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Díez López I, Cernada M, Galán L, Boix H, Ibañez L, Couce ML. Small for gestational age: concept, diagnosis and neonatal characterization, follow-up and recommendations. An Pediatr (Barc) 2024; 101:124-131. [PMID: 39127580 DOI: 10.1016/j.anpede.2024.07.012] [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: 05/26/2024] [Accepted: 06/12/2024] [Indexed: 08/12/2024] Open
Abstract
Newborns who do not reach a weight appropriate for their gestational age and sex can be classified in different ways. This article defines the concepts of small for gestational age (SGA) and intrauterine growth restriction, as well as the underlying causes of these conditions, with the goal of establishing consensus definitions for these patients, in whom treatment with growth hormone throughout childhood may be indicated and who may be at risk of developing endocrine or metabolic disorders in puberty and adulthood. Most SGA children experience spontaneous catch-up growth that is usually completed by age 2 years. In SGA children who remain short, treatment with recombinant human growth hormone is effective, increasing adult height. Small for gestational age infants with rapid catch-up growth and marked weight gain are at increased risk of premature adrenarche, early puberty, polycystic ovary syndrome (girls), insulin resistance and obesity, all of which are risk factors for type 2 diabetes and metabolic syndrome in adulthood. The SGA status can affect different areas of neurodevelopment and manifest at different stages in life; neurodevelopmental outcomes are better in SGA infants with spontaneous catch-up growth. Due to the potential risks associated with SGA, adequate characterization of these patients at birth is imperative, as it allows initiation of appropriate follow-up and early detection of abnormalities.
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Affiliation(s)
- Ignacio Díez López
- Departamento de Pediatría, UPV-EHU, Servicio de Pediatría. HU Araba, OSI Araba, BIOARABA, Vitoria, Spain
| | - María Cernada
- Servicio de Neonatología, Hospital Universitario y Politécnico La Fe, Grupo de Investigación en Perinatología, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Laura Galán
- Servicio de Pediatria, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - Hector Boix
- Unidad de Cuidados Intensivos Neonatales, Hospital Quironsalud, Barcelona, Spain
| | - Lourdes Ibañez
- Servicio de Endocrinología, Hospital Sant Joan de Déu, Universidad de Barcelona, CIBERDEM, Instituto de Salud Carlos III, Madrid, Spain.
| | - Maria L Couce
- Servicio de Neonatología, Hospital Clínico Universitario de Santiago, IDIS, RICORS-SAMID, Universidad de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
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Pagano F, Gaeta E, Morlino F, Riccio MT, Giordano M, De Bernardo G. Long-term benefits of exclusive human milk diet in small for gestational age neonates: a systematic review of the literature. Ital J Pediatr 2024; 50:88. [PMID: 38679716 PMCID: PMC11057117 DOI: 10.1186/s13052-024-01648-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 04/07/2024] [Indexed: 05/01/2024] Open
Abstract
Evidence about feeding practices' consequences in small for gestational age newborns is not well established because they are less likely to initiate and continue breastfeeding than other newborns. Our aim was to study current knowledge about the benefits of exclusive human milk diet after 2 years of age in small for gestational age newborns. A systematic review of the literature was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline criteria. Pubmed and Scopus were searched for studies published from databases inception until June 2, 2023. Included articles were analysed and synthesised. Risk of bias and level of evidence assessments were performed. They were enrolled small for gestational age newborns fed by breastfeeding, breast milk or donor milk. The systematic review included 9 articles which were related to 4 health domains: neurodevelopment, cardiovascular, somatic growth and bone mineralization and atopy. Extracted data support a beneficial effect of breastfeeding on these outcomes. Better quality of evidence and longer follow-up are needed.
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Affiliation(s)
- Federica Pagano
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Emanuele Gaeta
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Francesca Morlino
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Maria Teresa Riccio
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Maurizio Giordano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Giuseppe De Bernardo
- Department of Woman and Child, Ospedale Buon Consiglio Fatebenefratelli, Naples, Italy.
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3
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Abrão ACFDV, Schmidt GDJ, Mattar MJG, Cruz CS, Barbosa JDB, Daré DZ, Coca KP. Temperature curve of raw human milk heated by different methods: experimental study. Rev Esc Enferm USP 2024; 57:e20230130. [PMID: 38284617 PMCID: PMC10823800 DOI: 10.1590/1980-220x-reeusp-2023-0130en] [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: 05/11/2023] [Accepted: 10/18/2023] [Indexed: 01/30/2024] Open
Abstract
OBJECTIVE To analyze the temperature curve of raw or pasteurized human milk exposed to different heating methods. METHOD Experiments with volumes of 5 ml to 100 ml of human milk were carried out between 2016 and 2021 and analyzed according to the exposure time by different heating methods. Descriptive statistics included the calculation of means, medians, minimum and maximum values, measures of dispersion and standard deviation. RESULTS The thermal curve made it possible to identify the heating of human milk close to body temperature when subjected to a water bath and microwaves. Milk exposed to room temperature (21°C) was unable to reach this temperature. When heated in a water bath at 40°C, smaller volumes reached body temperature between 3 and 5 minutes, while in a microwave at 50% power, practically all volumes reached temperature. CONCLUSION The temperature curves of raw or pasteurized human milk were constructed, and it was possible to verify its behavior using different heating methods for administering the food in a neonatal intensive care unit, considering the volume, type and time of heating and temperature.
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Affiliation(s)
| | | | | | - Carla Santos Cruz
- Universidade Federal de São Paulo, Escola Paulista de Enfermagem,
São Paulo, SP, Brazil
| | | | - Dariza Zimiani Daré
- Universidade Federal de São Paulo, Escola Paulista de Enfermagem,
São Paulo, SP, Brazil
| | - Kelly Pereira Coca
- Universidade Federal de São Paulo, Escola Paulista de Enfermagem,
Departamento Enfermagem na Saúde da Mulher, São Paulo, SP, Brazil
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Calcaterra V, Mannarino S, Garella V, Rossi V, Biganzoli EM, Zuccotti G. Cardiovascular Risk in Pediatrics: A Dynamic Process during the First 1000 Days of Life. Pediatr Rep 2023; 15:636-659. [PMID: 37987283 PMCID: PMC10661305 DOI: 10.3390/pediatric15040058] [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: 09/06/2023] [Revised: 10/08/2023] [Accepted: 10/24/2023] [Indexed: 11/22/2023] Open
Abstract
The early childhood period, encompassing prenatal and early stages, assumes a pivotal role in shaping cardiovascular risk factors. We conducted a narrative review, presenting a non-systematic summation and analysis of the available literature, focusing on cardiovascular risk from prenatal development to the first 1000 days of life. Elements such as maternal health, genetic predisposition, inadequate fetal nutrition, and rapid postnatal growth contribute to this risk. Specifically, maternal obesity and antibiotic use during pregnancy can influence transgenerational risk factors. Conditions at birth, such as fetal growth restriction and low birth weight, set the stage for potential cardiovascular challenges. To consider cardiovascular risk in early childhood as a dynamic process is useful when adopting a personalized prevention for future healthcare and providing recommendations for management throughout their journey from infancy to early adulthood. A comprehensive approach is paramount in addressing early childhood cardiovascular risks. By targeting critical periods and implementing preventive strategies, healthcare professionals and policymakers can pave the way for improved cardiovascular outcomes. Investing in children's health during their early years holds the key to alleviating the burden of cardiovascular diseases for future generations.
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Affiliation(s)
- Valeria Calcaterra
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
- Pediatric Department, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Savina Mannarino
- Pediatric Cardiology Unit, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Vittoria Garella
- Pediatric Cardiology Unit, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Virginia Rossi
- Pediatric Department, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Elia Mario Biganzoli
- Medical Statistics Unit, Department of Biomedical and Clinical Sciences, University Hospital, University of Milan, 20157 Milan, Italy
| | - Gianvincenzo Zuccotti
- Pediatric Department, Buzzi Children's Hospital, 20154 Milan, Italy
- Department of Biomedical and Clinical Science, University of Milan, 20157 Milan, Italy
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Quitadamo PA, Zambianco F, Palumbo G, Copetti M, Gentile MA, Mondelli A. Trend and Predictors of Breastmilk Feeding among Very-Low-Birth-Weight Infants in NICU and at Discharge. Nutrients 2023; 15:3314. [PMID: 37571252 PMCID: PMC10421341 DOI: 10.3390/nu15153314] [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: 04/30/2023] [Revised: 07/10/2023] [Accepted: 07/20/2023] [Indexed: 08/13/2023] Open
Abstract
Mothers' own milk (MOM) for premature babies is considered a life-saving drug for its proven protective action against the complications of prematurity and for effects on outcome in the short and long term, especially neurological ones. We studied the use of MOM for infants weighing <1500 g for a period of 5 years, evaluating the trend over time and the impact of some variables on human milk feeding performance. Statistical comparisons concerned the rate of feeding with breast milk during a stay in an NICU and at discharge with respect to two types of variables: (1) maternal and neonatal characteristics (gestational age, birth weight, type of pregnancy (whether single or twin), maternal age) and (2) feeding characteristics (time of the start of minimal enteral feeding and availability of MOM, days until the achievement of full enteral feeding). Group comparisons were performed using ANOVA or t-test for continuous variables and Pearson chi-squared test or Fisher exact test for categorical variables. We observed an increase, between 2017 and 2021, in MOM use (p = 0.003). The availability of the own mothers' milk occurred, on average, on the fourth day of life and improved over the years. The start of minimal enteral feeding (MEF) with human milk averaged 1.78 days, and 54.3% of VLBWs received MEF with donor milk on the first day of life. The average percentage of feeding with the mothers' milk at discharge was 47.6%, with 36.1% of exclusive MOM and an increase from 45.8% in 2017 (33.3% exclusive) to 58.82% (41.18% exclusive) in 2021. The mean average daily growth of the weight improved (p < 0.001) during this period, and there was no statistical difference between infants fed with maternal milk and those fed with bank milk. Older maternal age, early-start feeding with maternal milk and low gestational age had a statistically significant impact on feeding with MOM at discharge.
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Affiliation(s)
- Pasqua Anna Quitadamo
- Neonatal Intensive Care Unit, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; (G.P.); (M.A.G.); (A.M.)
- HMB, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy
| | - Federica Zambianco
- San Raffaele Faculty of Medicine, University of San Raffaele Vita-Salute, 20132 Milano, Italy;
| | - Giuseppina Palumbo
- Neonatal Intensive Care Unit, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; (G.P.); (M.A.G.); (A.M.)
- HMB, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy
| | - Massimiliano Copetti
- Statistical Department, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy;
| | - Maria Assunta Gentile
- Neonatal Intensive Care Unit, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; (G.P.); (M.A.G.); (A.M.)
- HMB, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy
| | - Antonio Mondelli
- Neonatal Intensive Care Unit, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; (G.P.); (M.A.G.); (A.M.)
- HMB, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy
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Pathirana MM, Andraweera PH, Aldridge E, Harrison M, Harrison J, Leemaqz S, Arstall MA, Dekker GA, Roberts CT. The association of breast feeding for at least six months with hemodynamic and metabolic health of women and their children aged three years: an observational cohort study. Int Breastfeed J 2023; 18:35. [PMID: 37468924 DOI: 10.1186/s13006-023-00571-3] [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: 03/02/2022] [Accepted: 06/25/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Breastfeeding is important for both mother and child in reducing risk of future cardiovascular disease. Therefore, it may be an effective method to improve cardio-metabolic health, particularly those who are exposed to pregnancy complications which increase later CVD risk for both mother and child. The aim of this study is to assess differences in cardiometabolic health at three years postpartum in mothers who breastfed for at least six months and their children compared to those who did not. METHODS Women and children from the Screening Tests to Predict Poor Outcomes of Pregnancy (STOP) study (2015-2017) were invited to attend a health check-up at three years postpartum. Women's breastfeeding status at least six months postpartum was ascertained through their child health record. Anthropometric and hemodynamic measurements were taken from women and their children. A fasting blood sample was taken from women to measure blood glucose and lipids. RESULTS A total of 160 woman-child dyads were assessed in this study. Women who breastfed for at least six months had significantly lower maternal BMI, systolic blood pressure, diastolic blood pressure, mean arterial pressure, central systolic blood pressure, and central diastolic blood pressure than those who did not and this did not change after adjusting for BMI and socioeconomic index in early pregnancy, prenatal smoking and maternal age in early pregnancy. Subgroup analysis on women who had one or more pregnancy complications during the index pregnancy (i.e. preeclampsia, gestational hypertension, delivery of a small for gestational age infant, delivery of a preterm infant, and/or gestational diabetes mellitus) demonstrated that women who breastfed for at least six months had significantly lower maternal systolic and diastolic blood pressures, serum insulin and triglycerides, and higher HDL cholesterol. There were no differences in child anthropometric or hemodynamic variables at three years of age between those children who had been breastfed for at least six months and those who had not. CONCLUSION Breastfeeding for at least six months may reduce some maternal; cardiovascular risk factors in women at three years postpartum, in particular, in those who have experienced a complication of pregnancy. TRIAL REGISTRATION ACTRN12614000985684 (12/09/2014).
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Affiliation(s)
- Maleesa M Pathirana
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, 5000, Australia.
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, 5005, Australia.
- Department of Cardiology, Lyell McEwin Hospital, Elizabeth Vale, South Australia, 5112, Australia.
| | - Prabha H Andraweera
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, 5000, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, 5005, Australia
- Department of Cardiology, Lyell McEwin Hospital, Elizabeth Vale, South Australia, 5112, Australia
| | - Emily Aldridge
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, 5000, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, 5005, Australia
- Department of Cardiology, Lyell McEwin Hospital, Elizabeth Vale, South Australia, 5112, Australia
| | - Madeline Harrison
- Flinders Health and Medical Research Institute, Flinders Medical Centre, Flinders University of South Australia, Bedford Park, South Australia, 5042, Australia
| | - Jade Harrison
- Flinders Health and Medical Research Institute, Flinders Medical Centre, Flinders University of South Australia, Bedford Park, South Australia, 5042, Australia
| | - Shalem Leemaqz
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, 5000, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, 5005, Australia
- Flinders Health and Medical Research Institute, Flinders Medical Centre, Flinders University of South Australia, Bedford Park, South Australia, 5042, Australia
| | - Margaret A Arstall
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, 5000, Australia
- Department of Cardiology, Lyell McEwin Hospital, Elizabeth Vale, South Australia, 5112, Australia
| | - Gustaaf A Dekker
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, 5000, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, 5005, Australia
- Division of Women's Health, Lyell McEwin Hospital, Elizabeth Vale, South Australia, 5112, Australia
| | - Claire T Roberts
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, 5000, Australia.
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, 5005, Australia.
- Flinders Health and Medical Research Institute, Flinders Medical Centre, Flinders University of South Australia, Bedford Park, South Australia, 5042, Australia.
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7
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Kosmeri C, Giapros V, Rallis D, Balomenou F, Serbis A, Baltogianni M. Classification and Special Nutritional Needs of SGA Infants and Neonates of Multiple Pregnancies. Nutrients 2023; 15:2736. [PMID: 37375640 DOI: 10.3390/nu15122736] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/01/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023] Open
Abstract
Data regarding the nutritional management of preterm small for gestational age (SGA) infants are scarce. In the recent report of ESPGHAN, the recommended energy for very preterm infants during hospitalization has been increased, yet this may not fit the needs of all preterm infants. It is important to distinguish fetal growth-restricted (FGR) infants from constitutional SGA infants, as well as preterm SGA from preterm AGA infants, since they may have different nutritional needs. Preterm FGR infants, and specifically infants < 29 weeks' gestation, accumulate nutrient deficits due to intrauterine malnutrition, prematurity, morbidities, delayed initiation of feeding, and feeding intolerance. Therefore, these infants may need more aggressive nutrition for optimal catch-up growth and neurologic development. However, a balance should be kept between optimal and excessive catch-up growth, since the combination of intrauterine malnutrition and excessive postnatal growth has been linked with later adverse metabolic consequences. Furthermore, multiple gestation is often complicated by FGR and prematurity. There is controversy in the definition of FGR in multiple gestations, and it should be noted that FGR in multiple gestation usually differs etiologically from FGR in singletons. The aim of this review is to summarize existing knowledge regarding the nutritional needs of preterm FGR and FGR infants of multiple gestation.
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Affiliation(s)
- Chrysoula Kosmeri
- Department of Pediatrics, University Hospital of Ioannina, 455 00 Ioannina, Greece
| | - Vasileios Giapros
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, 455 00 Ioannina, Greece
| | - Dimitrios Rallis
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, 455 00 Ioannina, Greece
| | - Foteini Balomenou
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, 455 00 Ioannina, Greece
| | - Anastasios Serbis
- Department of Pediatrics, University Hospital of Ioannina, 455 00 Ioannina, Greece
| | - Maria Baltogianni
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, 455 00 Ioannina, Greece
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Cauzzo C, Chiavaroli V, Di Valerio S, Chiarelli F. Birth size, growth trajectory and later cardio-metabolic risk. Front Endocrinol (Lausanne) 2023; 14:1187261. [PMID: 37342257 PMCID: PMC10277632 DOI: 10.3389/fendo.2023.1187261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/19/2023] [Indexed: 06/22/2023] Open
Abstract
There is increasing evidence of a strong association between intrauterine growth and subsequent development of chronic disease in adult life. Birth size and growth trajectory have been demonstrated to have an impact on cardio-metabolic health, both in childhood and adult life. Hence, careful observation of the children's growth pattern, starting from the intrauterine period and the first years of life, should be emphasized to detect the possible onset of cardio-metabolic sequelae. This allows to intervene on them as soon as they are detected, first of all through lifestyle interventions, whose efficacy seems to be higher when they are started early. Recent papers suggest that prematurity may constitute an independent risk factor for the development of cardiovascular disease and metabolic syndrome, regardless of birth weight. The purpose of the present review is to examine and summarize the available knowledge about the dynamic association between intrauterine and postnatal growth and cardio-metabolic risk, from childhood to adulthood.
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Affiliation(s)
- Chiara Cauzzo
- Department of Pediatrics, University of Chieti, Chieti, Italy
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9
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Hokken-Koelega ACS, van der Steen M, Boguszewski MCS, Cianfarani S, Dahlgren J, Horikawa R, Mericq V, Rapaport R, Alherbish A, Braslavsky D, Charmandari E, Chernausek SD, Cutfield WS, Dauber A, Deeb A, Goedegebuure WJ, Hofman PL, Isganatis E, Jorge AA, Kanaka-Gantenbein C, Kashimada K, Khadilkar V, Luo XP, Mathai S, Nakano Y, Yau M. International Consensus Guideline on Small for Gestational Age (SGA): Etiology and Management from Infancy to Early Adulthood. Endocr Rev 2023; 44:539-565. [PMID: 36635911 PMCID: PMC10166266 DOI: 10.1210/endrev/bnad002] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/31/2022] [Accepted: 01/10/2023] [Indexed: 01/14/2023]
Abstract
This International Consensus Guideline was developed by experts in the field of SGA of 10 pediatric endocrine societies worldwide. A consensus meeting was held and 1300 articles formed the basis for discussions. All experts voted about the strengths of the recommendations. The guideline gives new and clinically relevant insights into the etiology of short stature after SGA birth, including novel knowledge about (epi)genetic causes. Besides, it presents long-term consequences of SGA birth and new treatment options, including treatment with gonadotropin-releasing hormone agonist (GnRHa) in addition to growth hormone (GH) treatment, and the metabolic and cardiovascular health of young adults born SGA after cessation of childhood-GH-treatment in comparison with appropriate control groups. To diagnose SGA, accurate anthropometry and use of national growth charts are recommended. Follow-up in early life is warranted and neurodevelopment evaluation in those at risk. Excessive postnatal weight gain should be avoided, as this is associated with an unfavorable cardio-metabolic health profile in adulthood. Children born SGA with persistent short stature < -2.5 SDS at age 2 years or < -2 SDS at age of 3-4 years, should be referred for diagnostic work-up. In case of dysmorphic features, major malformations, microcephaly, developmental delay, intellectual disability and/or signs of skeletal dysplasia, genetic testing should be considered. Treatment with 0.033-0.067 mg GH/kg/day is recommended in case of persistent short stature at age of 3-4 years. Adding GnRHa treatment could be considered when short adult height is expected at pubertal onset. All young adults born SGA require counseling to adopt a healthy lifestyle.
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Affiliation(s)
- Anita C S Hokken-Koelega
- Department of Pediatrics, subdivision of Endocrinology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Manouk van der Steen
- Department of Pediatrics, subdivision of Endocrinology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Stefano Cianfarani
- Department of Systems Medicine, University of Rome 'Tor Vergata', Children's Hospital, Rome, Italy.,Diabetology and Growth Disorders Unit, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy.,Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Jovanna Dahlgren
- Department of Pediatrics, the Sahlgrenska Academy, the University of Gothenburg and Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Reiko Horikawa
- Division of Endocrinology and Metabolism, National Center for Child Health and Development, Tokyo, Japan
| | - Veronica Mericq
- Institute of Maternal and Child Research, faculty of Medicine, University of Chile
| | - Robert Rapaport
- Icahn School of Medicine, Division of Pediatric Endocrinology, Mount Sinai Kravis Children's Hospital, New York, NY, USA
| | | | - Debora Braslavsky
- Centro de Investigaciones Endocrinológicas "Dr. Cesar Bergadá" (CEDIE), División de Endocrinología, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Evangelia Charmandari
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, 'Aghia Sophia' Children's Hospital, 11527, Athens, Greece.,Division of Endocrinology and Metabolism, Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, 11527 Athens, Greece
| | - Steven D Chernausek
- Department of Pediatrics, Section of Diabetes and Endocrinology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Wayne S Cutfield
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Andrew Dauber
- Division of Endocrinology, Children's National Hospital, Washington, DC 20012, USA
| | - Asma Deeb
- Paediatric Endocrine Division, Sheikh Shakhbout Medical City and College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Wesley J Goedegebuure
- Department of Pediatrics, subdivision of Endocrinology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | - Alexander A Jorge
- Unidade de Endocrinologia Genética (LIM25) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Christina Kanaka-Gantenbein
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, 'Aghia Sophia' Children's Hospital, 11527, Athens, Greece
| | - Kenichi Kashimada
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | | | - Xiao-Ping Luo
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sarah Mathai
- Department of Pediatrics, Christian Medical College, Vellore, India
| | - Yuya Nakano
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | - Mabel Yau
- Icahn School of Medicine, Division of Pediatric Endocrinology, Mount Sinai Kravis Children's Hospital, New York, NY, USA
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10
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Nurani N, Wibowo T, Susilowati R, Hastuti J, Julia M, Van Weissenbruch MM. Growth of exclusively breastfed small for gestational age term infants in the first six months of life: a prospective cohort study. BMC Pediatr 2022; 22:73. [PMID: 35105325 PMCID: PMC8805422 DOI: 10.1186/s12887-021-03080-6] [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: 03/30/2021] [Accepted: 12/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Compared to their appropriate-for-gestational-age (AGA) peers, small-for-gestational-age (SGA) infants are prone to growth deficits. As the first 6 months of exclusive breastfeeding is generally recommended, it is essential to understand how this intervention might impact SGA infants' growth. This study aims to assess growth of exclusively breastfed SGA term infants in the first 6 months of life. METHODS A prospective cohort study was conducted on term infants born in Dr. Sardjito General Hospital and two private hospitals in Yogyakarta, Indonesia. SGA was defined as birth weight less than the 10th percentile according to Fenton criteria. Weight, length, and head circumference (HC) were measured at birth and monthly until 6 months old. RESULTS A total of 39 AGA and 17 SGA term infants who were exclusively breastfed in their first 6 months were included and followed. In SGA compared to AGA, birth weight, length, and HC (mean ± SD) were significantly lower (p < 0.001). During the first 6 months, the SGAs grew in weight and length in parallel with the AGAs. At sixth months of age, the weight and length (mean ± SD) of the SGAs were significantly lower compared to the AGAs (p < 0.001). However, HC (mean ± SD) of SGAs grew significantly faster than the AGAs (p < 0.005). At sixth months of age, there were no significant differences in HC between the two groups (p = 0.824). CONCLUSIONS In the first 6 months, exclusively breastfed SGA term infants, in contrast to weight and length, only show catch up growth in HC, leading to HC comparable to their AGA peers at the age of 6 months.
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Affiliation(s)
- Neti Nurani
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/ Dr. Sardjito General Hospital, Yogyakarta, Indonesia.
| | - Tunjung Wibowo
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/ Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Rina Susilowati
- Department of Histology and Cell Biology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Janatin Hastuti
- Department of Health Nutrition, Laboratory of Bioanthropology & Paleoanthropology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Madarina Julia
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/ Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Mirjam M Van Weissenbruch
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands
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North K, Marx Delaney M, Bose C, Lee ACC, Vesel L, Adair L, Semrau K. The effect of milk type and fortification on the growth of low-birthweight infants: An umbrella review of systematic reviews and meta-analyses. MATERNAL & CHILD NUTRITION 2021; 17:e13176. [PMID: 33733580 PMCID: PMC8189224 DOI: 10.1111/mcn.13176] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 01/29/2021] [Accepted: 02/16/2021] [Indexed: 01/08/2023]
Abstract
Approximately 15% of infants worldwide are born with low birthweight (<2500 g). These children are at risk for growth failure. The aim of this umbrella review is to assess the relationship between infant milk type, fortification and growth in low-birthweight infants, with particular focus on low- and lower middle-income countries. We conducted a systematic review in PubMed, CINAHL, Embase and Web of Science comparing infant milk options and growth, grading the strength of evidence based on standard umbrella review criteria. Twenty-six systematic reviews qualified for inclusion. They predominantly focused on infants with very low birthweight (<1500 g) in high-income countries. We found the strongest evidence for (1) the addition of energy and protein fortification to human milk (donor or mother's milk) leading to increased weight gain (mean difference [MD] 1.81 g/kg/day; 95% confidence interval [CI] 1.23, 2.40), linear growth (MD 0.18 cm/week; 95% CI 0.10, 0.26) and head growth (MD 0.08 cm/week; 95% CI 0.04, 0.12) and (2) formula compared with donor human milk leading to increased weight gain (MD 2.51 g/kg/day; 95% CI 1.93, 3.08), linear growth (MD 1.21 mm/week; 95% CI 0.77, 1.65) and head growth (MD 0.85 mm/week; 95% CI 0.47, 1.23). We also found evidence of improved growth when protein is added to both human milk and formula. Fat supplementation did not seem to affect growth. More research is needed for infants with birthweight 1500-2500 g in low- and lower middle-income countries.
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Affiliation(s)
- Krysten North
- Department of PediatricsUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Megan Marx Delaney
- Ariadne LabsBrigham Women's Hospital and Harvard TH Chan School of Public HealthBostonMassachusettsUSA
| | - Carl Bose
- Department of PediatricsUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Anne C. C. Lee
- Department of Pediatric Newborn MedicineBrigham and Women's HospitalBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
| | - Linda Vesel
- Ariadne LabsBrigham Women's Hospital and Harvard TH Chan School of Public HealthBostonMassachusettsUSA
| | - Linda Adair
- Department of Nutrition, Carolina Population Center, Gillings School of Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Katherine Semrau
- Ariadne LabsBrigham Women's Hospital and Harvard TH Chan School of Public HealthBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
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12
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Zong X, Wu H, Zhao M, Magnussen CG, Xi B. Global prevalence of WHO infant feeding practices in 57 LMICs in 2010-2018 and time trends since 2000 for 44 LMICs. EClinicalMedicine 2021; 37:100971. [PMID: 34386748 PMCID: PMC8343261 DOI: 10.1016/j.eclinm.2021.100971] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/01/2021] [Accepted: 06/01/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The World Health Assembly set a global target of increasing exclusive breastfeeding for infants under 6 months to at least 50% by year 2025. However, little is known about the current status of breastfeeding practice, as well as the trends in breastfeeding practices during recent years. We examined global prevalence of the World Health Organization (WHO) feeding practices in 57 low- and middle-income countries (LMICs) and time trends since 2000 for 44 selected countries. METHODS We included 57 eligible LMICs that had completed data on breastfeeding and complementary feeding in 2010-2018 from the Demographic and Health Surveys (DHS) for examining current feeding status. We further selected 44 LMICs that had two standard DHS surveys between 2000 and 2009 and 2010-2018 to examine time trends of feeding status. We calculated global, regional, and national weighted prevalence estimates and 95% confidence intervals (CIs) for five breastfeeding indicators and two complementary feeding indicators. FINDINGS In 57 LMICs during 2010-2018, global weighted prevalence was 51.9% for early initiation of breastfeeding, 45.7% for exclusive breastfeeding under 6 months, 32.0% for exclusive breastfeeding at 4-5 months, 83.1% for continued breastfeeding at 1 year, 56.2% for continued breastfeeding at 2 years, 14.9% for introduction of solid, semi-solid or soft foods under 6 months, and 63.1% for introduction of solid, semi-solid or soft foods at 6-8 months. Eastern Mediterranean (34.5%) and European regions (43.7%) (vs. South-East Asia/Western Pacific (55.2%)), and upper middle-income countries (38.4%) (vs. lower middle-income countries (47.4%)) had poorer performance of exclusive breastfeeding under 6 months. South-East Asia/Western Pacific regions (51.0%) (vs. other regions (68.3%-84.1%)) and low-income (66.4%) or lower middle-income countries (58.2%) (vs. upper middle-income countries (81.7%)) had lower prevalence of introduction of solid, semi-solid or soft foods at 6-8 months. In 44 selected LMICs from 2000 to 2009 to 2010-2018, total weighted prevalence presented an increase of 10.1% for exclusive breastfeeding under 6 months, but a 1.7% decrease for continued breastfeeding at 1 year. Over this period, the Eastern Mediterranean region had a 5.3% decrease of exclusive breastfeeding under 6 months, and the European region had a 2.0% increase for introduction of solid, semi-solid or soft foods under 6 months. The prevalence of introduction of solid, semi-solid or soft foods at 6-8 months decreased in South-East Asia/Western Pacific region by 15.2%, and in lower middle-income countries by 24.4%. INTERPRETATION Breastfeeding practices in LMICs have continued to improve in the past decade globally, but practices still lag behind the WHO feeding recommendations. Breastfeeding practices differed greatly across WHO regions, with the Eastern Mediterranean and European regions, and upper middle-income countries facing the greatest challenges in meeting targets. Continued efforts are needed to achieve the 2025 global breastfeeding target.
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Affiliation(s)
- Xin'nan Zong
- Department of Epidemiology, School of Public Health, Shandong University, 44 Wen Hua Xi Road, Jinan 250012, China
- Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China
| | - Han Wu
- Department of Epidemiology, School of Public Health, Shandong University, 44 Wen Hua Xi Road, Jinan 250012, China
| | - Min Zhao
- Departments of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China
| | - Costan G. Magnussen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Bo Xi
- Department of Epidemiology, School of Public Health, Shandong University, 44 Wen Hua Xi Road, Jinan 250012, China
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Wagner KJP, Rossi CE, Hinnig PDF, Alves MDA, Retondario A, Vasconcelos FDAGD. ASSOCIATION BETWEEN BREASTFEEDING AND OVERWEIGHT/OBESITY IN SCHOOLCHILDREN AGED 7-14 YEARS. ACTA ACUST UNITED AC 2021; 39:e2020076. [PMID: 33656144 PMCID: PMC7903410 DOI: 10.1590/1984-0462/2021/39/2020076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/29/2020] [Indexed: 11/29/2022]
Abstract
Objective: To evaluate the prevalence of breastfeeding (BF) and the association between occurrence/duration of BF and overweight/obesity in schoolchildren aged 7-14 years. Methods: This is a cross-sectional study, conducted in 2012-2013, on schoolchildren aged 7-14 years from Florianópolis, Santa Catarina, Southern Brazil. Weight and height were measured according to procedures of the World Health Organization. Breastfeeding and sociodemographic data were obtained from a questionnaire responded by parents/guardians. BF was categorized as a dichotomous variable (yes/no) and according to duration (months). Nutritional status was evaluated according to the Z score of the body mass index per age for sex and it was categorized into two groups: normal weight (<Z score+1) and overweight/obesity (≥Z score+1). The adjusted analysis was performed by logistic regression in two age strata (age groups of 7-10 and 11-14 years). Results: 6.6% of schoolchildren had never breastfed; 16.8% had been breastfed for ≤3 months; 16.7%, for 4-6 months; and 59.9%, for ≥7 months. No statistically significant differences were found in the occurrence and duration of BF between the age groups. The prevalence of overweight/obesity was 34.2%. For age groups (7-10 and 11-14 years), the prevalence of overweight/obesity was 36.7% and 29.8%, respectively. Chance of overweight/obesity for the age group of 7-10 years was lower among schoolchildren who were breastfed (OR=0.54; 95%CI 0.33-0.88), when compared with those who never breastfed. When categorized, the chance of overweight/obesity in the age group of 7-10 years was lower for duration of BF ≤3 months (OR=0.41; 95%CI 0.20-0.83), and 4-6 months (OR=0.48; 95%CI 0.28-0.82) when compared with children who never breastfed. Conclusions: BF for at least six months was associated with a lower chance of overweight/obesity for schoolchildren aged 7-10 years. No association was found for schoolchildren aged 11-14 years.
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Dimnjakovic J, Poljicanin T, Svajda M. Breastfeeding: A standard or an intervention? Review of systematic reviews. Med Hypotheses 2020; 141:109737. [DOI: 10.1016/j.mehy.2020.109737] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/06/2020] [Accepted: 04/09/2020] [Indexed: 12/11/2022]
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Bovbjerg ML, Irvin V. Current Resources for Evidence-Based Practice, March 2020. J Obstet Gynecol Neonatal Nurs 2020; 49:212-222. [PMID: 32061594 DOI: 10.1016/j.jogn.2020.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes a discussion of the concept of overdiagnosis and implications for research and commentaries on reviews focused on exogenous progestogen to maintain pregnancies and cancer risk among children conceived using fertility treatments.
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Postnatal management of growth failure in children born small for gestational age. J Pediatr (Rio J) 2019; 95 Suppl 1:23-29. [PMID: 30550759 DOI: 10.1016/j.jped.2018.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 10/05/2018] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To discuss the etiology and growth consequences of small size at birth and the indications, effects, and safety of biosynthetic growth hormone therapy in children born small for gestational age. SOURCE OF DATA A comprehensive and non-systematic search was carried out in the PubMed, LILACS, and SciELO databases from 1980 to the present day, using the terms "small for gestational age," "intrauterine growth restriction," and "growth hormone". The publications were critically selected by the authors. DATA SYNTHESIS Although the majority of children born small for gestational age show spontaneous catch-up growth during the first two years of life, some of them remain with short stature during childhood, with high risk of short stature in adult life. Treatment with growth hormone might be indicated, preferably after 2-4 years of age, in those small for gestational age children who remain short, without catch-up growth. Treatment aims to increase growth velocity and to reach a normal height during childhood and an adult height within target height. Response to growth hormone treatment is variable, with better growth response during the pre-pubertal period. CONCLUSIONS Treatment with growth hormone in short children born small for gestational age is safe and effective to improve adult height. Efforts should be done to identify the etiology of small size at birth before treatment.
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