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Perrin T, Pradat P, Larcade J, Masclef-Imbert M, Pastor-Diez B, Picaud JC. Postnatal growth and body composition in extremely low birth weight infants fed with individually adjusted fortified human milk: a cohort study. Eur J Pediatr 2023; 182:1143-1154. [PMID: 36598567 PMCID: PMC10023649 DOI: 10.1007/s00431-022-04775-3] [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: 10/06/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 01/05/2023]
Abstract
This cohort study aimed to evaluate the impact of an individualised nutritional care approach combining standardised fortification with adjustable fortification on postnatal growth and body composition in extremely low birth weight (ELBW) infants. We included ELBW infants admitted to a neonatal intensive care unit and still hospitalised at 35 weeks postmenstrual age (PMA). The fortification of human milk was standardised (multicomponent fortifier) between 70 mL/kg/day and full enteral feeding, and then individualised using adjustable fortification. When weight gain was below 20 g/kg/day, protein or energy was added when serum urea was below or above 3.5 mmol/L, respectively. Postnatal growth failure (PNGF) was defined as being small for gestational age at discharge and/or when the Z-score loss between birth and discharge was higher than 1. Body composition was assessed between 35 and 41 weeks of PMA. Among the 310 ELBW infants included, the gestational age of birth was 26.7 ± 1.8 weeks, and the birth weight was 800 ± 128 g. The mean Z-score difference between birth and discharge was moderately negative for the weight (-0.32), more strongly negative for length (-1.21), and almost nil for head circumference (+ 0.03). Only 27% of infants presented PNGF. At discharge, fat mass was 19.8 ± 3.6%. Multivariable analysis showed that the proportion of preterm formula received and gestational age at birth were independently associated with the percentage of fat mass. Conclusion: The individualised nutritional care approach applied herein prevented postnatal weight loss in most infants, limited length growth deficit, and supported excellent head circumference growth. What is Known: • At least half of extremely low birth weight infants are small for gestational age at discharge and postnatal growth deficit has been associated with impaired neurocognitive and renal development. • Human milk is the main milk used in neonatology and, although fortification of human milk is a standard of care, there is no consensus regarding the optimal fortification strategy to be adopted. What is New: • Using an approach combining standardised fortification followed by individualised adjustable fortification limited postnatal growth deficit for body weight and head circumference. Postnatal growth failure is not a fatality in extremely low birth weight infants. • Each additional gestational age week at birth resulted in a decrease in fat mass percentage at discharge, which was higher than in foetuses of the same gestational age, likely representing a necessary adaptation to extra-uterine life.
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Affiliation(s)
- Tania Perrin
- Service de Néonatologie, Hospices Civils de Lyon, Hôpital Universitaire de La Croix-Rousse, 103 Grande Rue de La Croix-Rousse, 69004, Lyon, 69677, France
| | - Pierre Pradat
- Centre de Recherche Clinique, Hospices Civils de Lyon, Hôpital Universitaire de La Croix-Rousse, Lyon, 69004, France
| | - Julie Larcade
- Service de Néonatologie, Hospices Civils de Lyon, Hôpital Universitaire de La Croix-Rousse, 103 Grande Rue de La Croix-Rousse, 69004, Lyon, 69677, France
| | - Marion Masclef-Imbert
- Service de Néonatologie, Hospices Civils de Lyon, Hôpital Universitaire de La Croix-Rousse, 103 Grande Rue de La Croix-Rousse, 69004, Lyon, 69677, France
| | - Blandine Pastor-Diez
- Service de Néonatologie, Hospices Civils de Lyon, Hôpital Universitaire de La Croix-Rousse, 103 Grande Rue de La Croix-Rousse, 69004, Lyon, 69677, France
| | - Jean-Charles Picaud
- Service de Néonatologie, Hospices Civils de Lyon, Hôpital Universitaire de La Croix-Rousse, 103 Grande Rue de La Croix-Rousse, 69004, Lyon, 69677, France.
- Laboratoire CarMen, INSERM, INRA, Université Claude Bernard Lyon1, Pierre-Bénite, Lyon, 69310, France.
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Lucaccioni L, Iughetti L, Berardi A, Predieri B. Challenges in the growth and development of newborns with extra-uterine growth restriction. Expert Rev Endocrinol Metab 2022; 17:415-423. [PMID: 35941822 DOI: 10.1080/17446651.2022.2110468] [Citation(s) in RCA: 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: 04/03/2022] [Accepted: 08/03/2022] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Extra-uterine growth restriction (EUGR) is a condition caused by the failure of very preterm infants to reach their potential growth during the NICU hospital stay. Despite enormous improvements in nutritional support and strategies, the growth pattern of preterm infants is still far from the one expected. AREAS COVERED This review focuses on what EUGR is, highlighting controversial aspects of this topic. EUGR is still missing a univocal definition, and the international debate is also open on what is the best growth chart to use. Moreover, professionals in NICU may not be trained on how to perform anthropometric measurements, increasing the risk of over- or underestimation, especially for length assessment. EUGR has recently been described as one of the main comorbidities in NICU, influencing growth, metabolism, and neurodevelopment later in life. EXPERT OPINION There is still much to investigate about what the best growth pattern in the NICU should be. What is known so far is that the majority of preterm neonates develop EUGR, and this leads to several short- and long-term consequences. It is imperative that neonatologists and pediatric endocrinologists work together, to modulate growth in the NICU.
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Affiliation(s)
- Laura Lucaccioni
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Lorenzo Iughetti
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Alberto Berardi
- Neonatology Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Barbara Predieri
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
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3
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Branagan A, Costigan CS, Stack M, Slagle C, Molloy EJ. Management of Acute Kidney Injury in Extremely Low Birth Weight Infants. Front Pediatr 2022; 10:867715. [PMID: 35433560 PMCID: PMC9005741 DOI: 10.3389/fped.2022.867715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/22/2022] [Indexed: 12/11/2022] Open
Abstract
Acute kidney injury (AKI) is a common problem in the neonatal intensive care unit (NICU). Neonates born at <1,000 g (extremely low birth weight, ELBW) are at an increased risk of secondary associated comorbidities such as intrauterine growth restriction, prematurity, volume restriction, ischaemic injury, among others. Studies estimate up to 50% ELBW infants experience at least one episode of AKI during their NICU stay. Although no curative treatment for AKI currently exists, recognition is vital to reduce potential ongoing injury and mitigate long-term consequences of AKI. However, the definition of AKI is imperfect in this population and presents clinical challenges to correct identification, thus contributing to under recognition and reporting. Additionally, the absence of guidelines for the management of AKI in ELBW infants has led to variations in practice. This review summarizes AKI in the ELBW infant and includes suggestions such as close observation of daily fluid balance, review of medications to reduce nephrotoxic exposure, management of electrolytes, maximizing nutrition, and the use of diuretics and/or dialysis when appropriate.
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Affiliation(s)
- Aoife Branagan
- Paediatrics, Trinity Research in Childhood Centre (TRICC), Trinity College Dublin, Dublin, Ireland.,Neonatology, Coombe Women's and Infants University Hospital, Dublin, Ireland
| | - Caoimhe S Costigan
- Nephrology, Children's Health Ireland (CHI) at Crumlin & Temple Street, Dublin, Ireland
| | - Maria Stack
- Paediatrics, Trinity Research in Childhood Centre (TRICC), Trinity College Dublin, Dublin, Ireland.,Nephrology, Children's Health Ireland (CHI) at Crumlin & Temple Street, Dublin, Ireland
| | - Cara Slagle
- Division of Neonatology & Pulmonary Biology and the Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,The University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Eleanor J Molloy
- Paediatrics, Trinity Research in Childhood Centre (TRICC), Trinity College Dublin, Dublin, Ireland.,Neonatology, Coombe Women's and Infants University Hospital, Dublin, Ireland.,Children's Hospital Ireland (CHI) at Tallaght, Dublin, Ireland.,Neonatology, Children's Health Ireland (CHI) at Crumlin, Dublin, Ireland
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4
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De Rose DU, Cota F, Gallini F, Bottoni A, Fabrizio GC, Ricci D, Romeo DM, Mercuri E, Vento G, Maggio L. Extra-uterine growth restriction in preterm infants: Neurodevelopmental outcomes according to different definitions. Eur J Paediatr Neurol 2021; 33:135-145. [PMID: 34243041 DOI: 10.1016/j.ejpn.2021.06.004] [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] [Received: 12/02/2020] [Revised: 06/16/2021] [Accepted: 06/19/2021] [Indexed: 10/21/2022]
Abstract
AIM Extra-uterine Growth Restriction (EUGR) is common among preterm infants. Two types of EUGR definitions are still now available: cross-sectional definitions and longitudinal ones. In a cohort of very preterm infants, we aimed to evaluate which definition could better predict neurodevelopmental outcomes at 2 years of corrected age. We used Italian Neonatal Study Charts (INeS) growth charts and INTERGROWTH-21st (IG-21) standard charts and compared results. METHOD We restrospectively collected data from clinical charts of 324 preterm newborns with a gestational age ≤30 weeks born from 2012 to 2017. Then we compared forty-eight definitions (24 cross-sectional and 24 longitudinal) of EUGR, in term of neurodevelopmental outcomes at 2 years of corrected age. RESULTS We included in the study 254 preterm infants, whose clinical information met the enrolment criteria. Nineteen out of 48 definitions of EUGR were significantly predictive both for Griffith's Development Quotient (GDQ) and Neurodevelopment Impairment (NDI). Among these, longitudinal definitions appeared to have a higher negative predictive value for NDI than cross-sectional ones. Furthermore, infants with EUGR appeared to have a lower cognitive score than their peers without EUGR. INTERPRETATION A loss of Zs > 1 SDS in weight and head circumference, calculated from when physiological weight loss is over and identified as soon as possible rather than at discharge, better predicts neurodevelopmental outcomes of preterm infants.
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Affiliation(s)
- Domenico Umberto De Rose
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy; Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus - Newborn - Infant, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy.
| | - Francesco Cota
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Francesca Gallini
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Anthea Bottoni
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Giovanna Carmela Fabrizio
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Daniela Ricci
- Pediatric Neurology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy; National Centre of Services and Research for the Prevention of Blindness and Rehabilitation of Low Vision Patients - IAPB Italia Onlus, Rome, Italy
| | - Domenico Marco Romeo
- Università Cattolica Del Sacro Cuore, Rome, Italy; Pediatric Neurology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Eugenio Mercuri
- Università Cattolica Del Sacro Cuore, Rome, Italy; Pediatric Neurology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Giovanni Vento
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Luca Maggio
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy; Università Cattolica Del Sacro Cuore, Rome, Italy
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5
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Montealegre-Pomar ADP, Bertolotto-Cepeda AM, Romero-Marquez Y, Muñoz-Ramírez KJ. Effectiveness and Safety of Fast Enteral Advancement in Preterm Infants Between 1000 and 2000 g of Birth Weight. JPEN J Parenter Enteral Nutr 2020; 45:578-586. [PMID: 32441852 DOI: 10.1002/jpen.1925] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 05/11/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND The advancement of enteral nutrition in premature infants is still controversial. Clinicians must provide adequate caloric intake but avoiding feeding intolerance and necrotizing enterocolitis (NEC). The aim of this study was to establish the safety and effectiveness of fast enteral advancement by comparing it with traditional advancement. METHODS This is a controlled randomized clinical trial. Feeding was advanced at 30 mL/kg/d vs 20 mL/kg/d in premature infants under 34 weeks between 1000 and 1499g birth weight, and at 40 mL/kg/d vs 20 mL/kg/day in those weighing 1500-1999 g. Outcomes included time to reach total enteral nutrition, days of parenteral nutrition (PN) and/or intravenous fluid (IVF), days to recover birth weight, episodes of feeding intolerance, growth and weight gain at 40 weeks, sepsis, hypoglycemia, hyperbilirubinemia, NEC, and mortality. Student t-test or Mann-Whitney U test, Fisher test or χ2 test, and multiple linear regression were used. RESULTS Differences were found in days to reach total enteral nutrition (slow: 7 [IQR(interquartile range), 6-9], fast: 4 [IQR, 4-6]; P < .001) and days of IVF or PN (slow: 6 [IQR, 4-8], fast: 3 [IQR, 3-5]; P < .001). Fast advancement decreases time to total enteral nutrition by 3 days and PN and/or IVF by up to 5 days. There were no differences in other outcomes. CONCLUSIONS Fast enteral advancement decreases the days to reach total enteral nutrition and the days of PN and/or IVF without causing greater feeding intolerance. Additional studies are required for more evidence.
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Affiliation(s)
| | - Ana María Bertolotto-Cepeda
- Pediatrics Department, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Cra 7#40-62, Bogotá, 11001, Colombia
| | - Yoliseth Romero-Marquez
- Pediatrics Department, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Cra 7#40-62, Bogotá, 11001, Colombia
| | - Kelly José Muñoz-Ramírez
- Pediatrics Department, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Cra 7#40-62, Bogotá, 11001, Colombia
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6
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Buyukeren M, Yigit S, Buyukcam A, Kara A, Celik HT, Yurdakok M. A new use of Lactobacillus rhamnosus GG administration in the NICU: colonized vancomycin-resistant enterococcus eradication in the gastrointestinal system. J Matern Fetal Neonatal Med 2020; 35:1192-1198. [PMID: 32208789 DOI: 10.1080/14767058.2020.1743671] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Introduction: Enterococci are microbiota microorganisms that normally have low virulence; however, under some conditions they may cause community-acquired urinary tract and even hospital-acquired serious infections. Vancomycin-resistant enterococci (VRE) can cause aggressive infections in immunosuppressive patients; especially in newborns in intensive care units. Asymptomatic gastrointestinal system carriers are important sources of VRE. Asymptomatic patients colonized by VRE can infect both other patients and the environment. Prevention of gastrointestinal colonization of VRE is an important issue to prevent VRE infection, and for rational use of hospital source.Method: This study was carried out at Hacettepe University, Faculty of Medicine in Newborn Intensive Care Unit between November 2015 and March 2017. The newborn infants who were find as colonized by VRE during weekly surveillance VRE rectal stool culture screening were taken into the study. A single dose of one million colonies of Lactobacillus rhamnosus GG (LGG®) was given to the study group daily. The probiotic supplement continued until consecutive three negative cultures were detected or maximum 6 months. Control group received conventional treatment.Results: In the study group, VRE eradication was successful in 21 patients out of 22 within 6 months and 1 patient was still VRE positive at 6 months. In the control group, VRE was eradicated in 12 patients out of 23 and 11 patients continued to be colonized by VRE at 6 months. There was a statistically significant difference between the groups (p <.05).Conclusion: Lactobacillus rhamnosus GG use is associated with early clearance of vancomycin-resistant enterococcus in newborn patients.
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Affiliation(s)
- Melek Buyukeren
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sule Yigit
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ayse Buyukcam
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ates Kara
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Hasan Tolga Celik
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Murat Yurdakok
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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7
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Abdelrahman K, Jarjour J, Hagan J, Yang H, Sutton D, Hair A. Optimizing Delivery of Breast Milk for Premature Infants: Comparison of Current Enteral Feeding Systems. Nutr Clin Pract 2019; 35:697-702. [PMID: 31713294 PMCID: PMC7383482 DOI: 10.1002/ncp.10436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Incomplete delivery of fat from expressed breast milk (EBM) during enteral feeding to premature neonates remains a significant problem. Feeding system manufacturers have introduced changes to the enteral syringe design to improve fat delivery that have not yet been evaluated in the literature. Methods This study compares percentage delivery of fat from EBM using 2 major enteral feeding systems in various configurations with silicone and polyurethane tubing material and ENFit and Legacy connection systems at 3 clinically relevant infusion rates. Results The percent of fat delivery from EBM was significantly higher for the eccentric syringe system than the concentric system (P = 0.036) but did not vary significantly across infusion rates (P = 0.081). Silicone tubing had a significantly higher percent of fat delivery than polyurethane tubing within the eccentric syringe system (P = 0.039) but did not vary significantly across infusion rates (P = 0.105). There was no significant difference between ENFit and Legacy connectors using eccentric syringes with silicone tubing (P = 0.360). Conclusion We demonstrate that changes to syringe design and tubing material are effective and improve fat delivery from EBM, which may result in improved growth and outcomes in premature infants. The eccentric syringe marginally improves fat delivery in comparison with the concentric syringe, and silicone tubing significantly improves fat delivery compared with polyurethane tubing.
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Affiliation(s)
| | - Jane Jarjour
- Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Joseph Hagan
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Heeju Yang
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Danielle Sutton
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Amy Hair
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
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8
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Hansson L, Lind T, Wiklund U, Öhlund I, Rydberg A. Fluid restriction negatively affects energy intake and growth in very low birthweight infants with haemodynamically significant patent ductus arteriosus. Acta Paediatr 2019; 108:1985-1992. [PMID: 30980416 DOI: 10.1111/apa.14815] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 04/08/2019] [Accepted: 04/09/2019] [Indexed: 11/27/2022]
Abstract
AIM We explored if fluid restriction in very low birthweight (VLBW) infants with a haemodynamically significant patent ductus arteriosus (PDA) affected energy and protein intakes and growth. METHODS Retrospectively, we identified 90 VLBW infants that were admitted to Umea University Hospital, Sweden, between 2009 and 2012: 42 with and 48 without haemodynamically significant PDA (hsPDA). Anthropometric, fluid, energy and protein intake data during the first 28 days of life were expressed as z-scores. RESULTS In the 42 infants diagnosed with hsPDA, fluid intake was restricted after diagnosis, resulting in a decrease in energy and protein intake. No decrease was observed in the other 48 infants in the cohort. Multivariate analysis showed that the z-score of weight change depended on both ductus arteriosus status and energy intake; thus, infants with hsPDA did not grow as expected with the energy provided to them. CONCLUSION Energy and protein intake was diminished in prematurely born infants with hsPDA when fluid was restricted after diagnosis. The initial reduction in intakes may have contributed to the lower postnatal growth observed in these infants.
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Affiliation(s)
- Lena Hansson
- Department of Clinical Science Paediatrics Umeå University Umeå Sweden
| | - Torbjörn Lind
- Department of Clinical Science Paediatrics Umeå University Umeå Sweden
| | - Urban Wiklund
- Department of Radiation Sciences Biomedical Engineering Umeå University Umeå Sweden
| | - Inger Öhlund
- Department of Clinical Science Paediatrics Umeå University Umeå Sweden
| | - Annika Rydberg
- Department of Clinical Science Paediatrics Umeå University Umeå Sweden
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9
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Valid serial length measurements in preterm infants permit characterization of growth patterns. J Perinatol 2018; 38:1694-1701. [PMID: 30267002 DOI: 10.1038/s41372-018-0242-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 08/15/2018] [Accepted: 08/20/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND The lack of a valid and safe method for measuring length in critically ill preterm neonates has led to a primary focus on weight gain. LOCAL PROBLEM Paucity of valid length measurements, precluding the accurate analysis of growth patterns. METHODS Quality improvement project among infants < 29 weeks or small for gestational age < 35 weeks with embedded validation of (1) a caliper (infantometer) for length measurements and (2) length measurements during the first week to estimate birth length. INTERVENTION Implementation of valid methods to measure length. RESULTS We validated infantometer measurements and first week length measurements. The percentage of neonates with valid measurements during the first week rose from 10% to 78%, resulting in increased identification of classifiable growth patterns from < 10% to 89%. CONCLUSIONS By increasing the percentage of neonates with valid length measurements in the first week postnatal, we identified an increased number of neonates with classifiable growth abnormalities.
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10
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Darmaun D, Lapillonne A, Simeoni U, Picaud JC, Rozé JC, Saliba E, Bocquet A, Chouraqui JP, Dupont C, Feillet F, Frelut ML, Girardet JP, Turck D, Briend A. Parenteral nutrition for preterm infants: Issues and strategy. Arch Pediatr 2018; 25:286-294. [PMID: 29656825 DOI: 10.1016/j.arcped.2018.02.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 01/26/2018] [Accepted: 02/18/2018] [Indexed: 01/13/2023]
Abstract
Due to transient gut immaturity, most very preterm infants receive parenteral nutrition (PN) in the first few weeks of life. Yet providing enough protein and energy to sustain optimal growth in such infants remains a challenge. Extrauterine growth restriction is frequently observed in very preterm infants at the time of discharge from hospital, and has been found to be associated with later impaired neurodevelopment. A few recent randomized trials suggest that intensified PN can improve early growth; whether or not such early PN improves long-term neurological outcome is still unclear. Several other questions regarding what is optimal PN for very preterm infants remain unanswered. Amino acid mixtures designed for infants contain large amounts of branched-chain amino acids and taurine, but there is no consensus on the need for some nonessential amino acids such as glutamine, arginine, and cysteine. Whether excess growth in the first few weeks of life, at a time when very preterm infants receive PN, has an imprinting effect, increasing the risk of metabolic or vascular disease at adulthood continues to be debated. Even though uncertainty remains regarding the long-term effect of early PN, it appears reasonable to propose intensified initial PN. The aim of the current position paper is to review the evidence supporting such a strategy with regards to the early phase of nutrition, which is mainly covered by parenteral nutrition. More randomized trials are, however, needed to further support this type of approach and to demonstrate that this strategy improves short- and long-term outcome.
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Affiliation(s)
- D Darmaun
- Université Nantes-Atlantique, 44300 Nantes, France.
| | | | - U Simeoni
- Université de Lausanne, CHUV, 1011 Lausanne, Suisse
| | - J-C Picaud
- Université Claude-Bernard-Lyon 1, 69008 Lyon, France
| | - J-C Rozé
- Université Nantes-Atlantique, 44300 Nantes, France
| | - E Saliba
- Université François-Rabelais, 37000 Tours, France
| | - A Bocquet
- Université de Franche-Comté, 25000 Besançon, France
| | | | - C Dupont
- Université Paris Descartes, 75006 Paris, France
| | - F Feillet
- Université de Lorraine, 54000 Nancy, France
| | - M-L Frelut
- Université Paris-Sud, CHU de Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - J-P Girardet
- Université Pierre et Marie Curie-Paris 6, 75005 Paris, France
| | - D Turck
- Université Lille 2, LIRIC-Inserm U995, 59037 Lille, France
| | - A Briend
- Institut de recherche pour le développement, 13572 Marseille, France
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11
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Nutrition Practices and Predictors of Postnatal Growth in Preterm Infants During Hospitalization: A Longitudinal Study. J Pediatr Gastroenterol Nutr 2018; 66:312-317. [PMID: 28953525 DOI: 10.1097/mpg.0000000000001747] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
UNLABELLED Premature infants are at high risk of undernutrition and extrauterine growth restriction. AIM The aim of the study was to evaluate the relation between nutrition practices and growth rate in preterm infants from birth to 36 weeks postmenstrual age (PMA). METHODS Longitudinal data were collected retrospectively in 103 infants born <33 weeks gestation admitted to Dunedin Neonatal Intensive Care Unit, New Zealand. Weight, length, and head circumference at birth and 36 weeks PMA z scores were calculated using the INTERGROWTH Preterm Growth Standard. Growth velocity (g · kg · day) was determined via exponential model. Time to regain birth weight and nutritional practices including enteral nutrition, withholding feeds, nutrient intake, and feeding at discharge were described. Regression was used to explore associations between growth and nutritional variables. RESULTS Growth faltering (weight-for-age z score <-1.28/10th centile) increased from 9% at birth to 19% at 36 weeks PMA. Mean (standard deviation) growth velocity in-hospital (14.2 [3.3] g · kg · day) was well below the desirable rate of 18 g · kg · day. Forty-one percent of infants had feeds withheld, which was significantly associated with a longer time period to achieve full enteral feedings (P < 0.001) and poorer weight and length z score at 36 weeks PMA (both P < 0.05). The day of life to establish full enteral feedings was longer than recommended yet positively associated with weight at 36 weeks PMA (P = 0.019), whereas controlling for withholding feeds and other known confounders. CONCLUSIONS Extrauterine growth restriction was highly prevalent in this population. The negative association of withholding of feeds on growth reinforces the need to evaluate early life feeding protocols and further assess the longer-term influence of this practice on postdischarge growth outcomes.
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Brennan AM, Fenton S, Murphy BP, Kiely ME. Transition Phase Nutrition Recommendations: A Missing Link in the Nutrition Management of Preterm Infants. JPEN J Parenter Enteral Nutr 2017; 42:343-351. [PMID: 28555514 DOI: 10.1177/0148607116686289] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 12/01/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite the availability of international nutrition recommendations, preterm infants remain vulnerable to suboptimal nutrition. The standard approach of assessing nutrient intakes chronologically may make it difficult to identify the origin of nutrient deficits and/or excesses. OBJECTIVE To develop a "nutrition phase" approach to evaluating nutrition support, enabling analysis of nutrient intakes during the period of weaning from parenteral nutrition (PN) to enteral nutrition (EN), called the transition (TN) phase, and compare the data with those analyzed using the standard "chronological age" approach to assess whether the identification of nutrient deficits and/or excesses can be improved. METHODS Analysis of a comprehensive nutrition database developed using actual nutrient intake data collected on an hourly basis in 59 preterm infants (birth weight ≤1500 g, gestation <34 weeks) over the period of PN delivery (range, 2-21 days). RESULTS The nutrition phase analysis approach revealed substantial macronutrient and energy deficits during the TN phase. In particular, deficits were identified as maximal during the EN-dominant TN phase (enteral feeds ≥80 mL/kg/d) of the infant's nutrition course. In contrast, the chronological age analysis approach did not reveal a corresponding pattern of deficit occurrence but rather intakes that approximated or exceeded recommendations. CONCLUSION Actual intakes of nutrients, analyzed using a nutrition phase approach to evaluating nutrition support, enabled a more infant-driven rather than age-driven application of nutrition recommendations. This approach unmasked nutrient deficits occurring during the transition phase. Overcoming nutrient deficits in this nutrition phase should be prioritized to improve the nutrition management of preterm infants.
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Affiliation(s)
- Ann-Marie Brennan
- Department of Clinical Nutrition and Dietetics, Cork University Maternity Hospital, Cork, Ireland.,Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland.,The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
| | - Sarah Fenton
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland.,Pharmacy Department, Cork University Hospital, Cork, Ireland
| | - Brendan P Murphy
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland.,Department of Neonatology, Cork University Maternity Hospital, Cork, Ireland
| | - Mairead E Kiely
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland.,The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
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Butin M, Rasigade JP, Subtil F, Martins-Simões P, Pralong C, Freydière AM, Vandenesch F, Tigaud S, Picaud JC, Laurent F. Vancomycin treatment is a risk factor for vancomycin-nonsusceptible Staphylococcus capitis sepsis in preterm neonates. Clin Microbiol Infect 2017; 23:839-844. [PMID: 28373147 DOI: 10.1016/j.cmi.2017.03.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/20/2017] [Accepted: 03/27/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Multidrug-resistant, vancomycin-nonsusceptible Staphylococcus capitis is an emerging cause worldwide of late-onset sepsis (LOS) in preterm neonates. The pathophysiology and risk factors for S. capitis-related LOS are poorly understood, but we hypothesized that S. capitis LOS follows translocation from the gut microbiota rather than catheter invasion. The objective of this study was to investigate the risk factors of S. capitis LOS and gut colonization. METHODS We conducted a prospective single-centre cohort study of patients hospitalized in a tertiary-care unit (Lyon, France) from June 2011 to January 2012. S. capitis gut colonization was determined weekly from stool cultures. The determinants of gut colonization and LOS were established by multivariate Cox proportional hazards models. RESULTS Eighty-three (36.2%) of 229 patients had S. capitis-positive stool culture, and 28 (12.2%) developed S. capitis LOS during hospitalization. Independent risk factors for S. capitis LOS included prior administration of vancomycin independent of a previous LOS episode (hazard ratio 6.44, 95% confidence interval 2.15-19.3, p 0.001) and low birth weight (hazard ratio 0.72 per 100 g increase, 95% confidence interval 0.55-0.95, p 0.02). The prior administration of vancomycin was also an independent risk factor for S. capitis colonization (hazard ratio 3.45, 95% confidence interval 2.07-5.76, p <0.001), particularly in the first week of life and in noncolonized neonates. CONCLUSIONS Neonates treated with vancomycin are at a higher risk of LOS caused by vancomycin-nonsusceptible S. capitis. The use of vancomycin in neonates must urgently be optimized to limit the selection of vancomycin-nonsusceptible strains, for which alternative antibiotics are lacking.
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Affiliation(s)
- M Butin
- International Center of Research in Infectiology, INSERM U1111, CNRS UMR5308, Ecole Normale Supérieure, France.
| | - J-P Rasigade
- International Center of Research in Infectiology, INSERM U1111, CNRS UMR5308, Ecole Normale Supérieure, France; Institute of Infectious Agents, France; National Reference Center for Staphylococci, France
| | - F Subtil
- Department of Biostatistics, CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, France
| | - P Martins-Simões
- International Center of Research in Infectiology, INSERM U1111, CNRS UMR5308, Ecole Normale Supérieure, France; National Reference Center for Staphylococci, France
| | - C Pralong
- Institute of Infectious Agents, France
| | | | - F Vandenesch
- International Center of Research in Infectiology, INSERM U1111, CNRS UMR5308, Ecole Normale Supérieure, France; Institute of Infectious Agents, France; National Reference Center for Staphylococci, France
| | - S Tigaud
- Institute of Infectious Agents, France
| | - J-C Picaud
- Neonatal Intensive Care Unit, Northern Hospital Group, Hospices Civils de Lyon, Lyon, France
| | - F Laurent
- International Center of Research in Infectiology, INSERM U1111, CNRS UMR5308, Ecole Normale Supérieure, France; Institute of Infectious Agents, France; National Reference Center for Staphylococci, France; Department of Microbiology-Mycology, Institut des Sciences Pharmaceutiques et Biologiques de Lyon, University of Lyon, France
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Raaijmakers A, Allegaert K. Catch-Up Growth in Former Preterm Neonates: No Time to Waste. Nutrients 2016; 8:nu8120817. [PMID: 27999303 PMCID: PMC5188471 DOI: 10.3390/nu8120817] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 12/14/2016] [Indexed: 11/20/2022] Open
Affiliation(s)
- Anke Raaijmakers
- Department of Pediatrics, University Hospitals Leuven, Leuven B-3000, Belgium.
- Department of Development and Regeneration, KU Leuven, Leuven B-3000, Belgium.
| | - Karel Allegaert
- Department of Development and Regeneration, KU Leuven, Leuven B-3000, Belgium.
- Intensive Care and Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam 3015 CN, The Netherlands.
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Pandey V, Kumar D, Vijayaraghavan P, Chaturvedi T, Raina R. Non-dialytic management of acute kidney injury in newborns. J Renal Inj Prev 2016; 6:1-11. [PMID: 28487864 PMCID: PMC5414511 DOI: 10.15171/jrip.2017.01] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 10/10/2016] [Indexed: 01/04/2023] Open
Abstract
Treating acute kidney injury (AKI) in newborns is often challenging due to the functional immaturity of the neonatal kidney. Because of this physiological limitation, renal replacement therapy (RRT) in this particular patient population is difficult to execute and may lead to unwanted complications. Although fluid overload and electrolyte abnormalities, as seen in neonatal AKI, are indications for RRT initiation, there is limited evidence that RRT initiated in the first year of life improves long-term outcome. The underlying cause of AKI in a newborn patient should determine the treatment strategies to restore appropriate renal function. However, our understanding of this common clinical condition remains limited, as no standardized, evidence-based definition of neonatal AKI currently exists. Non-dialytic management of AKI in these patients may restore appropriate renal function to these patients without exposure to complications often encountered with RRT.
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Affiliation(s)
- Vishal Pandey
- Department of Pediatrics and Neonatology, University of Kansas Hospital, Kansas City, KS, USA
| | - Deepak Kumar
- Department of Pediatrics and Neonatology, MetroHealth Medical Center, Cleveland, OH, USA
| | - Prashant Vijayaraghavan
- Division of Nephrology, Department of Internal Medicine and Research Cleveland Clinic Akron General, Akron, OH, USA 4Akron Children's Hospital, Cleveland, OH, USA
| | - Tushar Chaturvedi
- Division of Nephrology, Department of Internal Medicine and Research Cleveland Clinic Akron General, Akron, OH, USA 4Akron Children's Hospital, Cleveland, OH, USA
| | - Rupesh Raina
- Division of Nephrology, Department of Internal Medicine and Research Cleveland Clinic Akron General, Akron, OH, USA 4Akron Children's Hospital, Cleveland, OH, USA.,Akron Children's Hospital, Cleveland, OH, USA
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16
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Flidel-Rimon O, Raz M, Balla U, Hofi L, Juster-Reicher A, Shinwell ES. Early, rapidly progressive enteral nutrition promotes growth of very low birth weight (VLBW) infants. J Matern Fetal Neonatal Med 2016; 30:1227-1231. [DOI: 10.1080/14767058.2016.1209651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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17
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Additional Protein Fortification Is Necessary in Extremely Low-Birth-Weight Infants Fed Human Milk. J Pediatr Gastroenterol Nutr 2016; 63:103-5. [PMID: 26859094 DOI: 10.1097/mpg.0000000000001142] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
In the present study, approximately one in three (49/152, 32.2%) extremely low-birth-weight infants were demonstrated to require additional protein intake to supplement the standard fortification to achieve satisfactory weight gain. This additional protein fortification also resulted in a rapid increase in length-for-age (P < 0.001) and head circumference-for-age (P = 0.02) z scores.
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18
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Mena P, Milad M, Vernal P, Escalante MJ. [Nutrition in the preterm hospitalized newborn. Recommendations of the Chilean Neonatology Branch, Chilean Pediatric Society]. ACTA ACUST UNITED AC 2016; 87:305-21. [PMID: 27156140 DOI: 10.1016/j.rchipe.2016.03.007] [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: 03/24/2016] [Accepted: 03/29/2016] [Indexed: 11/27/2022]
Abstract
Recommendations based on current publications are presented for postnatal preterm nutrition, depending on birth weight: less 1000g, between 1000 and 1500g, and above 1500g, as well for the development periods: adaptation, stabilisation, and growth. A review is also presented on the nutritional management of morbidities that affect or may affect nutrition, such as: osteopenia, bronchopulmonary dysplasia, patent ductus arteriosus, red cell transfusion, and short bowel syndrome.
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Affiliation(s)
- Patricia Mena
- Departamento de Neonatología, Facultad de Medicina, Pontificia Universidad Católica de Chile y Servicio de Recién Nacidos Hospital Dr. Sótero del Río, Santiago, Chile.
| | - Marcela Milad
- Servicio de Neonatología, Clínica Santa María, Santiago, Chile
| | - Patricia Vernal
- Servicio de Recién Nacidos, Hospital San José, Santiago, Chile
| | - M José Escalante
- Departamento de Neonatología, Facultad de Medicina, Pontificia Universidad Católica de Chile y Servicio de Recién Nacidos Hospital Dr. Sótero del Río, Santiago, Chile
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19
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Lapointe M, Barrington KJ, Savaria M, Janvier A. Preventing postnatal growth restriction in infants with birthweight less than 1300 g. Acta Paediatr 2016; 105:e54-9. [PMID: 26452335 DOI: 10.1111/apa.13237] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 09/28/2015] [Accepted: 10/05/2015] [Indexed: 11/27/2022]
Abstract
AIM To examine nutritional and growth outcomes in very preterm infants with a birthweight (BW) of ≤1300 g before and after the introduction of enhanced enteral and parenteral nutrition protocols. METHODS A comparison of two historical cohorts. RESULTS There were 153 infants in cohort 1 and 118 in cohort 2. A total of 19% were growth restricted at birth in both cohorts. Feeds advanced more quickly in cohort 2, with decreased duration of central lines and TPN; breastmilk fortification occurred sooner. Calorie and protein intakes were increased during all of the first 14 days of life. Adverse clinical outcomes were unchanged, including NEC. The proportion of infants discharged <10th percentile of expected weight, decreased from 23% to 9%. In cohort 2, the z-score for body weight decreased by 0.39, compared to an average 1.03 in cohort 1 (p < 0.001). Head circumference and body weight were also significantly improved at discharge (p < 0.01), but length was improved to a lesser degree. CONCLUSION Early and enhanced postnatal intravenous and enteral feeding can provide good postnatal growth among very immature infants without adverse effects. Calorie and particularly protein intake in early life could probably be further optimised.
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Affiliation(s)
- M Lapointe
- Division of Neonatology; Sainte-Justine Hospital; Montreal QC Canada
| | - KJ Barrington
- Division of Neonatology; Sainte-Justine Hospital; Montreal QC Canada
- Department of Pediatrics; Sainte-Justine Hospital Research Center; University of Montreal; Montréal QC Canada
| | - M Savaria
- Division of Neonatology; Sainte-Justine Hospital; Montreal QC Canada
| | - A Janvier
- Division of Neonatology; Sainte-Justine Hospital; Montreal QC Canada
- Department of Pediatrics; Sainte-Justine Hospital Research Center; University of Montreal; Montréal QC Canada
- Clinical Ethics University of Montreal and Hôpital Sainte-Justine; Montréal QC Canada
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20
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Rayyan M, Rommel N, Allegaert K. The Fate of Fat: Pre-Exposure Fat Losses during Nasogastric Tube Feeding in Preterm Newborns. Nutrients 2015; 7:6213-23. [PMID: 26230707 PMCID: PMC4555118 DOI: 10.3390/nu7085279] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 07/15/2015] [Accepted: 07/23/2015] [Indexed: 01/08/2023] Open
Abstract
Deficient nutritional support and subsequent postnatal growth failure are major covariates of short- and long-term outcome in preterm neonates. Despite its relevance, extrauterine growth restriction (EUGR) is still prevalent, occurring in an important portion of extremely preterm infants. Lipids provide infants with most of their energy needs, but also cover specific supplies critical to growth, development and health. The use of human milk in preterm neonates results in practices, such as milk storage, pasteurization and administration by an infusion system. All of these pre-exposure manipulations significantly affect the final extent of lipid deposition in the intestinal track available for absorption, but the impact of tube feeding is the most significant. Strategies to shift earlier to oral feeding are available, while adaptations of the infusion systems (inversion, variable flow) have only more recently been shown to be effective in “in vitro”, but not yet in “in vivo” settings. Pre-exposure-related issues for drugs and nutritional compounds show similarities. Therefore, we suggest that the available practices for “in vitro” drug evaluations should also be considered in feeding strategies to further reduce pre-exposure losses as a strategy to improve the nutritional status and outcome of preterm neonates.
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Affiliation(s)
- Maissa Rayyan
- Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
- Neonatal Intensive Care Unit, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Nathalie Rommel
- Translational Research Center for Gastrointestinal Diseases, KU Leuven, 3000 Leuven, Belgium.
- Neuro-gastroenterology and Motility, Gastroenterology, 3000 Leuven, Belgium.
- Neurosciences, Exp ORL, KU Leuven, Herestraat 49, O & N 2, PO Box 79, 3000 Leuven, Belgium.
| | - Karel Allegaert
- Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
- Neonatal Intensive Care Unit, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
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Abstract
BACKGROUND & AIMS Recent studies have suggested that the gut microflora has metabolic effects. We aimed to evaluate postnatal growth in preterm infants who received different probiotic supplements, and to assess the safety of probiotic administration. METHODS This prospective, randomized, double-blind, controlled trial was performed at three tertiary care neonatal units. Preterm infants were randomly assigned to receive daily supplementation over 4-6 weeks with placebo (group C) or probiotics (group P). Group P comprised three subgroups: P1 received Bifidobacterium lactis, P2 received Bifidobacterium longum, and P3 received B. lactis and B. longum. We assessed postnatal growth during the supplementation period and up to a corrected gestational age (GA) of 41 weeks when body composition was assessed using whole-body dual-energy X-ray absorptiometry. Aerobic and anaerobic blood cultures were performed on suspicion of late-onset sepsis. RESULTS The study comprised 199 preterm infants with a mean GA of 29.1 ± 1.4 weeks and a mean birth weight of 1173 ± 210 g, who received a placebo (group C, n = 52) or probiotics (group P, n = 147) from the first week of life. At the end of the supplementation period, no statistically significant differences were seen between the groups in relation to the mean body weight (group C = 1906 ± 23 g, group P = 1875 ± 14 g, p = 0.25), length, or head circumference. The incidence rates of necrotizing enterocolitis and late-onset sepsis were similar in the two groups. At the corrected GA of 41 weeks, there were no differences between the groups with respect to anthropometric measurements or body composition analysis. CONCLUSIONS Preterm infants receiving Bifidobacterium supplements did not exhibit better postnatal growth compared with those who received placebo treatment. No adverse effects were associated with probiotic administration. Registered under ClinicalTrials.gov Identifier no. NCT01379417.
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Abstract
PURPOSE OF REVIEW To outline new evidence published from 2013 to 2014 about breast milk fortification in preterm infants. RECENT FINDINGS Breast milk is the feeding choice for preterm infants because of its immunoprotective properties. However, breast milk's nutrient content is not sufficient for preterm infants, and interindividual variation is high. The variation challenges standard fortification, which assumes a standard breast milk composition. Two new fortification strategies (adjustable fortification and target fortification) optimize macronutrient intake and improve growth. Adjustable fortification uses blood urea nitrogen levels to adjust fortifier strength. Target fortification analyzes breast milk and fortifies macronutrients individually to achieve targeted intake. Its feasibility is shown in clinical routine. Current breast milk analyzers used for target fortification achieve acceptable precision for protein and fat but not for lactose and energy. Evidence of benefits for postdischarge breast milk fortification is lacking. Eliminating cow's milk products and feeding exclusively breast milk may decrease the occurrence of feeding intolerance and necrotizing enterocolitis. To facilitate exclusively breast milk diets, a collaboration of prenatal, nutrition and lactation stakeholders is key. Fortification increases osmolality; however, safety cutoffs to prevent necrotizing enterocolitis are unclear. There is also new evidence that composition and structure of various macronutrients and micronutrients affect growth and development, and might play a role in future fortification concepts. SUMMARY Recent research focuses on the variability of breast milk composition, its impact on postnatal growth patterns and the usefulness of target fortification. As well, diets exclusively composed of human milk are a promising approach to improve feeding tolerance. For safe fortification, osmolality cutoff levels are needed.
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Affiliation(s)
- Niels Rochow
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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24
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Maas C, Poets CF, Franz AR. Avoiding postnatal undernutrition of VLBW infants during neonatal intensive care: evidence and personal view in the absence of evidence. Arch Dis Child Fetal Neonatal Ed 2015; 100:F76-81. [PMID: 25280993 DOI: 10.1136/archdischild-2014-306195] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Inadequate nutrient intakes in the first postnatal weeks play a crucial role in the aetiology of postnatal growth restriction of very low birthweight (VLBW) infants. Efforts to improve early nutrition in these infants led to a significant reduction in postnatal growth failure. Initiation of enhanced parenteral nutrition immediately after birth and utilisation of the large potential of early enteral nutrition seem pivotal. Nevertheless, it remains challenging to further reduce the initial drop in weight and head circumference z-score and to improve body composition and linear growth. This review will summarise data on how near-fetal postnatal weight gain in VLBW infants can be achieved and makes suggestions for early nutrition of VLBW infants.
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Affiliation(s)
- Christoph Maas
- Department of Neonatology, University Hospital, Tuebingen, Germany
| | | | - Axel R Franz
- Department of Neonatology, University Hospital, Tuebingen, Germany
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Senterre T. Defining adequate nutritional targets in very-low-birth-weight infants to reduce postnatal growth restriction. concerning the article by M. Sáenz de Pipaón et al.: growth in preterm infants until 36 weeks' postmenstrual age is close to target recommendations [Neonatology 2014;106:30-36]. Neonatology 2015; 107:76-8. [PMID: 25401480 DOI: 10.1159/000367888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 08/25/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Thibault Senterre
- Department of Neonatology, CHR de la Citadelle, CHU de Liège, University of Liège, Liège, Belgium
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