluated. These effects seem to be mitigated in children who are breast-fed for a more extended period.
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