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Morgan C, Parry S, Park J, Tan M. Neurodevelopmental Outcome in Very Preterm Infants Randomised to Receive Two Different Standardised, Concentrated Parenteral Nutrition Regimens. Nutrients 2023; 15:4741. [PMID: 38004135 PMCID: PMC10674254 DOI: 10.3390/nu15224741] [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: 09/11/2023] [Revised: 11/04/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
We have previously shown that increasing parenteral protein (target: 3.8 versus 2.8 g/kg/d) and energy (12% versus 10% glucose; 3.8 versus 2.8 g/kg/d) intake using a Standardised, Concentrated with Added Macronutrients Parenteral (SCAMP) nutrition regimen ameliorates early head growth failure in very-preterm infants (VPIs). We hypothesised that the SCAMP nutrition regimen would also improve neurodevelopmental outcome. The original double-blind randomised, controlled study (ISRCTN: 76597892) received ethical approval. VPIs were randomised to either start SCAMP or remain on the control regimen. The consent process included neurodevelopmental assessments (Bayley III), all of which were performed (blinded) at 2-3.5 years of corrected gestational age. Bayley III assessments were performed for 38/60 SCAMP survivors and 41/63 control survivors at means of (sd) 29.2 (3.7) and 20.0 (3.9) months, respectively. Motor, cognitive, language, and combined scores were all higher in the SCAMP intervention group, but none of the differences were statistically significant. Nutrient intake and biochemical monitoring data confirmed that protein/energy ratios were maintained in the SCAMP intervention group without increasing the incidence of hyperglycaemia, insulin treatment, or the derangement of plasma mineral/electrolyte levels. This study did not show a statistically significant improvement in neurodevelopmental outcome when administering higher parenteral protein/energy intakes despite optimal energy and mineral intakes.
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Affiliation(s)
- Colin Morgan
- Liverpool Women’s Hospital, Liverpool L8 7SS, UK
| | - Samantha Parry
- Liverpool Women’s Hospital, Liverpool L8 7SS, UK
- Alder Hey Children’s Hospital, Liverpool L14 5AB, UK
| | - Julie Park
- Alder Hey Children’s Hospital, Liverpool L14 5AB, UK
| | - Maw Tan
- Alder Hey Children’s Hospital, Liverpool L14 5AB, UK
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2
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Jańczewska I, Wierzba J, Jańczewska A, Szczurek-Gierczak M, Domżalska-Popadiuk I. Prematurity and Low Birth Weight and Their Impact on Childhood Growth Patterns and the Risk of Long-Term Cardiovascular Sequelae. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1599. [PMID: 37892262 PMCID: PMC10605160 DOI: 10.3390/children10101599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/17/2023] [Accepted: 09/21/2023] [Indexed: 10/29/2023]
Abstract
Preterm birth (before 37 completed weeks of gestation) is a global health problem, remaining the main reason for neonatal mortality and morbidity. Improvements in perinatal and neonatal care in recent decades have been associated with a higher survival rate of extremely preterm infants, leading to a higher risk of long-term sequelae in this population throughout life. Numerous surveillance programs for formerly premature infants continue to focus on neurodevelopmental disorders, while long-term assessment of the impact of preterm birth and low birth weight on child growth and the associated risk of cardiovascular disease in young adults is equally necessary. This review will discuss the influence of prematurity and low birth weight on childhood growth and cardiovascular risk in children, adolescents and young adults. The risk of cardiovascular and metabolic disorders is increased in adult preterm survivors. In early childhood, preterm infants may show elevated blood pressure, weakened vascular growth, augmented peripheral vascular resistance and cardiomyocyte remodeling. Increased weight gain during the early postnatal period may influence later body composition, promote obesity and impair cardiovascular results. These adverse metabolic alterations contribute to an increased risk of cardiovascular incidents, adult hypertension and diabetes. Preterm-born children and those with fetal growth restriction (FGR) who demonstrate rapid changes in their weight percentile should remain under surveillance with blood pressure monitoring. A better understanding of lifelong health outcomes of preterm-born individuals is crucial for developing strategies to prevent cardiovascular sequelae and may be the basis for future research to provide effective interventions.
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Affiliation(s)
- Iwona Jańczewska
- Department of Neonatology, Medical University of Gdansk, Mariana Smoluchowskiego 17 Street, 80-214 Gdansk, Poland
| | - Jolanta Wierzba
- Department of Internal and Pediatric Nursing, Institute of Nursing and Midwifery, Medical University of Gdansk, Debinki 7 Street, 80-211 Gdansk, Poland
| | - Alicja Jańczewska
- Diagnostic Imaging Department, Voivodeship Oncology Centre, Skłodowskiej-Curie 2 Street, 80-210 Gdansk, Poland
| | - Małgorzata Szczurek-Gierczak
- Department of Obstetrics and Gynecology, Pomeranian Hospitals in Gdynia, Powstania Styczniowego 1 Street, 81-519 Gdynia, Poland
| | - Iwona Domżalska-Popadiuk
- Department of Neonatology, Medical University of Gdansk, Mariana Smoluchowskiego 17 Street, 80-214 Gdansk, Poland
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3
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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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4
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Preterm birth and subsequent timing of pubertal growth, menarche, and voice break. Pediatr Res 2022; 92:199-205. [PMID: 34429512 PMCID: PMC9411060 DOI: 10.1038/s41390-021-01690-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/10/2021] [Accepted: 07/19/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND We evaluated pubertal growth and pubertal timing of participants born preterm compared to those born at term. METHODS In the ESTER Preterm Birth Study, we collected growth data and measured final height of men/women born very or moderately preterm (<34 gestational weeks, n = 52/55), late preterm (34-<37 weeks, 94/106), and term (≥37 weeks, 131/151), resulting in median 9 measurements at ≥6 years. Timing of menarche or voice break was self-reported. Peak height velocity (PHV, cm/year) and age at PHV (years) were compared with SuperImposition by Translation And Rotation (SITAR) model (sexes separately). RESULTS Age at PHV (years) and PHV (cm/year) were similar in all gestational age groups. Compared to term controls, insignificant differences in age at PHV were 0.1 (95% CI: -0.2 to 0.4) years/0.2 (-0.1 to 0.4) for very or moderately/late preterm born men and -0.0 (-0.3 to 0.3)/-0.0 (-0.3 to 0.2) for women, respectively. Being born small for gestational age was not associated with pubertal growth. Age at menarche or voice break was similar in all the gestational age groups. CONCLUSIONS Timing of pubertal growth and age at menarche or voice break were similar in participants born preterm and at term. IMPACT Pubertal growth and pubertal timing were similar in preterm and term participants in a relatively large cohort with a wide range of gestational ages. Previous literature indicates that small for gestational age is a risk for early puberty in term born children. This was not shown in preterm children. While our study had limited power for children born very preterm, all children born preterm were not at increased risk for early puberty.
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Behnke J, Estreich V, Oehmke F, Zimmer KP, Windhorst A, Ehrhardt H. Compatibility of rapid enteral feeding advances and noninvasive ventilation in preterm infants-An observational study. Pediatr Pulmonol 2022; 57:1117-1126. [PMID: 35191216 DOI: 10.1002/ppul.25868] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 11/05/2022]
Abstract
AIM To evaluate safety and clinical outcome of rapid enteral feeding advances in preterm infants <1500 g birthweight (BW). METHODS In this single-center retrospective cohort study, 293 preterm infants born during 2015-2018 were comparatively analyzed before (n = 145) and after (n = 148) the implementation of a rapid enteral feeding protocol with daily milk increments of 20-30 ml/kg of body weight. Major outcome parameters were focused toward pulmonary morbidities and nutritional variables. RESULTS Preterm infants in the rapid feeding advancement group were more successfully stabilized on noninvasive ventilation (p < 0.001) never requiring mechanical ventilation. Duration of respiratory support (0.465) and frequency of bronchopulmonary dysplasia (BPD) (p = 0.341) and severe BPD (0.273) did not differ between both groups. Furthermore, patients in the rapid feeding group achieved full volume feedings faster (p < 0.001), regained BW earlier (p = 0.009), and displayed significantly improved somatic growth at 36 weeks gestational age (p < 0.001). There was no increased risk for further morbidities of prematurity including feeding intolerance, necrotizing enterocolitis (NEC), and focal intestinal perforation. CONCLUSION Rapid enteral feeding advancements in preterm infants <1500 g BW are safe and do not impede stabilization on noninvasive ventilation.
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Affiliation(s)
- Judith Behnke
- Department of General Pediatrics & Neonatology, Justus Liebig University and Universities of Giessen and Marburg Lung Center, Giessen, Germany.,German Center for Lung Research (DZL), Giessen, Germany
| | - Vanessa Estreich
- Department of General Pediatrics & Neonatology, Justus Liebig University and Universities of Giessen and Marburg Lung Center, Giessen, Germany
| | - Frank Oehmke
- Department of Gynecology and Obstetrics, Justus Liebig University of Giessen, Giessen, Germany
| | - Klaus-Peter Zimmer
- Department of General Pediatrics & Neonatology, Justus Liebig University and Universities of Giessen and Marburg Lung Center, Giessen, Germany
| | - Anita Windhorst
- Department of Medical Statistics, Justus Liebig University of Giessen, Giessen, Germany
| | - Harald Ehrhardt
- Department of General Pediatrics & Neonatology, Justus Liebig University and Universities of Giessen and Marburg Lung Center, Giessen, Germany.,German Center for Lung Research (DZL), Giessen, Germany
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Growth Trajectories during the First 6 Years in Survivors Born at Less Than 25 Weeks of Gestation Compared with Those between 25 and 29 Weeks. J Clin Med 2022; 11:jcm11051418. [PMID: 35268509 PMCID: PMC8911231 DOI: 10.3390/jcm11051418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 11/30/2022] Open
Abstract
We aimed to determine the differences in the growth trajectories of the youngest gestational survivors (<25 weeks’ gestation) up to 6 years of age compared to those of older gestational ages. Preterm infants were divided into two groups: 22−24 weeks’ gestation (male (M) 16, female (F) 28) and 25−29 weeks’ gestation (M 84, F 59). Z-scores of body weight (BW), body length (BL), and body mass index (BMI) were derived from Japanese standards at 1, 1.5, 3, and 6 years of corrected age. Comparisons between the two groups by sex were made using the Wilcoxon test and linear regression analysis to examine the longitudinal and time-point associations of anthropometric z-scores, the presence of small for gestational age (SGA), and the two gestational groups. BW, BL, BMI, and z-scores were significantly lower in the 22−24 weeks group at almost all assessment points. However, there were no significant differences in BW, BL, BMI, and z-scores between the two female groups after 3 years. BMI z-scores were significantly associated with the youngest gestational age and the presence of SGA at all ages in males, but not in females. The youngest gestational age had a greater influence in males on the z-score of anthropometric parameters up to 6 years of age.
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Ni Y, Lancaster R, Suonpera E, Bernardi M, Fahy A, Larsen J, Trickett J, Hurst JR, Wolke D, Johnson S, Marlow N. Growth in extremely preterm children born in England in 1995 and 2006: the EPICure studies. Arch Dis Child Fetal Neonatal Ed 2022; 107:193-200. [PMID: 34257100 PMCID: PMC8867260 DOI: 10.1136/archdischild-2020-321107] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 06/28/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To determine growth outcomes at 11 years of age in children born <27 weeks of gestation in England in 2006 (EPICure2) and to compare growth from birth to 11 years of age for births<26 weeks with those in England in 1995 (EPICure). METHODS 200 EPICure2 children assessed at 11 years alongside 143 term-born controls. Growth measures from birth to 11 years were compared for births<26 weeks between EPICure2 (n=112) and EPICure (n=176). Growth parameter z-scores were derived from 1990 UK standards. RESULTS Among EPICure2 children, mean z-scores for height and weight were close to the population standards (0.08 and 0.18 SD, respectively) but significantly below those of controls: difference in mean (Δ) z-scores for weight -0.42 SD (95% CI -0.68 to -0.17), for height -0.45 SD (-0.70 to -0.20) and for head circumference (HC) -1.05 SD (-1.35 to -0.75); mean body mass index (BMI) z-score in EPICure2 children was 0.18 SD, not significantly different from controls (0.43 SD, p=0.065). Compared with EPICure, EPICure2 children born <26 weeks at 11 years had higher z-scores for weight (Δ 0.72 (0.47, 0.96)), height (Δ 0.55 (0.29, 0.81)) and BMI (Δ 0.56 (0.24, 0.87)), which were not fully explained by perinatal/demographic differences between eras. Weight catch-up was greater from term-age to 2.5/3 years in EPICure2 than in EPICure (1.25 SD vs 0.53 SD; p<0.001). Poor HC growth was observed in EPICure2, unchanged from EPICure. CONCLUSIONS Since 1995, childhood growth in weight, height and BMI have improved for births <26 weeks of gestation, but there was no improvement in head growth.
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Affiliation(s)
- Yanyan Ni
- EGA Institute for Women's Health, University College London, London, UK .,Department of Psychology, University of Warwick, Coventry, UK
| | - Rebecca Lancaster
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Emmi Suonpera
- EGA Institute for Women's Health, University College London, London, UK
| | | | - Amanda Fahy
- EGA Institute for Women's Health, University College London, London, UK
| | - Jennifer Larsen
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Jayne Trickett
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
| | - Dieter Wolke
- Department of Psychology, University of Warwick, Coventry, UK,Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Samantha Johnson
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Neil Marlow
- EGA Institute for Women's Health, University College London, London, UK
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8
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Walton K, Daniel AI, Mahood Q, Vaz S, Law N, Unger SL, O'Connor DL. Eating Behaviors, Caregiver Feeding Interactions, and Dietary Patterns of Children Born Preterm: A Systematic Review and Meta-Analysis. Adv Nutr 2022; 13:875-912. [PMID: 35157009 PMCID: PMC9156386 DOI: 10.1093/advances/nmac017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/26/2022] [Accepted: 02/11/2022] [Indexed: 11/13/2022] Open
Abstract
Infants born preterm (<37 weeks of gestation) often experience feeding problems during hospitalization. Whether difficulties persist or have long-term sequelae on childhood eating is unclear. We aimed to describe the oromotor eating skills (e.g., chewing/swallowing), eating behaviors (e.g., food neophobia), food parenting practices (e.g., pressure to eat), and dietary patterns of preterm children during late infancy (6-12 mo) and early childhood (>12 mo-7 y) and to determine whether these differed from those of term-born peers. We identified 67 articles (57 unique studies) for inclusion. We used random-effects meta-analysis of proportions to examine the prevalence of oromotor eating skill and eating behavior challenges among preterm children, standard meta-analysis for comparisons with term-born peers, and the Grading of Recommendations, Assessment, Development and Evaluation approach to assess the certainty of evidence. Forty-three percent (95% CI: 24%, 62%) of infants and 25% (95% CI: 17%, 33%) of children born preterm experienced oromotor eating difficulties and 16% (95% CI: 4%, 27%) and 20% (95% CI: 11%, 28%), respectively, exhibited challenging eating behaviors. During late infancy and early childhood, oromotor eating difficulties (OR: 2.86; 95% CI: 1.71, 4.77; I2 = 67.8%) and challenging eating behaviors (OR: 1.52; 95% CI: 1.11, 2.10; I2 = 0.0%) were more common in those born preterm than in those born term: however, the certainty of evidence was very low. Owing to the low number and heterogeneity of studies, we narratively reviewed literature on food parenting and dietary patterns. Mothers of preterm infants appeared to have heightened anxiety while feeding and utilized coercive food parenting practices; their infants reportedly received less human milk, started solid foods earlier, and had poorer diet quality than term-born peers. In conclusion, meta-analyses show preterm children experience frequent oromotor eating difficulties and challenging eating behaviors throughout the early years. Given preterm birth increases risk of later obesity and diet-related chronic disease, research examining the effects of caregiver-child interactions on subsequent diet is warranted. This review was registered at www.crd.york.ac.uk/prospero/ as CRD42020176063.
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Affiliation(s)
- Kathryn Walton
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Allison I Daniel
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada,Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Quenby Mahood
- Hospital Library & Archives, Learning Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Simone Vaz
- Department of Pediatrics, William Osler Health System, Brampton, Ontario, Canada
| | - Nicole Law
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sharon L Unger
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada,Paediatrics, Sinai Health, Toronto, Ontario, Canada,Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
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9
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Abstract
Individuals born extremely preterm (before 28 weeks of gestation) comprise only about 0.7% of births in the United States and an even lower proportion in other high resource countries. However, these individuals account for a disproportionate number of children with cerebral palsy, intellectual deficit, autism spectrum disorder, attention deficit hyperactivity disorder, and epilepsy. This review describes two large multiple center cohorts comprised of individuals born extremely preterm: the EPICURE cohort, recruited 1995 in the United Kingdom and the Republic of Ireland, and the Extremely Low Gestational Age Newborn (ELGAN), recruited 2002-2004 in five states in the United States. The primary focus of these studies has been neurodevelopmental disorders, but also of interest are growth, respiratory illness, and parent- and self-reported global health and well-being. Both of these studies indicate that among individuals born extremely preterm the risks of most neurodevelopmental disorders are increased. Early life factors that contribute to this risk include perinatal brain damage, some of which can be identified using neonatal head ultrasound, bronchopulmonary dysplasia, and neonatal systemic inflammation. Prenatal factors, particularly the family's socioeconomic position, also appear to contribute to risk. For most adverse outcomes, the risk is higher in males. Young adults born extremely preterm who have neurodevelopmental impairment, as compared to those without such impairment, rate their quality of life lower. However, young adults born extremely preterm who do not have neurodevelopmental impairments rate their quality of life as being similar to that of young adults born at term. Finally, we summarize the current state of interventions designed to improve the life course of extremely premature infants, with particular focus on efforts to prevent premature birth and on postnatal efforts to prevent adverse neurodevelopmental outcomes.
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Affiliation(s)
- Genevieve L Taylor
- Genevieve L Taylor MD: Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of North Carolina School of Medicine
| | - T Michael O'Shea
- T. Michael O'Shea, MD, MPH: Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of North Carolina School of Medicine.
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10
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Yeoh M, Rafferty S, Saw C, Beedie J, Davis JW. Fifteen-minute consultation: Outcomes of the extremely preterm infant (<27 weeks): what to tell the parents. Arch Dis Child Educ Pract Ed 2022; 108:163-166. [PMID: 35045993 DOI: 10.1136/archdischild-2020-321178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 12/10/2021] [Indexed: 11/04/2022]
Abstract
An extremely preterm infant is one born at less than 27 weeks' gestation. Over time, survival rates in this population have improved. This cohort remains at high risk of mortality and life-long morbidity. The birth of extremely preterm infants is an important public health issue and one which concerns neonatologists, paediatricians, general practitioners and parents alike. This paper aims to provide guidance for the antenatal discussion between clinicians and expectant families and may serve as a template to facilitate open communication.
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Affiliation(s)
- Melanie Yeoh
- Neonatal Clinical Care Unit, King Edward Memorial Hospital Neonatal Clinical Care Unit, Subiaco, Western Australia, Australia
| | | | - Chia Saw
- Paediatrics, St John of God Midland Public Hospital, Perth, Western Australia, Australia
| | - Joanne Beedie
- Helping Little Hands (Parent Support Charity), Perth, Western Australia, Australia.,Parent Representative, King Edward Memorial Hospital Neonatal Clinical Care Unit, Subiaco, Western Australia, Australia
| | - Jonathan W Davis
- Neonatal Clinical Care Unit, King Edward Memorial Hospital Neonatal Clinical Care Unit, Subiaco, Western Australia, Australia .,School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.,Newborn Emergency Transport Service Western Australia (NETS WA), Perth Children's Hospital, Perth, Western Australia, Australia
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11
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Awata K, Shoji H, Santosa I, Ikeda N, Murano Y, Ohkawa N, Nishizaki N, Hisata K, Kantake M, Obinata K, Shimizu T. Associations between size at birth and size at 6 years among preterm infants: a retrospective cohort study. Pediatr Int 2022; 64:e14844. [PMID: 33999477 DOI: 10.1111/ped.14844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 04/30/2021] [Accepted: 05/12/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Little is known about the relationship between fetal growth and size at school age in children born prematurely. We evaluated the relationships between gestational age and anthropometric z-scores at birth and size at 6 years of age in very-low-birthweight infants born at <30 weeks' gestation. METHODS We collected data from the medical records of 187 preterm children at birth and 6 years of age. We evaluated correlations between gestational age and z-scores for weight, body length, and head circumference at birth and z-scores for weight, height, and body mass index at 6 years of age. RESULTS Simple regression analysis showed that, in boys and the overall group, gestational age and z-scores for weight, body length, and head circumference at birth had significant association with z-scores for weight, height, and body mass index at 6 years of age. No significant associations were found in girls, except for weight z-scores at 6 years with gestational age and head circumference z-scores at birth. Multiple regression analysis showed that gestational age and length z-score at birth were significantly and independently associated with weight and height z-score at 6 years. Gestational age was also significantly and independently associated with body mass index z-score at 6 years. CONCLUSION Gestational age and fetal growth in length (assessed with the birth-length z-score) were associated with anthropometric z-scores at 6 years in very-low-birthweight children born at <30 weeks of gestation, especially in boys.
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Affiliation(s)
- Kentaro Awata
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiromichi Shoji
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Irena Santosa
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Naho Ikeda
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yayoi Murano
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Natsuki Ohkawa
- Department of Neonatology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Naoto Nishizaki
- Department of Pediatrics, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Ken Hisata
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Masato Kantake
- Department of Neonatology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Kaoru Obinata
- Department of Pediatrics, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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12
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Townley Flores C, Gerstein A, Phibbs CS, Sanders LM. Short-Term and Long-Term Educational Outcomes of Infants Born Moderately and Late Preterm. J Pediatr 2021; 232:31-37.e2. [PMID: 33412166 DOI: 10.1016/j.jpeds.2020.12.070] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 12/23/2020] [Accepted: 12/29/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the relationship of moderate and late preterm birth (320/7-366/7 weeks) to long-term educational outcomes. STUDY DESIGN We hypothesized that moderate and late preterm birth would be associated with adverse outcomes in elementary school. To test this, we linked vital statistics patient discharge data from the Office of Statewide Health Planning and Development including birth outcomes, to the 2015-2016 school year administrative data of a large, urban school district (n = 72 316). We compared the relative risk of moderate and late preterm and term infants for later adverse neurocognitive and behavioral outcomes in kindergarten through the 12th grade. RESULTS After adjusting for socioeconomic status, compared with term birth, moderate and late preterm birth was associated with an increased risk of low performance in mathematics and English language arts, chronic absenteeism, and suspension. These risks emerged in kindergarten through grade 2 and remained in grades 3-5, but seemed to wash out in later grades, with the exception of suspension, which remained through grades 9-12. CONCLUSIONS Confirming our hypothesis, moderate and late preterm birth was associated with adverse educational outcomes in late elementary school, indicating that it is a significant risk factor that school districts could leverage when targeting early intervention. Future studies will need to test these relations in geographically and socioeconomically diverse school districts, include a wider variety of outcomes, and consider how early interventions moderate associations between birth outcomes and educational outcomes.
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Affiliation(s)
- Carrie Townley Flores
- Institute of Education Sciences Fellow, Center for Education Policy Analysis, Stanford University, Stanford, CA.
| | - Amy Gerstein
- John W. Gardner Center for Youth and Their Communities, Stanford University, Stanford, CA
| | - Ciaran S Phibbs
- Health Economics Resource Center, Palo Alto VA Health Care System, Department of Pediatrics, Stanford University, Stanford, CA
| | - Lee M Sanders
- Division of General Pediatrics, Center for Policy, Outcomes and Prevention, Stanford University, Stanford, CA
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13
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Pados BF, Hill RR, Yamasaki JT, Litt JS, Lee CS. Prevalence of problematic feeding in young children born prematurely: a meta-analysis. BMC Pediatr 2021; 21:110. [PMID: 33676453 PMCID: PMC7936467 DOI: 10.1186/s12887-021-02574-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 02/24/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Difficulties related to eating are often reported in children born preterm. The objective of this study was to quantitatively synthesize available data on the prevalence of problematic feeding in children under 4 years of age who were born preterm. METHODS Literature was identified from PubMed, CINAHL, and PsycInfo. The search was limited to English language and publication years 2000-2020. To be included in the meta-analysis, the article had to report the prevalence of problematic oral feeding within a population of children born prematurely (< 37 weeks' gestation), and the child age at the time of study had to be between full-term corrected age and 48 months. For studies meeting inclusion criteria, the following data were extracted: sample size and subsamples by gestational age and/or child age at time of study; definition of problematic feeding; measures used for assessment of feeding; gestational age at time of birth of sample; child age at time of study; exclusion criteria for the study; and prevalence of problematic feeding. Random-effects meta-analyses were performed to estimate the prevalence of problematic feeding across all studies, by gestational age at birth, and by child age at time of study. RESULTS There were 22 studies that met inclusion criteria. Overall prevalence of problematic feeding (N = 4381) was 42% (95% CI 33-51%). Prevalence was neither significantly different across categories of gestational age nor by child age at the time of study. Few studies used psychometrically-sound assessments of feeding. CONCLUSION Problematic feeding is highly prevalent in prematurely-born children in the first 4 years of life regardless of degree of prematurity. Healthcare providers of children born preterm should consider screening for problematic feeding throughout early childhood as a potential complication of preterm birth. SYSTEMATIC REVIEW REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- Britt Frisk Pados
- Boston College William F. Connell School of Nursing, 140 Commonwealth Avenue, Maloney Hall 268, Chestnut Hill, MA, 02467, USA.
| | - Rebecca R Hill
- Boston College William F. Connell School of Nursing, 140 Commonwealth Avenue, Maloney Hall 268, Chestnut Hill, MA, 02467, USA
| | - Joy T Yamasaki
- CHA Hollywood Presbyterian Medical Center, Los Angeles, CA, USA
| | - Jonathan S Litt
- Beth Israel Deaconess Medical Center, Boston Children's Hospital, Harvard Medical School, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Christopher S Lee
- Boston College William F. Connell School of Nursing, 140 Commonwealth Avenue, Maloney Hall 268, Chestnut Hill, MA, 02467, USA
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Ni Y, Beckmann J, Hurst JR, Morris JK, Marlow N. Size at birth, growth trajectory in early life, and cardiovascular and metabolic risks in early adulthood: EPICure study. Arch Dis Child Fetal Neonatal Ed 2021; 106:149-155. [PMID: 32796060 PMCID: PMC7116791 DOI: 10.1136/archdischild-2020-319328] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/13/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate whether size at birth and growth trajectories in infancy and childhood are associated with determinants of cardiovascular and metabolic risks in young adults born extremely preterm (EP, <26 weeks of gestation). METHODS We used longitudinal data from the EPICure study of 129 EP survivors up to 19 years in the UK and Ireland in 1995. Determinants of cardiovascular and metabolic risks at 19 years included the presence of metabolic syndrome, body mass index (BMI) and systolic blood pressure (SBP). Predictors were birth weight for gestation and gain in weight z-scores in the following periods: birth-postmenstrual age of 40 weeks (term), infancy (term-2.5 years), early childhood (2.5-6.0 years) and late childhood (6-11 years). RESULTS Metabolic syndrome was present in 8.7% of EP participants at 19 years. Compared with subjects without metabolic syndrome, those with metabolic syndrome tended to have a smaller size at birth (difference in means: -0.55 SD, 95% CI -1.10 to 0.01, p=0.053) and a greater increase in weight z-scores from term to 2.5 years (difference in means: 1.00 SD, 95% CI -0.17 to 2.17, p=0.094). BMI at 19 years was positively related to growth from 2.5 to 6.0 years ( β : 1.03, 95% CI 0.31 to 1.75, p=0.006); an inverse association with birthweight z-scores was found in the lower socioeconomic status group ( β : -1.79, 95% CI -3.41 to -0.17, p=0.031). Central SBP was positively related to growth from 2.5 to 6.0 years ( β : 1.75, 95% CI 0.48 to 3.02, p=0.007). CONCLUSION Size at EP birth and increased catch-up in weight from 2.5 to 6.0 years were associated with BMI and central SBP in early adulthood.
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Affiliation(s)
- Yanyan Ni
- UCL EGA Institute for Women's Health, University College London, London, UK
| | - Joanne Beckmann
- Institute for Women’s Health, University College London, London, UK
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
| | - Joan K Morris
- Population Health Research Institute, St George’s, University of London, UK
| | - Neil Marlow
- Institute for Women’s Health, University College London, London, UK
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15
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Do CHT, Børresen ML, Pedersen FK, Nguyen TT, Nguyen HT, Kruse AY. Poor Head Growth Is Associated with Later Mental Delay among Vietnamese Preterm Infants: A Follow-up Study. J Trop Pediatr 2021; 67:fmaa117. [PMID: 33346849 PMCID: PMC7948389 DOI: 10.1093/tropej/fmaa117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Preterm infants in low- and middle-income countries are at high risk of poor physical growth, but their growth data are still scarce. OBJECTIVES To describe the growth of Vietnamese preterm infants in the first 2 years, and to compare with references: World Health Organization (WHO) child growth standards, and healthy Southeast Asian (SEA) infants. Further, to assess the association between growth in the first year and neurodevelopment at 2 years corrected age (CA). METHODS We conducted a cohort study to follow up preterm infants discharged from a neonatal intensive care unit for 2 years. Weight, length and head circumference (HC) were measured at 3, 12 and 24 months CA. Neurodevelopment was assessed using Bayley Scales of Infant and Toddler Development-3rd Edition at 24 months CA. RESULTS Over 90% of the cohort showed catch-up weight at 3 months CA. Weight and length were comparable to healthy SEA but were lower than WHO standards. HC was significantly smaller than those of WHO standards with HC Z-scores steadily decreasing from -0.95 at 3 months CA to -1.50 at 24 months CA. Each one decrement of HC Z-score from 3 to 12 months CA was associated with nearly twice an increase in odds of mental delay at 24 months CA (odds ratio 1.89; 95% confidence interval 1.02-3.50). CONCLUSION Vietnamese preterm infants exhibited early catch-up weight but poor head growth, which was associated with later delays in mental development. Our findings support the importance of HC measures in follow-up for preterm infants.
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Affiliation(s)
- Chuong Huu Thieu Do
- Neonatal Intensive Care Unit, Children's Hospital 1, Ho Chi Minh City, Vietnam
| | - Malene Landbo Børresen
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Freddy Karup Pedersen
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Tinh Thu Nguyen
- Neonatal Intensive Care Unit, Children's Hospital 1, Ho Chi Minh City, Vietnam
- Department of Pediatrics, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Hung Thanh Nguyen
- Scientific Research Unit, Children's Hospital 1, Ho Chi Minh City, Vietnam
| | - Alexandra Yasmin Kruse
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Paediatrics, Copenhagen University Hospital, Hvidovre, Denmark
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16
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Vermeulen MJ, Burkhardt W, Fritze A, Roelants J, Mense L, Willemsen S, Rüdiger M. Reference Charts for Neonatal Cranial Volume Based on 3D Laser Scanning to Monitor Head Growth. Front Pediatr 2021; 9:654112. [PMID: 34123964 PMCID: PMC8192695 DOI: 10.3389/fped.2021.654112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/07/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Postnatal brain growth is an important predictor of neurodevelopmental outcome in preterm infants. A new reliable proxy for brain volume is cranial volume, which can be measured routinely by 3-D laser scanning. The aim of this study was to develop reference charts for normal cranial volume in newborn infants at different gestational ages starting from late preterm for both sexes. Methods: Cross-sectional cohort study in a German university hospital, including singleton, clinically stable, neonates born after 34 weeks of gestation. Cranial volume was measured in the first week of life by a validated 3-D laser scanner. Cranial volume data was modeled to calculate percentile values by gestational age and birth weight and to develop cranial volume reference charts for girls and boys separately. Results: Of the 1,703 included infants, 846 (50%) were female. Birth weights ranged from 1,370 to 4,830 grams (median 3,370). Median cranial volume ranged from 320 [interquartile range (IQR) 294-347] ml at 34 weeks to 469 [IQR 442-496] ml at 42 weeks and was higher in boys than in girls. Conclusions: This study presents the first reference charts of cranial volume which can be used in clinical practice to monitor brain growth between 34 and 42 weeks gestation in infants.
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Affiliation(s)
- Marijn Jorien Vermeulen
- Division of Neonatology, Department of Pediatrics, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Wolfram Burkhardt
- Division of Neonatology and Pediatric Intensive Care Medicine, Department of Pediatrics, Medizinische Fakultät der Technischen Universität, Dresden, Germany
| | - Anne Fritze
- Division of Neonatology and Pediatric Intensive Care Medicine, Department of Pediatrics, Medizinische Fakultät der Technischen Universität, Dresden, Germany
| | - Jorine Roelants
- Division of Neonatology, Department of Pediatrics, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Lars Mense
- Division of Neonatology and Pediatric Intensive Care Medicine, Department of Pediatrics, Medizinische Fakultät der Technischen Universität, Dresden, Germany
| | - Sten Willemsen
- Division of Biostatistics, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Mario Rüdiger
- Division of Neonatology and Pediatric Intensive Care Medicine, Department of Pediatrics, Medizinische Fakultät der Technischen Universität, Dresden, Germany.,Saxonian Center for Feto-Neonatal Health, Technische Universität Dresden, Dresden, Germany
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17
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Bernardo FMM, Veiga ECA, Quintana SM, Camayo FJA, Batista RFL, Alves MTSSB, Bettiol H, Barbieri MA, Cardoso VC, Cavalli RC. Association of genitourinary infections and cervical length with preterm childbirth. ACTA ACUST UNITED AC 2020; 54:e10235. [PMID: 33338099 PMCID: PMC7747871 DOI: 10.1590/1414-431x202010235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/28/2020] [Indexed: 11/21/2022]
Abstract
A prospective cohort study was conducted on a convenience sample of 1370 pregnant
women with a gestational age of 20 to 25 weeks in the city of Ribeirão Preto.
Data on obstetrical history, maternal age, parity, smoking habit, and a history
of preterm delivery was collected with the application of a sociodemographic
questionnaire. Cervical length was determined by endovaginal ultrasound, and
urine and vaginal content samples were obtained to determine urinary tract
infection (UTI) and bacterial vaginosis (BV), respectively. The aim of this
study was to verify the association of cervical length and genitourinary
infections with preterm birth (PTB). Ultrasound showed no association of UTI or
BV with short cervical length. PTB rate was 9.63%. Among the women with PTB, 15
showed UTI (RR: 1.55, 95%CI: 0.93–2.58), 19 had BV (RR: 1.22, 95%CI: 0.77–1.94),
and one had both UTI and BV (RR: 0.85, 95%CI: 0.13–5.62). Nineteen (14.4%) PTB
occurred in women with a cervical length ≤2.5 cm (RR: 2.89, 95%CI: 1.89–4.43).
Among the 75 patients with PTB stratified as spontaneous, 10 showed UTI (RR:
2.02, 95%CI: 1.05–3.86) and 14 had a diagnosis of BV (RR: 1.72, 95%CI:
0.97–3.04). A short cervical length between 20 and 25 weeks of pregnancy was
associated with PTB, whereas UTI and BV determined at this age were not
associated with short cervical length or with PTB, although UTI, even if
asymptomatic, was related to spontaneous PTB.
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Affiliation(s)
- F M M Bernardo
- Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - E C A Veiga
- Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - S M Quintana
- Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - F J A Camayo
- Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - R F L Batista
- Departamento de Saúde Pública, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - M T S S B Alves
- Departamento de Saúde Pública, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - H Bettiol
- Departamento de Puericultura e Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - M A Barbieri
- Departamento de Puericultura e Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - V C Cardoso
- Departamento de Puericultura e Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - R C Cavalli
- Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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18
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Ni Y, Beckmann J, Gandhi R, Hurst JR, Morris JK, Marlow N. Growth to early adulthood following extremely preterm birth: the EPICure study. Arch Dis Child Fetal Neonatal Ed 2020; 105:496-503. [PMID: 31907276 PMCID: PMC7115967 DOI: 10.1136/archdischild-2019-318192] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/21/2019] [Accepted: 12/10/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate growth trajectories from age 2.5 to 19 years in individuals born before 26 weeks of gestation (extremely preterm; EP) compared with term-born controls. METHODS Multilevel modelling of growth data from the EPICure study, a prospective 1995 birth cohort of 315 EP participants born in the UK and Ireland and 160 term-born controls recruited at school age. Height, weight, head circumference and body mass index (BMI) z-scores were derived from UK standards at ages 2.5, 6, 11 and 19 years. RESULTS 129 (42%) EP children were assessed at 19 years. EP individuals were on average 4.0 cm shorter and 6.8 kg lighter with a 1.5 cm smaller head circumference relative to controls at 19 years. Relative to controls, EP participants grew faster in weight by 0.06 SD per year (95% CI 0.05 to 0.07), in head circumference by 0.04 SD (95% CI 0.03 to 0.05), but with no catch-up in height. For the EP group, because of weight catch-up between 6 and 19 years, BMI was significantly elevated at 19 years to +0.32 SD; 23.4% had BMI >25 kg/m2 and 6.3% >30 kg/m2 but these proportions were similar to those in control subjects. EP and control participants showed similar pubertal development in early adolescence, which was not associated with height at 19 years in either study group. Growth through childhood was related to birth characteristics and to neonatal feeding practices. CONCLUSIONS EP participants remained shorter and lighter and had smaller head circumferences than reference data or controls in adulthood but had elevated BMI.
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Affiliation(s)
- Yanyan Ni
- Institute for Women's Health, University College London, London, UK
| | - Joanne Beckmann
- Institute for Women's Health, University College London, London, UK
| | | | - John R Hurst
- UCL Respiratory, University College London, London, UK
| | - Joan K Morris
- Population Health Research Institute, St George's University of London, London, UK
| | - Neil Marlow
- Institute for Women's Health, University College London, London, UK
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19
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Clinical and molecular evidence of accelerated ageing following very preterm birth. Pediatr Res 2020; 87:1005-1010. [PMID: 31812156 DOI: 10.1038/s41390-019-0709-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 10/14/2019] [Accepted: 10/16/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND The mechanisms responsible for the associations between very preterm birth and a higher risk of poor cardiovascular and metabolic health in adult life are unknown. METHODS Here, we compare the clinical and molecular phenotypes of healthy, normal-weight young adults (18-27 years), born very preterm (<33 weeks gestational age (GA)) and at full-term (37-42 weeks GA). Outcomes included whole-body MRI, hepatic and muscle 1H MRS, blood pressure measurements and telomere length. RESULTS We recruited 156 volunteers, 69 preterm (45 women; 24 men) and 87 born at full-term (45 women; 42 men). Preterm individuals had a significantly altered blood pressure profile, including higher systolic blood pressure (SBP mmHg: preterm men 133.4 ± 10.1, term men 23.0 ± 6.9; preterm women 124.3 ± 7.1, term women 118.4 ± 8.0, p < 0.01 for all). Furthermore, preterm men had fewer long telomeres (145-48.5 kb: preterm men 14.1 ± 0.9%, term men 17.8 ± 1.1%, p < 0.05; 48.5-8.6 kb: preterm men 28.2 ± 2.6, term men 37.0 ± 2.4%, p < 0.001) and a higher proportion of shorter telomeres (4.2-1.3 kb: preterm men 40.4 ± 3.5%, term men 29.9 ± 3.2%, p < 0.01). CONCLUSION Our data indicate that healthy young adults born very preterm manifest clinical and molecular evidence of accelerated ageing.
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20
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Feeding Formula Eliminates the Necessity of Bacterial Dysbiosis and Induces Inflammation and Injury in the Paneth Cell Disruption Murine NEC Model in an Osmolality-Dependent Manner. Nutrients 2020; 12:nu12040900. [PMID: 32224880 PMCID: PMC7230818 DOI: 10.3390/nu12040900] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/19/2020] [Accepted: 03/24/2020] [Indexed: 01/08/2023] Open
Abstract
Necrotizing enterocolitis (NEC) remains a significant cause of morbidity and mortality in preterm infants. Formula feeding is a risk factor for NEC and osmolality, which is increased by the fortification that is required for adequate growth of the infant, has been suggested as a potential cause. Our laboratory has shown that Paneth cell disruption followed by induction of dysbiosis can induce NEC-like pathology in the absence of feeds. We hypothesized adding formula feeds to the model would exacerbate intestinal injury and inflammation in an osmolality-dependent manner. NEC-like injury was induced in 14-16 day-old C57Bl/6J mice by Paneth cell disruption with dithizone or diphtheria toxin, followed by feeding rodent milk substitute with varying osmolality (250-1491 mOsm/kg H2O). Animal weight, serum cytokines and osmolality, small intestinal injury, and cecal microbial composition were quantified. Paneth cell-disrupted mice fed formula had significant NEC scores compared to controls and no longer required induction of bacterial dysbiosis. Significant increases in serum inflammatory markers, small intestinal damage, and overall mortality were osmolality-dependent and not related to microbial changes. Overall, formula feeding in combination with Paneth cell disruption induced NEC-like injury in an osmolality-dependent manner, emphasizing the importance of vigilance in designing preterm infant feeds.
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21
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Hübl N, Costa SPD, Kaufmann N, Oh J, Willmes K. Sucking patterns are not predictive of further feeding development in healthy preterm infants. Infant Behav Dev 2020; 58:101412. [DOI: 10.1016/j.infbeh.2019.101412] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 12/13/2019] [Accepted: 12/15/2019] [Indexed: 10/25/2022]
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22
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Chmielewska A, Farooqi A, Domellöf M, Ohlund I. Lean Tissue Deficit in Preterm Infants Persists up to 4 Months of Age: Results from a Swedish Longitudinal Study. Neonatology 2020; 117:80-87. [PMID: 31822002 DOI: 10.1159/000503292] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 09/10/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND At term-equivalent age, infants born prematurely are shorter, lighter and have more adipose tissue compared to term counterparts. Little is known on whether the differences in body composition persist in later age. METHODS We prospectively recruited 33 preterm infants (<32 weeks gestational age, mean gestational age 28.1 weeks) and 69 term controls. Anthropometry and body composition (air displacement plethysmography) were monitored up to 4 months of age. Nutrient intakes from preterm infants were collected from clinical records. RESULTS At 4 months of age preterm infants were lighter and shorter than term controls (mean weight-for-age z-score: -0.73 vs. 0.06, p = 0.001; mean length-for-age z-score: -1.31 vs. 0.29, p < 0.0001). The significantly greater percentage of total body fat seen in preterm infants at term-equivalent age (20.2 vs. 11.7%, p < 0.0001) was no longer observed at 4 months. A deficit of fat-free mass persisted until 4 months of age (fat-free mass at term-equivalent age: 2.71 vs. 3.18 kg, p < 0.0001; at 4 months: 4.3 vs. 4.78 kg, p < 0.0001). The fat mass index and fat-free mass index (taking length into account) did not differ between the groups. Nutrition had little effect on body composition. Higher protein intake at week 2 was a negative predictor of fat-free mass at discharge. CONCLUSIONS At 4 months corrected age, preterm infants were both lighter and shorter than term controls and the absolute fat-free mass deficit remained until this age. Little effect of nutrition on body composition was observed.
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Affiliation(s)
- Anna Chmielewska
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden,
| | - Aijaz Farooqi
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Inger Ohlund
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
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23
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Hall NJ, Drewett M, Burge DM, Eaton S. Growth pattern of infants with gastroschisis in the neonatal period. Clin Nutr ESPEN 2019; 32:82-87. [PMID: 31221296 DOI: 10.1016/j.clnesp.2019.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 04/25/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND/AIM Early postnatal growth patterns may have significant long term health effects. Although preterm infants on parenteral nutrition (PN) exhibit poor growth, growth pattern of term or near-term infants requiring PN is not well reported. We aimed to investigate this in infants born with gastroschisis. METHODS Retrospective review of all infants with gastroschisis requiring PN treated at a single centre over a 4 year period. Growth and clinical data were retrieved, and weight SDS scores for corrected gestational age calculated. Weight SDS (mean ± SD) were compared at clinically relevant timepoints and multi-level regression used to model growth trends over time. MAIN RESULTS During the study period 61 infants with gastroschisis were treated; all were included. Infants were small for gestational age at birth for weight (SDS score -0.87 ± 0.85). Weight SDS decreased significantly during the first 10 days of age (mean decrease 0.81 ± 0.56; p < 0.0001) and between birth and discharge (mean decrease 0.81 ± 0.56; p < 0.0001). Despite tolerating full enteral feeds, weight SDS velocity was negative around the time of transition from parenteral to enteral feed. There was evidence of 'catch up' growth between 3 and 6 months of age. CONCLUSION Despite nutritional support with PN, infants with gastroschisis demonstrate significant growth failure during the newborn period. Further efforts are required to understand the underlying mechanisms, improve nutritional support and to evaluate the long term consequences of postnatal growth failure in this population.
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Affiliation(s)
- Nigel J Hall
- University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, UK; Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK.
| | - Melanie Drewett
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK
| | - David M Burge
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK
| | - Simon Eaton
- Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, London, UK
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24
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Andrews ET, Ashton JJ, Pearson F, Beattie RM, Johnson MJ. Early postnatal growth failure in preterm infants is not inevitable. Arch Dis Child Fetal Neonatal Ed 2019; 104:F235-F241. [PMID: 30135111 DOI: 10.1136/archdischild-2018-315082] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 06/24/2018] [Accepted: 07/08/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Previously published data have demonstrated that preterm infants experience a fall across marked centile lines for weight in early life with early poor head growth also reported. This study describes a single neonatal unit's experience of longitudinal change in weight, head circumference (HC) and length in a cohort of preterm infants born <32 weeks' gestation. METHODS Data were collected from a single neonatal unit between July 2012 and June 2017. This period followed the introduction of improved nutritional guidelines. Patients were grouped according to their gestational age at birth. Growth lines were constructed for weight, HC and length in each gestational age group from the median measures and compared with reference centile lines. RESULTS Data were analysed from 396 patients consisting of 2808, 1991 and 2004 measures for weight, HC and length, respectively. Longitudinal growth plots did not show an initial absolute weight loss in any of the subgroups. Across all groups, the mean change in SD score between birth and 36 weeks was -0.27 (95% CI -0.39 to -0.15). CONCLUSIONS This description of longitudinal growth in a cohort of preterm infants demonstrates that early postnatal growth failure is not inevitable, with most infants growing along a trajectory close to their birth centile. There is no evidence of a 2 marked centile line weight decrease or weight loss. These data provide evidence to suggest that extrauterine weight gain tracking centile lines can be achieved.
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Affiliation(s)
- Edward Thomas Andrews
- Department of Neonatal Medicine, Princess Anne Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - James John Ashton
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK.,Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
| | - Freya Pearson
- Department of Neonatal Medicine, Princess Anne Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - R Mark Beattie
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK.,National Institute for Health Research, Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
| | - Mark John Johnson
- Department of Neonatal Medicine, Princess Anne Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,National Institute for Health Research, Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
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Strydom K, Van Niekerk E, Dhansay MA. Factors affecting body composition in preterm infants: Assessment techniques and nutritional interventions. Pediatr Neonatol 2019; 60:121-128. [PMID: 29239827 DOI: 10.1016/j.pedneo.2017.10.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 07/26/2017] [Accepted: 10/20/2017] [Indexed: 11/19/2022] Open
Abstract
Limited research has been conducted that elucidates the growth and body composition of preterm infants. It is known that these infants do not necessarily achieve extra-utero growth rates and body composition similar to those of their term counterparts. Preterm infants, who have difficulty in achieving these growth rates, could suffer from growth failure. These infants display an increased intra-abdominal adiposity and abnormal body composition when they achieve catch-up growth. These factors affect the quality of weight gain, as these infants are not only shorter and lighter than term infants, they also have more fat mass (FM) and less fat-free mass (FFM), resulting in a higher total fat percentage. This could cause metabolic syndrome and cardiovascular problems to develop later in a preterm infant's life. The methods used to determine body composition in preterm infants should be simple, quick, non-invasive and inexpensive. Available literature was reviewed and the Dauncey anthropometric model, which includes skinfold thickness at two primary sites and nine body dimensions, is considered in this review the best method to accurately determine body composition in preterm infants, especially in resource-poor countries. It is imperative to accurately assess the quality of growth and body composition of this fragile population in order to determine whether currently prescribed nutritional interventions are beneficial to the overall nutritional status and quality of life-in the short- and long-term-of the preterm infant, and to enable timely implementation of appropriate interventions, if required.
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Affiliation(s)
- K Strydom
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa.
| | - E Van Niekerk
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - M A Dhansay
- South African Medical Research Council, Burden of Disease Research Unit, Cape Town, South Africa; Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Scherman A, Wiedrick J, Lang W, Rdesinski R, Lapidus J, McEvoy C, Abu-Shamsieh A, Buckley S, Rogers B, Buist N. Quantification of nutritive sucking among preterm and full-term infants. RESEARCH AND REPORTS IN NEONATOLOGY 2018; 8:53-63. [PMID: 33746526 DOI: 10.2147/rrn.s165421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose We developed summaries of oral bottle-feeding skills among preterm (<37 gestational weeks) and full-term (≥37 gestational weeks) infants using a mechanical device (Orometer) to measure intraoral pressure changes, with accompanying automated software and analytics. We then compared the rates of change in feeding skills over several weeks (feeding trends) between preterm and full-term infants. We also compared group means at 40 weeks post menstrual age (PMA). Patients and methods Healthy full-term and preterm infants capable of oral feeding were recruited from the Pediatric Outpatient Clinic at University of California San Francisco, Fresno, and from the Oregon Health & Science University Doernbecher Neonatal Critical Care Unit, respectively. Feeding skill was quantified using an Orometer and automated suck-analysis software. Factor analysis reduced the >40 metrics produced by the Orometer system to the following seven factors that accounted for >99% of the sample covariance: suck vigor, endurance, resting, irregularity, frequency, variability, and bursting. We proposed that these factors represent feeding skills and they served as the dependent variables in linear models estimating trends in feeding skills over time for full-term and preterm infants (maturation). At approximately 40 weeks PMA we compared mean feedings skills between infants born preterm and those born full-term using predictions from our models. Results Feeding skills for 117 full-term infants and 82 preterm infants were first captured at mean PMA of 42.3 and 36.0 weeks, respectively. For some feeding skills, preterm and full-term infants showed different trends over time. At 37-40 weeks PMA, preterm infants took approximately 15% fewer sucks than infants born full-term (p=0.06) and generally had weaker suck vigor, greater resting, and less endurance than full-term babies. Preterm infant-feeding skills appeared similar to those of full-term infants upon reaching ≥40 weeks PMA, although preterm infants showed greater variability for all factors. Conclusion The Orometer device, accompanying software, and analytic methods provided a framework for describing trends in oral feeding, thereby allowing us to characterize differences in maturation of feeding between healthy preterm and full-term infants.
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Affiliation(s)
- Ashley Scherman
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA.,Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
| | - Jack Wiedrick
- Biostatistics and Design Program, Oregon Health & Science University, Portland, OR, USA
| | - William Lang
- Department of Mathematics, Indiana University Southeast, New Albany, IN, USA
| | - Rebecca Rdesinski
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Jodi Lapidus
- Biostatistics and Design Program, Oregon Health & Science University, Portland, OR, USA
| | - Cynthia McEvoy
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
| | - Aimee Abu-Shamsieh
- Department of Pediatrics, University of California, San Francisco at Fresno, Fresno, CA
| | | | - Brian Rogers
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
| | - Neil Buist
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
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Carter FA, Msall ME. Long-Term Functioning and Participation Across the Life Course for Preterm Neonatal Intensive Care Unit Graduates. Clin Perinatol 2018; 45:501-527. [PMID: 30144852 PMCID: PMC11160115 DOI: 10.1016/j.clp.2018.05.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
To understand the trajectories of risk and resilience in the vulnerable preterm and neonatal brain, clinicians must go beyond survival and critically examine on a population basis the functional outcomes of children, adolescents, and adults across their life course. Evaluations must go well beyond Bayley assessments and counts of neonatal morbidities, such as bronchopulmonary dysplasia, retinopathy of prematurity, sonographic brain injury, sepsis, and necrotizing enterocolitis. Proactively providing support to families and developmental and educational supports to children can optimize academic functioning and participation in adult learning, physical and behavioral health activities, community living, relationships, and employment.
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Affiliation(s)
- Frances A Carter
- Department of Psychology, The Center for Early Childhood Research, University of Chicago, 5848 S. University Avenue, Chicago, IL 60637, USA
| | - Michael E Msall
- Department of Pediatrics, Section of Developmental and Behavioral Pediatrics, Kennedy Research Center on Intellectual and Neurodevelopmental Disabilities, University of Chicago Comer Children's Hospital, Woodlawn Social Services Center, 950 East 61st Street, Chicago, IL 60637, USA.
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28
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Strydom K, Nel DG, Dhansay MA, Van Niekerk E. The effect of maternal HIV status and treatment duration on body composition of HIV-exposed and HIV-unexposed preterm, very and extremely low-birthweight infants. Paediatr Int Child Health 2018; 38:163-174. [PMID: 29790827 DOI: 10.1080/20469047.2018.1466481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND There is an evidence gap regarding the relationship between HIV exposure, body composition (and the quality thereof) and preterm infants. AIM This study determined the body composition of HIV-exposed, preterm very low-birthweight (VLBW) and extremely low-birthweight (ELBW) infants and to assess the effect of maternal HAART duration on the body composition of this vulnerable population. METHODS A descriptive cross-sectional study was conducted. HIV-exposed and -unexposed preterm infants (<37 weeks) with a birthweight of ≤1200g were included. Maternal medical background was recorded. Infant body composition measurements were recorded weekly during the 28-day follow-up period. RESULTS Thirty preterm infants (27%) were HIV-exposed. HIV-exposed infants had significantly (=0.01) lower gestational ages than HIV-unexposed infants (25-28 weeks). HIV-exposed infants had significantly lower measurements on day 21 and day 28 for triceps skinfold (TSF) (2.5 mm vs 2.7 mm, = 0.02 and 2.6 mm vs 2.9 mm, <0.01), subscapular skinfold (SSSF) (2.3 mm vs 2.6 mm, = 0.02 and 2.4 mm vs 2.7 mm, =<0.01) and fat mass percentage (FM%) (0.9% vs 1.4%, = 0.02 and 1.0% vs 1.5%, = 0.03). HIV-exposed infants whose mothers received HAART for ≥ 20 weeks were heavier and had a higher FM% and lower fat-free mass percentage (FFM%) at birth than HIV-exposed preterm infants whose mothers received highly active antiretroviral therapy for ≥ 4- < 20 weeks. CONCLUSION Mothers receiving HAART could have increased risk of preterm delivery, and the duration of maternal HAART affects postnatal body composition of their infants. Body composition differs between HIV-exposed and HIV-unexposed preterm infants.
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Key Words
- ANOVA, analysis of variance
- ART, antiretroviral therapy
- AZT, zidovudine
- Body composition
- CVD, cardiovascular diseases
- DRC, Democratic Republic of Congo
- ELBW, extremely low birthweight
- FFM%, fat-free mass percentage
- FFM, fat-free mass
- FM%, fat mass percentage
- FM, fat mass
- GA, gestational age
- HAART duration
- HAART, highly active antiretroviral therapy
- HIC, high-income countries
- HIV-exposed
- HIV-unexposed
- IUGR, intrauterine growth restriction
- LBW, low birthweight
- LGA, large for gestational age
- LMIC, low- and middle-income countries
- MCT, medium-chain triglycerides
- MTCT, mother-to-child transmission
- NCPAP, nasal continuous positive airway pressure
- NHANES, National Health and Nutrition Examination Survey
- NICU, neonatal Intensive Care Unit
- NVP, nevirapine
- PCR, polymerase chain reaction
- PMTCT, prevention of mother-to-child transmission
- SAPMTCTE, South African prevention of mother-to-child transmission evaluation
- SFT, skinfold thickness
- SGA, small for gestational age
- SSSF, subscapular skinfold
- TAH, Tygerberg Academic Hospital
- TBCH, Tygerberg Children’s Hospital
- TEA, term equivalent age
- TSF, triceps skinfold
- USA, United States of America
- VLBW, very low birthweight
- fat mass
- fat-free mass
- preterm infant
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Affiliation(s)
- Klara Strydom
- a Faculty of Medicine and Health Sciences, Division of Human Nutrition , Stellenbosch University , Cape Town , South Africa
| | - Daniel Gerhardus Nel
- d Department of Statistics and Actuarial Sciences , Stellenbosch University , Tygerberg , South Africa
| | - Muhammad Ali Dhansay
- a Faculty of Medicine and Health Sciences, Division of Human Nutrition , Stellenbosch University , Cape Town , South Africa.,b South African Medical Research Council, Burden of Disease Research Unit , Cape Town , South Africa.,c Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health , Stellenbosch University , Cape Town , South Africa
| | - Evette Van Niekerk
- a Faculty of Medicine and Health Sciences, Division of Human Nutrition , Stellenbosch University , Cape Town , South Africa
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29
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Aujoulat I, Henrard S, Charon A, Johansson AB, Langhendries JP, Mostaert A, Vermeylen D, Verellen G. End-of-life decisions and practices for very preterm infants in the Wallonia-Brussels Federation of Belgium. BMC Pediatr 2018; 18:206. [PMID: 29945564 PMCID: PMC6020374 DOI: 10.1186/s12887-018-1168-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 06/05/2018] [Indexed: 11/26/2022] Open
Abstract
Background Very preterm birth (24 to < 32 week’s gestation) is a major public health issue due to its prevalence, the clinical and ethical questions it raises and the associated costs. It raises two major clinical and ethical dilemma: (i) during the perinatal period, whether or not to actively manage a baby born very prematurely and (ii) during the postnatal period, whether or not to continue a curative treatment plan initiated at birth. The Wallonia-Brussels Federation in Belgium counts 11 neonatal intensive care units. Methods An inventory of key practices was compiled on the basis of an online questionnaire that was sent to the 65 neonatologists working in these units. The questionnaire investigated care-related decisions and practices during the antenatal, perinatal and postnatal periods, as well as personal opinions on the possibility of standardising and/or legislating for end-of-life decisions and practices. The participation rate was 89% (n = 58). Results The results show a high level of homogeneity pointing to overall agreement on the main principles governing curative practice and the gestational age that can be actively managed given the current state of knowledge. There was, however, greater diversity regarding principles governing the transition to end-of-life care, as well as opinions about the need for a common protocol or law to govern such practices. Conclusion Our results reflect the uncertainty inherent in the complex and diverse situations that are encountered in this extreme area of clinical practice, and call for qualitative research and expert debates to further document and make recommendations for best practices regarding several “gray zones” of end-of-life care in neonatology, so that high quality palliative care may be granted to all neonates concerned with end-of-life decisions. Electronic supplementary material The online version of this article (10.1186/s12887-018-1168-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Isabelle Aujoulat
- Université catholique de Louvain (UCL), Institute of Health and Society (IRSS), Clos chapelle-aux-champs, n° 30.14 - 1200, Brussels, Belgium.
| | - Séverine Henrard
- Université catholique de Louvain (UCL), Institute of Health and Society (IRSS), Clos chapelle-aux-champs, n° 30.14 - 1200, Brussels, Belgium
| | - Anne Charon
- Grand Hôpital de Charleroi (GHC), Charleroi, Belgium
| | | | | | - Anne Mostaert
- Centre hospitalier régional (CHR) de Namur, Namur, Belgium
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30
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Radom-Aizik S, Zaldivar FP, Nance DM, Haddad F, Cooper DM, Adams GR. A Translational Model of Incomplete Catch-Up Growth: Early-Life Hypoxia and the Effect of Physical Activity. Clin Transl Sci 2018; 11:412-419. [PMID: 29603633 PMCID: PMC6039202 DOI: 10.1111/cts.12550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 02/14/2018] [Indexed: 12/19/2022] Open
Abstract
Advances in therapies have led to prolonged survival from many previously lethal health threats in children, notably among prematurely born babies and those with congenital heart disease. Evidence for catch‐up growth is common in these children, but in many cases the adult phenotype is never achieved. A translational animal model is required in which specific tissues can be studied over a reasonable time interval. We investigated the impact of postnatal hypoxia (HY) (12%O2 (HY12) or 10% O2 (HY10)) on growth in rats relative to animals raised in room air. Subgroups had access to running wheels following the HY period. Growth was fully compensated in adult HY12 rats but not HY10 rats. The results of this study indicate that neonatal hypoxia can be a useful model for the elucidation of mechanisms that mediate successful catch‐up growth following neonatal insults and identify the critical factors that prevent successful catch‐up growth.
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Affiliation(s)
- Shlomit Radom-Aizik
- Pediatric Exercise and Genomics Research Center (PERC), Departments of Pediatrics, University of California, Irvine, California, USA
| | - Frank P Zaldivar
- Pediatric Exercise and Genomics Research Center (PERC), Departments of Pediatrics, University of California, Irvine, California, USA
| | - Dwight M Nance
- Pediatric Exercise and Genomics Research Center (PERC), Departments of Pediatrics, University of California, Irvine, California, USA
| | - Fadia Haddad
- Pediatric Exercise and Genomics Research Center (PERC), Departments of Pediatrics, University of California, Irvine, California, USA
| | - Dan M Cooper
- Pediatric Exercise and Genomics Research Center (PERC), Departments of Pediatrics, University of California, Irvine, California, USA
| | - Gregory R Adams
- Department of Physiology & Biophysics, University of California, Irvine, California, USA
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31
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Abduljalil K, Johnson TN, Rostami-Hodjegan A. Fetal Physiologically-Based Pharmacokinetic Models: Systems Information on Fetal Biometry and Gross Composition. Clin Pharmacokinet 2017; 57:1149-1171. [DOI: 10.1007/s40262-017-0618-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Mann JP, Statnikov E, Modi N, Johnson N, Springett A, Morris JK. Management and outcomes of neonates with down syndrome admitted to neonatal units. ACTA ACUST UNITED AC 2017; 106:468-74. [PMID: 27301559 DOI: 10.1002/bdra.23513] [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: 03/11/2016] [Accepted: 03/22/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Neonates with Down syndrome have an increased risk of being admitted to a neonatal unit compared with unaffected neonates. We aimed to estimate the proportion of neonates with Down syndrome admitted to a neonatal unit and compare their management and outcomes with other neonatal admissions. METHODS Case-control study of neonates born from 2009 to 2011 admitted to 122 NHS Neonatal Units in England using data from the National Down Syndrome Cytogenetic Register and the National Neonatal Research Database. For each neonate with Down syndrome, three neonates admitted to the same unit in the same month and born at the same gestation were identified. RESULTS Forty-six percent of neonates with Down syndrome were admitted to a neonatal unit. Boys were more likely to be admitted than girls (odds ratio = 1.7; 95% confidence interval, 1.4-2.0). Neonates with Down syndrome required more intensive or high dependency care compared with unaffected neonates (37% vs. 27%. p < 0.01) and stayed in neonatal units for longer (11 days vs. 5 days, p < 0.01). A total of 31% of neonates with Down syndrome required respiratory support compared with 22% (p < 0.001) of unaffected neonates, and 11% were discharged requiring oxygen supplementation compared with 3% (p < 0.001) of unaffected neonates. A total of 3% of neonates with Down syndrome died in a neonatal unit compared with 1% (p = 0.01) of unaffected neonates. CONCLUSION Neonates with Down syndrome are more likely than unaffected neonates to be admitted to a neonatal unit, have a prolonged stay, and be discharged home on supplemental oxygen. Birth Defects Research (Part A) 106:468-474, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jake P Mann
- Department of paediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Eugene Statnikov
- Section of Neonatal Medicine, Department of Medicine, Imperial College London, Chelsea and Westminster Hospital campus, London, United Kingdom
| | - Neena Modi
- Section of Neonatal Medicine, Department of Medicine, Imperial College London, Chelsea and Westminster Hospital campus, London, United Kingdom
| | - Nik Johnson
- Children's unit, Hinchingbrooke Hospital, Huntingdon, United Kingdom
| | - Anna Springett
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Joan K Morris
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
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Does preterm period sleep development predict early childhood growth trajectories? J Perinatol 2017; 37:1047-1052. [PMID: 28617425 PMCID: PMC5599328 DOI: 10.1038/jp.2017.91] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 03/27/2017] [Accepted: 05/15/2017] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The current study examined the relationship between sleep state development across the preterm and early post-term periods and subsequent growth trajectories from 1 to 27 months corrected age. STUDY DESIGN Retrospective analysis of data collected prospectively from 111 preterm infants (⩽34 weeks gestation) who participated in a multi-site longitudinal study. Separate longitudinal parallel process models were calculated for each sleep state (active and quiet sleep) and growth (weight, length and body mass index (BMI) Z-scores) variable to estimate the associations between their developmental trajectories. RESULTS Significant associations were identified between the trajectories of quiet sleep and weight, active sleep and weight, quiet sleep and BMI, and active sleep and BMI. No statistically meaningful associations were identified between the trajectories of early childhood length and the preterm sleep states. CONCLUSION Faster preterm period sleep development appears to predict more favorable early childhood growth trajectories, particularly for weight, indicating preterm sleep may be an important biomarker for subsequent growth outcomes.
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Ashton JJ, Johnson MJ, Pond J, Crowley P, Dimitrov BD, Pearson F, Beattie RM. Assessing the growth of preterm infants using detailed anthropometry. Acta Paediatr 2017; 106:889-896. [PMID: 28240375 DOI: 10.1111/apa.13804] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 02/10/2017] [Accepted: 02/22/2017] [Indexed: 11/28/2022]
Abstract
AIM Preterm infants display altered body composition compared to term infants, and weight gain is a crude indicator body composition. Childhood mid-upper arm circumference (MUAC) is a measure of nutritional status. This study investigates MUAC and mid-thigh circumference (MTC) to monitor growth in preterm infants. METHODS Preterm infants (<30-week gestation) were recruited. MUAC, MTC, weight, length and head circumference (HC) were measured at recruitment and weekly intervals until discharge. Descriptive, correlation and regression analyses were used. RESULTS Ninety-three infants were recruited. Median measurement duration was eight weeks (1-19). Median gestational age was 27 weeks (23-29). Analysis by curve estimation displayed a mean increase of 2.58 mm/week (left MUAC) (p ≤ 0.0001), 2.56 mm/week (right MUAC) (p ≤ 0.0001), 4.16 mm/week (left MTC) (p ≤ 0.0001), 4.20 mm/week (right MTC) (p ≤ 0.0001). Coefficients of determination (R2 ) were calculated using a growth regression model for MUAC and MTC (0.866-0.917); measures were comparable to growth modelling of weight (0.913), length (0.945) and HC (0.928). High concordance between left and right MUAC and MTC generated a Pearson's correlation coefficient of 0.999 (MUAC) (p ≤ 0.001) and 0.994 (MTC) (p ≤ 0.001). CONCLUSION Data demonstrate the potential utility of MUAC and MTC as additional measures of growth in preterm infants that are reproducible over time. There is potential to gain insights to improve lean-mass accretion in preterm infants.
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Affiliation(s)
- James J. Ashton
- Department of Paediatric Gastroenterology and Nutrition; Southampton Children's Hospital; Southampton UK
- Department of Neonatal Medicine; Princess Anne Hospital; Southampton UK
- NIHR Southampton Biomedical Research Centre; University of Southampton Faculty of Medicine and University Hospital Southampton NHS Foundation Trust; Southampton UK
| | - Mark J. Johnson
- Department of Neonatal Medicine; Princess Anne Hospital; Southampton UK
- NIHR Southampton Biomedical Research Centre; University of Southampton Faculty of Medicine and University Hospital Southampton NHS Foundation Trust; Southampton UK
| | - Jenny Pond
- Department of Neonatal Medicine; Princess Anne Hospital; Southampton UK
| | - Philippa Crowley
- Department of Neonatal Medicine; Princess Anne Hospital; Southampton UK
| | - Borislav D. Dimitrov
- Primary Care and Population Sciences; Faculty of Medicine; University of Southampton; Southampton UK
| | - Freya Pearson
- Department of Neonatal Medicine; Princess Anne Hospital; Southampton UK
| | - R. Mark Beattie
- Department of Paediatric Gastroenterology and Nutrition; Southampton Children's Hospital; Southampton UK
- NIHR Southampton Biomedical Research Centre; University of Southampton Faculty of Medicine and University Hospital Southampton NHS Foundation Trust; Southampton UK
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35
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The prevalence of feeding problems in children formerly treated in a neonatal intensive care unit. J Perinatol 2017; 37:578-584. [PMID: 28102855 DOI: 10.1038/jp.2016.256] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 10/13/2016] [Accepted: 12/16/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine the prevalence of oral feeding problems in neonatal intensive care unit (NICU) graduates at 1 to 2 years, and to identify clinical risk factors during NICU admission. STUDY DESIGN Observational cohort study of 378 children, who received level III/IV NICU care for 4 days or more in 2011 to 2012, chromosomal abnormalities excluded. We detected feeding problems in four gestational age (GA) groups (<28, 28 to 31, 32 to 36 weeks, and term-borns) using the Dutch standardized Screeningslijst Eetgedrag Peuters, and collected clinical factors for logistic regression analyses. RESULTS The prevalence of feeding problems was higher in NICU (20.4%) than in reference (15.0%) population (P=0.024), but similar for all GA groups (P=0.468). Prolonged tube feeding, that is, >30 days (odds ratio (OR) 2.50, confidence interval (CI) 1.13 to 5.56) and being born small for GA (OR 4.79, CI 1.64 to 14.03) were the most prevalent risk factors in children with GA ⩾32 and GA <32 weeks, respectively. CONCLUSION Feeding problems are more prevalent in NICU graduates, with prolonged tube feeding as most important risk factor.
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Boguszewski MCDS, Cardoso-Demartini ADA. MANAGEMENT OF ENDOCRINE DISEASE: Growth and growth hormone therapy in short children born preterm. Eur J Endocrinol 2017; 176:R111-R122. [PMID: 27803030 DOI: 10.1530/eje-16-0482] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 10/25/2016] [Accepted: 11/01/2016] [Indexed: 11/08/2022]
Abstract
Approximately 15 million babies are born preterm across the world every year, with less than 37 completed weeks of gestation. Survival rates increased during the last decades with the improvement of neonatal care. With premature birth, babies are deprived of the intense intrauterine growth phase, and postnatal growth failure might occur. Some children born prematurely will remain short at later ages and adult life. The risk of short stature increases if the child is also born small for gestational age. In this review, the effects of being born preterm on childhood growth and adult height and the hormonal abnormalities possibly associated with growth restriction are discussed, followed by a review of current information on growth hormone treatment for those who remain with short stature during infancy and childhood.
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Nunes VH, Perosa GB. Cárie dentária em crianças de 5 anos: fatores sociodemográficos, lócus de controle e atitudes parentais. CIENCIA & SAUDE COLETIVA 2017; 22:191-200. [DOI: 10.1590/1413-81232017221.13582015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 10/03/2015] [Indexed: 11/21/2022] Open
Abstract
Resumo A cárie dentária afeta grande parte das crianças, principalmente as de baixo nível socioeconômico. Neste estudo, de delineamento transversal, objetivou-se investigar o papel de fatores sociodemográficos, atitudes parentais e do Lócus de Controle, indicador da percepção pessoal sobre o que controla a saúde do sujeito, na prevalência de cárie em pré-escolares de cinco anos, moradores de cidade de médio porte paulista. Avaliou-se o índice ceo-d de 426 crianças; os pais informaram sobre as características sociodemográficas, responderam a dois questionários de Lócus de Controle e um de atitudes parentais. Os resultados mostraram que 52,35% dos pré-escolares apresentaram cárie, com a severa em níveis mais altos nos estratos mais baixos E-F. Nível socioeconômico mais alto e baixa externalidade mostraram-se como fatores de proteção. Baixa internalidade parental apareceu como um fator de risco para cárie nos dentes decíduos, possivelmente porque a mãe espera ou delega a ação a outros, retardando os cuidados. A percepção parental de controle sobre a saúde do filho parece favorecer cuidados preventivos e, consequentemente, o nível de cárie da criança.
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Nieuwenhuis T, Verhagen EA, Bos AF, van Dijk MWG. Children born preterm and full term have similar rates of feeding problems at three years of age. Acta Paediatr 2016; 105:e452-7. [PMID: 27170494 DOI: 10.1111/apa.13467] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 02/22/2016] [Accepted: 05/09/2016] [Indexed: 11/29/2022]
Abstract
AIM We determined the prevalence of feeding problems and their association with perinatal risk factors in three-year-old children born preterm and compared them with a full-term reference group. METHODS This pilot study assessed feeding problem scores in 35 preterm children, with a median gestational age of 30 weeks (range 26-32) and median birthweight of 1260 grams (730-2250), who were enrolled during their admission to a neonatal intensive care unit. These were compared with existing data on 248 term children from child healthcare centres at the age of three. We excluded children with severe perinatal complications from the reference group. The Screeningslijst Eetgedrag Peuters (SEP), a validated Dutch version of the Montreal Children's Hospital Feeding Scale, was used to identify feeding problems. RESULTS We found no difference in SEP scores between the preterm children and the reference group (p = 0.217) and did not identify any perinatal risk factors for developing feeding problems. Only 23% of the parents of preterm or term children with moderate-to-severe feeding problems consulted a medical professional. CONCLUSION Using a parental report instrument showed that the prevalence of feeding problems in three-year-old preterm children was low and similar to that of term children.
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Affiliation(s)
- Tjitske Nieuwenhuis
- Beatrix Children's Hospital; Division of Neonatology; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - Elise A. Verhagen
- Beatrix Children's Hospital; Division of Neonatology; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - Arend F. Bos
- Beatrix Children's Hospital; Division of Neonatology; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - Marijn W. G. van Dijk
- Department of Developmental Psychology; University of Groningen; Groningen The Netherlands
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Chan SH, Johnson MJ, Leaf AA, Vollmer B. Nutrition and neurodevelopmental outcomes in preterm infants: a systematic review. Acta Paediatr 2016; 105:587-99. [PMID: 26813585 DOI: 10.1111/apa.13344] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 01/19/2016] [Accepted: 01/21/2016] [Indexed: 11/28/2022]
Abstract
UNLABELLED A systematic review with meta-analysis was carried out to investigate the effects of increased nutritional intake, via either macronutrient or multinutrient intervention, during the neonatal period on neurodevelopmental outcomes in infants born at <32 weeks of gestation or weighing <1501 g at birth. CONCLUSION Although the relationship remains unclear, increased early nutrition may reduce neurodevelopmental impairment in this group of infants. Future research should focus on using standardised nutritional interventions and an agreed neurodevelopmental assessment battery.
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Affiliation(s)
| | - Mark J. Johnson
- NIHR Biomedical Research Centre Southampton; University Hospital Southampton NHS Foundation Trust and University of Southampton; Southampton UK
- Department of Neonatal Medicine; Southampton Children's Hospital; University Hospital Southampton NHS Foundation Trust; Southampton UK
| | - Alison A. Leaf
- NIHR Biomedical Research Centre Southampton; University Hospital Southampton NHS Foundation Trust and University of Southampton; Southampton UK
- Department of Neonatal Medicine; Southampton Children's Hospital; University Hospital Southampton NHS Foundation Trust; Southampton UK
| | - Brigitte Vollmer
- Clinical and Experimental Sciences; Clinical Neurosciences; Faculty of Medicine; University of Southampton; Southampton UK
- Neonatal and Paediatric Neurology; Southampton Children's Hospital; University Hospital Southampton NHS Foundation Trust; Southampton UK
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Field D, Boyle E, Draper E, Evans A, Johnson S, Khan K, Manktelow B, Marlow N, Petrou S, Pritchard C, Seaton S, Smith L. Towards reducing variations in infant mortality and morbidity: a population-based approach. PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BackgroundOur aims were (1) to improve understanding of regional variation in early-life mortality rates and the UK’s poor performance in international comparisons; and (2) to identify the extent to which late and moderately preterm (LMPT) birth contributes to early childhood mortality and morbidity.ObjectiveTo undertake a programme of linked population-based research studies to work towards reducing variations in infant mortality and morbidity rates.DesignTwo interlinked streams: (1) a detailed analysis of national and regional data sets and (2) establishment of cohorts of LMPT babies and term-born control babies.SettingCohorts were drawn from the geographically defined areas of Leicestershire and Nottinghamshire, and analyses were carried out at the University of Leicester.Data sourcesFor stream 1, national data were obtained from four sources: the Office for National Statistics, NHS Numbers for Babies, Centre for Maternal and Child Enquiries and East Midlands and South Yorkshire Congenital Anomalies Register. For stream 2, prospective data were collected for 1130 LMPT babies and 1255 term-born control babies.Main outcome measuresDetailed analysis of stillbirth and early childhood mortality rates with a particular focus on factors leading to biased or unfair comparison; review of clinical, health economic and developmental outcomes over the first 2 years of life for LMPT and term-born babies.ResultsThe deprivation gap in neonatal mortality has widened over time, despite government efforts to reduce it. Stillbirth rates are twice as high in the most deprived as in the least deprived decile. Approximately 70% of all infant deaths are the result of either preterm birth or a major congenital abnormality, and these are heavily influenced by mothers’ exposure to deprivation. Births at < 24 weeks’ gestation constitute only 1% of all births, but account for 20% of infant mortality. Classification of birth status for these babies varies widely across England. Risk of LMPT birth is greatest in the most deprived groups within society. Compared with term-born peers, LMPT babies are at an increased risk of neonatal morbidity, neonatal unit admission and poorer long-term health and developmental outcomes. Cognitive and socioemotional development problems confer the greatest long-term burden, with the risk being amplified by socioeconomic factors. During the first 24 months of life each child born LMPT generates approximately £3500 of additional health and societal costs.ConclusionsHealth professionals should be cautious in reviewing unadjusted early-life mortality rates, particularly when these relate to individual trusts. When more sophisticated analysis is not possible, babies of < 24 weeks’ gestation should be excluded. Neonatal services should review the care they offer to babies born LMPT to ensure that it is appropriate to their needs. The risk of adverse outcome is low in LMPT children. However, the risk appears higher for some types of antenatal problems and when the mother is from a deprived background.Future workFuture work could include studies to improve our understanding of how deprivation increases the risk of mortality and morbidity in early life and investigation of longer-term outcomes and interventions in at-risk LMPT infants to improve future attainment.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- David Field
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Elaine Boyle
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Elizabeth Draper
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Alun Evans
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Samantha Johnson
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Kamran Khan
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Bradley Manktelow
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Neil Marlow
- Institute for Women’s Health, University College London, London, UK
| | - Stavros Petrou
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Sarah Seaton
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Lucy Smith
- Department of Health Sciences, University of Leicester, Leicester, UK
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Hvelplund C, Hansen BM, Koch SV, Andersson M, Skovgaard AM. Perinatal Risk Factors for Feeding and Eating Disorders in Children Aged 0 to 3 Years. Pediatrics 2016; 137:e20152575. [PMID: 26764360 DOI: 10.1542/peds.2015-2575] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/10/2015] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To describe the incidence, age at diagnosis, and associations between perinatal risk factors of feeding and eating disorders (FED) diagnosed at hospital in children aged 0 to 3 years. METHODS A nationwide cohort of 901 227 children was followed until 48 months of age in the national registers from 1997 to 2010. Multivariable Cox proportional hazards regression was used to estimate hazard ratios (HRs) for FED diagnosis according to the International Classification of Diseases and associations with perinatal risk factors. RESULTS A total of 1365 children (53% girls) were diagnosed with FED at hospital, corresponding to a cumulative incidence of 1.6 per 1000 live births. High risk of FED was seen in children born before gestational week 28 (HR, 3.52; 95% confidence interval [CI], 2.15-5.78). HRs were 3.74 for children small for gestational age ≤3 SD (95% CI, 2.71-5.17) and 4.71 in those with congenital malformations (95% CI, 3.86-5.74). Increased risk of FED was associated with female gender (HR, 1.2; 95% CI, 1.08-1.34), maternal smoking in pregnancy (HR, 1.24; 95% CI, 1.08-1.42), immigrant status (HR, 2.24; 95% CI, 1.92-2.61), and being the firstborn (HR, 1.33; 95% CI, 1.19-1.50). CONCLUSIONS FED in referred children aged 0 to 3 years are associated with perinatal adversities, female gender, maternal smoking in pregnancy, being firstborn, and having immigrant parents. The results suggest complex causal mechanisms of FED and underscore the need for a multidisciplinary approach in the clinical management of young children with persistent problems of feeding, eating, and weight faltering.
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Affiliation(s)
- Carolina Hvelplund
- Department of Pediatrics and Adolescence, University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Pediatrics, University Hospital Herlev, Copenhagen, Denmark;
| | - Bo Mølholm Hansen
- Department of Pediatrics, University Hospital Herlev, Copenhagen, Denmark
| | - Susanne Vinkel Koch
- Child and Adolescent Psychiatric Centre, Mental Health Services, Copenhagen Region, Denmark; Institutes of Clinical Medicine and
| | - Mikael Andersson
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Anne Mette Skovgaard
- Public Health, Faculty of Health Sciences, University of Copenhagen, Denmark; and
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Pagliaro CL, Bühler KEB, Ibidi SM, Limongi SCO. Dietary transition difficulties in preterm infants: critical literature review. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2016. [DOI: 10.1016/j.jpedp.2015.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Dietary transition difficulties in preterm infants: critical literature review. J Pediatr (Rio J) 2016; 92:7-14. [PMID: 26481169 DOI: 10.1016/j.jped.2015.05.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 05/27/2015] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To analyze the scientific literature on dietary changes in preterm children during the first years of life. DATA SOURCE The PubMed database was used for article selection. The texts were analyzed according to their objectives, research design, and research group characteristics. The following were selected to comprise the criteria: (1) publications in the period from 1996 to 2014; (2) participation of infants and children from birth to 10 years of age; (3) development of oral motor skills necessary for feeding; (4) development of the feeding process; and (5) feeding difficulties during childhood. SUMMARY OF THE FINDINGS There were 282 studies identified, of which 17 were used in the review, and five more articles were identified through the reference list of selected articles, totaling 22 references. CONCLUSION Very low birth weight preterm newborns are more likely to have feeding problems in early postnatal stages and during childhood when compared with full-term infants. Monitoring the feeding of these infants after hospital discharge is strictly recommended in an early intervention program aiming at better development of feeding skills.
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Ong KK, Kennedy K, Castañeda‐Gutiérrez E, Forsyth S, Godfrey KM, Koletzko B, Latulippe ME, Ozanne SE, Rueda R, Schoemaker MH, Beek EM, Buuren S, Fewtrell M. Postnatal growth in preterm infants and later health outcomes: a systematic review. Acta Paediatr 2015; 104:974-86. [PMID: 26179961 PMCID: PMC5054880 DOI: 10.1111/apa.13128] [Citation(s) in RCA: 188] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 05/20/2015] [Accepted: 07/09/2015] [Indexed: 11/30/2022]
Abstract
UNLABELLED In preterm infants, poor postnatal growth is associated with adverse neurocognitive outcomes; conversely, rapid postnatal growth is supposedly harmful for future development of metabolic diseases. CONCLUSION In this systematic review, observational studies reported consistent positive associations between postnatal weight or head growth and neurocognitive outcomes; however, there was limited evidence from the few intervention studies. Evidence linking postnatal weight gain to later adiposity and other cardiovascular disease risk factors in preterm infants was also limited.
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Affiliation(s)
- Ken K. Ong
- MRC Epidemiology Unit University of Cambridge Cambridge UK
| | | | | | | | - Keith M. Godfrey
- MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre University of Southampton and University Hospital Southampton NHS Foundation Trust Southampton UK
| | | | | | - Susan E. Ozanne
- Metabolic Research Laboratories Institute of Metabolic Sciences University of Cambridge Cambridge UK
| | | | | | - Eline M. Beek
- Nutricia Research Danone Nutricia Early Life Nutrition Singapore Singapore
| | - Stef Buuren
- University of Utrecht Utrecht The Netherlands
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Johnson MJ, Wiskin AE, Pearson F, Beattie RM, Leaf AA. How to use: nutritional assessment in neonates. Arch Dis Child Educ Pract Ed 2015; 100:147-54. [PMID: 25267876 DOI: 10.1136/archdischild-2014-306448] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2014] [Indexed: 11/04/2022]
Abstract
Adequate nutrition and growth during the neonatal period are important, especially for preterm infants, for whom there is evidence of poor nutrient intakes and growth, and this has important implications for their health in later life. Increased nutritional support while on the neonatal intensive care unit has been shown to improve growth, but such support is not universally available. Being able to carry out and interpret a nutritional assessment is therefore an important skill for paediatricians caring for neonates. This article aims to explain how to use nutritional assessment in neonates and provides some tools to make this process as straightforward as possible.
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Affiliation(s)
- Mark J Johnson
- National Institute for Health Research, Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK Department of Neonatal Medicine, Princess Anne Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Anthony E Wiskin
- National Institute for Health Research, Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK Faculty of Medicine, University of Southampton, Southampton, Hampshire, UK
| | - Freya Pearson
- Department of Neonatal Medicine, Princess Anne Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - R Mark Beattie
- Paediatric Medical Unit, Southampton General Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Alison A Leaf
- National Institute for Health Research, Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK Department of Neonatal Medicine, Princess Anne Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Verd S, Porta R, Botet F, Gutiérrez A, Ginovart G, Barbero AH, Ciurana A, Plata II. Hospital outcomes of extremely low birth weight infants after introduction of donor milk to supplement mother's milk. Breastfeed Med 2015; 10:150-5. [PMID: 25775218 DOI: 10.1089/bfm.2014.0138] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIM This study evaluated the impact of an exclusive human milk diet to nourish extremely low birth weight infants in the neonatal intensive care unit. MATERIALS AND METHODS This multicenter pre-post retrospective study included all inborn infants <1,000 g admitted to four Level IV neonatal intensive care units either before or after implementing a donor human milk policy. The feeding protocol was unchanged in both periods. Collected data included maternal/infant demographics, infant clinical data, and enteral intake as mother's own milk, donor milk, and formula. RESULTS Two hundred one infants were enrolled. Infant growth and other clinical outcomes were similar in both groups. Exposure to mother's own milk at discharge was not different. Median time in oxygen and duration of mechanical ventilation were significantly higher among formula-fed infants (63 versus 192 hours [p=0.046] and 24 versus 60 hours [p=0.016], respectively). CONCLUSIONS Our results add evidence supporting the safety of donor milk. This study also found an association between exposure to formula in preterm infants and the requirement for respiratory support, a finding that warrants further investigation.
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Affiliation(s)
- Sergio Verd
- 1 Department of Paediatrics, Hospital de la Santa Creu i Sant Pau , Barcelona. Spain
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Brown K, Johnson MJ, Leaf AA. Suboptimal nutrition in moderately preterm infants. Acta Paediatr 2014; 103:e510-2. [PMID: 25048576 DOI: 10.1111/apa.12755] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 06/27/2014] [Accepted: 07/16/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Kelly Brown
- NIHR Southampton Biomedical Research Centre; University of Southampton and University Hospital Southampton NHS Foundation Trust; Southampton UK
- Department of Neonatal Medicine; Princess Anne Hospital; University Hospital Southampton NHS Foundation Trust; Southampton UK
| | - Mark J. Johnson
- NIHR Southampton Biomedical Research Centre; University of Southampton and University Hospital Southampton NHS Foundation Trust; Southampton UK
- Department of Neonatal Medicine; Princess Anne Hospital; University Hospital Southampton NHS Foundation Trust; Southampton UK
| | - Alison A. Leaf
- NIHR Southampton Biomedical Research Centre; University of Southampton and University Hospital Southampton NHS Foundation Trust; Southampton UK
- Department of Neonatal Medicine; Princess Anne Hospital; University Hospital Southampton NHS Foundation Trust; Southampton UK
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Abdel-Latif ME, Bajuk B, Oei J, Lui K. Population study of neurodevelopmental outcomes of extremely premature infants admitted after office hours. J Paediatr Child Health 2014; 50:E45-54. [PMID: 23252772 DOI: 10.1111/jpc.12028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2012] [Indexed: 11/28/2022]
Abstract
AIM The aim of the study was to compare neurodevelopmental outcomes of extremely preterm infants admitted during (OH) and after (AH) office hours. METHODS A retrospective review of the New South Wales and Australian Capital Territory Neonatal Intensive Care Units' (NICUs) Data Collection of all infants <29 weeks gestation admitted to New South Wales and Australian Capital Territory NICUs between January 1998 and December 2004 was conducted. The primary outcome was moderate/severe functional disability (FD) at 2-3 years follow-up defined as developmental delay (Griffiths Mental Developmental Scales general quotient or Bayley Scales of Infant Development-II mental developmental index >2 standard deviations below the mean), cerebral palsy (unable to walk without aids), deafness (requiring bilateral hearing aids) or blindness (visual acuity <6/60 in the better eye). RESULTS Mortality and age at follow-up were comparable between the AH and OH groups. Developmental outcome was evaluated in 972 (74.9%) infants admitted during AH and 501 (74.6%) admitted during OH. FD was not significantly different between the AH and OH groups (17.1% vs. 14.8%, adjusted odds ratio 1.131, 95% confidence interval 1.131 (0.839-1.523), P = 0.420). There were no significant differences between AH and OH infants with cerebral palsy (9.6% vs. 7.6%), developmental delay (5.4% vs. 5.0%) or any other component of FD. CONCLUSION There is little circadian variation in mortality and adverse neurodevelopmental outcomes in an NICU network with the current model of after hours staffing and support, and sharing of NICU workload within a network.
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Affiliation(s)
- Mohamed E Abdel-Latif
- Department of Neonatology, Canberra Hospital, Woden; School of Clinical Medicine, Australian National University, Canberra, Australian Capital Territory
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Ragab MH, Al-Hindi MY, Alrayees MM. Neonatal parenteral nutrition: Review of the pharmacist role as a prescriber. Saudi Pharm J 2014; 24:429-40. [PMID: 27330373 PMCID: PMC4908069 DOI: 10.1016/j.jsps.2014.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 06/24/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction In the context of the continuous quest to improve the care of the neonates especially the critically ill premature infants, the extended role of pharmacists in the process of parenteral nutrition order writing and effective participation in decision-making especially in the neonatal population is increasingly important. This review aims to present results from the literature review of available evidence on the pharmacist role in neonatal parenteral nutrition therapy. Material and methods Key medical, clinical, and review databases were searched; relevant articles were retrieved and evaluated. Results and discussion A total of 19 papers out of 7127 searched papers met the criteria for inclusion, discussing the review topic. The main focus of the selected papers was on parenteral nutrition practice as related to the pharmacy practice. The overall quality of studies was mixed. Conclusion Overall, the review presents the up-to-date status of the most recent analysis being undertaken on the topic of pharmacist involvement in the parenteral nutrition order writing practices and more specific in the neonatal population over the period from 1979 to 2013. The overall impression is that the practice of pharmacist writing neonatal parenteral nutrition orders already exists, but still limited if compared with the practice of pharmacist writing adult parenteral nutrition orders which is much more established in many countries. There was no single clinical study evaluating this practice, as we were able to retrieve only two surveys, which make it difficult to evaluate the pharmacist role in this area. Nevertheless, despite the wide variation in literature types, characteristics and quality, there are consistent patterns across all the reviewed literatures that competencies of the pharmacist in this field are well represented, which make it very important to carry out good quality clinical studies in this field. Finally, we are currently conducting a prospective clinical study to evaluate the impact of clinical pharmacist as a neonatal PN prescriber, this impact will be judged through the study outcomes as reducing the metabolic and electrolyte complications and increasing the mean daily weight gain during PN therapy and reducing the average number of days of PN till enteral feeding is achieved.
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Affiliation(s)
- Mohamed H Ragab
- Department of Pharmacy, Prince Salman Northwestern Armed Forces Hospital, Tabuk, Saudi Arabia
| | - Mohammed Y Al-Hindi
- Department of Pediatrics, Prince Salman Northwestern Armed Forces Hospital, Tabuk, Saudi Arabia
| | - Meshari M Alrayees
- Department of Pharmacy, Prince Salman Northwestern Armed Forces Hospital, Tabuk, Saudi Arabia
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50
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Padonou G, Le Port A, Cottrell G, Guerra J, Choudat I, Rachas A, Bouscaillou J, Massougbodji A, Garcia A, Martin-Prevel Y. Factors associated with growth patterns from birth to 18 months in a Beninese cohort of children. Acta Trop 2014; 135:1-9. [PMID: 24674879 DOI: 10.1016/j.actatropica.2014.03.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 02/26/2014] [Accepted: 03/12/2014] [Indexed: 11/18/2022]
Abstract
The aim of this study was to analyze factors influencing the growth pattern of children from birth to 18 months. A longitudinal prospective study was conducted in three maternity wards in Southern Benin. Inclusion took place between June 2007 and July 2008; children were followed-up until 18 months of age. Height-for-age and weight-for-height Z-scores were computed using the newborn's anthropometric measurements taken at delivery, every month up to 6 months and then quarterly. Infant and young child feeding (IYCF) practices and malarial morbidity were recorded. Gestational age was estimated using the Ballard method; William's sex-specific reference curve of birth weight-for-gestational-age was used to determine intrauterine growth retardation (IUGR). Analyses were performed on 520 children using a linear mixed model. Low birth weight (coef=-0.43; p=0.002), IUGR (coef=-0.49; p<0.001), maternal short stature (coef=-0.25; p=0.001) and maternal low weight status (coef=-0.19; p=0.006) were significantly associated with growth impairment. Only LBW (coef=-0.28; p=0.05) and maternal low weight status (coef=-0.23; p=0.004) were associated with wasting. A good IYCF score was positively associated with weight gain (coef=0.14; p<0.001) whereas we found a paradoxical association with length (coef=-0.18; p<0.001). Malaria morbidity was not associated with growth. LBW, IUGR and maternal low weight status and height were important determinants of children's growth. These results reinforce and justify continuing public health initiatives to fight IUGR and LBW and break the intergenerational cycle of malnutrition.
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Affiliation(s)
- Géraud Padonou
- Institut de Recherche pour le Développement (IRD) UMR216, Mère et enfant face aux infections tropicales, Paris, France; Faculté de Pharmacie, Université Paris Descartes, Paris, France; Ecole doctorale 393, Université Pierre et Marie Curie Paris 6, France; Centre d'Etudes et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfant (CERPAGE), Faculté des Sciences de la Santé, Champs de Foire, Cotonou, Benin.
| | - Agnès Le Port
- Institut de Recherche pour le Développement (IRD) UMR216, Mère et enfant face aux infections tropicales, Paris, France; Faculté de Pharmacie, Université Paris Descartes, Paris, France; Ecole doctorale 393, Université Pierre et Marie Curie Paris 6, France
| | - Gilles Cottrell
- Institut de Recherche pour le Développement (IRD) UMR216, Mère et enfant face aux infections tropicales, Paris, France; Faculté de Pharmacie, Université Paris Descartes, Paris, France; Centre d'Etudes et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfant (CERPAGE), Faculté des Sciences de la Santé, Champs de Foire, Cotonou, Benin
| | - José Guerra
- Institut de Recherche pour le Développement (IRD) UMR216, Mère et enfant face aux infections tropicales, Paris, France; Faculté de Pharmacie, Université Paris Descartes, Paris, France
| | - Isabelle Choudat
- Institut de Recherche pour le Développement (IRD) UMR216, Mère et enfant face aux infections tropicales, Paris, France; Faculté de Pharmacie, Université Paris Descartes, Paris, France
| | - Antoine Rachas
- Institut de Recherche pour le Développement (IRD) UMR216, Mère et enfant face aux infections tropicales, Paris, France; Faculté de Pharmacie, Université Paris Descartes, Paris, France
| | - Julie Bouscaillou
- Institut de Recherche pour le Développement (IRD) UMR216, Mère et enfant face aux infections tropicales, Paris, France; Faculté de Pharmacie, Université Paris Descartes, Paris, France
| | - Achille Massougbodji
- Centre d'Etudes et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfant (CERPAGE), Faculté des Sciences de la Santé, Champs de Foire, Cotonou, Benin; Faculté des Sciences de la Santé, Université d'Abomey-Calavi, Cotonou, Benin
| | - André Garcia
- Institut de Recherche pour le Développement (IRD) UMR216, Mère et enfant face aux infections tropicales, Paris, France; Faculté de Pharmacie, Université Paris Descartes, Paris, France
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