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MARQUES PC, ROCHA G, FLOR-DE-LIMA F, GUIMARÃES H. Extrauterine growth restriction at discharge in very-low-birth weight infants: a retrospective study in a level III neonatal intensive care unit. Minerva Pediatr (Torino) 2022; 74:553-561. [DOI: 10.23736/s2724-5276.18.05253-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Jasper EA, Cho H, Breheny PJ, Bao W, Dagle JM, Ryckman KK. Perinatal determinants of growth trajectories in children born preterm. PLoS One 2021; 16:e0245387. [PMID: 33507964 PMCID: PMC7842887 DOI: 10.1371/journal.pone.0245387] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/29/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A growing amount of evidence indicates in utero and early life growth has profound, long-term consequences for an individual's health throughout the life course; however, there is limited data in preterm infants, a vulnerable population at risk for growth abnormalities. OBJECTIVE To address the gap in knowledge concerning early growth and its determinants in preterm infants. METHODS A retrospective cohort study was performed using a population of preterm (< 37 weeks gestation) infants obtained from an electronic medical record database. Weight z-scores were acquired from discharge until roughly two years corrected age. Linear mixed effects modeling, with random slopes and intercepts, was employed to estimate growth trajectories. RESULTS Thirteen variables, including maternal race, hypertension during pregnancy, preeclampsia, first trimester body mass index, multiple status, gestational age, birth weight, birth length, head circumference, year of birth, length of birth hospitalization stay, total parenteral nutrition, and dextrose treatment, were significantly associated with growth rates of preterm infants in univariate analyses. A small percentage (1.32% - 2.07%) of the variation in the growth of preterm infants can be explained in a joint model of these perinatal factors. In extremely preterm infants, additional variation in growth trajectories can be explained by conditions whose risk differs by degree of prematurity. Specifically, infants with periventricular leukomalacia or retinopathy of prematurity experienced decelerated rates of growth compared to infants without such conditions. CONCLUSIONS Factors found to influence growth over time in children born at term also affect growth of preterm infants. The strength of association and the magnitude of the effect varied by gestational age, revealing that significant heterogeneity in growth and its determinants exists within the preterm population.
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Affiliation(s)
- Elizabeth A. Jasper
- Department of Epidemiology, University of Iowa, Iowa City, IA, United States of America
- * E-mail:
| | - Hyunkeun Cho
- Department of Biostatistics, University of Iowa, Iowa City, IA, United States of America
| | - Patrick J. Breheny
- Department of Biostatistics, University of Iowa, Iowa City, IA, United States of America
| | - Wei Bao
- Department of Epidemiology, University of Iowa, Iowa City, IA, United States of America
| | - John M. Dagle
- Department of Pediatrics, University of Iowa, Iowa City, IA, United States of America
| | - Kelli K. Ryckman
- Department of Epidemiology, University of Iowa, Iowa City, IA, United States of America
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Merhar SL, Meinzen-Derr J, Sprague J, Wessel JJ, Leugers S, Painter J, Valentine CJ. Safety and Tolerability of Enteral Protein Supplementation for Infants With Brain Injury. Nutr Clin Pract 2015; 30:546-50. [PMID: 25616519 DOI: 10.1177/0884533614567715] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND We hypothesized that enteral protein supplementation in infants with brain injury would be safe and well tolerated and improve growth. MATERIALS AND METHODS Twenty-five infants with perinatal brain injury were randomized to a high-protein (4 g/kg/d) or standard-protein diet and followed for 12 months. RESULTS The whey protein powder was well tolerated by 9 of the 13 infants in the high-protein group, and no adverse events related to the supplement were seen. The protein group had higher serum urea nitrogen at 10 and 30 days after study initiation but no difference in bicarbonate levels at either time point. Infants in the protein group maintained their weight z score from birth to 3 months of age, while infants in the standard group had a significant decrease in their weight z score over the same time period. CONCLUSION These results suggest that enteral protein supplementation may reduce growth failure in infants with brain injury.
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Affiliation(s)
| | | | - Jennifer Sprague
- Division of Nutrition Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jacqueline J Wessel
- Division of Nutrition Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Staci Leugers
- Division of Nutrition Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Godown J, Friedland-Little JM, Gajarski RJ, Yu S, Donohue JE, Schumacher KR. Abnormal nutrition affects waitlist mortality in infants awaiting heart transplant. J Heart Lung Transplant 2013; 33:235-40. [PMID: 24559943 DOI: 10.1016/j.healun.2013.11.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 10/22/2013] [Accepted: 11/12/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Although nutritional status affects survival after heart transplant (HTx) in adults and older children, its effect on outcomes in young children is unknown. This study aimed to assess the effect of pre-HTx nutrition on outcomes in this population. METHODS Children aged 0 to 2 years old listed for HTx from 1997 to 2011 were identified from the Organ Procurement and Transplantation Network database. Nutritional status was classified according to percentage of ideal body weight at listing and at HTx. Logistic regression analysis evaluated the risk of waitlist mortality. Cox proportional hazard models assessed the effect of nutrition on post-HTx survival. RESULTS Of 1,653 children evaluated, 899 (54%) had normal nutrition at listing, 445 (27%) were mildly wasted, 203 (12%) were moderate or severely wasted, and 106 (6%) had an elevated weight-to-height (W:H) ratio. Moderate or severe wasting (adjusted odds ratio, 1.9; 95% confidence interval, 1.3-2.7) and elevated W:H (adjusted odds ratio, 1.7; 95% confidence interval, 1.1-2.6) were independent risk factors for waitlist mortality. HTx was performed in 1,167 patients, and 1,016 (87%) survived to 1-year post-HTx. Nutritional status at listing or at HTx was not associated with increased post-HTx mortality. Nutritional status did not affect the need for early reoperation, dialysis, or the incidences of infection, stroke, or rejection before hospital discharge. CONCLUSIONS Moderate or severe wasting and an elevated W:H are independent risk factors for waitlist mortality in patients aged < 2 years but do not affect post-HTx mortality. Optimization of pre-HTx nutritional status constitutes a strategy to reduce waitlist mortality in this age range.
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Affiliation(s)
- Justin Godown
- Congenital Heart Center, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan.
| | | | - Robert J Gajarski
- Congenital Heart Center, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | - Sunkyung Yu
- Congenital Heart Center, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | - Janet E Donohue
- Congenital Heart Center, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | - Kurt R Schumacher
- Congenital Heart Center, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
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Affiliation(s)
- Morag J. Andrew
- University of Oxford Department of Paediatrics
- The Children’s Hospital
- The John Radcliffe Hospital, Oxford, United Kingdom
| | - Peter B. Sullivan
- University of Oxford Department of Paediatrics
- The Children’s Hospital
- The John Radcliffe Hospital, Oxford, United Kingdom
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Innovative strategies for feeding and nutrition in infants with congenitally malformed hearts. Cardiol Young 2009; 19 Suppl 2:90-5. [PMID: 19857355 DOI: 10.1017/s1047951109991673] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
Very low birth weight premature (VLBWPT) infants demonstrate growth patterns in the early years of life which differ from those of term and large low birth weight preterm (LBWPT) peers. Optimal post natal growth of VLBWPT children is associated with more positive later health and neurodevelopmental outcomes. The neonatologist engaged in the follow of care of VLBWPT infants after discharge from the Neonatal Intensive Care Unit should monitor over time the velocity of weight, length, head circumference and weight/length ratio utilizing appropriate growth references. VLBW children who demonstrate atypically low weight gain in the early years of life have a higher probability of less than optimal cognitive development over time, while those with excessive weight gain have a greater likelihood of later childhood and adult obesity, cardiovascular disease, and diabetes. Nutritional planning should provide adequate calories for gradual normalization in all growth variables, while attempting to avoid atypically low or excessive weight gain. This nutritional planning should take into account the child's genetic growth potential, small for gestational age (SGA) or at gestational age (AGA), and clinical issues such as the presence of diseases like gastroesophageal (GE) reflux or chronic lung disease. Whatever nutritional approach is used, the neonatologist in follow up should track weight, length, head circumference, and weight/length ratio and adjust the nutrition plan and caloric intake to assure gradual return to normal in all growth variables while avoiding excessive weight gain.
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Affiliation(s)
- Patrick H Casey
- Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR 72202, USA.
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Dabydeen L, Thomas JE, Aston TJ, Hartley H, Sinha SK, Eyre JA. High-energy and -protein diet increases brain and corticospinal tract growth in term and preterm infants after perinatal brain injury. Pediatrics 2008; 121:148-56. [PMID: 18166569 DOI: 10.1542/peds.2007-1267] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Our hypothesis was that infants with perinatal brain injury fail to thrive in the first postnatal year because of increased energy and protein requirements from deficits that accumulated during neonatal intensive care. Our aim was to assess whether dietary energy and protein input was a rate-limiting factor in brain and body growth in the first year after birth. METHODS We conducted a prospective, double-blind and randomized, 2-stage group sequential study and controlled for gestation, gender, and brain lesion. Neonates with perinatal brain damage were randomly allocated to receive either a high- (120% recommended average intake) or average (100% recommended average intake) energy and protein diet. The study began at term and continued for 12 months. Three-day dietary diaries estimated energy and protein intake. The primary outcome measure was growth of occipitofrontal circumference. Other measures were growth of axonal diameters in the corticospinal tract, which were estimated by using transcranial magnetic stimulation, weight gain, and length. RESULTS The study was terminated at the first analysis when the 16 subjects had completed the protocol, because the predetermined stopping criterion of >1 SD difference in occipitofrontal circumference at 12 months' corrected age in those receiving the higher-energy and -protein diet had been demonstrated. Axonal diameters in the corticospinal tract, length, and weight were also significantly increased. CONCLUSIONS These data support our hypothesis that infants with significant perinatal brain damage have increased nutritional requirements in the first postnatal year and suggest that decreased postnatal brain growth may exacerbate their impairment. There are no measures of cognitive ability at 12 months of age, and whether there will be any improvement in the status of these children, therefore, remains to be shown.
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Affiliation(s)
- Lyvia Dabydeen
- Developmental Neuroscience, School of Clinical Medical Sciences (Child Health), University of Newcastle Upon Tyne, Newcastle Upon Tyne, United Kingdom
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Abstract
BACKGROUND Children born very preterm who attend mainstream schools have a high prevalence of minor motor, behavioural, and learning disorders. These appear to be associated with reduced postnatal growth, particularly of the head. It is unclear when this poor growth occurs and whether growth restriction during different periods has different effects on later function. OBJECTIVE To identify periods during early development, in children born preterm, when impaired head growth may influence minor motor and cognitive function. POPULATION A geographically defined cohort of 194 infants born in Merseyside during 1980-81 and weighing less than 1500 g. METHODS Measurements of head circumference (occipitofrontal circumference (OFC)) were available at birth, hospital discharge, 4 years, and 15 years of age. Assessments of intelligence (intelligence quotient (IQ)) and minor motor impairment (test of motor impairment (TOMI)) were made at 8 years of age. Clinical, social, and demographic variables were obtained from the clinical record and maternal interviews. RESULTS IQ correlated significantly with OFC at 4 and 15 years of age after correction for growth restriction at birth (intrauterine growth restriction (IUGR)) and social class. TOMI scores correlated significantly with OFC at all four times, but especially with OFC at discharge and with change in OFC between birth and discharge. They were not affected by correction for social class or IUGR. CONCLUSION Although both IQ and minor motor impairments correlate strongly with each other at school age in very low birthweight children, the factors determining them and their timing of operation are different. Interventions designed to improve IQ in this population would need to reduce IUGR and improve later childhood growth. Those aimed to improve motor ability need to be targeted more at brain protection during the neonatal period.
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Affiliation(s)
- R W I Cooke
- School of Reproductive and Developmental Medicine, University of Liverpool, UK.
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Abstract
Disorders of feeding and swallowing are common in children with cerebral palsy. Feeding and swallowing disorders have significant implications for development, growth and nutrition, respiratory health, gastrointestinal function, parent-child interaction, and overall family life. Assessments need to be comprehensive in scope and centered around the medical home. Oral feeding interventions for children with cerebral palsy may be effective in promoting oral motor function, but have not been shown to be effective in promoting feeding efficiency or weight gain. Feeding gastrostomy tubes are a reasonable alternative for children with severe feeding and swallowing problems who have had poor weight gain.
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Affiliation(s)
- Brian Rogers
- Department of Pediatrics, Division of Developmental Pediatrics, Oregon Health and Science University, Portland, Oregon, USA.
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White-Traut RC, Nelson MN, Silvestri JM, Patel M, Berbaum M, Gu GG, Rey PM. Developmental patterns of physiological response to a multisensory intervention in extremely premature and high-risk infants. J Obstet Gynecol Neonatal Nurs 2004; 33:266-75. [PMID: 15095806 DOI: 10.1177/0884217504263289] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To compare the developmental patterns of heart rate (HR), respiratory rate (RR), and hemoglobin oxygen saturation (SaO2) of premature infants with and without central nervous system (CNS) injury, and evaluate whether a multisensory intervention altered this development. SAMPLE Thirty-seven premature infants born at 23-26 weeks with normal head ultrasounds or at 24-32 weeks and diagnosed with periventricular leukomalacia (PVL) and/or intraventricular hemorrhage (IVH) were studied at 33-35 weeks postconceptional age. DESIGN Infants were randomly assigned to control and experimental groups. The experimental group infants received auditory, tactile, visual, and vestibular (ATVV) multisensory intervention twice daily from 33 weeks postconceptional age (PCA) until hospital discharge. MAIN OUTCOME MEASURES HR, RR, and SaO2 were continuously monitored during baseline, intervention, and the 30-minute postintervention period. RESULTS Between 33 and 35 weeks PCA, control group infants with and without CNS injury and experimental group infants without CNS injury had a significant decrease in resting mean HR, whereas RR and SaO2 remained stable. The infants with PVL who received the intervention showed increases in HR even at rest. CONCLUSIONS The absence of a weekly decline in HR for experimental group infants with PVL suggests that PVL may affect maturation of the autonomic nervous system and increase risk of decelerative HR changes and associated clinical compromise. Infants diagnosed with PVL should be closely monitored during procedures or interventions that may be stressful or involve handling. Further research is needed to tailor multisensory interventions for infants with PVL.
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Affiliation(s)
- Rosemary C White-Traut
- University of Illinois at Chicago, College of Nursing, Department of Maternal-Child Nursing, 60612, USA
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Smith MF. Aftercare in severe neurological impairment. ACTA ACUST UNITED AC 2004; 8:147-57. [PMID: 15001151 DOI: 10.1016/s1084-2756(02)00140-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2002] [Revised: 02/20/2002] [Accepted: 02/20/2002] [Indexed: 10/27/2022]
Abstract
Modern neonatal intensive care has major emphasis on the resuscitation and management of infants born at the limits of viability. An additional significant group of infants are those, born at or close to term, who present with major neurological disease. This is a heterogeneous group of infants who have major care needs due to the continuing neurological abnormalities into the postneonatal period. Re-admissions to hospital are frequent and long-term developmental progress is poor. In this group of infants, there is a high early mortality. The recurrent admission of infants in this group for active resuscitation and/or intensive care may not always be the wisest management, and important medical, ethical and legal dilemmas are faced by families and carers of these infants.
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Affiliation(s)
- M F Smith
- Regional Neonatal Intensive Care Unit, The Jessop Wing, Royal Hallamshire Hospital, Sheffield, UK.
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Cooke RWI, Foulder-Hughes L. Growth impairment in the very preterm and cognitive and motor performance at 7 years. Arch Dis Child 2003; 88:482-7. [PMID: 12765911 PMCID: PMC1763118 DOI: 10.1136/adc.88.6.482] [Citation(s) in RCA: 152] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Infants born of low birth weight often have poor subsequent growth (especially if they were born very preterm), which has been shown to relate to later motor and cognitive development. AIMS To assess a cohort of preterm infants at the age of 7 years for growth, motor, and cognitive measures, and investigate the effects of growth impairment on school performance. METHODS A cohort of 280 children born before 32 completed weeks of gestation were tested, together with 210 term controls. RESULTS Preterm children were significantly lighter and shorter than term controls and had smaller heads and lower body mass index (BMI). Median centiles for weight, height, head circumference, and BMI were 25, 25, 9, and 50 for boys and 50, 25, 9, and 50 for girls compared with 50, 50, 50, and 75 for controls. They performed significantly less well on all tests with a mean score of 91 (9.2) on the Developmental Test of Visual-Motor Integration, 89 (14.5) on the Wechsler-III IQ test, and 30.7% scoring at or below the 5th centile on the Movement Assessment Battery for Children. In boys, short stature and small heads were the best predictors of poor performance; in girls, a small head alone was a predictor for poor motor and cognitive performance. CONCLUSION Poor postnatal growth in preterm infants, especially of the head, is associated with increased levels of motor and cognitive impairment at 7 years of age. This growth restriction appears to occur largely in the postnatal rather than antenatal period and may be amenable to intervention and subsequent improvement in outcome.
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Affiliation(s)
- R W I Cooke
- Department of Child Health, Institute of Child Health, Royal Liverpool Children's Hospital, Liverpool L12 2AP, UK.
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Ross ES, Browne JV. Developmental progression of feeding skills: an approach to supporting feeding in preterm infants. SEMINARS IN NEONATOLOGY : SN 2002; 7:469-75. [PMID: 12614599 DOI: 10.1053/siny.2002.0152] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Infants born prematurely, with congenital or acquired medical conditions, or who have extended stays in the neonatal intensive care unit (NICU) are at higher risk of developing feeding and nutritional problems than are full-term, healthy newborns. Because of the complex nature of feeding, it is necessary to have a thorough understanding of the developmental nature of this skill. The importance of recognizing stability in the physiologic, motor and state systems and using stability to determine both readiness to begin nipple feeding and progress in feeding, is discussed. Intervention strategies to promote stability leading to successful feeding are also described. Viewing infant feeding from a developmental skill acquisition perspective can guide the caregiver in determining how challenging it is for the infant, and therefore is useful in supporting the progression of feeding.
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Affiliation(s)
- Erin Sundseth Ross
- Department of Pediatrics, University of Colorado School of Medicine, Denver 80218, USA.
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