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Wu Z, Tien NTN, Bæk O, Zhong J, Klabunde B, Nguyen TT, Yen NTH, Long NP, Nguyen DN. Regulation of host metabolism and defense strategies to survive neonatal infection. Biochim Biophys Acta Mol Basis Dis 2024; 1870:167482. [PMID: 39213794 DOI: 10.1016/j.bbadis.2024.167482] [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: 04/29/2024] [Revised: 08/05/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024]
Abstract
Two distinct defense strategies, disease resistance (DR) and disease tolerance (DT), enable a host to survive infectious diseases. Newborns, constrained by limited energy reserves, predominantly rely on DT to cope with infection. However, this approach may fail when pathogen levels surpass a critical threshold, prompting a shift to DR that can lead to dysregulated immune responses and sepsis. The mechanisms governing the interplay between DR and DT in newborns remain poorly understood. Here, we compare metabolic traits and defense strategies between survivors and non-survivors in Staphylococcus epidermidis (S. epidermidis)-infected preterm piglets, mimicking infection in preterm infants. Compared to non-survivors, survivors displayed elevated DR during the initial phase of infection, followed by stronger DT in later stages. In contrast, non-survivors showed clear signs of respiratory and metabolic acidosis and hyperglycemia, together with exaggerated inflammation and organ dysfunctions. Hepatic transcriptomics revealed a strong association between the DT phenotype and heightened oxidative phosphorylation in survivors, coupled with suppressed glycolysis and immune signaling. Plasma metabolomics confirmed the findings of metabolic regulations associated with DT phenotype in survivors. Our study suggests a significant association between the initial DR and subsequent DT, which collectively contributes to improved infection survival. The regulation of metabolic processes that optimize the timing and balance between DR and DT holds significant potential for developing novel therapeutic strategies for neonatal infection.
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Affiliation(s)
- Ziyuan Wu
- Section for Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, University of Copenhagen, Denmark
| | - Nguyen Tran Nam Tien
- Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine, Busan 47392, Republic of Korea
| | - Ole Bæk
- Section for Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, University of Copenhagen, Denmark
| | - Jingren Zhong
- Section for Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, University of Copenhagen, Denmark
| | - Björn Klabunde
- Section for Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, University of Copenhagen, Denmark
| | - Tinh Thu Nguyen
- Department of Pediatrics, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Nguyen Thi Hai Yen
- Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine, Busan 47392, Republic of Korea
| | - Nguyen Phuoc Long
- Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine, Busan 47392, Republic of Korea.
| | - Duc Ninh Nguyen
- Section for Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, University of Copenhagen, Denmark.
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Bjerager MO, Hansen BM, Sørensen F, Petersen JR, Jensen KV, Hjelvang BR, Hvelplund AC, Olsen DA, Nielsen AA, Forman JL, Brandslund I, Greisen G, Slidsborg C. Blood-Biomarkers for Glucose Metabolism in Preterm Infants. Biomedicines 2023; 11:2377. [PMID: 37760819 PMCID: PMC10525969 DOI: 10.3390/biomedicines11092377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/19/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023] Open
Abstract
This was an exploratory, prospective, longitudinal, cohort study that aimed to establish "healthy" reference levels related to growth parameters and glucose metabolites in preterm infants. This was conducted to further investigate growth and metabolic disturbances potentially related to neonatal illness. The study sample consisted of 108 preterm infants born before 32 weeks in 2018-2019 in the Capital Region of Denmark. Repetitive blood samples were acquired at the neonatal wards, while clinical data were obtained from the regional hospital medical record system. Thirty-four "healthy" preterm infants (31%) were identified. The "ill" infants were divided into four subgroups dependent on gestational age and small for gestational age. Reference levels for the growth parameters and metabolic biomarkers glucose, albumin, and adiponectin, and two glucose control indicators, glycated albumin and fructosamine, were determined for the "healthy" and "ill" subgroups. The "ill" extremely preterm infants had increased glucose levels (mean difference 0.71 mmol/L, 95% CI 0.23; 1.18 mmol/L) and glycated albumin (corrected; %) (mean difference 0.92 mmol/L, 95% CI 0.38 mmol/L;1.47 mmol/L) compared to the "healthy" infants. In "ill" extremely preterm infants and "ill" very preterm infants born small for gestational age, levels of biomarkers containing proteins were decreased. In the "Ill" extremely preterm infants and infants born small for gestational age, postnatal growth was continuously decreased throughout the postconceptional period. The short-term glucose-control indicator, glycated albumin (corrected; %), reflected well the high glucose levels due to its correction for the depleted plasma-protein pool.
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Affiliation(s)
- Mia O. Bjerager
- Department of Neonatology, Nordsjælland Hospital, 3400 Hillerød, Denmark; (M.O.B.); (B.M.H.)
| | - Bo M. Hansen
- Department of Neonatology, Nordsjælland Hospital, 3400 Hillerød, Denmark; (M.O.B.); (B.M.H.)
| | - Frederik Sørensen
- Department of Public Health, Section of of Biostatistics, University of Copenhagen, 1352 Copenhagen, Denmark; (F.S.); (J.L.F.)
| | - Jes R. Petersen
- Department of Neonatology, Herlev Hospital, 2730 Herlev, Denmark;
| | - Kristian V. Jensen
- Department of Neonatology, Hvidovre Hospital, 2650 Hvidovre, Denmark; (K.V.J.); (B.R.H.); (A.C.H.)
| | - Brian R. Hjelvang
- Department of Neonatology, Hvidovre Hospital, 2650 Hvidovre, Denmark; (K.V.J.); (B.R.H.); (A.C.H.)
| | - Anna C. Hvelplund
- Department of Neonatology, Hvidovre Hospital, 2650 Hvidovre, Denmark; (K.V.J.); (B.R.H.); (A.C.H.)
| | - Dorte A. Olsen
- Department of Biochemistry and Immunology, Vejle Sygehus, University of Southern, 7100 Vejle, Denmark; (D.A.O.); (A.A.N.); (I.B.)
| | - Aneta A. Nielsen
- Department of Biochemistry and Immunology, Vejle Sygehus, University of Southern, 7100 Vejle, Denmark; (D.A.O.); (A.A.N.); (I.B.)
| | - Julie L. Forman
- Department of Public Health, Section of of Biostatistics, University of Copenhagen, 1352 Copenhagen, Denmark; (F.S.); (J.L.F.)
| | - Ivan Brandslund
- Department of Biochemistry and Immunology, Vejle Sygehus, University of Southern, 7100 Vejle, Denmark; (D.A.O.); (A.A.N.); (I.B.)
| | - Gorm Greisen
- Department of Neonatology, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark;
| | - Carina Slidsborg
- Department of Neonatology, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark;
- Department of Ophthalmology, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
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3
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Fukushima S, Nakanishi N, Fujioka K, Suga K, Shirakawa T, Osawa K, Hara K, Tsutsumi R, Urushihara M, Nakagawa R, Awano H, Oto J, Sakaue H, Iijima K, Matsuo M. Assessment of catabolic state in infants with the use of urinary titin N-fragment. Pediatr Res 2022; 91:1748-1753. [PMID: 34274960 DOI: 10.1038/s41390-021-01658-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/30/2021] [Accepted: 07/02/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Urinary titin N-fragment levels have been used to assess the catabolic state, and we used this biomarker to evaluate the catabolic state of infants. METHODS We retrospectively measured urinary titin N-fragment levels of urinary samples. The primary outcome was its changes according to postmenstrual age. The secondary outcomes included differences between gestational age, longitudinal change after birth, influence on growth, and relationship with blood tests. RESULTS This study included 219 patients with 414 measurements. Urinary titin N-fragment exponentially declined with postmenstrual age. These values were 12.5 (7.1-19.6), 8.1 (5.1-13.0), 12.8 (6.0-21.3), 26.4 (16.4-52.0), and 81.9 (63.3-106.4) pmol/mg creatinine in full, late, moderate, very, and extremely preterm infants, respectively (p < 0.01). After birth, urinary levels of titin N-fragment exponentially declined, and the maximum level within a week was associated with the time to return to birth weight in preterm infants (ρ = 0.39, p < 0.01). This was correlated with creatine kinase in full-term infants (ρ = 0.58, p < 0.01) and with blood urea nitrogen in preterm infants (ρ = 0.50, p < 0.01). CONCLUSIONS The catabolic state was increased during the early course of the postmenstrual age and early preterm infants. IMPACT Catabolic state in infants, especially in preterm infants, was expected to be increased, but no study has clearly verified this. In this retrospective study of 219 patients with 414 urinary titin measurements, the catabolic state was exponentially elevated during the early postmenstrual age. The use of the urinary titin N-fragment clarified catabolic state was prominently increased in very and extremely preterm infants.
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Affiliation(s)
- Sachiyo Fukushima
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Nobuto Nakanishi
- Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, Japan. .,Department of Disaster and Emergency Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan.
| | - Kazumichi Fujioka
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kenichi Suga
- Department of Pediatrics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Taku Shirakawa
- Department of Physical Therapy, Faculty of Rehabilitation, Kobe Gakuin University, Kobe, Japan
| | - Kayo Osawa
- Department of Medical Technology, Kobe Tokiwa University, Kobe, Japan
| | - Kanako Hara
- Department of Nutrition and Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Rie Tsutsumi
- Department of Nutrition and Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Maki Urushihara
- Department of Pediatrics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Ryuji Nakagawa
- Department of Pediatrics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Hiroyuki Awano
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Jun Oto
- Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Hiroshi Sakaue
- Department of Nutrition and Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Kazumoto Iijima
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masafumi Matsuo
- Research Center for Locomotion Biology, Kobe Gakuin University, Kobe, Japan
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Sadri H, Ghaffari MH, Steinhoff-Wagner J, Görs S, Hammon HM, Sauerwein H. Expression of specific signaling components related to muscle protein turnover and of branched-chain amino acid catabolic enzymes in muscle and adipose tissue of preterm and term calves. J Dairy Sci 2021; 104:11291-11305. [PMID: 34334194 DOI: 10.3168/jds.2021-20527] [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: 03/26/2021] [Accepted: 06/14/2021] [Indexed: 11/19/2022]
Abstract
Postnatal metabolism depends on maturation of key metabolic pathways around birth. In this regard, endogenous glucose production is impaired in calves born preterm. Concerning protein metabolism, the rates of protein turnover are greater during the neonatal period than at any other period of postnatal life. The mammalian target of rapamycin (mTOR) and the ubiquitin-proteasome system (UPS) are considered as the major regulators of cellular protein turnover. The objectives of this study were to investigate (1) the changes in plasma AA profiles, (2) the mRNA abundance of mTOR signaling and UPS-related genes in skeletal muscle, and (3) the mRNA abundance of branched-chain AA (BCAA) catabolic enzymes in skeletal muscle and adipose tissue in neonatal calves with different degree of maturation during the transition to extrauterine life. Calves (n = 7/treatment) were born either preterm (PT; delivered by cesarean section 9 d before term) or at term (T; spontaneous vaginal delivery) and were left unfed for 1 d. Calves in treatment TC were also spontaneously born but were fed colostrum and transition milk for 4 d. Blood samples were collected from all calves at birth and at 24 h of life. Additional blood samples were taken 2 h after feeding (26 h of life) for PT and T calves, and on d 4 of life for TC, to determine plasma glucose, urea, and AA. Tissue samples from 3 muscles [M. longissimus dorsi (MLD), M. semitendinosus (MST), and M. masseter (MM)], and kidney fat were collected following euthanasia at 26 h after birth (PT, T) or on d 4 of life (TC) at 2 h after feeding. The concentrations of the majority of plasma AA (Ala, Gln, Asn, Cit, Lys, Orn, Thr, and Tyr), nonessential AA, and total AA were greater during the first 24 h and also before and 2 h after feeding in PT than in T. The ratio of plasma BCAA to the aromatic AA (Tyr and Phe) was greatest in TC, followed by T, and least in PT. The mRNA abundance of mTOR and ribosomal protein S6 kinase 1 (S6K1) in MLD and MM was greater in PT and T than in TC. The mRNA abundance of muscle-specific ligases FBXO32 (F-box only protein 32) in the 3 different skeletal muscles and TRIM63 (tripartite motif containing 63) in MLD was greater in PT and T than in TC; in MM, TRIM63 mRNA was greatest in PT. The mRNA for BCKDHA and BCKDHB (the α and β polypeptide of branched-chain α-keto acid dehydrogenase) in kidney fat was elevated in PT and T compared with TC, suggesting a possible enhancement of BCAA oxidation as energy source to cover the energetic and nutritional postnatal demands in PT and T in a starved state. The increased abundances of mTOR-associated signaling factors and muscle-specific ligase mRNA indicate a greater rate of protein turnover in muscles of PT and T in a starved state. Elevated plasma concentrations of several AA may result from enhanced muscle proteolysis and impaired conversion to glucose in the liver of PT calves.
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Affiliation(s)
- H Sadri
- Department of Clinical Science, Faculty of Veterinary Medicine, University of Tabriz, 5166616471 Tabriz, Iran
| | - M H Ghaffari
- Institute of Animal Science, Physiology Unit, University of Bonn, 53111 Bonn, Germany
| | - J Steinhoff-Wagner
- Institute of Nutritional Physiology "Oskar Kellner," Leibniz Institute for Farm Animal Biology (FBN), 18196 Dummerstorf, Germany
| | - S Görs
- Institute of Nutritional Physiology "Oskar Kellner," Leibniz Institute for Farm Animal Biology (FBN), 18196 Dummerstorf, Germany
| | - H M Hammon
- Institute of Nutritional Physiology "Oskar Kellner," Leibniz Institute for Farm Animal Biology (FBN), 18196 Dummerstorf, Germany
| | - H Sauerwein
- Institute of Animal Science, Physiology Unit, University of Bonn, 53111 Bonn, Germany.
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Pendleton AL, Wesolowski SR, Regnault TRH, Lynch RM, Limesand SW. Dimming the Powerhouse: Mitochondrial Dysfunction in the Liver and Skeletal Muscle of Intrauterine Growth Restricted Fetuses. Front Endocrinol (Lausanne) 2021; 12:612888. [PMID: 34079518 PMCID: PMC8165279 DOI: 10.3389/fendo.2021.612888] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 04/22/2021] [Indexed: 11/14/2022] Open
Abstract
Intrauterine growth restriction (IUGR) of the fetus, resulting from placental insufficiency (PI), is characterized by low fetal oxygen and nutrient concentrations that stunt growth rates of metabolic organs. Numerous animal models of IUGR recapitulate pathophysiological conditions found in human fetuses with IUGR. These models provide insight into metabolic dysfunction in skeletal muscle and liver. For example, cellular energy production and metabolic rate are decreased in the skeletal muscle and liver of IUGR fetuses. These metabolic adaptations demonstrate that fundamental processes in mitochondria, such as substrate utilization and oxidative phosphorylation, are tempered in response to low oxygen and nutrient availability. As a central metabolic organelle, mitochondria coordinate cellular metabolism by coupling oxygen consumption to substrate utilization in concert with tissue energy demand and accretion. In IUGR fetuses, reducing mitochondrial metabolic capacity in response to nutrient restriction is advantageous to ensure fetal survival. If permanent, however, these adaptations may predispose IUGR fetuses toward metabolic diseases throughout life. Furthermore, these mitochondrial defects may underscore developmental programming that results in the sequela of metabolic pathologies. In this review, we examine how reduced nutrient availability in IUGR fetuses impacts skeletal muscle and liver substrate catabolism, and discuss how enzymatic processes governing mitochondrial function, such as the tricarboxylic acid cycle and electron transport chain, are regulated. Understanding how deficiencies in oxygen and substrate metabolism in response to placental restriction regulate skeletal muscle and liver metabolism is essential given the importance of these tissues in the development of later lifer metabolic dysfunction.
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Affiliation(s)
- Alexander L. Pendleton
- School of Animal and Comparative Biomedical Sciences, The University of Arizona, Tucson, AZ, United States
| | - Stephanie R. Wesolowski
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States
| | | | - Ronald M. Lynch
- School of Animal and Comparative Biomedical Sciences, The University of Arizona, Tucson, AZ, United States
| | - Sean W. Limesand
- School of Animal and Comparative Biomedical Sciences, The University of Arizona, Tucson, AZ, United States
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6
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Cormack BE, Jiang Y, Harding JE, Crowther CA, Lynn A, Nair A, Hewson M, Meyer M, Broadbent R, Webster D, Glamuzina E, Ryder B, Bloomfield FH. Plasma ammonia concentrations in extremely low birthweight infants in the first week after birth: secondary analysis from the ProVIDe randomized clinical trial. Pediatr Res 2020; 88:250-256. [PMID: 31896121 PMCID: PMC7384986 DOI: 10.1038/s41390-019-0730-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/20/2019] [Accepted: 12/09/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND Little is known about normative ammonia concentrations in extremely low birthweight (ELBW) babies and whether these vary with birth characteristics. We aimed to determine ammonia concentrations in ELBW babies in the first week after birth and relationships with neonatal characteristics and protein intake. METHODS Arterial blood samples for the measurement of plasma ammonia concentration were collected within 7 days of birth from ProVIDe trial participants in six New Zealand neonatal intensive care units. RESULTS Three hundred and twenty-two babies were included. Median (range) gestational age was 25.7 (22.7-31.6) weeks. Median (interquartile range (IQR)) ammonia concentration was 102 (80-131) µg/dL. There were no statistically significant associations between ammonia concentrations and birthweight or sex. Ammonia concentrations were weakly correlated with mean total (Spearman's rs = 0.11, P = 0.047) and intravenous (rs = 0.13, P = 0.02) protein intake from birth, gestational age at birth (rs = -0.13, P = 0.02) and postnatal age (rs = -0.13, P = 0.02). CONCLUSIONS Plasma ammonia concentrations in ELBW babies are similar to those of larger and more mature babies and only weakly correlated with protein intake. Currently, recommended thresholds for investigation of hyperammonaemia are appropriate for ELBW babies. Protein intake should not be limited by concerns about potential hyperammonaemia.
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Affiliation(s)
- Barbara E Cormack
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Newborn Services, Auckland City Hospital, Auckland, New Zealand
| | - Yannan Jiang
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Jane E Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | - Adrienne Lynn
- Neonatal Intensive Care Unit, Christchurch Women's Hospital, Christchurch, New Zealand
| | - Arun Nair
- Newborn Intensive Care Unit, Waikato Hospital, Hamilton, New Zealand
| | - Michael Hewson
- Neonatal Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
| | - Mike Meyer
- Neonatal Unit, Middlemore Hospital, Auckland, New Zealand
| | - Roland Broadbent
- Neonatal Intensive Care Unit, Dunedin Hospital, Dunedin, New Zealand
| | - Dianne Webster
- LabPlus, Auckland District Health Board, Auckland, New Zealand
| | - Emma Glamuzina
- National Adult and Paediatric Metabolic Service, Auckland, New Zealand
| | - Bryony Ryder
- National Adult and Paediatric Metabolic Service, Auckland, New Zealand
| | - Frank H Bloomfield
- Liggins Institute, University of Auckland, Auckland, New Zealand.
- Newborn Services, Auckland City Hospital, Auckland, New Zealand.
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7
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Bahado-Singh RO, Yilmaz A, Bisgin H, Turkoglu O, Kumar P, Sherman E, Mrazik A, Odibo A, Graham SF. Artificial intelligence and the analysis of multi-platform metabolomics data for the detection of intrauterine growth restriction. PLoS One 2019; 14:e0214121. [PMID: 30998683 PMCID: PMC6472728 DOI: 10.1371/journal.pone.0214121] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 03/07/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To interrogate the pathogenesis of intrauterine growth restriction (IUGR) and apply Artificial Intelligence (AI) techniques to multi-platform i.e. nuclear magnetic resonance (NMR) spectroscopy and mass spectrometry (MS) based metabolomic analysis for the prediction of IUGR. MATERIALS AND METHODS MS and NMR based metabolomic analysis were performed on cord blood serum from 40 IUGR (birth weight < 10th percentile) cases and 40 controls. Three variable selection algorithms namely: Correlation-based feature selection (CFS), Partial least squares regression (PLS) and Learning Vector Quantization (LVQ) were tested for their diagnostic performance. For each selected set of metabolites and the panel consists of metabolites common in three selection algorithms so-called overlapping set (OL), support vector machine (SVM) models were developed for which parameter selection was performed busing 10-fold cross validations. Area under the receiver operating characteristics curve (AUC), sensitivity and specificity values were calculated for IUGR diagnosis. Metabolite set enrichment analysis (MSEA) was performed to identify which metabolic pathways were perturbed as a direct result of IUGR in cord blood serum. RESULTS All selected metabolites and their overlapping set achieved statistically significant accuracies in the range of 0.78-0.82 for their optimized SVM models. The model utilizing all metabolites in the dataset had an AUC = 0.91 with a sensitivity of 0.83 and specificity equal to 0.80. CFS and OL (Creatinine, C2, C4, lysoPC.a.C16.1, lysoPC.a.C20.3, lysoPC.a.C28.1, PC.aa.C24.0) showed the highest performance with sensitivity (0.87) and specificity (0.87), respectively. MSEA revealed significantly altered metabolic pathways in IUGR cases. Dysregulated pathways include: beta oxidation of very long fatty acids, oxidation of branched chain fatty acids, phospholipid biosynthesis, lysine degradation, urea cycle and fatty acid metabolism. CONCLUSION A systematically selected panel of metabolites was shown to accurately detect IUGR in newborn cord blood serum. Significant disturbance of hepatic function and energy generating pathways were found in IUGR cases.
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Affiliation(s)
- Ray Oliver Bahado-Singh
- Department of Obstetrics and Gynecology, William Beaumont Health, Royal Oak, MI, United States of America
- Oakland University-William Beaumont School of Medicine, Rochester, MI, United States of America
- * E-mail:
| | - Ali Yilmaz
- Department of Obstetrics and Gynecology, William Beaumont Health, Royal Oak, MI, United States of America
| | - Halil Bisgin
- Department of Computer Science, Engineering and Physics, University of Michigan-Flint, Flint, MI, United States of America
| | - Onur Turkoglu
- Department of Obstetrics and Gynecology, William Beaumont Health, Royal Oak, MI, United States of America
| | - Praveen Kumar
- Department of Obstetrics and Gynecology, William Beaumont Health, Royal Oak, MI, United States of America
| | - Eric Sherman
- University of Michigan, Ann Arbor, MI, United States of America
| | - Andrew Mrazik
- Department of Computer Science, Engineering and Physics, University of Michigan-Flint, Flint, MI, United States of America
| | - Anthony Odibo
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL, United States of America
| | - Stewart F. Graham
- Department of Obstetrics and Gynecology, William Beaumont Health, Royal Oak, MI, United States of America
- Oakland University-William Beaumont School of Medicine, Rochester, MI, United States of America
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8
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Hong CR, Fullerton BS, Mercier CE, Morrow KA, Edwards EM, Ferrelli KR, Soll RF, Modi BP, Horbar JD, Jaksic T. Growth morbidity in extremely low birth weight survivors of necrotizing enterocolitis at discharge and two-year follow-up. J Pediatr Surg 2018; 53:1197-1202. [PMID: 29627178 DOI: 10.1016/j.jpedsurg.2018.02.085] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 02/27/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE The purpose of this study was to examine postnatal growth outcomes and predictors of growth failure at 18-24months corrected age among extremely low birth weight (ELBW) survivors of necrotizing enterocolitis (NEC) compared to survivors without NEC. METHODS Data were collected prospectively on ELBW (22-27weeks gestation or 401-1000g birth weight) infants born 2000-2013 at 46 centers participating in the Vermont Oxford Network follow-up project. Severe growth failure was defined as <3rd percentile weight-for-age. RESULTS There were 9171 evaluated infants without NEC, 416 with medical NEC, and 462 with surgical NEC. Rates of severe growth failure at discharge were higher among infants with medical NEC (56%) and surgical NEC (61%), compared to those without NEC (36%). At 18-24months follow-up, rates of severe growth failure decreased and were similar between without NEC (24%), medical NEC (24%), and surgical NEC (28%). On multivariable analysis, small for gestational age, chronic lung disease, severe intraventricular hemorrhage or cystic periventricular leukomalacia, severe growth failure at discharge, and postdischarge tube feeding predicted <3rd percentile weight-for-age at follow-up. CONCLUSIONS ELBW survivors of NEC have higher rates of severe growth failure at discharge. While NEC is not associated with severe growth failure at follow-up, one quarter of ELBW infants have severe growth failure at 18-24months. TYPE OF STUDY Prognosis study. LEVEL OF EVIDENCE II.
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MESH Headings
- Enteral Nutrition
- Enterocolitis, Necrotizing/complications
- Enterocolitis, Necrotizing/physiopathology
- Enterocolitis, Necrotizing/therapy
- Female
- Follow-Up Studies
- Growth Disorders/etiology
- Humans
- Infant
- Infant, Extremely Low Birth Weight
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/physiopathology
- Infant, Premature, Diseases/therapy
- Male
- Patient Discharge
- Survivors
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Affiliation(s)
- Charles R Hong
- Center for Advanced Intestinal Rehabilitation, Department of Surgery, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Brenna S Fullerton
- Center for Advanced Intestinal Rehabilitation, Department of Surgery, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Charles E Mercier
- University of Vermont, 89 Beaumont Avenue, Burlington, VT 05405, USA
| | - Kate A Morrow
- Vermont Oxford Network, 33 Kilburn Street, Burlington, VT 05401, USA
| | - Erika M Edwards
- University of Vermont, 89 Beaumont Avenue, Burlington, VT 05405, USA; Vermont Oxford Network, 33 Kilburn Street, Burlington, VT 05401, USA
| | - Karla R Ferrelli
- Vermont Oxford Network, 33 Kilburn Street, Burlington, VT 05401, USA
| | - Roger F Soll
- University of Vermont, 89 Beaumont Avenue, Burlington, VT 05405, USA; Vermont Oxford Network, 33 Kilburn Street, Burlington, VT 05401, USA
| | - Biren P Modi
- Center for Advanced Intestinal Rehabilitation, Department of Surgery, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Jeffrey D Horbar
- University of Vermont, 89 Beaumont Avenue, Burlington, VT 05405, USA; Vermont Oxford Network, 33 Kilburn Street, Burlington, VT 05401, USA
| | - Tom Jaksic
- Center for Advanced Intestinal Rehabilitation, Department of Surgery, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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9
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Effect of increased enteral protein intake on plasma and urinary urea concentrations in preterm infants born at < 32 weeks gestation and < 1500 g birth weight enrolled in a randomized controlled trial - a secondary analysis. BMC Pediatr 2018; 18:154. [PMID: 29739389 PMCID: PMC5941684 DOI: 10.1186/s12887-018-1136-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 04/30/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Feeding breast milk is associated with reduced morbidity and mortality, as well as improved neurodevelopmental outcome but does not meet the high nutritional requirements of preterm infants. Both plasma and urinary urea concentrations represent amino acid oxidation and low concentrations may indicate insufficient protein supply. This study assesses the effect of different levels of enteral protein on plasma and urinary urea concentrations and determines if the urinary urea-creatinine ratio provides reliable information about the protein status of preterm infants. METHODS Sixty preterm infants (birthweight < 1500 g; gestational age < 32 weeks) were enrolled in a randomized controlled trial and assigned to either a lower-protein group (median protein intake 3.7 g/kg/d) or a higher-protein group (median protein intake 4,3 g/kg/d). Half the patients in the higher-protein group received standardized supplementation with a supplement adding 1.8 g protein/100 ml milk, the other half received individual supplementation depending on the respective mother's milk macronutrient content. Plasma urea concentration was determined in two scheduled blood samples (BS1; BS2); urinary urea and creatinine concentrations in weekly spot urine samples. RESULTS The higher-protein group showed higher plasma urea concentrations in both BS1 and BS2 and a higher urinary urea-creatinine-ratio in week 3 and 5-7 compared to the lower-protein group. In addition, a highly positive correlation between plasma urea concentrations and the urinary urea-creatinine-ratio (p < 0.0001) and between actual protein intake and plasma urea concentrations and the urinary urea-creatinine-ratio (both p < 0.0001) was shown. CONCLUSIONS The urinary urea-creatinine-ratio, just like plasma urea concentrations, may help to estimate actual protein supply, absorption and oxidation in preterm infants and, additionally, can be determined non-invasively. Further investigations are needed to determine reliable cut-off values of urinary urea concentrations to ensure appropriate protein intake. TRIAL REGISTRATION Clinicaltrials.gov; NCT01773902 registered 15 January 2013, retrospectively registered.
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10
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Abd El-Wahed M, El-Farghali O, ElAbd H, El-Desouky E, Hassan S. Metabolic derangements in IUGR neonates detected at birth using UPLC-MS. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2017. [DOI: 10.1016/j.ejmhg.2016.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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11
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Posod A, Müller S, Komazec IO, Dejaco D, Peglow UP, Griesmaier E, Scholl-Bürgi S, Karall D, Kiechl-Kohlendorfer U. Former very preterm infants show alterations in plasma amino acid profiles at a preschool age. Pediatr Res 2017; 81:787-794. [PMID: 28141791 DOI: 10.1038/pr.2017.24] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 12/30/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND Amino acid analysis is a valuable tool for cardiovascular risk assessment. Preterm infants display plasma amino acid changes in the newborn period. Whether these changes persist is unknown to date. The aim of this study was to assess whether former very preterm infants (VPI) show alterations in amino acid patterns indicative of an unfavorable cardiovascular risk profile at a preschool age. METHODS From 5-7 y-old children born at term or <32 wk gestation (VPI) were included in the study. Plasma amino acid concentrations were determined after an overnight fast. RESULTS 29 former term infants and 79 former VPI were included in the study. Former VPI showed changes in various plasma amino acids including glutamine, arginine, citrulline, tryptophan, glutamate, ornithine, and taurine. Branched-chain amino acids were lower, alanine/lysine ratios significantly higher in the preterm population. CONCLUSION Former VPI show altered plasma amino acid profiles indicative of a dualistic cardiovascular risk profile (e.g., potentially beneficial elevations in citrulline, arginine, glutamine, and tryptophan, but also raised alanine/lysine ratios, low ornithine and taurine levels) at a preschool age. Whether this is associated with an adverse cardiovascular outcome has to be addressed by future studies. Long-term cardiometabolic follow-up of VPI might be warranted.
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Affiliation(s)
- Anna Posod
- Pediatrics II (Neonatology), Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Susanne Müller
- Pediatrics II (Neonatology), Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Irena Odri Komazec
- Pediatrics II (Neonatology), Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria.,Pediatrics III (Pediatric Cardiology), Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniel Dejaco
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Ulrike Pupp Peglow
- Pediatrics II (Neonatology), Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Elke Griesmaier
- Pediatrics II (Neonatology), Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Sabine Scholl-Bürgi
- Pediatrics I (Inherited Metabolic Disorders), Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniela Karall
- Pediatrics I (Inherited Metabolic Disorders), Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Ursula Kiechl-Kohlendorfer
- Pediatrics II (Neonatology), Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
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12
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Ho MY, Yen YH. Trend of Nutritional Support in Preterm Infants. Pediatr Neonatol 2016; 57:365-370. [PMID: 26948464 DOI: 10.1016/j.pedneo.2015.10.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/13/2015] [Accepted: 10/21/2015] [Indexed: 11/30/2022] Open
Abstract
Without appropriate nutritional support, preterm infants fail to grow after birth and have malnutrition. The main reason for delayed feeding is fear of immaturity of gastrointestinal function. The principles of nutritional practice should be as follows: (1) minimal early initiation of enteral feeding with breast milk (0.5-1 mL/h) to start on Day 1 if possible and gradual increase as tolerated; (2) early aggressive parenteral nutrition as soon as possible; (3) provision of lipids at rates that will meet the additional energy needs of about 2-3 g/kg/d; and (4) attempt to increase enteral feeding rather than parenteral nutrition.
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Affiliation(s)
- Man-Yau Ho
- Department of Pediatrics, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yu-Hsuan Yen
- Department of Pharmacy, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
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13
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Alterations of protein expression in serum of infants with intrauterine growth restriction and different gestational ages. J Proteomics 2015; 119:169-82. [DOI: 10.1016/j.jprot.2015.02.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 02/16/2015] [Indexed: 01/19/2023]
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Ramel SE, Brown LD, Georgieff MK. The Impact of Neonatal Illness on Nutritional Requirements-One Size Does Not Fit All. CURRENT PEDIATRICS REPORTS 2014; 2:248-254. [PMID: 25722954 PMCID: PMC4337785 DOI: 10.1007/s40124-014-0059-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Sick neonates are at high risk for growth failure and poorer neurodevelopment than their healthy counterparts. The etiology of postnatal growth failure in sick infants is likely multi-factorial and includes undernutrition due to the difficulty of feeding them during their illness and instability. Illness also itself induces fundamental changes in cellular metabolism that appear to significantly alter nutritional demand and nutrient handling. Inflammation and physiologic stress play a large role in inducing the catabolic state characteristic of the critically ill newborn infant. Inflammatory and stress responses are critical short-term adaptations to promote survival, but are not conducive to promoting long-term growth and development. Conditions such as sepsis, surgery, necrotizing enterocolitis, chronic lung disease and intrauterine growth restriction and their treatments are characterized by altered energy, protein and micronutrient metabolism that result in nutritional requirements that are different from those of the healthy, growing term or preterm infant.
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Affiliation(s)
- Sara E. Ramel
- Assistant Professor of Pediatrics, University of Minnesota
Children’s Hospital, 2450 Riverside Avenue; MB630 East Building,
Minneapolis, MN 55454, Ph: 612-626-0644; Fax: 612-624-8176
| | - Laura D. Brown
- Associate Professor of Pediatrics, University of Colorado School of
Medicine, Aurora, CO, Ph: 303-724-0106 Fax: 303-724-0898
| | - Michael K. Georgieff
- Professor of Pediatrics and Child Psychology, University of
Minnesota Children’s Hospital, 2450 Riverside Avenue; MB630 East
Building, Minneapolis, MN 55454, Ph: 612-626-0644; Fax: 612-624-8176
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15
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Abstract
Approximately 10% of all babies worldwide are born preterm, and preterm birth is the leading cause of perinatal mortality in developed countries. Although preterm birth is associated with adverse short- and long-term health outcomes, it is not yet clear whether this relationship is causal. Rather, there is evidence that reduced foetal growth, preterm birth and the long-term health effects of both of these may all arise from a suboptimal intrauterine environment. Further, most infants born preterm also experience suboptimal postnatal growth, with potential adverse effects on long-term health and development. A number of interventions are used widely in the neonatal period to optimise postnatal growth and development. These commonly include supplementation with macronutrients and/or micronutrients, all of which have potential short-term risks and benefits for the preterm infant, whereas the long-term health consequences are largely unknown. Importantly, more rapid postnatal growth trajectory (and the interventions required to achieve this) may result in improved neurological outcomes at the expense of increased cardiovascular risk in later life.
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16
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Alexandre-Gouabau MC, Courant F, Moyon T, Küster A, Le Gall G, Tea I, Antignac JP, Darmaun D. Maternal and cord blood LC-HRMS metabolomics reveal alterations in energy and polyamine metabolism, and oxidative stress in very-low birth weight infants. J Proteome Res 2013; 12:2764-78. [PMID: 23527880 DOI: 10.1021/pr400122v] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
To assess the global effect of preterm birth on fetal metabolism and maternal-fetal nutrient transfer, we used a mass spectrometric-based chemical phenotyping approach on cord blood obtained at the time of birth. We sampled umbilical venous, umbilical arterial, and maternal blood from mothers delivering very-low birth weight (VLBW, with a median gestational age and weight of 29 weeks, and 1210 g, respectively) premature or full-term (FT) neonates. In VLBW group, we observed a significant elevation in the levels and maternal-fetal gradients of butyryl-, isovaleryl-, hexanoyl- and octanoyl-carnitines, suggesting enhanced short- and medium chain fatty acid β-oxidation in human preterm feto-placental unit. The significant decrease in glutamine-glutamate in preterm arterial cord blood beside lower levels of amino acid precursors of Krebs cycle suggest increased glutamine utilization in the fast growing tissues of preterm fetus with a deregulation in placental glutamate-glutamine shuttling. Enhanced glutathione utilization is likely to account for the decrease in precursor amino acids (serine, betaine, glutamate and methionine) in arterial cord blood. An increase in both the circulating levels and maternal-fetal gradients of several polyamines in their acetylated form (diacetylspermine and acetylputrescine) suggests an enhanced polyamine metabolic cycling in extreme prematurity. Our metabolomics study allowed the identification of alterations in fetal energy, antioxidant defense, and polyamines and purines flux as a signature of premature birth.
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17
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Enhanced feeding in very-low-birth-weight infants may cause electrolyte disturbances and septicemia – A randomized, controlled trial. Clin Nutr 2013; 32:207-12. [DOI: 10.1016/j.clnu.2012.09.004] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 09/07/2012] [Accepted: 09/13/2012] [Indexed: 11/21/2022]
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Cormack B, Sinn J, Lui K, Tudehope D. Australasian neonatal intensive care enteral nutrition survey: implications for practice. J Paediatr Child Health 2013; 49:E340-7. [PMID: 23227901 DOI: 10.1111/jpc.12016] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2011] [Indexed: 11/27/2022]
Abstract
AIM This survey investigated standardised feeding guidelines and nutrition policy in Australasian neonatal intensive care units and compared these with previously published surveys and international consensus nutrition recommendations. METHODS An electronic survey on enteral nutrition comprising a wide range of questions about clinical practice was e-mailed to all 25 Australasian neonatal intensive care unit directors of tertiary perinatal centres. RESULTS Twenty-five surveys were distributed; 24 (96%) were completed. All respondents preferred breast milk as the first feed. For infants <1000 g, 58% started feeds at 1 mL every 4 hours and 83% started enteral feeds on day 0-2 in the absence of contraindications. The identification of bile-stained gastric aspirates significant enough to withhold feeds varied. Multicomponent breast milk fortifiers were added by 58% when enteral feeds reached 150 mL/kg day, while 21% added these earlier at 120 mL/kg day or less. Iron supplementation was started at 4 weeks by 63% and at 6 weeks by 27%. Only 42% of units had a neonatal dietitian. Of the 24 units who responded, 58% had no written enteral feeding guidelines. CONCLUSION Enteral nutrition was initiated earlier than in the past. Great variation remains in clinical practices. Nutritional implications are discussed. Standardisation of feeding guidelines and enteral nutrition policy based on current evidence and international consensus nutrition recommendations may be beneficial and should be encouraged.
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19
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García LV, Erroz IO, Freire MM, Muñuzuri AP, Souto AB, Pico MLC, Bermúdez JMF. [Does early parenteral protein intake improve extrauterine growth in low birth weight preterms?]. An Pediatr (Barc) 2011; 76:127-32. [PMID: 22056312 DOI: 10.1016/j.anpedi.2011.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 04/05/2011] [Accepted: 04/07/2011] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Extrauterine growth restriction affects most premature newborns. Early and higher parenteral protein intake seems to improve postnatal growth and associated comorbidities. We evaluate the impact of a new parenteral nutrition protocol based on early amino acid administration on postnatal growth in premature infants with a birth weight < 1,500 grams. MATERIAL AND METHODS A case-control study in 58 premature newborns with a birth weight < 1,500 grams. In the case group we included 29 preterm neonates who received at least 1.5 g/kg/day parenteral amino acid during the first 24 hours after birth, reaching a maximum dose of 3.5 g/kg/day on the 3(rd)-4(th) day after birth. The control group was formed by 29 preterm neonates for whom protein support began on the 2(nd-)3(rd) day after birth with a dose of 1g/kg/day with lower daily increases than the case group. Growth rates and complications were followed until 28 days of life or discharge from NICU. RESULTS There were no differences between groups in baseline characteristics. Premature newborns who received higher and earlier doses of proteins had a greater weight gain than the control group, and this difference was statistically significant (423 ± 138 g vs. 315 ± 142 g; P=.005). In addition, they had a higher daily weight gain rate (19.4 ± 3.3 vs. 16.5 ± 4.8; P=.010) and they regained birth weight earlier (11.5 ± 3.3 days vs. 14.5 ± 4.5 days; P=.045). A higher incidence of complications was not observed. CONCLUSIONS Early and higher amino acid administration improves growth rate in premature neonates with no apparent increase in risks for the patient.
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Affiliation(s)
- L Vázquez García
- Servicio de Neonatología, Departamento de Pediatría, Hospital Clínico Universitario de Santiago de Compostela, A Coruña, España.
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20
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Heimler R, Bamberger JM, Sasidharan P. The effects of early parenteral amino acids on sick premature infants. Indian J Pediatr 2010; 77:1395-9. [PMID: 20830534 DOI: 10.1007/s12098-010-0187-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2009] [Accepted: 08/18/2010] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To study the effects of early parenteral amino acid administration on body weight, fluid compartments and metabolic parameters during the first week of life in sick premature infants. METHODS Appropriate for gestational age, sick premature infants were randomized into two groups. Group A infants (n=8, birth weight 1258±339 g) were supplemented with amino acids starting within 24 h of birth and advanced to 2.5 g/kg per day by day 3. Group G infants (n=9, birth weight 1182±214 g) received amino acids starting on day 4 of life. Energy intake was comparable in the 2 groups. Amino acid concentrations and nitrogen balance studies were performed on day 3 of life. Total body water and extracellular water were measured on day 1 and 8 and change in intracellular volume was calculated. RESULTS There was no significant difference between the 2 groups in terms of weight, intracellular volume change from day 1 to day 8 of life, despite a significant (P<0.01) difference in protein intake. Plasma ammonia levels were comparable in the 2 groups, but plasma urea levels were significantly higher in group A vs. group G infants (7.2±3.4 mmol/L vs. 3.2±1.2 mmol/L respectively, P<0.01). Nitrogen balance was positive in all group A infants and negative in group G infants. Nitrogen loss was inversely correlated with energy intake in group G infants (P<0.05). The mean plasma amino acid concentrations in group A infants (compared to those of group G) were within previously reported ranges in older premature infants. CONCLUSIONS There was no significant effect on body weight and redistribution of body fluid compartments in infants receiving amino acids early during the first week of life. Serum urea concentrations were significantly higher in infants receiving early amino acids. Nitrogen losses in infants who did not receive amino acids were inversely correlated with energy intake during the first 3 days of life.
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Affiliation(s)
- Ruth Heimler
- Department of Pediatrics, Medical College of Wisconsin and the Children's Hospital of Wisconsin, Milwaukee, WI 53217, USA
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21
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van den Akker CHP, Vlaardingerbroek H, van Goudoever JB. Nutritional support for extremely low-birth weight infants: abandoning catabolism in the neonatal intensive care unit. Curr Opin Clin Nutr Metab Care 2010; 13:327-35. [PMID: 20216411 DOI: 10.1097/mco.0b013e328337d925] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Obviously, the ultimate goal in neonatology is to achieve a functional outcome in premature infants that is comparable to healthy term-born infants. As nutrition is one of the key factors for normal cell growth, providing the right amount and quality of nutrients could prove pivotal for normal development. However, many premature infants are catabolic during the first week of life, which has directly been linked to growth failure, disease, and suboptimal long-term outcome. This review describes the progress in research on parenteral nutrition for premature infants with a focus on amino acids and the influence of nutrition on later outcome. RECENT FINDINGS Although randomized clinical trials on early nutrition for premature infants remain relatively sparse, evidence is accumulating on its beneficial effects both on the short-term and long-term. However, some research also warns for adverse effects. SUMMARY Despite the fact that substantially improved nutritional therapies for preterm neonates have been implemented, still, some reluctance exists when it comes to providing high amounts of nutrition to the most immature infants. Pros and cons are outlined, as well as deficits in knowledge, when it comes to providing the optimal nutrient strategy in the first postnatal phase.
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Affiliation(s)
- Chris H P van den Akker
- Division of Neonatology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
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22
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Shan J, Lopez MC, Baker HV, Kilberg MS. Expression profiling after activation of amino acid deprivation response in HepG2 human hepatoma cells. Physiol Genomics 2010; 41:315-27. [PMID: 20215415 DOI: 10.1152/physiolgenomics.00217.2009] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Dietary protein malnutrition is manifested as amino acid deprivation of individual cells, which activates an amino acid response (AAR) that alters cellular functions, in part, by regulating transcriptional and posttranscriptional mechanisms. The AAR was activated in HepG2 human hepatoma cells, and the changes in mRNA content were analyzed by microarray expression profiling. The results documented that 1,507 genes were differentially regulated by P < 0.001 and by more than twofold in response to the AAR, 250 downregulated and 1,257 upregulated. The spectrum of altered genes reveals that amino acid deprivation has far-reaching implications for gene expression and cellular function. Among those cellular functions with the largest numbers of altered genes were cell growth and proliferation, cell cycle, gene expression, cell death, and development. Potential biological relationships between the differentially expressed genes were analyzed by computer software that generates gene networks. Proteins that were central to the most significant of these networks included c-myc, polycomb group proteins, transforming growth factor β1, nuclear factor (erythroid-derived 2)-like 2-related factor 2, FOS/JUN family members, and many members of the basic leucine zipper superfamily of transcription factors. Although most of these networks contained some genes that were known to be amino acid responsive, many new relationships were identified that underscored the broad impact that amino acid stress has on cellular function.
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Affiliation(s)
- Jixiu Shan
- Department of Biochemistry and Molecular Biology and
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23
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Abstract
Nutritional support to promote optimal postnatal growth for very low birth weight (VLBW) newborns less than 1500 g at birth during the initial prolonged hospitalization is a significant issue. This article reviews the concepts involved in the nutritional support of VLBW newborns, including definitions and discussions of growth, optimal postnatal growth, body composition, initial weight loss, growth expectations, growth assessment tools used during the postnatal period, the relation between inadequate nutrition and neurodevelopment, the relation between protein intake and cognitive outcome, postnatal nutrition balance, the potential for programming of future adult-onset chronic conditions, a review of fetal nutritional intake, and current recommendations for nutritional support of VLBW newborns.
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Halliday HL. Neonatal management and long-term sequelae. Best Pract Res Clin Obstet Gynaecol 2009; 23:871-80. [PMID: 19632899 DOI: 10.1016/j.bpobgyn.2009.06.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Accepted: 03/26/2009] [Indexed: 01/21/2023]
Abstract
Intrauterine or fetal growth restriction is best defined by using customised birth weight percentiles based upon the growth potential for an individual infant. Growth restriction in utero may be classified as asymmetric or symmetric depending upon the duration of the process. Asymmetric growth restriction is caused by placental insufficiency, maternal hypertensive conditions, long-standing maternal diabetes, smoking, living at altitude or multiple gestation. Symmetric growth restriction may be due to congenital infections, chromosomal or other abnormalities, fetal alcohol syndrome, low socioeconomic status or be constitutional. The underlying cause of growth restriction often predicts the potential adverse effects on the foetus and newborn and later effects in childhood and adulthood. With placental insufficiency, there may be chronic or acute on chronic fetal hypoxia with birth asphyxia and hypothermia, neonatal hypoglycaemia, polycythaemia and coagulopathy. Management is directed at prevention or early treatment of these conditions. In contrast, symmetrically growth-restricted infants should be examined carefully to look for congenital infections and malformations that may need specific interventions. Infants with constitutional short stature generally do not need any specific management. Feeding of growth-restricted infants is important to overcome deficiencies incurred in utero. Most infants show catch-up growth although about 10% do not. Those with excessive catch-up growth may be at greatest risk of developing insulin resistance in adulthood leading to diabetes, obesity and heart disease. The so-called fetal origins of disease may actually have a postnatal onset related more to excessive weight gain in infancy. There is still controversy over the indications for growth hormone treatment in growth-restricted infants who remain of short stature in early childhood. Intrauterine growth restriction is also associated with a five- to seven-fold increased risk of cerebral palsy probably due to chronic placental insufficiency.
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Affiliation(s)
- Henry L Halliday
- Perinatal Medicine, Royal Maternity Hospital, and Department of Child Health, Queen's University Belfast, Belfast, Northern Ireland.
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Current world literature. Ageing: biology and nutrition. Curr Opin Clin Nutr Metab Care 2009; 12:95-100. [PMID: 19057195 DOI: 10.1097/mco.0b013e32831fd97a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Abstract
There is compelling evidence that current nutritional practice fails to provide sufficient dietary protein for preterm infants, especially extremely and very low birth weight infants. Nutrient requirements can be estimated by a variety of techniques, but most suggest that these infants will require a protein intake of 3.5-4.0 g/kg/d. Even when these infants are able to tolerate full enteral feeds, most currently available artificial milk formula or breast milk fortifiers will not ensure these protein requirements are met except when fed at high volumes. Energy requirements on the other hand may be currently met, and evidence from controlled studies suggests that intakes higher than 110-135 kcal/kg/d might not be beneficial. The data from studies on neonatal adiposity outcomes, and from studies examining relationship between early growth and later cardiovascular outcome, also suggest that excess nutrient intake might be harmful. In the light of this data, optimal intakes and protein-energy ratios require re-appraisal.
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Affiliation(s)
- Nicholas D Embleton
- Newcastle Neonatal Service, Royal Victoria Infirmary, University of Newcastle, Newcastle upon Tyne, UK.
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