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Metsälä J, Risnes K, Persson M, Veijola R, Pulakka A, Heikkilä K, Alenius S, Gissler M, Opdahl S, Sandin S, Kajantie E. Gestational age at birth and type 1 diabetes in childhood and young adulthood: a nationwide register study in Finland, Norway and Sweden. Diabetologia 2024:10.1007/s00125-024-06139-y. [PMID: 38613666 DOI: 10.1007/s00125-024-06139-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 03/01/2024] [Indexed: 04/15/2024]
Abstract
AIMS/HYPOTHESIS Children and adults born preterm have an increased risk of type 1 diabetes. However, there is limited information on risk patterns across the full range of gestational ages, especially after extremely preterm birth (23-27 weeks of gestation). We investigated the risk of type 1 diabetes in childhood and young adulthood across the full range of length of gestation at birth. METHODS Data were obtained from national registers in Finland, Norway and Sweden. In each country, information on study participants and gestational age was collected from the Medical Birth Registers, information on type 1 diabetes diagnoses was collected from the National Patient Registers, and information on education, emigration and death was collected from the respective national register sources. Individual-level data were linked using unique personal identity codes. The study population included all individuals born alive between 1987 and 2016 to mothers whose country of birth was the respective Nordic country. Individuals were followed until diagnosis of type 1 diabetes, death, emigration or end of follow-up (31 December 2016 in Finland, 31 December 2017 in Norway and Sweden). Gestational age was categorised as extremely preterm (23-27 completed weeks), very preterm (28-31 weeks), moderately preterm (32-33 weeks), late preterm (34-36 weeks), early term (37-38 weeks), full term (39-41 weeks; reference) and post term (42-45 weeks). HRs and 95% CIs from country-specific covariate-adjusted Cox regression models were combined in a meta-analysis using a common-effect inverse-variance model. RESULTS Among 5,501,276 individuals, 0.2% were born extremely preterm, 0.5% very preterm, 0.7% moderately preterm, 4.2% late preterm, 17.7% early term, 69.9% full term, and 6.7% post term. A type 1 diabetes diagnosis was recorded in 12,326 (0.8%), 6364 (0.5%) and 16,856 (0.7%) individuals at a median age of 8.2, 13.0 and 10.5 years in Finland, Norway and Sweden, respectively. Individuals born late preterm or early term had an increased risk of type 1 diabetes compared with their full-term-born peers (pooled, multiple confounder-adjusted HR 1.12, 95% CI 1.07, 1.18; and 1.15, 95% CI 1.11, 1.18, respectively). However, those born extremely preterm or very preterm had a decreased risk of type 1 diabetes (adjusted HR 0.63, 95% CI 0.45, 0.88; and 0.78, 95% CI 0.67, 0.92, respectively). These associations were similar across all three countries. CONCLUSIONS/INTERPRETATION Individuals born late preterm and early term have an increased risk of type 1 diabetes while individuals born extremely preterm or very preterm have a decreased risk of type 1 diabetes compared with those born full term.
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Affiliation(s)
- Johanna Metsälä
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.
| | - Kari Risnes
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Children's Clinic, St Olav University Hospital, Trondheim, Norway
| | - Martina Persson
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Endocrinology and Diabetology, Sachsska Childrens' and Youth Hospital, Stockholm, Sweden
| | - Riitta Veijola
- Clinical Medicine Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Anna Pulakka
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Katriina Heikkilä
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Public Health, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Suvi Alenius
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mika Gissler
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Signe Opdahl
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Sven Sandin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Seaver Autism Center for Research and Treatment at Mount Sinai, New York, NY, USA
| | - Eero Kajantie
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinical Medicine Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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Rocha AS, Ribeiro-Silva RDC, Silva JFM, Pinto EJ, Silva NJ, Paixao ES, Fiaccone RL, Kac G, Rodrigues LC, Anderson C, Barreto ML. Postnatal growth in small vulnerable newborns: a longitudinal study of 2 million Brazilians using routine register-based linked data. Am J Clin Nutr 2024; 119:444-455. [PMID: 38128734 PMCID: PMC10884605 DOI: 10.1016/j.ajcnut.2023.12.009] [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: 08/07/2023] [Revised: 11/21/2023] [Accepted: 12/18/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Preterm, low-birth weight (LBW) and small-for-gestational age (SGA) newborns have a higher frequency of adverse health outcomes, including linear and ponderal growth impairment. OBJECTIVE To describe the growth trajectories and to estimate catch-up growth during the first 5 y of life of small newborns according to 3 vulnerability phenotypes (preterm, LBW, SGA). METHODS Longitudinal study using linked data from the 100 Million Brazilian Cohort baseline, the Brazilian National Live Birth System (SINASC), and the Food and Nutrition Surveillance System (SISVAN) from 2011 to 2017. We estimated the length/height-for-age (L/HAZ) and weight-for-age z-score (WAZ) trajectories from children of 6-59 mo using the linear mixed model for each vulnerable newborn phenotype. Growth velocity for both L/HAZ and WAZ was calculated considering the change (Δ) in the mean z-score between 2 time points. Catch-up growth was defined as a change in z-score > 0.67 at any time during follow-up. RESULTS We analyzed 2,021,998 live born children and 8,726,599 observations. The prevalence of at least one of the vulnerable phenotypes was 16.7% and 0.6% were simultaneously preterm, LBW, and SGA. For those born at term, all phenotypes had a period of growth recovery from 12 mo. For preterm infants, the onset of L/HAZ growth recovery started later at 24 mo and the growth trajectories appear to be lower than those born at term, a condition aggravated among children with the 3 phenotypes. Preterm and female infants seem to experience slower growth recovery than those born at term and males. The catch-up growth occurs at 24-59 mo for males preterm: preterm + AGA + NBW (Δ = 0.80), preterm + AGA + LBW (Δ = 0.88), and preterm + SGA + LBW (Δ = 1.08); and among females: term + SGA + NBW (Δ = 0.69), term + AGA + LBW (Δ = 0.72), term + SGA + LBW (Δ = 0.77), preterm + AGA + LBW (Δ = 0.68), and preterm + SGA + LBW (Δ = 0.83). CONCLUSIONS Children born preterm seem to reach L/HAZ and WAZ growth trajectories lower than those attained by children born at term, a condition aggravated among the most vulnerable.
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Affiliation(s)
- Aline S Rocha
- Center of Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil; School of Nutrition, Federal University of Bahia (UFBA), Salvador, Brazil.
| | - Rita de Cássia Ribeiro-Silva
- Center of Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil; School of Nutrition, Federal University of Bahia (UFBA), Salvador, Brazil; Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
| | - Juliana F M Silva
- Center of Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Elizabete J Pinto
- Center of Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil; Health Sciences Center, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus, Brazil
| | - Natanael J Silva
- Center of Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil; ISGlobal, Hospital Clínic. Universitat de Barcelona, Barcelona, Spain
| | - Enny S Paixao
- Center of Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Rosemeire L Fiaccone
- Center of Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil; Department of Statistics, Federal University of Bahia (UFBA), Salvador, Brazil
| | - Gilberto Kac
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Laura C Rodrigues
- Center of Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Craig Anderson
- School of Mathematics and Statistics, University of Glasgow, Scotland, United Kingdom
| | - Mauricio L Barreto
- Center of Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil; Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
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Bagga N, Panigrahi N, Germain A, Namazova I, Rahman MM, Saugstad OD, Maheshwari A. Extrauterine Growth Restriction: Need for an Accurate Definition. NEWBORN (CLARKSVILLE, MD.) 2023; 2:198-202. [PMID: 37974930 PMCID: PMC10653204 DOI: 10.5005/jp-journals-11002-0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Neonates show considerable variation in growth that can be recognized through serial measurements of basic variables such as weight, length, and head circumference. If possible, measurement of subcutaneous and total body fat mass can also be useful. These biometric measurements at birth may be influenced by demographics, maternal and paternal anthropometrics, maternal metabolism, preconceptional nutritional status, and placental health. Subsequent growth may depend on optimal feeding, total caloric intake, total metabolic activity, genetic makeup, postnatal morbidities, medications, and environmental conditions. For premature infants, these factors become even more important; poor in utero growth can be an important reason for spontaneous or induced preterm delivery. Later, many infants who have had intrauterine growth restriction (IUGR) and are born small for gestational age (SGA) continue to show suboptimal growth below the 10th percentile, a condition that has been defined as extrauterine growth restriction (EUGR) or postnatal growth restriction (PNGR). More importantly, a subset of these growth-restricted infants may also be at high risk of abnormal neurodevelopmental outcomes. There is a need for well-defined criteria to recognize EUGR/PNGR, so that correctional steps can be instituted in a timely fashion.
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Affiliation(s)
- Nitasha Bagga
- Department of Neonatology, Rainbow Children’s Hospital, Hyderabad, Telangana, India; Global Newborn Society, Maryland, United States of America
| | - Nalinikanta Panigrahi
- Department of Neonatology, Rainbow Children’s Hospital, Hyderabad, Telangana, India; Global Newborn Society, Maryland, United States of America
| | - Aaron Germain
- Department of Neonatology, Johns Hopkins All Children’s Maternal, Fetal, and Neonatal Institute, St. Petersburg, Florida, United States of America
| | - Ilhama Namazova
- Department of Pediatrics, Azərbaycan Tibb Universiteti, Baku, Azerbaijan; Global Newborn Society, Maryland, United States of America
| | - Md Mozibur Rahman
- Department of Neonatology, Institute of Child and Mother Health, Dhaka, Bangladesh
| | | | - Akhil Maheshwari
- Department of Neonatology and Pediatrics, Louisiana State University Health Sciences Center – Shreveport, Louisiana, United States of America
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Morkuniene R, Cole TJ, Jakimaviciene EM, Bankauskiene A, Isakova J, Drazdiene N, Basys V, Tutkuviene J. Regional references vs. international standards for assessing weight and length by gestational age in Lithuanian neonates. Front Pediatr 2023; 11:1173685. [PMID: 37388293 PMCID: PMC10303945 DOI: 10.3389/fped.2023.1173685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/30/2023] [Indexed: 07/01/2023] Open
Abstract
Introduction There is no global consensus as to which standards are the most appropriate for the assessment of birth weight and length. The study aimed to compare the applicability of regional and global standards to the Lithuanian newborn population by sex and gestational age, based on the prevalence of small or large for gestational age (SGA/LGA). Materials and Methods Analysis was performed on neonatal length and weight data obtained from the Lithuanian Medical Birth Register from 1995 to 2015 (618,235 newborns of 24-42 gestational weeks). Their distributions by gestation and sex were estimated using generalized additive models for location, scale, and shape (GAMLSS), and the results were compared with the INTERGROWTH-21st (IG-21) standard to evaluate the prevalence of SGA/LGA (10th/90th centile) at different gestational ages. Results The difference in median length at term between the local reference and IG-21 was 3 cm-4 cm, while median weight at term differed by 200 g. The Lithuanian median weight at term was higher than in IG-21 by a full centile channel width, while the median length at term was higher by two channel widths. Based on the regional reference, the prevalence rates of SGA/LGA were 9.7%/10.1% for boys and 10.1%/9.9% for girls, close to the nominal 10%. Conversely, based on IG-21, the prevalence of SGA in boys/girls was less than half (4.1%/4.4%), while the prevalence of LGA was double (20.7%/19.1%). Discussion Regional population-based neonatal references represent Lithuanian neonatal weight and length much more accurately than the global standard IG-21 which provides the prevalence rates for SGA/LGA that differ from the true values by a factor of two.
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Affiliation(s)
- Ruta Morkuniene
- Department of Anatomy, Histology and Anthropology, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Tim J. Cole
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Egle Marija Jakimaviciene
- Department of Anatomy, Histology and Anthropology, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Agne Bankauskiene
- Department of Human and Medical Genetics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Jelena Isakova
- Health Information Center, Institute of Hygiene, Vilnius, Lithuania
| | - Nijole Drazdiene
- Clinic of Children’s Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Vytautas Basys
- Division of Biological, Medical and Geosciences, Lithuanian Academy of Sciences, Vilnius, Lithuania
| | - Janina Tutkuviene
- Department of Anatomy, Histology and Anthropology, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Mistry JN, Silvennoinen S, Zaman F, Sävendahl L, Mariniello K, Hall C, Howard SR, Dunkel L, Sankilampi U, Guasti L. The crosstalk between FGF21 and GH leads to weakened GH receptor signaling and IGF1 expression and is associated with growth failure in very preterm infants. Front Endocrinol (Lausanne) 2023; 14:1105602. [PMID: 37251684 PMCID: PMC10213667 DOI: 10.3389/fendo.2023.1105602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/28/2023] [Indexed: 05/31/2023] Open
Abstract
Background Fibroblast growth factor 21 (FGF21) is an essential metabolic regulator that adapts to changes in nutritional status. Severe childhood undernutrition induces elevated FGF21 levels, contributing to growth hormone (GH) resistance and subsequent linear growth attenuation potentially through a direct action on chondrocytes. Methods In this study, we assessed expression of the components of both GH and FGF21 pathways in rare and unique human growth plates obtained from children. Moreover, we investigated the mechanistic interplay of FGF21 on GH receptor (GHR) signaling in a heterologous system. Results Chronic FGF21 exposure increased GH-induced GHR turnover and SOCS2 expression, leading to the inhibition of STAT5 phosphorylation and IGF-1 expression. The clinical significance of FGF21 signaling through GH receptors was tested in nutritionally driven growth failure seen in very preterm (VPT) infants right after birth. VPT infants display an immediate linear growth failure after birth followed by growth catch-up. Consistent with the in vitro model data, we show that circulating FGF21 levels were elevated during deflection in linear growth compared to catch-up growth and were inversely correlated with the length velocity and circulating IGF1 levels. Conclusions This study further supports a central role of FGF21 in GH resistance and linear growth failure and suggests a direct action on the growth plate.
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Affiliation(s)
- Jayna N. Mistry
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Sanna Silvennoinen
- Department of Pediatrics, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Farasat Zaman
- Department of Women’s and Children’s Health, Karolinska Institutet and Karolinska University, Solna, Sweden
| | - Lars Sävendahl
- Department of Women’s and Children’s Health, Karolinska Institutet and Karolinska University, Solna, Sweden
| | - Katia Mariniello
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Charlotte Hall
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Sasha R. Howard
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Leo Dunkel
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Ulla Sankilampi
- Department of Pediatrics, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Leonardo Guasti
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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Prematurity and BPD: what general pediatricians should know. Eur J Pediatr 2023; 182:1505-1516. [PMID: 36763190 PMCID: PMC10167192 DOI: 10.1007/s00431-022-04797-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/27/2022] [Accepted: 12/29/2022] [Indexed: 02/11/2023]
Abstract
More and more very low birth weight (VLBW) infants around the world survive nowadays, with consequently larger numbers of children developing prematurity-related morbidities, especially bronchopulmonary dysplasia (BPD). BPD is a multifactorial disease and its rising incidence in recent years means that general pediatricians are much more likely to encounter a child born extremely preterm, possibly with BPD, in their clinical practice. Short- and long-term sequelae in VLBW patients may affect not only pulmonary function (principally characterized by an obstructive pattern), but also other aspect including the neurological (neurodevelopmental and neuropsychiatric disorders), the sensorial (earing and visual impairment), the cardiological (systemic and pulmonary hypertension, reduced exercise tolerance and ischemic heart disease in adult age), nutritional (feeding difficulties and nutritional deficits), and auxological (extrauterine growth restriction). For the most premature infants at least, a multidisciplinary follow-up is warranted after discharge from the neonatal intensive care unit in order to optimize their respiratory and neurocognitive potential, and prevent respiratory infections, nutritional deficiencies or cardiovascular impairments. Conclusion: The aim of this review is to summarize the main characteristics of preterm and BPD infants, providing the general pediatrician with practical information regarding these patients' multidisciplinary complex follow-up. We explore the current evidence on respiratory outcomes and their management that actually does not have a definitive available option. We also discuss the available investigations, treatments, and strategies for prevention and prophylaxis to improve the non-respiratory outcomes and the quality of life for these children and their families, a critical aspect not always considered. This comprehensive approach, added to the increased needs of a VLBW subjects, is obviously related to very high health-related costs that should be beared in mind. What is Known: • Every day, a general pediatrician is more likely to encounter a former very low birth weight infant. • Very low birth weight and prematurity are frequently related not only with worse respiratory outcomes, but also with neurological, sensorial, cardiovascular, renal, and nutritional issues. What is New: • This review provides to the general pediatrician a comprehensive approach for the follow-up of former premature very low birth weight children, with information to improve the quality of life of this special population.
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Itoshima R, Oda A, Ogawa R, Yanagisawa T, Hiroma T, Nakamura T. Neurodevelopment and physical measurements in infants with birthweight of 500 grams or less. Pediatr Int 2023; 65:e15689. [PMID: 37991183 DOI: 10.1111/ped.15689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/13/2023] [Accepted: 09/21/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND In infants born weighing ≤500 g, little has been studied about the association between neurodevelopmental prognosis and growth. This study aimed to evaluate the association between neurodevelopmental impairment (NDI) and z-scores of physical measurements in infants born weighing ≤500 g. METHODS A single-center, retrospective cohort study in a level IV neonatal intensive care unit in Japan. Infants born weighing ≤500 g between 2010 and 2019 were eligible. Z-scores in weight, length/height, and head circumference at birth, due date (or discharge), 6 and 18 months of corrected age, and 3 years of age were compared between infants with and without NDI at 3 years of age. Three infants with severe intraventricular hemorrhage or periventricular leukomalacia were excluded from the comparison analyses. NDI was defined as having a developmental quotient of ≤70, cerebral palsy, visual impairment, or hearing impairment. RESULTS Of 22 eligible infants, the incidence of NDI at 3 years of age was 54.5%. The z-score was significantly smaller in the NDI group (n = 10) than that in the non-NDI group (n = 9) in head circumference at birth (median, -1.94 vs. -0.75; Z = 0.54; p = 0.020), and in height at 18 months of corrected age (median, -2.84 vs. -1.79; Z = 0.58; p = 0.013) and 3 years of age (median, -2.02 vs. -1.21; Z = 0.47; p = 0.046). CONCLUSIONS NDI at 3 years of age was associated with a small head circumference z-score at birth, height at 18 months of corrected age, and height at 3 years of age in infants born weighing ≤500 g.
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Affiliation(s)
- Ryo Itoshima
- Division of Neonatology, Nagano Children's Hospital, Azumino, Japan
- Life Science Research Center, Nagano Children's Hospital, Azumino, Japan
- Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Arata Oda
- Division of Neonatology, Nagano Children's Hospital, Azumino, Japan
- Life Science Research Center, Nagano Children's Hospital, Azumino, Japan
| | - Ryo Ogawa
- Division of Neonatology, Nagano Children's Hospital, Azumino, Japan
- Life Science Research Center, Nagano Children's Hospital, Azumino, Japan
| | | | - Takehiko Hiroma
- Division of Neonatology, Nagano Children's Hospital, Azumino, Japan
- Life Science Research Center, Nagano Children's Hospital, Azumino, Japan
| | - Tomohiko Nakamura
- Division of Neonatology, Nagano Children's Hospital, Azumino, Japan
- Life Science Research Center, Nagano Children's Hospital, Azumino, Japan
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Zhang DL, Yoon HH, deRegnier RAO, Arzu J, Rahmani S. Postnatal Growth Trajectories and Neurodevelopmental Outcomes Following Bevacizumab Treatment for Retinopathy of Prematurity. Clin Ophthalmol 2022; 16:2713-2722. [PMID: 36035240 PMCID: PMC9401100 DOI: 10.2147/opth.s378520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/04/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the postnatal growth and neurodevelopment of infants with retinopathy of prematurity (ROP) treated with intravitreal bevacizumab (IVB). Patients and Methods This was a retrospective comparative study. A total of 262 infants were divided among three study groups: 22 treated with intravitreal bevacizumab, 55 treated with laser, and 185 with ROP that resolved without treatment. Infants with nonviable course or hydrocephalus, a source of non-physiologic weight gain, were excluded. Neurodevelopment was assessed with Bayley III scores at 17–28 months if available and presence of hearing loss or cerebral palsy. Weekly weight, height, and head circumference from birth through 50 weeks postmenstrual age (PMA) were modeled to determine differences in growth trajectories following treatment. Results Comparison of postnatal growth curves from the time of treatment to 50 weeks PMA showed no significant differences in growth trajectories between groups after adjusting for the corresponding growth parameters at birth. Comparison of Bayley scores in patients with available data (n = 120) showed no significant differences. There was an increased risk of cerebral palsy in the IVB group after logistic regression adjusting for baseline confounders, but this did not retain statistical significance after applying the false discovery rate correction for multiple testing. Conclusion To our knowledge, this is the first large retrospective study to examine longitudinal growth in infants treated with IVB compared to controls. There were no significant differences in postnatal growth or neurodevelopmental outcomes between groups, which overall continue to support the safety of bevacizumab treatment for ROP.
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Affiliation(s)
- David L Zhang
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Hawke H Yoon
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Ophthalmology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Raye-Ann O deRegnier
- Division of Neonatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Jennifer Arzu
- Division of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Safa Rahmani
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Ophthalmology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
- Correspondence: Safa Rahmani, Division of Ophthalmology, Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL, 60611, USA, Tel +1 312 227-6180, Fax +1 312 227-9411, Email
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9
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Brummel SS, Stringer J, Mills E, Tierney C, Caniglia EC, Colbers A, Chi BH, Best BM, Gaaloul ME, Hillier S, Jourdain G, Khoo SH, Mofenson LM, Myer L, Nachman S, Stranix-Chibanda L, Clayden P, Sachikonye M, Lockman S. Clinical and population-based study design considerations to accelerate the investigation of new antiretrovirals during pregnancy. J Int AIDS Soc 2022; 25 Suppl 2:e25917. [PMID: 35851758 PMCID: PMC9294861 DOI: 10.1002/jia2.25917] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 04/28/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Pregnant women are routinely excluded from clinical trials, leading to the absence or delay in even the most basic pharmacokinetic (PK) information needed for dosing in pregnancy. When available, pregnancy PK studies use a small sample size, resulting in limited safety information. We discuss key study design elements that may enhance the timely availability of pregnancy data, including the role and timing of randomized controlled trials (RCTs) to evaluate pregnancy safety; efficacy and safety outcome measures; stand‐alone protocols, platform trials, single arm studies, sample size and the effect that follow‐up time during gestation has on analysis interpretations; and observational studies. Discussion Pregnancy PK should be studied during drug development, after dosing in non‐pregnant persons is established (unless non‐clinical or other data raise pregnancy concerns). RCTs should evaluate the safety during pregnancy of priority new HIV agents that are likely to be used by large numbers of females of childbearing age. Key endpoints for pregnancy safety studies include birth outcomes (prematurity, small for gestational age and stillbirth) and neonatal death, with traditional adverse events and infant growth also measured (congenital anomalies are best studied through surveillance). We recommend that viral efficacy be studied as a secondary endpoint of pregnancy RCTs, once PK studies confirm adequate drug exposure in pregnancy. RCTs typically use a stand‐alone protocol for new agents. In contrast, master protocols using a platform design can add agents over time, possibly speeding safety data ascertainment. To speed accrual, stand‐alone pregnancy trial protocols can include pre‐specified starting rules based upon adequate PK levels in pregnancy; and seamless master protocols or platform trials can include a pregnancy PK and safety component. When RCTs are unethical or cost‐prohibitive, observational studies should be conducted, preferably using target trial emulation to avoid bias. Conclusions Pregnancy PK needs to be obtained earlier in drug evaluation. Timely RCTs are needed to understand safety in pregnancy for high‐priority new HIV agents. RCTs that enrol pregnant women should focus on outcomes unique to pregnancy, and observational studies should focus on questions that RCTs are not equipped to answer.
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Affiliation(s)
- Sean S Brummel
- Department of Biostatistics, Center for Biostatistics in AIDS Research, Boston, Massachusetts, USA.,Harvard T.H. Chan School of Public Heath, Boston, Massachusetts, USA
| | - Jeff Stringer
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ed Mills
- MTEK Sciences, Vancouver, British Columbia, Canada.,MTEK Sciences, Kigali, Rwanda
| | - Camlin Tierney
- Department of Biostatistics, Center for Biostatistics in AIDS Research, Boston, Massachusetts, USA.,Harvard T.H. Chan School of Public Heath, Boston, Massachusetts, USA
| | - Ellen C Caniglia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Angela Colbers
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Benjamin H Chi
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brookie M Best
- Skaggs School of Pharmacy and Pharmaceutical Sciences, San Diego, California, USA.,Pediatrics Department - Rady Children's Hospital San Diego, University of California San Diego, La Jolla, California, USA
| | - Myriam El Gaaloul
- Product Development, Medicines for Malaria Venture, Geneva, Switzerland
| | - Sharon Hillier
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh and the Magee-Womens Research Institute, Pittsburgh, Pennsylvania, USA
| | | | - Saye H Khoo
- Department of Pharmacology, University of Liverpool, Liverpool, UK
| | - Lynne M Mofenson
- Research Department, Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, USA
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Sharon Nachman
- Department of Pediatrics, The State University of New York (SUNY), Stony Brook, New York, USA
| | - Lynda Stranix-Chibanda
- Child and Adolescent Health Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | | | | | - Shahin Lockman
- Harvard T.H. Chan School of Public Heath, Boston, Massachusetts, USA.,Brigham and Women's Hospital, Boston, Massachusetts, USA
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10
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Ruiz Brunner MDLM, Cuestas E, Heinen F, Schroeder AS. Growth in infants, children and adolescents with unilateral and bilateral cerebral palsy. Sci Rep 2022; 12:1879. [PMID: 35115566 PMCID: PMC8813947 DOI: 10.1038/s41598-022-05267-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 11/26/2021] [Indexed: 11/09/2022] Open
Abstract
To compare growth patterns during infancy, childhood and adolescence in children with unilateral and bilateral cerebral palsy (CP) phenotype and to assess the association with gross motor impairment, dysphagia and gestational age. We retrospectively studied 389 children with CP from a single center population in Munich, Germany. 1536 measurements of height and weight were tabulated and z-scored from 6 to 180 months of age. Generalized linear mixed model were used to examine the association between growth, GMFCS, dysphagia and gestational age by CP phenotype. Children with unilateral CP tend to grow similarly to their typically developed peers. In the main effect model, bilateral CP phenotype was significantly associated with decreased mean z-scores for height (β [95% CI] − 0.953 [− 1.145, − 0.761], p < 0.001), weight (− 0.999 [− 1.176, − 0.807], p < 0.001) and BMI (β [95% CI] − 0.437 [− 0.799, − 0.075]), compared with unilateral CP phenotype. This association remained significant in the interaction models. The height-for-age z-scores, weight-for-age decreased z-scores and BMI-for-age z-scores of children with bilateral CP and GMFCS III–V or dysphagia decreased more significantly than those of children with unilateral CP. Preterm birth was not significantly associated with decreased growth in height, weight and BMI. Reduced growth in children with bilateral CP was strongly associated with moderate to severe impairment in gross motor function (GMFCS III–V) and dysphagia.
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Affiliation(s)
- Maria de Las Mercedes Ruiz Brunner
- Instituto de Investigación en Ciencias de la Salud, Universidad Nacional de Córdoba, Consejo Nacional de Investigaciones Científicas y Técnicas, Bv de la Reforma S/N, Pabellón de Biología Celular, Ciudad Universitaria, CP: 5016, Córdoba, Argentina. .,Department of Pediatric Neurology, Developmental Medicine and Social Pediatrics, University Hospital of Munich (LMU), Hauner Children's Hospital, Munich, Germany.
| | - Eduardo Cuestas
- Instituto de Investigación en Ciencias de la Salud, Universidad Nacional de Córdoba, Consejo Nacional de Investigaciones Científicas y Técnicas, Bv de la Reforma S/N, Pabellón de Biología Celular, Ciudad Universitaria, CP: 5016, Córdoba, Argentina.,Cátedra de Clínica Pediátrica, Hospital Nuestra Señora de la Misericordia, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Florian Heinen
- Department of Pediatric Neurology, Developmental Medicine and Social Pediatrics, University Hospital of Munich (LMU), Hauner Children's Hospital, Munich, Germany
| | - Andreas Sebastian Schroeder
- Department of Pediatric Neurology, Developmental Medicine and Social Pediatrics, University Hospital of Munich (LMU), Hauner Children's Hospital, Munich, Germany. .,Ludwig Maximilian University of Munich (LMU), Hauner Children's Hospital, Paediatric Neurology, Developmental Medicine, Lindwurmstr. 4, 80337, Munich, Germany.
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11
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Ruzok T, Schmitz-Koep B, Menegaux A, Eves R, Daamen M, Boecker H, Rieger-Fackeldey E, Priller J, Zimmer C, Bartmann P, Wolke D, Sorg C, Hedderich DM. Lower hypothalamus subunit volumes link with impaired long-term body weight gain after preterm birth. Front Endocrinol (Lausanne) 2022; 13:1057566. [PMID: 36589836 PMCID: PMC9797519 DOI: 10.3389/fendo.2022.1057566] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Preterm birth is associated with an increased risk for impaired body weight gain. While it is known that in prematurity several somatic and environmental factors (e.g., endocrine factors, nutrition) modulate short- and long-term body weight gain, the contribution of potentially impaired body weight control in the brain remains elusive. We hypothesized that the structure of hypothalamic nuclei involved in body weight control is altered after preterm birth, with these alterations being associated with aberrant body weight development into adulthood. MATERIALS AND METHODS We assessed 101 very preterm (i.e., <32 weeks of gestational age) and/or very low birth weight (i.e., <1500g; VP/VLBW) and 110 full-term born (FT) adults of the population-based Bavarian Longitudinal Study with T1-weighted MRI, deep learning-based hypothalamus subunit segmentation, and multiple body weight assessments from birth into adulthood. RESULTS Volumes of the whole hypothalamus and hypothalamus subunits relevant for body weight control were reduced in VP/VLBW adults and associated with birth variables (i.e., gestational age and intensity of neonatal treatment), body weight (i.e., weight at birth and adulthood), and body weight trajectories (i.e., trajectory slopes and cluster/types such as long-term catch-up growth). Particularly, VP/VLBW subgroups, whose individuals showed catch-up growth and/or were small for gestational age, were mostly associated with volumes of distinct hypothalamus subunits such as lateral or infundibular/ventromedial hypothalamus. CONCLUSION Results demonstrate lower volumes of body weight control-related hypothalamus subunits after preterm birth that link with long-term body weight gain. Data suggest postnatal development of body weight -related hypothalamic nuclei in VP/VLBW individuals that corresponds with distinct body weight trajectories into adulthood.
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Affiliation(s)
- Tobias Ruzok
- Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- TUM-NIC, Technical University of Munich Neuroimaging Center, Munich, Germany
- *Correspondence: Tobias Ruzok,
| | - Benita Schmitz-Koep
- Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- TUM-NIC, Technical University of Munich Neuroimaging Center, Munich, Germany
| | - Aurore Menegaux
- Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- TUM-NIC, Technical University of Munich Neuroimaging Center, Munich, Germany
| | - Robert Eves
- Department of Psychology, University of Warwick, Coventry, United Kingdom
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Marcel Daamen
- Clinical Functional Imaging Group, Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
- Department of Neonatology, University Hospital Bonn, Bonn, Germany
| | - Henning Boecker
- Clinical Functional Imaging Group, Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
| | - Esther Rieger-Fackeldey
- Department of Neonatology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Josef Priller
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- Neuropsychiatry, Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
- UK Dementia Research Institute, University of Edinburgh (UK DRI), Edinburgh, United Kingdom
| | - Claus Zimmer
- Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- TUM-NIC, Technical University of Munich Neuroimaging Center, Munich, Germany
| | - Peter Bartmann
- Department of Neonatology, University Hospital Bonn, Bonn, Germany
| | - Dieter Wolke
- Department of Psychology, University of Warwick, Coventry, United Kingdom
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Christian Sorg
- Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- TUM-NIC, Technical University of Munich Neuroimaging Center, Munich, Germany
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Dennis M. Hedderich
- Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- TUM-NIC, Technical University of Munich Neuroimaging Center, Munich, Germany
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12
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Han JH, Yoon SJ, Lim JH, Shin JE, Eun HS, Park MS, Park KI, Lee SM. The impact of neonatal morbidities on child growth and developmental outcomes in very low birth weight infants: a nationwide cohort study. Eur J Pediatr 2022; 181:197-205. [PMID: 34236516 DOI: 10.1007/s00431-021-04177-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/11/2021] [Accepted: 06/22/2021] [Indexed: 11/26/2022]
Abstract
Growth in preterm infants has long-term implications for neurodevelopmental outcomes. We aimed to estimate the nationwide growth outcomes from birth to 5 years in infants born under 1500 g and to analyze the effects of major morbidities in preterm infants on growth. In total, 2961 children born in 2013 with a birth weight under 1500 g who underwent an infant health checkup between 2013 and 2018 according to the National Health Insurance Service database were included. Checkups were conducted at 4-6, 9-12, 18-24, 30-36, 42-48, and 54-60 months of age. Information was obtained from the International Classification of Diseases-10 codes or a questionnaire administered during the check-up. At 60 months of age, the mean percentiles of weight, height, and head circumference fell within only the 30-40th percentile of normal growth values. About 30% of infants had growth parameters below the 10th percentile and showed worse neurodevelopmental outcomes. Using multiple logistic regression, infants with bronchopulmonary dysplasia showed a significantly higher incidence of growth restriction in all three categories of weight (odds ratio [OR] 1.50), height (OR 1.33), and head circumference (OR 1.36) at 60 months. Sepsis was associated with growth restriction in weight (OR 1.43) and head circumference (OR 1.33). Periventricular leukomalacia infants had relatively small head circumferences (OR 1.91) and poor developmental screening results (OR 2.89).Conclusion: Catch-up growth remains a major issue in infants born under 1500 g, especially those with some morbidities from preterm birth. Regular checkups to monitor and early intervention to achieve normal growth are essential. What is Known: • Growth in preterm infants has long-term implications for neurodevelopmental and cardiometabolic outcomes. • Data are lacking on the time-serial effects of many preterm morbidities simultaneously on long-term growth outcomes. What is New: • All growth parameters of VLBW infants, including weight, height, and head circumference, fell within the 30-40th percentile of normal growth for infants at 60 months of age, indicating that catch-up growth for VLBW infants remains an issue. • VLBW infants with major preterm morbidities, including BPD, PVL, and sepsis, showed difficulties in achieving normal catch-up growth and neurodevelopment at 60 months of age.
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Affiliation(s)
- Jung Ho Han
- Department of Pediatrics, Yonsei University College of Medicine, 211 Eonjuro Gangnamgu, Seoul, 06273, Korea
| | - So Jin Yoon
- Department of Pediatrics, Yonsei University College of Medicine, 211 Eonjuro Gangnamgu, Seoul, 06273, Korea
| | - Joo Hee Lim
- Department of Pediatrics, Yonsei University College of Medicine, 211 Eonjuro Gangnamgu, Seoul, 06273, Korea
| | - Jeong Eun Shin
- Department of Pediatrics, Yonsei University College of Medicine, 211 Eonjuro Gangnamgu, Seoul, 06273, Korea
| | - Ho Seon Eun
- Department of Pediatrics, Yonsei University College of Medicine, 211 Eonjuro Gangnamgu, Seoul, 06273, Korea
| | - Min Soo Park
- Department of Pediatrics, Yonsei University College of Medicine, 211 Eonjuro Gangnamgu, Seoul, 06273, Korea
| | - Kook In Park
- Department of Pediatrics, Yonsei University College of Medicine, 211 Eonjuro Gangnamgu, Seoul, 06273, Korea
| | - Soon Min Lee
- Department of Pediatrics, Yonsei University College of Medicine, 211 Eonjuro Gangnamgu, Seoul, 06273, Korea.
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13
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Kempf E, Vogel M, Vogel T, Kratzsch J, Landgraf K, Kühnapfel A, Gausche R, Gräfe D, Sergeyev E, Pfäffle R, Kiess W, Stanik J, Körner A. Dynamic alterations in linear growth and endocrine parameters in children with obesity and height reference values. EClinicalMedicine 2021; 37:100977. [PMID: 34386750 PMCID: PMC8343253 DOI: 10.1016/j.eclinm.2021.100977] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Obesity can affect linear growth of children but there is uncertainty regarding the dynamics and potential causes. METHODS In the population-based LIFE Child and the obesity-enriched Leipzig Obesity Childhood cohorts (8,629 children, 37,493 measurements), recruited from 1999 to 2018 in Germany, we compared height, growth, and endocrine parameters between normal-weight and children with obesity (0-20 years). Derived from the independent German CrescNet registry (12,703 children) we generated height reference values specific for children with obesity (data collected from 1999 to 2020). FINDINGS Children with obesity were significantly taller than normal-weight peers, differing at maximum by 7·6 cm (1·4 height, standard deviation scores or SDS) at age 6-8 years. Already at birth, children with obesity were slightly taller and thereafter had increased growth velocities by up to 1·2 cm/year. This growth acceleration was unrelated to parental height, but was accompanied by increased levels of insulin-like growth factor-1 (IGF-1), insulin and leptin. During puberty, children with obesity showed a catch-down in height SDS. The reduction in pubertal growth velocity by up to 25% coincided with a decrease in levels of IGF-1 (by 17%) and testosterone (by 62%) in boys and estradiol (by 37%) in girls. We confirmed these alterations in growth in the independent CrescNet cohort and furthermore provide height reference values for children with obesity for open access. INTERPRETATION Dynamics of linear growth are altered distinctively in different developmental phases in children with obesity. Early emergence before other profound comorbidities implies predisposition, environmental, and/or endocrine factors affecting growth in early life. Height reference values for children with obesity may enhance the precision of clinical health surveillance. FUNDING German Research Foundation, German Diabetes Association, EU, ESF, ERDF, State of Saxony, ESPE, Hexal, Novo Nordisk, Pfizer Pharma.
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Affiliation(s)
- Elena Kempf
- University of Leipzig, Medical Faculty, University Hospital for Children and Adolescents, Center for Pediatric Research, Liebigstr.19, Leipzig 04103, Germany
| | - Mandy Vogel
- University of Leipzig, Medical Faculty, LIFE–Leipzig Research Center for Civilization Diseases, Philipp-Rosenthal-Str. 27, Leipzig 04103, Germany
| | - Tim Vogel
- University of Leipzig, Medical Faculty, University Hospital for Children and Adolescents, Center for Pediatric Research, Liebigstr.19, Leipzig 04103, Germany
| | - Jürgen Kratzsch
- University of Leipzig, Medical Faculty, Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, Liebigstr. 27b, Leipzig 04103, Germany
| | - Kathrin Landgraf
- University of Leipzig, Medical Faculty, University Hospital for Children and Adolescents, Center for Pediatric Research, Liebigstr.19, Leipzig 04103, Germany
| | - Andreas Kühnapfel
- University of Leipzig, Medical Faculty, Institute for Medical Informatics, Statistics and Epidemiology (IMISE), Härtelstr. 16-18, Leipzig 04107, Germany
| | - Ruth Gausche
- University of Leipzig, Medical Faculty, Growth Network CrescNet, Liebigstr. 20a, Leipzig 04103, Germany,
| | - Daniel Gräfe
- University of Leipzig, Medical Faculty, Pediatric Radiology, Liebigstr. 20a, Leipzig 04103, Germany
| | - Elena Sergeyev
- University of Leipzig, Medical Faculty, University Hospital for Children and Adolescents, Center for Pediatric Research, Liebigstr.19, Leipzig 04103, Germany
| | - Roland Pfäffle
- University of Leipzig, Medical Faculty, University Hospital for Children and Adolescents, Center for Pediatric Research, Liebigstr.19, Leipzig 04103, Germany
| | - Wieland Kiess
- University of Leipzig, Medical Faculty, University Hospital for Children and Adolescents, Center for Pediatric Research, Liebigstr.19, Leipzig 04103, Germany
- University of Leipzig, Medical Faculty, LIFE–Leipzig Research Center for Civilization Diseases, Philipp-Rosenthal-Str. 27, Leipzig 04103, Germany
| | - Juraj Stanik
- University of Leipzig, Medical Faculty, University Hospital for Children and Adolescents, Center for Pediatric Research, Liebigstr.19, Leipzig 04103, Germany
- Comenius University, Medical Faculty and Children Faculty Hospital, First Department of Pediatrics, Limbova 1, 833 40 Bratislava, Slovakia and Slovak Academy of Sciences, Biomedical Research Center, Institute of Experimental Endocrinology, DIABGENE Laboratory, Dúbravská cesta 9, Bratislava 845 05, Slovakia
| | - Antje Körner
- University of Leipzig, Medical Faculty, University Hospital for Children and Adolescents, Center for Pediatric Research, Liebigstr.19, Leipzig 04103, Germany
- University of Leipzig, Medical Faculty, LIFE–Leipzig Research Center for Civilization Diseases, Philipp-Rosenthal-Str. 27, Leipzig 04103, Germany
- Corresponding author.
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14
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Ruys CA, van de Lagemaat M, Rotteveel J, Finken MJJ, Lafeber HN. Improving long-term health outcomes of preterm infants: how to implement the findings of nutritional intervention studies into daily clinical practice. Eur J Pediatr 2021; 180:1665-1673. [PMID: 33517483 PMCID: PMC8105221 DOI: 10.1007/s00431-021-03950-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 11/29/2022]
Abstract
Preterm-born children are at risk for later neurodevelopmental problems and cardiometabolic diseases; early-life growth restriction and suboptimal neonatal nutrition have been recognized as risk factors. Prevention of these long-term sequelae has been the focus of intervention studies. High supplies of protein and energy during the first weeks of life (i.e., energy > 100 kcal kg-1 day-1 and a protein-to-energy ratio > 3 g/100 kcal) were found to improve both early growth and later neurodevelopmental outcome. Discontinuation of this high-energy diet is advised beyond 32-34 weeks postconceptional age to prevent excess fat mass and possible later cardiometabolic diseases. After discharge, nutrition with a higher protein-to-energy ratio (i.e., > 2.5-3.0 g/100 kcal) may improve growth and body composition in the short term.Conclusion: Preterm infants in their first weeks of life require a high-protein high-energy diet, starting shortly after birth. Subsequent adjustments in nutritional composition, aimed at achieving optimal body composition and minimizing the long-term cardiometabolic risks without jeopardizing the developing brain, should be guided by the growth pattern. The long-term impact of this strategy needs to be studied. What is Known: • Preterm infants are at risk for nutritional deficiencies and extrauterine growth restriction. • Extrauterine growth restriction and suboptimal nutrition are risk factors for neurodevelopmental problems and cardiometabolic disease in later life. What is New: • Postnatally, a shorter duration of high-energy nutrition may prevent excess fat mass accretion and its associated cardiometabolic risks and an early switch to a protein-enriched diet should be considered from 32-34 weeks postconceptional age. • In case of formula feeding, re-evaluate the need for the continuation of a protein-enriched diet, based on the infant's growth pattern.
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Affiliation(s)
- Charlotte A. Ruys
- Department of Pediatrics/Neonatology, Emma Children’s Hospital, Amsterdam UMC, VU University Amsterdam, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Monique van de Lagemaat
- Department of Pediatrics/Neonatology, Emma Children’s Hospital, Amsterdam UMC, VU University Amsterdam, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Joost Rotteveel
- Department of Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands
| | - Martijn J. J. Finken
- Department of Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands
| | - Harrie N. Lafeber
- Department of Pediatrics/Neonatology, Emma Children’s Hospital, Amsterdam UMC, VU University Amsterdam, PO Box 7057, 1007 MB Amsterdam, The Netherlands
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15
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Abiramalatha T, Thomas N, Thanigainathan S. High versus standard volume enteral feeds to promote growth in preterm or low birth weight infants. Cochrane Database Syst Rev 2021; 3:CD012413. [PMID: 33733486 PMCID: PMC8092452 DOI: 10.1002/14651858.cd012413.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Human milk is the best enteral nutrition for preterm infants. However, human milk, given at standard recommended volumes, is not adequate to meet the protein, energy, and other nutrient requirements of preterm or low birth weight infants. One strategy that may be used to address the potential nutrient deficits is to give a higher volume of enteral feeds. High volume feeds may improve nutrient accretion and growth, and in turn may improve neurodevelopmental outcomes. However, there are concerns that high volume feeds may cause feed intolerance, necrotising enterocolitis, or complications related to fluid overload such as patent ductus arteriosus and chronic lung disease. This is an update of a review published in 2017. OBJECTIVES To assess the effect on growth and safety of high versus standard volume enteral feeds in preterm or low birth weight infants. In infants who were fed fortified human milk or preterm formula, high and standard volume feeds were defined as > 180 mL/kg/day and ≤ 180 mL/kg/day, respectively. In infants who were fed unfortified human milk or term formula, high and standard volume feeds were defined as > 200 mL/kg/day and ≤ 200 mL/kg/day, respectively. SEARCH METHODS We used the standard search strategy of Cochrane Neonatal to search Cochrane Central Register of Controlled Trials (CENTRAL; 2020 Issue 6) in the Cochrane Library; Ovid MEDLINE (1946 to June 2020); Embase (1974 to June 2020); and CINAHL (inception to June 2020); Maternity & Infant Care Database (MIDIRS) (1971 to April 2020); as well as previous reviews, and trial registries. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared high versus standard volume enteral feeds for preterm or low birth weight infants. DATA COLLECTION AND ANALYSIS Two review authors assessed trial eligibility and risk of bias and independently extracted data. We analysed treatment effects in individual trials and reported risk ratio (RR) and risk difference for dichotomous data, and mean difference (MD) for continuous data, with respective 95% confidence intervals (CIs). We used the GRADE approach to assess the certainty of evidence. The primary outcomes were weight gain, linear and head growth during hospital stay, and extrauterine growth restriction at discharge. MAIN RESULTS We included two new RCTs (283 infants) in this update. In total, we included three trials (347 infants) in this updated review. High versus standard volume feeds with fortified human milk or preterm formula Two trials (283 infants) met the inclusion criteria for this comparison. Both were of good methodological quality, except for lack of masking. Both trials were performed in infants born at < 32 weeks' gestation. Meta-analysis of data from both trials showed high volume feeds probably improves weight gain during hospital stay (MD 2.58 g/kg/day, 95% CI 1.41 to 3.76; participants = 271; moderate-certainty evidence). High volume feeds may have little or no effect on linear growth (MD 0.05 cm/week, 95% CI -0.02 to 0.13; participants = 271; low-certainty evidence), head growth (MD 0.02 cm/week, 95% CI -0.04 to 0.09; participants = 271; low-certainty evidence), and extrauterine growth restriction at discharge (RR 0.71, 95% CI 0.50 to 1.02; participants = 271; low-certainty evidence). We are uncertain of the effect of high volume feeds with fortified human milk or preterm formula on the risk of necrotising enterocolitis (RR 0.74, 95% CI 0.12 to 4.51; participants = 283; very-low certainty evidence). High versus standard volume feeds with unfortified human milk or term formula One trial with 64 very low birth weight infants met the inclusion criteria for this comparison. This trial was unmasked but otherwise of good methodological quality. High volume feeds probably improves weight gain during hospital stay (MD 6.2 g/kg/day, 95% CI 2.71 to 9.69; participants = 61; moderate-certainty evidence). The trial did not provide data on linear and head growth, and extrauterine growth restriction at discharge. We are uncertain as to the effect of high volume feeds with unfortified human milk or term formula on the risk of necrotising enterocolitis (RR 1.03, 95% CI 0.07 to 15.78; participants = 61; very low-certainty evidence). AUTHORS' CONCLUSIONS High volume feeds (≥ 180 mL/kg/day of fortified human milk or preterm formula, or ≥ 200 mL/kg/day of unfortified human milk or term formula) probably improves weight gain during hospital stay. The available data is inadequate to draw conclusions on the effect of high volume feeds on other growth and clinical outcomes. A large RCT is needed to provide data of sufficient quality and precision to inform policy and practice.
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Affiliation(s)
| | - Niranjan Thomas
- Neonatology, Joan Kirner Women's and Children's at Sunshine Hospital, Western Health, St Albans, Australia
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Identification of Growth Patterns in Low Birth Weight Infants from Birth to 5 Years of Age: Nationwide Korean Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031206. [PMID: 33572910 PMCID: PMC7908118 DOI: 10.3390/ijerph18031206] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/25/2021] [Accepted: 01/25/2021] [Indexed: 12/24/2022]
Abstract
This study aimed to investigate the nationwide growth pattern of infants in Korea according to the birth-weight group and to analyze the effect of growth on development. A total of 430,541 infants, born in 2013 and who received the infant health check-up regularly from 6 months to 60 months of age, were included. The weight, height, head circumferences percentiles, and neurodevelopment using screening tests results were compared among the birth-weight groups. Using longitudinal analysis, the study found a significant difference in height, weight, and head circumference, respectively, according to age at health check-up, birth weight group, and combination of age and birth weight (p < 0.001). The growth parameters at 60 months of age showed a significant correlation with those at 6 months of age especially in extremely low birth weight infants. The incidence of suspected developmental delay was significantly higher in infants with growth below the 10th percentiles than in those with growth above the 10th percentiles. Among 4571 (1.6%) infants with suspected developmental delay results at 60 months of age, birth weight, sex, and poor growth parameters were confirmed as associated factors. This nationwide Korean study shows that poor growth and neurodevelopment outcomes persisted among low-birth-weight infants at 60 months of age. Our findings provide guidance for developing a nationwide follow-up program for infants with perinatal risk factors in Korea.
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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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18
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Balogun OS, Atsa'am DD, Akingbade TJ, Kolog EA, Agjei RO, Devine SNO. Modeling the Effect of Mother's Characteristics on the Weight of a Newborn. INTERNATIONAL JOURNAL OF CHILDBIRTH 2020. [DOI: 10.1891/ijcbirth-d-20-00024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUNDNeonatal mortality related to fetal growth is a public policy issue in Nigeria.METHODTo determine maternal characteristics associated with fetal growth and neonatal birth weight, a secondary analysis of data collected from 701 mothers using a multiple linear regression model was undertaken.FINDINGSMaternal age, parity, and weight were found to be significantly associated with neonatal birth weight. The number of antenatal visits and maternal level of education were not found to be associated with neonatal birth weight.CONCLUSIONSTo the extent that providers might influence maternal weight, education and counselling during pregnancy may impact fetal growth and neonatal birth weight.
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O'Dea CA, Logie K, Wilson AC, Pillow JJ, Murray C, Banton G, Simpson SJ, Hall GL, Maiorana A. Lung abnormalities do not influence aerobic capacity in school children born preterm. Eur J Appl Physiol 2020; 121:489-498. [PMID: 33141263 DOI: 10.1007/s00421-020-04530-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/12/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Children born preterm have impaired lung function and altered lung structure. However, there are conflicting reports on how preterm birth impacts aerobic exercise capacity in childhood. We aimed to investigate how neonatal history and a diagnosis of bronchopulmonary dysplasia (BPD) impact the relationship between function and structure of the lung, and aerobic capacity in school-aged children born very preterm. METHODS Preterm children (≤ 32 w completed gestation) aged 9-12 years with (n = 38) and without (n = 35) BPD, and term-born controls (n = 31), underwent spirometry, lung volume measurements, gas transfer capacity, a high-resolution computer tomography (CT) scan of the chest, and an incremental treadmill exercise test. RESULTS Children born preterm with BPD had an elevated breathing frequency to tidal volume ratio compared to term controls (76% vs 63%, p = 0.002). The majority (88%) of preterm children had structural changes on CT scan. There were no differences in peak V̇O2 (47.1 vs 47.7 mL/kg/min, p = 0.407) or oxygen uptake efficiency slope when corrected for body weight (67.6 vs 67.3, p = 0.5) between preterm children with BPD and term controls. There were no differences in any other exercise outcomes. The severity of structural lung disease was not associated with exercise outcomes in this preterm population. CONCLUSION Children born preterm have impaired lung function, and a high prevalence of structural lung abnormalities. However, abnormal lung function and structure do not appear to impact on the aerobic exercise capacity of preterm children at school age.
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Affiliation(s)
- Christopher A O'Dea
- Respiratory Medicine, Perth Children's Hospital, Perth, WA, Australia.,School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.,Telethon Kids Institute, Perth, WA, Australia
| | - Karla Logie
- Telethon Kids Institute, Perth, WA, Australia.,Centre for Child Health Research, University of Western Australia, Perth, WA, Australia.,Division of Paediatrics and Child Health, Medical School, University of Western Australia, Perth, WA, Australia
| | - Andrew C Wilson
- Respiratory Medicine, Perth Children's Hospital, Perth, WA, Australia.,School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.,Telethon Kids Institute, Perth, WA, Australia.,Centre for Child Health Research, University of Western Australia, Perth, WA, Australia
| | - J Jane Pillow
- Division of Paediatrics and Child Health, Medical School, University of Western Australia, Perth, WA, Australia.,School of Human Sciences, University of Western Australia, Perth, WA, Australia
| | - Conor Murray
- Diagnostic Imaging, Perth Children's Hospital, Perth, WA, Australia
| | | | - Shannon J Simpson
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.,Telethon Kids Institute, Perth, WA, Australia.,Centre for Child Health Research, University of Western Australia, Perth, WA, Australia
| | - Graham L Hall
- Respiratory Medicine, Perth Children's Hospital, Perth, WA, Australia.,School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.,Telethon Kids Institute, Perth, WA, Australia.,Centre for Child Health Research, University of Western Australia, Perth, WA, Australia
| | - Andrew Maiorana
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia. .,Allied Health Department and Advanced Heart Failure and Cardiac Transplant Service, Fiona Stanley Hospital, Perth, WA, Australia.
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20
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Brown JV, Lin L, Embleton ND, Harding JE, McGuire W. Multi-nutrient fortification of human milk for preterm infants. Cochrane Database Syst Rev 2020; 6:CD000343. [PMID: 35658821 PMCID: PMC7268980 DOI: 10.1002/14651858.cd000343.pub4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Human breast milk-fed preterm infants can accumulate nutrient deficits leading to extrauterine growth restriction. Feeding preterm infants with multi-nutrient fortified human milk could increase nutrient accretion and growth rates and improve neurodevelopmental outcomes. Concern exists, however, that multi-nutrient fortifiers are associated with adverse events such as feed intolerance and necrotising enterocolitis. OBJECTIVES To determine whether multi-nutrient fortified human milk, compared with unfortified human milk, affects important outcomes (including growth rate and neurodevelopment) of preterm infants without increasing the risk of adverse effects (such as feed intolerance and necrotising enterocolitis). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 9), MEDLINE via PubMed (1966 to 26 September 2019), Embase (1980 to 26 September 2019), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 26 September 2019). We searched clinical trials databases, conference proceedings, and reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. SELECTION CRITERIA Randomised and quasi-randomised controlled trials that compared feeding preterm infants with multi-nutrient (protein and energy plus minerals, vitamins, or other nutrients) fortified human breast milk versus unfortified (no added protein or energy) breast milk. DATA COLLECTION AND ANALYSIS We used the standard methods of Cochrane Neonatal. Two review authors separately evaluated trial quality, extracted data, and synthesised effect estimates using risk ratios (RRs), risk differences, and mean differences (MDs). We assessed the certainty of the body of evidence at the outcome level using "Grading of Recommendations Assessment, Development and Evaluation" (GRADE) methods. MAIN RESULTS We identified 18 trials in which a total of 1456 preterm infants participated. These trials were generally small and methodologically weak. Meta-analyses provided low- to moderate-certainty evidence showing that multi-nutrient fortification of human milk increases in-hospital rate of weight gain (MD 1.76 g/kg/d, 95% confidence interval (CI) 1.30 to 2.22), body length (MD 0.11 cm/week, 95% CI 0.08 to 0.15), or head circumference (MD 0.06 cm/week, 95% CI 0.03 to 0.08) among preterm infants. Few data on growth and developmental outcomes assessed beyond infancy are available, and these do not show effects of multi-nutrient fortification. The data do not suggest other benefits or harms and provide low-certainty evidence suggesting effects of multi-nutrient fortification on the risk of necrotising enterocolitis in preterm infants (typical RR 1.37, 95% CI 0.72 to 2.63; 13 studies, 1110 infants). AUTHORS' CONCLUSIONS Feeding preterm infants with multi-nutrient fortified human breast milk compared with unfortified human breast milk is associated with modest increases in in-hospital growth rates. Evidence is insufficient to show whether multi-nutrient fortification has any effect on long-term growth or neurodevelopment.
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Affiliation(s)
- Jennifer Ve Brown
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Luling Lin
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Nicholas D Embleton
- Newcastle Neonatal Service, Newcastle Hospitals NHS Foundation Trust and University of Newcastle, Newcastle upon Tyne, UK
| | - Jane E Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - William McGuire
- Centre for Reviews and Dissemination, University of York, York, UK
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Petrova A, Eccles S, Mehta R. Role of the Proportional Intake of Fortified Mother's Own Milk in the Weight Gain Pattern of Their Very-Preterm-Born Infants. Nutrients 2020; 12:nu12061571. [PMID: 32481495 PMCID: PMC7352929 DOI: 10.3390/nu12061571] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 05/19/2020] [Accepted: 05/26/2020] [Indexed: 11/30/2022] Open
Abstract
Breastfeeding has been recommended for preterm infants as the optimal diet from nutritional, gastrointestinal, immunological, and developmental perspectives. However, the relevance of differing intakes of fortified mother’s own milk (MOM) on the growth of their preterm infants is a challenging question because of the potential risk of extrauterine growth impairment, apart from its essential role in the provision of biological and immunological factors, and the reduction of serious morbidities. We aimed to identify the weight gain pattern in very-preterm-born infants with respect to their proportional intake of fortified MOM. The daily and average weight gain, dietary volume, calories, and proportional intake of fortified MOM were studied in a cohort of 84 very-preterm-born infants during the first 2 weeks post initiation of full enteral feeds. Groups 1, 2, and 3 were comprised of infants with a proportional fortified MOM intake of 85% or more, 35% to 84.9%, and 0 to 34.9%, respectively. Data analysis included regression models and a group-based comparison of the number of infants with weight gain that would be considered minimally acceptable for normal intrauterine growth. The infants’ weight gain was not found to be associated with the proportional intake of fortified MOM or other feeding parameters. Overall, the intergroup variability in the proportion of infants with weight gain less than the lower limit of normal fetal growth was insignificant. During the first 2 weeks post initiation of full enteral feeds, the weight gain pattern of the studied very-preterm-born infants was not significantly dependent on the proportional intake of fortified maternal milk.
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Affiliation(s)
- Anna Petrova
- Correspondence: ; Tel.: +1-732-235-7319; Fax: +1-732-235-8005
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Lin L, Amissah E, Gamble GD, Crowther CA, Harding JE. Impact of macronutrient supplements on later growth of children born preterm or small for gestational age: A systematic review and meta-analysis of randomised and quasirandomised controlled trials. PLoS Med 2020; 17:e1003122. [PMID: 32453739 PMCID: PMC7250404 DOI: 10.1371/journal.pmed.1003122] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 04/23/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Nutritional supplements may improve short-term growth of infants born small (preterm or small for gestational age), but there are few data on long-term effects and concerns that body composition may be adversely affected. Effects also may differ between girls and boys. Our systematic review and meta-analysis assessed the effects of macronutrient supplements for infants born small on later growth. METHODS AND FINDINGS We searched OvidMedline, Embase, Cochrane CENTRAL, and Cochrane Database of Systematic Reviews from inception to January 30, 2020, and controlled-trials.com, clinicaltrials.gov, and anzctr.org.au on January 30, 2020. Randomised or quasirandomised trials were included if the intention was to increase macronutrient intake to improve growth or development of infants born small and growth was assessed after discharge. Primary outcome was body mass index (BMI) in childhood. Data were pooled using random-effect models. Outcomes were evaluated in toddlers (< 3 years), childhood (3 to 8 years), adolescence (9 to 18 years), and adulthood (>18 years). Forty randomised and 2 quasirandomised trials of variable methodological quality with 4,352 infants were included. Supplementation did not alter BMI in childhood (7 trials, 1,136 children; mean difference [MD] -0.10 kg/m2, [95% confidence interval (CI) -0.37 to 0.16], p = 0.45). In toddlers, supplementation increased weight (31 trials, 2,924 toddlers; MD 0.16 kg, [0.01 to 0.30], p = 0.03) and length/height (30 trials, 2,889 toddlers; MD 0.44 cm, [0.10 to 0.77], p = 0.01), but not head circumference (29 trials, 2,797 toddlers; MD 0.15 cm, [-0.03 to 0.33], p = 0.10). In childhood, there were no significant differences between groups in height (7 trials, 1,136 children; MD 0.22 cm, [-0.48 to 0.92], p = 0.54) or lean mass (3 trials, 354 children; MD -0.07 kg, [-0.98 to 0.85], p = 0.88), although supplemented children appeared to have higher fat mass (2 trials, 201 children; MD 0.79 kg, [0.19 to 1.38], p = 0.01). In adolescence, there were no significant differences between groups in BMI (2 trials, 216 adolescents; MD -0.48 kg/m2, [-2.05 to 1.08], p = 0.60), height (2 trials, 216 adolescents; MD -0.55 cm, [-2.95 to 1.86], p = 0.65), or fat mass (2 trials, 216 adolescents; MD -1.3 5 kg, [-5.76 to 3.06], p = 0.55). In adulthood, there also were no significant differences between groups in weight z-score (2 trials, 199 adults; MD -0.11, [-0.72 to 0.50], p = 0.73) and height z-score (2 trials, 199 adults; MD -0.07, [-0.36 to 0.22], p = 0.62). In subgroup analysis, supplementation was associated with increased length/height in toddler boys (2 trials, 173 boys; MD 1.66 cm, [0.75 to 2.58], p = 0.0003), but not girls (2 trials, 159 girls; MD 0.15 cm, [-0.71 to 1.01], p = 0.74). Limitations include considerable unexplained heterogeneity, low to very low quality of evidence, and possible bias due to low or unbalanced followup. CONCLUSIONS In this systematic review and meta-analysis, we found no evidence that early macronutrient supplementation for infants born small altered BMI in childhood. Although supplements appeared to increase weight and length in toddlers, effects were inconsistent and unlikely to be clinically significant. Limited data suggested that supplementation increased fat mass in childhood, but these effects did not persist in later life. PROSPERO registration: CRD42019126918.
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Affiliation(s)
- Luling Lin
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Emma Amissah
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | | | - Jane E. Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
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Growth patterns and body composition in former extremely low birth weight (ELBW) neonates until adulthood: a systematic review. Eur J Pediatr 2020; 179:757-771. [PMID: 31901983 DOI: 10.1007/s00431-019-03552-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 12/10/2019] [Accepted: 12/12/2019] [Indexed: 10/25/2022]
Abstract
Preterm infants are obviously born lighter and shorter, with smaller head circumferences than normal birth weight term born neonates. They also have a different body composition. Compromised growth is associated with adverse health outcomes. Both growth retardation and accelerated growth are suggested to cause metabolic, cardiovascular, and renal complications. Reviews regarding growth and body composition in preterm infants often do not differentiate between birth weight and gestational age. The purpose of this systematic review is to assemble growth data, specific in extremely low birth weight children. Different databases were searched for studies regarding growth and body composition in former extremely low birth weight infants until adulthood. We compared height, weight, head circumference, body mass index, fat mass, lean mass, fat distribution, and body water to matched normal birth weight controls and the World Health Organization growth charts. Studies consistently reported that former extremely low birth weight neonates experience a period of accelerated postnatal growth, but they achieve lower anthropometric parameters than normal birth weight children. There is no consensus about differences in body composition and how to measure this.Conclusion: Although extremely low birth weight infants exhibit a period of catch-up growth, their growth remains retarded later in life. Further research is needed to investigate body composition and the associated risk of cardiovascular diseases or metabolic syndrome.What is Known:• Extremely low birth weight infants have lower anthropometric parameters and a different body composition at birth and term-corrected age than normal birth weight infants.• Former extremely low birth weight infants also have a higher risk on adverse cardiovascular health outcomes in later life.What is New:• After hospital discharge, extremely low birth weight neonates remain smaller and probably also lighter, with smaller head circumferences at each corrected age throughout childhood and adolescence when compared to normal birth weight infants or the World Health Organization growth charts. It is not clear whether extremely low birth weight infants reach a lower or similar body mass index score as normal birth weight infants.• There is a lack of (long-term) information on body composition in extremely low birth weight infants.
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Domellöf E, Johansson AM, Farooqi A, Domellöf M, Rönnqvist L. Risk for Behavioral Problems Independent of Cognitive Functioning in Children Born at Low Gestational Ages. Front Pediatr 2020; 8:311. [PMID: 32676487 PMCID: PMC7333186 DOI: 10.3389/fped.2020.00311] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 05/14/2020] [Indexed: 11/28/2022] Open
Abstract
This study aimed to investigate cognitive and behavioral outcomes in relation to gestational age (GA) in school-aged children born preterm (PT). Results from the Wechsler Intelligence Scale for Children, 4th edition (WISC-IV), and the Child Behavior Checklist (CBCL) were analyzed in 51 children (mean age: 7.8 years [range: 7.0-8.7]) born PT (mean GA: 31 weeks [range: 23-35]; birth weight, mean: 1,637 g [range: 404-2,962]) with the majority (96%) having no diagnosed cognitive, sensory, or motor impairments. The control group included 57 age-matched typically developing children (mean age: 7.9 years [range: 6.2-8.7]) born full-term (FT). Children born PT, extremely PT (GA < 28) in particular, showed significantly lower cognitive performance and higher behavioral problem scores compared with children born FT. GA was found to predict aspects of both cognitive functioning and behavioral problems within the PT group, with lower GA being related to both poorer cognitive outcomes and elevated affective and attention-deficit/hyperactivity problems. Global cognitive functioning did not independently predict aspects of behavioral outcomes. Findings demonstrate that, even in children born PT without severe perinatal and/or postnatal complications and receiving active perinatal care, a short gestation is an evident risk factor for long-term negative effects on mental health independent of cognitive functioning. Additional findings suggest that both reduced growth and lower parental educational level may contribute to increased risk for poorer cognitive and behavioral functioning in children born PT.
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Affiliation(s)
- Erik Domellöf
- Department of Psychology, Umeå University, Umeå, Sweden
| | | | - Aijaz Farooqi
- Division of Pediatrics, Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Magnus Domellöf
- Division of Pediatrics, Department of Clinical Sciences, Umeå University, Umeå, Sweden
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Walsh V, Brown JVE, Askie LM, Embleton ND, McGuire W. Nutrient-enriched formula versus standard formula for preterm infants. Cochrane Database Syst Rev 2019; 7:CD004204. [PMID: 31314903 PMCID: PMC6636703 DOI: 10.1002/14651858.cd004204.pub3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Preterm infants may accumulate nutrient deficits leading to extrauterine growth restriction. Feeding preterm infants with nutrient-enriched rather than standard formula might increase nutrient accretion and growth rates and might improve neurodevelopmental outcomes. OBJECTIVES To compare the effects of feeding with nutrient-enriched formula versus standard formula on growth and development of preterm infants. SEARCH METHODS We used the Cochrane Neonatal standard search strategy. This included electronic searches of the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 11), MEDLINE, Embase, and the Cumulative Index to Nursing and Allied Health Literature (until November 2018), as well as conference proceedings, previous reviews, and clinical trials databases. SELECTION CRITERIA Randomised and quasi-randomised controlled trials that compared feeding preterm infants with nutrient-enriched formula (protein and energy plus minerals, vitamins, or other nutrients) versus standard formula. DATA COLLECTION AND ANALYSIS We extracted data using the Cochrane Neonatal standard methods. Two review authors separately evaluated trial quality and extracted and synthesised data using risk ratios (RRs), risk differences, and mean differences (MDs). We assessed certainty of evidence at the outcome level using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods. MAIN RESULTS We identified seven trials in which a total of 590 preterm infants participated. Most participants were clinically stable preterm infants of birth weight less than 1850 g. Few participants were extremely preterm, extremely low birth weight, or growth restricted at birth. Trials were conducted more than 30 years ago, were formula industry funded, and were small with methodological weaknesses (including lack of masking) that might bias effect estimates. Meta-analyses of in-hospital growth parameters were limited by statistical heterogeneity. There is no evidence of an effect on time to regain birth weight (MD -1.48 days, 95% confidence interval (CI) -4.73 to 1.77) and low-certainty evidence suggests that feeding with nutrient-enriched formula increases in-hospital rates of weight gain (MD 2.43 g/kg/d, 95% CI 1.60 to 3.26) and head circumference growth (MD 1.04 mm/week, 95% CI 0.18 to 1.89). Meta-analysis did not show an effect on the average rate of length gain (MD 0.22 mm/week, 95% CI -0.70 to 1.13). Fewer data are available for growth and developmental outcomes assessed beyond infancy, and these do not show consistent effects of nutrient-enriched formula feeding. Data from two trials did not show an effect on Bayley Mental Development Index scores at 18 months post term (MD 2.87, 95% CI -1.38 to 7.12; moderate-certainty evidence). Infants who received nutrient-enriched formula had higher Bayley Psychomotor Development Index scores at 18 months post term (MD 6.56. 95% CI 2.87 to 10.26; low-certainty evidence), but no evidence suggested an effect on cerebral palsy (typical RR 0.79, 95% CI 0.30 to 2.07; 2 studies, 377 infants). Available data did not indicate any other benefits or harms and provided low-certainty evidence about the effect of nutrient-enriched formula feeding on the risk of necrotising enterocolitis in preterm infants (typical RR 0.72, 95% CI 0.41 to 1.25; 3 studies, 489 infants). AUTHORS' CONCLUSIONS Available trial data show that feeding preterm infants nutrient-enriched (compared with standard) formulas has only modest effects on growth rates during their initial hospital admission. No evidence suggests effects on long-term growth or development. The GRADE assessment indicates that the certainty of this evidence is low, and that these findings should be interpreted and applied with caution. Further randomised trials would be needed to resolve this uncertainty.
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Affiliation(s)
- Verena Walsh
- University of YorkCentre for Reviews and DisseminationYorkUKY010 5DD
| | | | - Lisa M Askie
- University of SydneyNHMRC Clinical Trials CentreLocked Bag 77CamperdownNSWAustralia2050
| | - Nicholas D Embleton
- Newcastle Hospitals NHS Foundation Trust and University of NewcastleNewcastle Neonatal ServiceRichardson RoadNewcastle upon TyneUKNE1 4LP
| | - William McGuire
- University of YorkCentre for Reviews and DisseminationYorkUKY010 5DD
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Walsh V, Brown JVE, Askie LM, Embleton ND, McGuire W. Nutrient-enriched formula versus standard formula milk for preterm infants. Hippokratia 2019. [DOI: 10.1002/14651858.cd004204.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Verena Walsh
- University of York; Centre for Reviews and Dissemination; York UK Y010 5DD
| | | | - Lisa M Askie
- University of Sydney; NHMRC Clinical Trials Centre; Locked Bag 77 Camperdown NSW Australia 2050
| | - Nicholas D Embleton
- Newcastle Hospitals NHS Foundation Trust and University of Newcastle; Newcastle Neonatal Service; Richardson Road Newcastle upon Tyne UK NE1 4LP
| | - William McGuire
- University of York; Centre for Reviews and Dissemination; York UK Y010 5DD
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Aldakauskienė I, Tamelienė R, Marmienė V, Rimdeikienė I, Šmigelskas K, Kėvalas R. Influence of Parenteral Nutrition Delivery Techniques on Growth and Neurodevelopment of Very Low Birth Weight Newborns: A Randomized Trial. ACTA ACUST UNITED AC 2019; 55:medicina55040082. [PMID: 30925739 PMCID: PMC6524051 DOI: 10.3390/medicina55040082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 03/22/2019] [Indexed: 11/16/2022]
Abstract
Background and Objectives: In very low birth weight (VLBW) newborns, parenteral nutrition (PN) is delivered via a peripheral venous catheter (PVC), a central venous catheter (CVC), or a peripherally inserted central venous catheter (PICC). Up to 45% of PICCs are accompanied by complications, the most common being sepsis. A PVC is an unstable PN delivery technique requiring frequent change. The growth and neurodevelopment of VLBW newborns may be disturbed because of catheters used for early PN delivery and complications thereof. The aim of the conducted study was to evaluate the effect of two PN delivery techniques (PICC and PVC) on anthropometric parameters and neurodevelopment of VLBW newborns. Materials and Methods: A prospective randomized clinical trial was conducted in VLBW (≥750–<1500 g) newborns that met the inclusion criteria and were randomized into two groups: PICC and PVC. We assessed short-term outcomes (i.e., anthropometric parameters from birth until corrected age (CA) 36 weeks) and long-term outcomes (i.e., anthropometric parameters from CA 3 months to 12 months as well as neurodevelopment at CA 12 months according to the Bayley II scale). Results: In total, 108 newborns (57 in the PICC group and 51 in the PVC group) were randomized. Short-term outcomes were assessed in 47 and 38 subjects, and long-term outcomes and neurodevelopment were assessed in 38 and 33 subjects of PICC and PVC groups, respectively. There were no differences observed in anthropometric parameters between the subjects of the two groups in the short- and long-term. Mental development index (MDI) < 85 was observed in 26.3% and 21.2% (p = 0.781), and psychomotor development index (PDI) < 85 was observed in 39.5% and 54.5% (p = 0.239) of PICC and PVC subjects, respectively. Conclusions: In the short- and long-term, no differences were observed in the anthropometric parameters of newborns in both groups. At CA 12 months, there was no difference in neurodevelopment in both groups.
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Affiliation(s)
- Ilona Aldakauskienė
- Department of Neonatology, Medical Academy, Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania.
- Hospital of Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania.
| | - Rasa Tamelienė
- Department of Neonatology, Medical Academy, Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania.
- Hospital of Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania.
| | - Vitalija Marmienė
- Hospital of Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania.
| | - Inesa Rimdeikienė
- Hospital of Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania.
- Department of Rehabilitation, Medical Academy, Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania.
| | - Kastytis Šmigelskas
- Department of Health Psychology, Medical Academy, Lithuanian University of Health Sciences, LT-47181 Kaunas, Lithuania.
- Health Research Institute, Medical Academy, Lithuanian University of Health Sciences, LT-47181 Kaunas, Lithuania.
| | - Rimantas Kėvalas
- Hospital of Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania.
- Department of Pediatrics, Medical Academy, Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania.
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Earlier achievement of full enteral feeding in extremely low birth weight neonates is not associated with growth improvement in the first 2 years of life. Eur J Pediatr 2018; 177:1247-1254. [PMID: 29850934 DOI: 10.1007/s00431-018-3178-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 05/15/2018] [Accepted: 05/16/2018] [Indexed: 10/16/2022]
Abstract
UNLABELLED Limiting the number of days until achievement of full enteral feeding in extremely low birth weight neonates (ELBW; < 1000 g) might affect growth in the first years of life. This study compared the Z scores in growth over time of two cohorts of ELBW neonates that were comparable on maternal and neonatal characteristics and characteristics of hospitalization, but differed in enteral feeding strategy during neonatal admission. In the 2010-2014 cohort, full enteral feeding was achieved on average 16 days earlier than in the 2000-2005 cohort. In both cohorts, weight, height, and head circumference were recorded at birth and at the corrected ages of 9 and 24 months. A linear mixed model with repeated measures controlling for neonates small for gestational age showed no significant effect of different strategies in achievement of full enteral feeding on any anthropometric Z scores over time. Although full enteral feeding was achieved earlier in the 2010-2014 cohort, this was not associated with growth patterns during the first two years of life. CONCLUSION The effect of a change in strategy to achieve full enteral feeding at an earlier stage in ELBW neonates was assessed. Early enteral feeding strategies do not necessarily improve growth during the first two years of life. What is Known: • Feeding strategies during neonatal stay may affect growth in the first years of life. • Strategies to achieve full enteral feeding earlier were implemented, but data on the impact on subsequent growth after discharge are limited. What is New: • Full enteral feeding was achieved earlier, but this was not associated with improved growth during the first 2 years of life after discharge. • Early enteral feeding strategies do not necessarily improve growth during the first 2 years of life.
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Ahn YM, Sohn M, Lee S. Hydration and pH of the Stratum Corneum in High-risk Newborns in the First 2 Weeks of Life. CHILD HEALTH NURSING RESEARCH 2018. [DOI: 10.4094/chnr.2018.24.3.345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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Lee EJ, Lee SY. The effects of early-stage neurodevelopmental treatment on the growth of premature infants in neonatal intensive care unit. J Exerc Rehabil 2018; 14:523-529. [PMID: 30018943 PMCID: PMC6028218 DOI: 10.12965/jer.1836214.107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 05/08/2018] [Indexed: 12/03/2022] Open
Abstract
The purpose of this study was to investigate the effects of early-stage neurodevelopmental treatment on the growth of premature infants in the neonatal intensive care unit. A total of 85 premature infants were included in this study. Infants with a birth weight of less than 2.5 kg and of 2.5 kg or higher were classified as premature infants with a high risk of growth delay and with a low risk of growth delay respectively. Of the 55 premature infants with a high risk of growth delay, 27 premature infants were placed in the intervention group and 28 were placed in the control group according to their hospitalization time. Thirty premature infants with a low risk of growth delay were included in the comparative group. The same general nursing care of the neonatal intensive care unit was provided to the intervention group, the control group, and the comparative group, but an additional neurodevelopmental treatment program was given only to the intervention group, for 15 min per session, 4 times a week, up to 40 weeks after conception. As growth indicators, the body weight and head circumference were measured before and 2 weeks after the intervention, and at 40 weeks after conception when the intervention was completed. The body weight and head circumference of the intervention group, which received the neurodevelopmental treatment, were significantly improved compared to the control group (P<0.05), but they were not significantly different from those of the comparative group. However, the body weight and head circumference of the control.
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Affiliation(s)
- Eun-Ju Lee
- Department of Physical Therapy, College of Science, Kyungsung University, Busan, Korea
| | - Sang-Yeol Lee
- Department of Physical Therapy, College of Science, Kyungsung University, Busan, Korea
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Growth Responses of Preterm Pigs Fed Formulas with Different Protein Levels and Supplemented with Leucine or β-Hydroxyl β-Methylbutyrate. Nutrients 2018; 10:nu10050636. [PMID: 29783624 PMCID: PMC5986515 DOI: 10.3390/nu10050636] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 05/09/2018] [Accepted: 05/16/2018] [Indexed: 11/30/2022] Open
Abstract
Growth after preterm birth is an important determinant of long-term outcomes. Yet, many preterm infants suffer ex utero growth retardation. We evaluated effects of leucine and the metabolite, β-hydroxy β-methylbutyrate (HMB) on growth of preterm pigs, a previously-validated translational model for preterm infants. After 48 h of parenteral nutrition preterm pigs were fed for 6 to 7 days isocaloric formulas with different levels of protein (50 or 100 g/L) with leucine (10 g/L, 76 mM) or HMB (at 1.1 g/L, 4 mM) added to stimulate protein synthesis or with alanine (6.8 g/L; 76 mM) as the control. Rates of growth of pigs fed the low protein formula with alanine (3.4 ± 0.2% gain per day) or leucine (3.7 ± 0.2) exceeded that of pigs fed the high protein formula (2.8 ± 0.2, p = 0.02 for comparison with both low protein formulas; p = 0.01 compared with low protein + leucine). Supplementing the high protein formula with leucine or HMB did not increase growth relative to alanine (2.72 ± 0.20, 2.74 ± 0.27, and 2.52 ± 0.20, respectively). Small pigs (<700 g birth weight) grew slower during parenteral nutrition and had a more pronounced response to leucine. Females fed the high protein formulas grew faster than males, and particularly for small pigs (p < 0.05). Blood urea nitrogen values were lower for pigs fed the low versus the high protein formulas (p < 0.05). Leucine and HMB improved growth of preterm pigs fed low, but not high protein formulas, even after controlling for birth weight and sex, which independently correlated with growth rates. They offer an option to improve growth without increasing the amino acid load, with its attendant metabolic disadvantages.
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Early introduction of complementary foods and childhood overweight in breastfed and formula-fed infants in the Netherlands: the PIAMA birth cohort study. Eur J Nutr 2018; 57:1985-1993. [PMID: 29470690 PMCID: PMC6060808 DOI: 10.1007/s00394-018-1639-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 02/17/2018] [Indexed: 12/03/2022]
Abstract
Purpose To investigate whether early introduction of complementary foods (CF) is associated with an increased risk of overweight during childhood, and whether this association differs between formula-fed and breastfed infants. Methods We included 2611 participants that were born at term from a Dutch population-based birth cohort (n = 3963) designed to investigate the development of asthma and allergies. Parents kept records of their infant’s age when CF were first introduced. Weight and height were parent reported yearly from age 1 to 8 years, and at ages 11, 14 and 17 years. We used multivariate generalized estimating equations analysis to investigate the association between timing of CF introduction (before 4 months vs at or after 4 months of age) and overweight at ages 1–17 years. Results Children with CF introduction before 4 months had higher odds of being overweight during childhood than children with CF introduction at or after 4 months (OR 1.32, 95% CI 1.19, 1.47). This association was observed in formula-fed infants (OR 1.51, 95% CI 1.17, 1.94) and breastfed infants (OR 1.32, 95% CI 1.19, 1.47). The duration of breastfeeding modified the association between CF introduction and overweight: children breastfed for shorter than 4 months, but not children breastfed for 4 months or longer with CF introduction before 4 months had higher odds of being overweight (OR 1.37, 95% CI 1.19, 1.57 and 1.07, 95% CI 0.87, 1.32, respectively), compared to those with CF introduction at or after 4 months. Conclusions In children born at term, formula-fed infants and infants who were breastfed for shorter than 4 months, but not infants who were breastfed for 4 months or longer, had a higher risk of being overweight during childhood when being introduced to CF before 4 months of age. Electronic supplementary material The online version of this article (10.1007/s00394-018-1639-8) contains supplementary material, which is available to authorized users.
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Martins-Celini FP, Gonçalves-Ferri WA, Aragon DC, Bernichi JP, Calixto C, Sacramento EMF, Santos MA, Martinez FE. Association between type of feeding at discharge from the hospital and nutritional status of very low birth weight preterm infants. Braz J Med Biol Res 2018. [PMID: 29513880 PMCID: PMC5912099 DOI: 10.1590/1414-431x20176540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The ideal feeding for premature babies has been the source of extensive debate. The aim of this study was to assess the association between type of feeding at discharge and the nutritional status of very low birth weight infants. This was a retrospective cohort of preterm babies with birth weight ≤1500 g, born between January 2006 and December 2013. The infants were divided into 3 groups according to type of feeding at discharge: exclusive breast milk (group 1), mixed feeding (group 2) and exclusive artificial formula (group 3). Frequencies of each group were calculated, as well as mean Z-score differences in weight, length and head circumference. Six hundred and forty-nine newborns were included. The mean weight of groups 1, 2, and 3 was 1338.7, 1104.0, and 1254.7 g, respectively, and their mean gestational age was 31.9, 30, and 31.2 weeks, respectively. The Z-score differences (means±SD) for groups 1, 2, and 3 were: −0.84±0.68, −1.02±0.75, and −0.86±0.71 for weight, −0.21±1.23, −0.52±1.64 and −0.08±1.34 for head circumference, and −1.10±1.18, −1.54±1.37, and −0.97±1.21 for length. A significant difference was observed between groups 2 and 3 in the adjusted Z-score model for length, with no significant differences in anthropometric measurements for the other comparative analyses. Because of its many advantages, breastfeeding should be stimulated within neonatal units since nutritional status was not influenced by the different types of feeding.
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Abiramalatha T, Thomas N, Gupta V, Viswanathan A, McGuire W. High versus standard volume enteral feeds to promote growth in preterm or low birth weight infants. Cochrane Database Syst Rev 2017; 9:CD012413. [PMID: 28898404 PMCID: PMC6483816 DOI: 10.1002/14651858.cd012413.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Breast milk alone, given at standard recommended volumes (150 to 180 mL/kg/d), is not adequate to meet the protein, energy, and other nutrient requirements of growing preterm or low birth weight infants. One strategy that may be used to address these potential nutrient deficits is to give infants enteral feeds in excess of 200 mL/kg/d ('high-volume' feeds). This approach may increase nutrient uptake and growth rates, but concerns include that high-volume enteral feeds may cause feed intolerance, gastro-oesophageal reflux, aspiration pneumonia, necrotising enterocolitis, or complications related to fluid overload, including patent ductus arteriosus and bronchopulmonary dysplasia. OBJECTIVES To assess the effect on growth and safety of feeding preterm or low birth weight infants with high (> 200 mL/kg/d) versus standard (≤ 200 mL/kg/d) volume of enteral feeds. Infants in intervention and control groups should have received the same type of milk (breast milk, formula, or both), the same fortification or micronutrient supplements, and the same enteral feeding regimen (bolus, continuous) and rate of feed volume advancement.To conduct subgroup analyses based on type of milk (breast milk vs formula), gestational age or birth weight category of included infants (very preterm or VLBW vs preterm or LBW), presence of intrauterine growth restriction (using birth weight relative to the reference population as a surrogate), and income level of the country in which the trial was conducted (low or middle income vs high income) (see 'Subgroup analysis and investigation of heterogeneity'). SEARCH METHODS We used the Cochrane Neonatal standard search strategy, which included searches of the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 2) in the Cochrane Library; MEDLINE (1946 to November 2016); Embase (1974 to November 2016); and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to November 2016), as well as conference proceedings, previous reviews, and trial registries. SELECTION CRITERIA Randomised and quasi-randomised controlled trials that compared high-volume versus standard-volume enteral feeds for preterm or low birth weight infants. DATA COLLECTION AND ANALYSIS Two review authors assessed trial eligibility and risk of bias and independently extracted data. We analysed treatment effects in individual trials and reported the risk ratio and risk difference for dichotomous data, and the mean difference for continuous data, with respective 95% confidence intervals. . We assessed the quality of evidence at the outcome level via the GRADE approach. MAIN RESULTS We found one eligible trial that included 64 infants. This trial was not blinded. Analysis showed a higher rate of weight gain in the high-volume feeds group: mean difference 6.20 g/kg/d (95% confidence interval 2.71 to 9.69). There was no increase in the risk of feed intolerance or necrotising enterocolitis with high-volume feeds, but 95% confidence intervals around these estimates were wide. We assessed the quality of evidence for these outcomes as 'low' or 'very low' because of imprecision of the estimates of effect and concern about risk of bias due to lack of blinding in the included trial. Trial authors provided no data on other outcomes, including gastro-oesophageal reflux, aspiration pneumonia, necrotising enterocolitis, patent ductus arteriosus, bronchopulmonary dysplasia, or long-term growth and neurodevelopment. AUTHORS' CONCLUSIONS We found only very limited data from one small unblinded trial on the effects of high-volume feeds on important outcomes for preterm or low birth weight infants. The quality of evidence is low to very low. Hence, available evidence is insufficient to support or refute high-volume enteral feeds in preterm or low birth weight infants. A large, pragmatic randomised controlled trial is needed to provide data of sufficient quality and precision to inform policy and practice.
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Affiliation(s)
| | | | - Vijay Gupta
- Christian Medical CollegeNeonatologyVelloreIndia
| | - Anand Viswanathan
- Christian Medical CollegeCochrane South Asia, Prof. BV Moses Center for Evidence‐Informed Health Care and Health PolicyBagayamVelloreIndia632002
| | - William McGuire
- Centre for Reviews and Dissemination, The University of YorkYorkUK
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Hollanders JJ, van der Pal SM, van Dommelen P, Rotteveel J, Finken MJJ. Growth pattern and final height of very preterm vs. very low birth weight infants. Pediatr Res 2017; 82:317-323. [PMID: 28422945 DOI: 10.1038/pr.2017.63] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 01/14/2017] [Indexed: 11/09/2022]
Abstract
BackgroundBoth very preterm (VP; i.e., gestational age <32 weeks) and very low birth weight (VLBW; i.e., birth weight <1,500 g) are used as inclusion criteria by studies on preterm birth. We aimed to quantify the impact of these entities on postnatal growth until final height.MethodsSubjects born VP and/or with VLBW from the Project On Preterm and Small-for-gestational-age infants cohort were classified as follows: (1) VP+/VLBW+ (n=495), (2) VP+/VLBW- (n=207), or (3) VP-/VLBW+ (n=296) infants. Anthropometric data were collected at birth, 3, 6, 12, and 24 months' corrected age, and at 5 and 19 years. At 19 years, 590/998 (59%) of the subjects enrolled in 1983 were followed up.ResultsBirth size was smallest in the VP-/VLBW+ group compared with the VP+/VLBW+ and VP+/VLBW- groups. During childhood, length, weight, and head circumference SD scores increased in the VP-/VLBW+ group, whereas SD scores in the VP+/VLBW+ and VP+/VLBW- groups either remained stable or decreased. Despite catch-up growth, VP-/VLBW+ infants remained the shortest and lightest at age 19.ConclusionClassification on the basis of VP and VLBW impacts growth, causing different growth patterns for infants born VP+/VLBW+, VP+/VLBW-, or VP-/VLBW+. For future studies, we recommend, at least for industrialized countries, including preterm infants based on gestational age.
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Affiliation(s)
- Jonneke J Hollanders
- Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands
| | | | | | - Joost Rotteveel
- Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands
| | - Martijn J J Finken
- Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands
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Finken MJJ, van der Voorn B, Heijboer AC, de Waard M, van Goudoever JB, Rotteveel J. Glucocorticoid Programming in Very Preterm Birth. Horm Res Paediatr 2017; 85:221-31. [PMID: 26943327 DOI: 10.1159/000443734] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 12/29/2015] [Indexed: 11/19/2022] Open
Abstract
Very preterm (i.e., <32 weeks of gestation) infants admitted to the neonatal intensive care unit are compromised in their abilities to respond adequately to common threats like hemodynamic changes and reduced energy supplies, which is partly attributable to adrenocortical insufficiency. Conversely, later in life, these infants show features of increased glucocorticoid bioactivity, such as abdominal fat distribution, raised blood pressure, insulin resistance and diabetes mellitus type 2. It has been suggested that the very preterm newborn responds to the adverse postnatal environment with a sustained elevation in hypothalamus-pituitary-adrenal axis activity that persists beyond infancy. This has implications for subsequent growth, body composition, metabolism, neurodevelopment and, ultimately, long-term disease risk. The mechanisms underpinning these associations are not fully elucidated yet. This review gives a brief summary of studies that investigated adrenocortical function in very preterm newborns and how the axis changes with age, as a possible explanation for the association between prematurity and long-term outcome.
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Affiliation(s)
- Martijn J J Finken
- Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands
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Simon L, Nusinovici S, Flamant C, Cariou B, Rouger V, Gascoin G, Darmaun D, Rozé JC, Hanf M. Post-term growth and cognitive development at 5 years of age in preterm children: Evidence from a prospective population-based cohort. PLoS One 2017; 12:e0174645. [PMID: 28350831 PMCID: PMC5370142 DOI: 10.1371/journal.pone.0174645] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 03/13/2017] [Indexed: 11/18/2022] Open
Abstract
While the effects of growth from birth to expected term on the subsequent development of preterm children has attracted plentiful attention, less is known about the effects of post-term growth. We aimed to delineate distinct patterns of post-term growth and to determine their association with the cognitive development of preterm children. Data from a prospective population-based cohort of 3,850 surviving infants born at less than 35 weeks of gestational age were used. Growth was assessed as the Body Mass Index (BMI) Z-scores at 3, 9, 18, 24, 36, 48, and 60 months. Cognitive development at five years of age was evaluated by the Global School Adaptation score (GSA). Latent class analysis was implemented to identify distinct growth patterns and logistic regressions based on propensity matching were used to evaluate the relationship between identified growth trajectories and cognitive development. Four patterns of post-term growth were identified: a normal group with a Z-score consistently around zero during childhood (n = 2,469; 64%); a group with an early rapid rise in the BMI Z-score, but only up to 2 years of age (n = 195; 5%); a group with a slow yet steady rise in the BMI Z-score during childhood (n = 510; 13%); and a group with a negative Z-score growth until 3 years of age (n = 676; 18%). The group with a slow yet steady rise in the BMI Z-score was significantly associated with low GSA scores. Our findings indicate heterogeneous post-term growth of preterm children, with potential for association with their cognitive development.
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Affiliation(s)
- Laure Simon
- Department of Paediatric Medicine, Nantes University Hospital, Nantes, France
| | - Simon Nusinovici
- INSERM CIC 1413, Clinical Investigation Center, Nantes University Hospital, Nantes, France
| | - Cyril Flamant
- Department of Paediatric Medicine, Nantes University Hospital, Nantes, France
| | - Bertrand Cariou
- Department of Endocrinology, l’Institut du Thorax, Nantes University Hospital, Nantes, France
| | - Valérie Rouger
- Réseau “Grandir ensemble”, Nantes University Hospital, Nantes, France
| | - Géraldine Gascoin
- Department of Neonatal Medicine, Angers University Hospital, Angers, France
| | - Dominique Darmaun
- National Institute for Agricultural Research, UMR 1280 PHAN, Nantes University, Institut des Maladies de l’Appareil Digestif (IMAD), and CRNH-Ouest, Nantes, France
| | - Jean-Christophe Rozé
- Department of Paediatric Medicine, Nantes University Hospital, Nantes, France
- INSERM CIC 1413, Clinical Investigation Center, Nantes University Hospital, Nantes, France
| | - Matthieu Hanf
- INSERM CIC 1413, Clinical Investigation Center, Nantes University Hospital, Nantes, France
- INSERM UMR 1181 Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Versailles Saint Quentin University, Villejuif, France
- * E-mail:
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Finken MJJ, van der Voorn B, Hollanders JJ, Ruys CA, de Waard M, van Goudoever JB, Rotteveel J. Programming of the Hypothalamus-Pituitary-Adrenal Axis by Very Preterm Birth. ANNALS OF NUTRITION AND METABOLISM 2017; 70:170-174. [PMID: 28301846 DOI: 10.1159/000456040] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 01/08/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Many very preterm (i.e., <32 weeks of gestation) newborns fail to mount an adequate adrenocortical response to stress or illness, termed relative adrenal insufficiency. Conversely, later in life these infants show features of increased glucocorticoid bioactivity, such as abdominal adiposity, insulin resistance, raised blood pressure, shorter stature and internalizing problem behavior. SUMMARY Studies suggested that very preterm newborns have impairments along multiple levels of the hypothalamus-pituitary-adrenal (HPA) axis. Among the impairment were defects in: (1) the pituitary responsiveness to exogenous corticotropin-releasing hormone, (2) 11β-hydroxylase activity, and (3) the interconversion between cortisol and inert cortisone. There is some evidence suggesting that later in life these infants have an increased basal secretion rate of cortisol and adrenal hyperandrogenism. However, the response to acute (psychosocial) stress was blunted rather than enhanced in them. The mechanisms explaining this switch in HPA axis activity are complex and not yet fully understood. Key Messages: Very preterm newborns have several impairments along the HPA axis that could impede an adequate adrenocortical response to stress or illness. Later in life, these infants are predisposed to increased HPA axis activity, which could partially explain their phenotype.
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Affiliation(s)
- Martijn J J Finken
- Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands
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Catch-up growth in the first two years of life in Extremely Low Birth Weight (ELBW) infants is associated with lower body fat in young adolescence. PLoS One 2017; 12:e0173349. [PMID: 28278233 PMCID: PMC5344416 DOI: 10.1371/journal.pone.0173349] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 02/20/2017] [Indexed: 12/25/2022] Open
Abstract
Aim To investigate growth patterns and anthropometrics in former extremely low birth weight (ELBW, <1000 g) children and link these outcomes to neurocognition and body composition in childhood. Methods ELBW children were examined at birth (n = 140), at 9 and 24 months (n≥96) and at approximately 11 years within the framework of the PREMATCH (PREMATurity as predictor children’s of Cardiovascular and renal Health) case–control (n = 93–87) study. Regional growth charts were used to convert anthropometrics into Z–scores. Catch–up growth in the first two years of life was qualified as present if ΔZ–score >0.67 SDS. At 11 years, anthropometrics, neurocognitive performance, body composition, grip strength and puberty scores were assessed. Results ELBW neonates displayed extra–uterine growth restriction with mean Z–scores for height, weight and head circumference of –0.77, –0.93 and –0.46 at birth, –1.61, –1.67 and –0.72 at 9 months, –1.22, –1.61 and –0.84 at 24 months, and –0.42, –0.49 and –1.09 at 11 years. ELBW children performed consistently worse on neurocognitive testing with an average intelligence quotient equivalent at 11 years of 92.5 (SD 13.1). Catch–up growth was not associated with neurocognitive performance. Compared to controls, ELBW cases had lower grip strength (13.6 vs. 15.9 kg) and percentage lean body weight (75.1 vs. 80.5%), but higher body fat (24.6 vs. 19.2%) and advanced puberty scores at 11 years (all P≤0.025). Catch–up growth for weight and height in the first two years of life in cases was associated with a lower percentage body fat compared to cases without catch–up growth (16.8% catch-up growth for weight vs. 25.7%, P<0.001; 20.9% catch-up for height vs. 25.8%, P = 0.049). Conclusions In young adolescence, former ELBW children still have difficulties to reach their target height. Compared to normal birth weight controls, ELBW adolescents show lower neurocognitive performance and grip strength and a higher percentage body fat, a potential risk factor for adverse health outcomes in adulthood. Our key finding is that catch–up growth in ELBW children in the first two years of life is associated with a lower percentage body fat and is therefore likely to be beneficial.
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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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Implementation of a Nutrition Program Reduced Post-Discharge Growth Restriction in Thai Very Low Birth Weight Preterm Infants. Nutrients 2016; 8:nu8120820. [PMID: 27999313 PMCID: PMC5188473 DOI: 10.3390/nu8120820] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 12/02/2016] [Accepted: 12/08/2016] [Indexed: 11/21/2022] Open
Abstract
Very low birth weight (VLBW) preterm infants are vulnerable to growth restriction after discharge due to cumulative protein and energy deficits during their hospital stay and early post-discharge period. The current study evaluated the effectiveness of the preterm infant, post-discharge nutrition (PIN) program to reduce post-discharge growth restriction in Thai VLBW preterm infants. A prospective, non-randomized interventional cohort study was undertaken to assess the growth of 22 VLBW preterm infants who received the PIN program and compared them with 22 VLBW preterm infants who received conventional nutrition services. Infant’s growth was recorded monthly until the infants reached six months’ corrected age (6-moCA). Intervention infants had significantly greater body weights (p = 0.013) and head circumferences (p = 0.009). Also, a greater proportion of the intervention group recovered their weight to the standard weight at 4-moCA (p = 0.027) and at 6-moCA (p = 0.007) and their head circumference to the standard head circumference at 6-moCA (p = 0.004) compared to their historical comparison counterparts. Enlistment in the PIN program thus resulted in significantly reduced post-discharge growth restriction in VLBW preterm infants. Further research on longer term effects of the program on infant’s growth and development is warranted.
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Young L, Embleton ND, McGuire W. Nutrient-enriched formula versus standard formula for preterm infants following hospital discharge. Cochrane Database Syst Rev 2016; 12:CD004696. [PMID: 27958643 PMCID: PMC6463855 DOI: 10.1002/14651858.cd004696.pub5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Preterm infants are often growth-restricted at hospital discharge. Feeding nutrient-enriched formula rather than standard formula to infants after hospital discharge might facilitate 'catch-up' growth and might improve development. OBJECTIVES To compare the effects of nutrient-enriched formula versus standard formula on growth and development of preterm infants after hospital discharge. SEARCH METHODS We used the standard search strategy of the Cochrane Neonatal Review Group. This included searches of the Cochrane Central Register of Controlled Trials (2016, Issue 8) in the Cochrane Library, MEDLINE, Embase and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; to 8 September 2016), as well as conference proceedings and previous reviews. SELECTION CRITERIA Randomised and quasi-randomised controlled trials that compared the effects of feeding nutrient-enriched formula (postdischarge formula or preterm formula) versus standard term formula to preterm infants after hospital discharge . DATA COLLECTION AND ANALYSIS Two review authors assessed trial eligibility and risk of bias and extracted data independently. We analysed treatment effects as described in the individual trials and reported risk ratios and risk differences for dichotomous data, and mean differences (MDs) for continuous data, with respective 95% confidence intervals (CIs). We used a fixed-effect model in meta-analyses and explored potential causes of heterogeneity by performing sensitivity analyses. We assessed quality of evidence at the outcome level using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. MAIN RESULTS We included 16 eligible trials with a total of 1251 infant participants. Trials were of variable methodological quality, with lack of allocation concealment and incomplete follow-up identified as major potential sources of bias. Trials (N = 11) that compared feeding infants with 'postdischarge formula' (energy density about 74 kcal/100 mL) versus standard term formula (about 67 kcal/100 mL) did not find consistent evidence of effects on growth parameters up to 12 to 18 months post term. GRADE assessments indicated that evidence was of moderate quality, and that inconsistency within pooled estimates was the main quality issue.Trials (N = 5) that compared feeding with 'preterm formula' (about 80 kcal/100 mL) versus term formula found evidence of higher rates of growth throughout infancy (weighted mean differences at 12 to 18 months post term: about 500 g in weight, 5 to 10 mm in length, 5 mm in head circumference). GRADE assessments indicated that evidence was of moderate quality, and that imprecision of estimates was the main quality issue.Few trials assessed neurodevelopmental outcomes, and these trials did not detect differences in developmental indices at 18 months post term. Data on growth or development through later childhood have not been provided. AUTHORS' CONCLUSIONS Recommendations to prescribe 'postdischarge formula' for preterm infants after hospital discharge are not supported by available evidence. Limited evidence suggests that feeding 'preterm formula' (which is generally available only for in-hospital use) to preterm infants after hospital discharge may increase growth rates up to 18 months post term.
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Affiliation(s)
- Lauren Young
- Birmingham Children's HospitalPaediatric Intensive Care UnitSteelhouse LaneBirminghamWest MidlandsUKB4 6NH
| | - Nicholas D Embleton
- Newcastle Hospitals NHS Foundation Trust and University of NewcastleNewcastle Neonatal ServiceRichardson RoadNewcastle upon TyneUKNE1 4LP
| | - William McGuire
- Centre for Reviews and DisseminationThe University of YorkYorkY010 5DDUK
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Lee S, Sohn M, Kim S, Choi S, Jun Y, Ahn Y. Health in Optimal Fitness and its Related Factors in Young Korean Children Born Prematurely. CHILD HEALTH NURSING RESEARCH 2016. [DOI: 10.4094/chnr.2016.22.4.336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Berglund SK, Kriström B, Björn M, Lindberg J, Westrup B, Norman M, Domellöf M. Marginally low birthweight increases the risk of underweight and short stature at three and a half years of age. Acta Paediatr 2016; 105:610-7. [PMID: 26849678 DOI: 10.1111/apa.13356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 11/23/2015] [Accepted: 02/02/2016] [Indexed: 12/27/2022]
Abstract
AIM Little is known about the long-term health of marginally low birthweight (LBW) children. This study characterised growth among infants weighing 2000 g-2500 g and explored the prevalence and predictors of sustained growth restriction. METHOD This prospective observational trial followed the weight and height of 281 Swedish marginally LBW children from birth to 3.5 years of age. Children with a standard deviation score (SDS) for body mass index or height below -2 were considered underweight and short, respectively. RESULTS The mean SDS for weight and height showed a rapid increase before 12-19 weeks of age. The most rapid weight gain was in infants born small for gestational age. However, at 3.5 years of age, 9.5% of the children remained underweight and 6.5% had short stature. Regression models showed that slow weight gain before 19 weeks of age was the strongest predictor for lasting underweight, while slow height gain before 19 weeks of age and male sex were associated with short stature. CONCLUSION Marginally LBW infants were more likely to be underweight and have a short stature at 3.5 years of age and the absence of catch-up growth during the first five months after birth identified those at highest risk.
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Affiliation(s)
| | - Berit Kriström
- Department of Clinical Sciences; Pediatrics; Umeå University; Umeå Sweden
| | - Matias Björn
- Department of Clinical Sciences; Pediatrics; Umeå University; Umeå Sweden
| | - Josefine Lindberg
- Department of Clinical Sciences; Pediatrics; Umeå University; Umeå Sweden
| | - Björn Westrup
- Department of Women's and Children's Health; Division of Neonatology; Karolinska Institutet Stockholm Sweden
| | - Mikael Norman
- Department of Clinical Science; Intervention and Technology; Division of Pediatrics; Karolinska Institutet; Stockholm Sweden
| | - Magnus Domellöf
- Department of Clinical Sciences; Pediatrics; Umeå University; Umeå Sweden
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Brown JVE, Embleton ND, Harding JE, McGuire W. Multi-nutrient fortification of human milk for preterm infants. Cochrane Database Syst Rev 2016:CD000343. [PMID: 27155888 DOI: 10.1002/14651858.cd000343.pub3] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Exclusively breast milk-fed preterm infants may accumulate nutrient deficits leading to extrauterine growth restriction. Feeding preterm infants with multi-nutrient fortified human breast milk rather than unfortified breast milk may increase nutrient accretion and growth rates and may improve neurodevelopmental outcomes. OBJECTIVES To determine whether multi-nutrient fortified human breast milk improves important outcomes (including growth and development) over unfortified breast milk for preterm infants without increasing the risk of adverse effects (such as feed intolerance and necrotising enterocolitis). SEARCH METHODS We used the standard search strategy of the Cochrane Neonatal Review Group. This included electronic searches of the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 2), MEDLINE, EMBASE and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (until February 2016), as well as conference proceedings and previous reviews. SELECTION CRITERIA Randomised and quasi-randomised controlled trials that compared feeding preterm infants with multi-nutrient (protein and energy plus minerals, vitamins or other nutrients) fortified human breast milk versus unfortified (no added protein or energy) breast milk. DATA COLLECTION AND ANALYSIS We extracted data using the standard methods of the Cochrane Neonatal Review Group. We separately evaluated trial quality, data extracted by two review authors and data synthesised using risk ratios (RRs), risk differences and mean differences (MDs). We assessed the quality of evidence at the outcome level using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. MAIN RESULTS We identified 14 trials in which a total of 1071 infants participated. The trials were generally small and weak methodologically. Meta-analyses provided low-quality evidence that multi-nutrient fortification of breast milk increases in-hospital rates of growth (MD 1.81 g/kg/d, 95% confidence interval (CI) 1.23 to 2.40); length (MD 0.12 cm/wk, 95% CI 0.07 to 0.17); and head circumference (MD 0.08 cm/wk, 95% CI 0.04 to 0.12). Only very limited data are available for growth and developmental outcomes assessed beyond infancy, and these show no effects of fortification. The data did not indicate other potential benefits or harms and provided low-quality evidence that fortification does not increase the risk of necrotising enterocolitis in preterm infants (typical RR 1.57, 95% CI 0.76 to 3.23; 11 studies, 882 infants). AUTHORS' CONCLUSIONS Limited available data do not provide strong evidence that feeding preterm infants with multi-nutrient fortified breast milk compared with unfortified breast milk affects important outcomes, except that it leads to slightly increased in-hospital growth rates.
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van Deutekom AW, Chinapaw MJM, Vrijkotte TGM, Gemke RJBJ. The association of birth weight and postnatal growth with energy intake and eating behavior at 5 years of age - a birth cohort study. Int J Behav Nutr Phys Act 2016; 13:15. [PMID: 26847088 PMCID: PMC4743237 DOI: 10.1186/s12966-016-0335-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 01/26/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Low and high birth weight and accelerated postnatal weight gain are associated with an increased risk of obesity. Perinatal effects on energy intake and eating behavior have been proposed as underlying mechanisms. This study aimed to examine the independent associations of birth weight and postnatal weight and height gain with childhood energy intake and satiety response. METHODS In a birth cohort study, we used data from 2227 children (52% male), mean age 5.6 (±0.4) years. Mean daily energy intake and satiety response were parent-reported through validated questionnaires. Exposures were birth weight z-score and conditional weight and height gain between 0-1, 1-3, 3-6, 6-12 months and 12 months to 5 years. Conditional weight and height are residuals of current weight and height regressed on prior growth data, to represent deviations from expected growth. Analyses were adjusted for a set of potential confounding variables. RESULTS Conditional weight gain between 1-3, 3-6 months and 12 months to 5 years was significantly associated with energy intake, with 29.7 (95%-CI: 4.6; 54.8), 24.0 (1.8; 46.1) and 79.5 (29.4; 129.7) kcal/day more intake for each Z-score conditional weight gain between 1-3, 3-6 months and 12 months to 5 years, respectively. Conditional height gain between 0-1, 1-3 months and 12 months to 5 years was negatively associated with energy intake (β: -42.0 [66.6; -17.4] for 0-1 months, -35.1 [-58.4; -11.8] for 1-3 months and -37.4 [-72.4; -2.3] for 12 months to 5 years). Conditional weight gain in all periods was negatively associated with satiety response, with effect sizes from - 0.03 (-0.06; -0.002) in early infancy to -0.12 (-0.19; -0.06) in childhood. Birth weight was not associated with energy intake or satiety response. CONCLUSIONS Our findings suggest that accelerated infant and childhood weight gain are associated with increased energy intake and diminished satiety response at 5 years. Accelerated height gain seems to be beneficial for childhood energy intake. This perinatal 'programming' of energy intake and eating behavior provide a potential mechanism linking early life influences with later obesity and cardiovascular disease.
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Affiliation(s)
- Arend W van Deutekom
- Department of Pediatrics, EMGO Institute for Health & Care Research, Institute for Cardiovascular Research VU, VU University Medical Center, Amsterdam, The Netherlands
| | - Mai J M Chinapaw
- Department of Public and Occupational Health, EMGO institute for Health & Care Research, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Tanja G M Vrijkotte
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Reinoud J B J Gemke
- Department of Pediatrics, EMGO Institute for Health & Care Research, Institute for Cardiovascular Research VU, VU University Medical Center, Amsterdam, The Netherlands
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González Stäger MA, Rodríguez Fernández A, Muñoz Valenzuela C, Ojeda Sáez A, San Martín Navarrete A. [Nutritional status of adolescents from a cohort of preterm children]. ACTA ACUST UNITED AC 2016; 87:268-73. [PMID: 26794475 DOI: 10.1016/j.rchipe.2015.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/25/2015] [Accepted: 11/30/2015] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Catch-up growth in preterm-born children occurs in the first months of life, but in some cases, growth recovery takes place in adolescence. The objective of this study was to study the growth and development of preterm-born adolescents from a cohort of preterm infants born between 1995 and 1996, who resided in the cities of Chillán and San Carlos in the Biobío Region, Chile. The results were then compared with term-born adolescents. SUBJECTS AND METHOD A sample of 91 children from the cohort was studied and compared with 91 term-born adolescents matched for gender, age, and attendance at the same educational institution. The nutritional status was assessed by BMI-for-age, height-for-age, body composition by skinfold, cardiovascular risk due to blood pressure, and waist circumference. RESULTS There was 23.0% and 24.1% overweight and obesity in preterm-born and term-born adolescents, respectively, with 25.5% of preterm-born and small for gestational age adolescents vs. 14.5% of those born adequate for gestational age were overweight. Lower height was observed in 16.5% and 5.5% of the preterm-born and term-born adolescents, respectively, and with a higher proportion of girls (P<.04). Preterm-born adolescents had a more fat mass than the controls, particularly in the suprailiac skinfold. No significant differences were found in blood pressure and waist circumference. CONCLUSIONS The results indicate that there is a group of preterm-born children who do not recover height during adolescence, especially girls.
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Affiliation(s)
- M Angélica González Stäger
- Nutricionista, Departamento de Nutrición y Salud Pública, Facultad Ciencias de la Salud y de los Alimentos, Universidad del Bío-Bío, Chillán, Chile.
| | - Alejandra Rodríguez Fernández
- Biólogo Marino, Departamento de Nutrición y Salud Pública, Facultad Ciencias de la Salud y de los Alimentos, Universidad del Bío-Bío, Chillán, Chile
| | - Carolina Muñoz Valenzuela
- Escuela de Nutrición Dietética, Facultad Ciencias de la Salud y de los Alimentos, Universidad del Bío-Bío, Chillán, Chile
| | - Alejandra Ojeda Sáez
- Escuela de Nutrición Dietética, Facultad Ciencias de la Salud y de los Alimentos, Universidad del Bío-Bío, Chillán, Chile
| | - Ana San Martín Navarrete
- Escuela de Nutrición Dietética, Facultad Ciencias de la Salud y de los Alimentos, Universidad del Bío-Bío, Chillán, Chile
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Dos Reis HLB, Araujo KDS, Ribeiro LP, Da Rocha DR, Rosato DP, Passos MRL, Merçon De Vargas PR. Preterm birth and fetal growth restriction in HIV-infected Brazilian pregnant women. Rev Inst Med Trop Sao Paulo 2016; 57:111-20. [PMID: 25923889 PMCID: PMC4435008 DOI: 10.1590/s0036-46652015000200003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 07/24/2014] [Indexed: 01/06/2023] Open
Abstract
Introduction: Maternal HIV infection and related co-morbidities may have two outstanding
consequences to fetal health: mother-to-child transmission (MTCT) and adverse
perinatal outcomes. After Brazilian success in reducing MTCT, the attention must
now be diverted to the potentially increased risk for preterm birth (PTB) and
intrauterine fetal growth restriction (IUGR). Objective: To determine the prevalence of PTB and IUGR in low income, antiretroviral users,
publicly assisted, HIV-infected women and to verify its relation to the HIV
infection stage. Patients and Methods: Out of 250 deliveries from HIV-infected mothers that delivered at a tertiary
public university hospital in the city of Vitória, state of Espírito Santo,
Southeastern Brazil, from November 2001 to May 2012, 74 single pregnancies were
selected for study, with ultrasound validated gestational age (GA) and data on
birth dimensions: fetal weight (FW), birth length (BL), head and abdominal
circumferences (HC, AC). The data were extracted from clinical and pathological
records, and the outcomes summarized as proportions of preterm birth (PTB, < 37
weeks), low birth weight (LBW, < 2500g) and small (SGA), adequate (AGA) and
large (LGA) for GA, defined as having a value below, between or beyond the ±1.28
z/GA score, the usual clinical cut-off to demarcate the 10th and 90th
percentiles. Results: PTB was observed in 17.5%, LBW in 20.2% and SGA FW, BL, HC and AC in 16.2%, 19.1%,
13.8%, and 17.4% respectively. The proportions in HIV-only and AIDS cases were:
PTB: 5.9 versus 27.5%, LBW: 14.7% versus 25.0%, SGA BW: 17.6% versus 15.0%, BL:
6.0% versus 30.0%, HC: 9.0% versus 17.9%, and AC: 13.3% versus 21.2%; only SGA BL
attained a significant difference. Out of 15 cases of LBW, eight (53.3%) were
preterm only, four (26.7%) were SGA only, and three (20.0%) were both PTB and SGA
cases. A concomitant presence of, at least, two SGA dimensions in the same fetus
was frequent. Conclusions: The proportions of preterm birth and low birth weight were higher than the local
and Brazilian prevalence and a trend was observed for higher proportions of SGA
fetal dimensions than the expected population distribution in this small casuistry
of newborn from the HIV-infected, low income, antiretroviral users, and publicly
assisted pregnant women. A trend for higher prevalence of PTB, LBW and SGA fetal
dimensions was also observed in infants born to mothers with AIDS compared to
HIV-infected mothers without AIDS.
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Affiliation(s)
| | | | | | | | | | - Mauro Romero Leal Passos
- Materno-fetal Health Postgraduate Course, Fluminense Federal University, Niteroi, Rio de Janeiro, Brazil
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Hui LL, Lam HS, Leung GM, Schooling CM. Late prematurity and adiposity in adolescents: Evidence from "Children of 1997" birth cohort. Obesity (Silver Spring) 2015; 23:2309-14. [PMID: 26381497 DOI: 10.1002/oby.21267] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 06/06/2015] [Accepted: 07/01/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The association of late prematurity with later adiposity is unclear, and the mediating role of infant growth is seldom studied. We assessed the association of late prematurity with markers of adiposity in adolescence and tested whether accelerated infant weight gain mediated the association. METHODS In the Chinese birth cohort "Children of 1997," we used multivariable linear regression to assess the adjusted association of late premature (n = 295), compared to term (n = 6874), births with markers of adiposity at 14 years. We tested whether any association was mediated by accelerated weight gain from birth to 12 months, i.e., a change in weight z-score ≥0.67. RESULTS Late premature births had greater body mass index (BMI) z-score (0.21, 95% confidence interval (CI) 0.07, 0.35), waist-hip ratio z-score (0.16, 95% CI 0.03, 0.29), and waist-height ratio z-score (0.27, 95% CI 0.14, 0.40) than term births in adolescence. The association of late prematurity with higher adolescent BMI, but not waist ratios, was mediated by accelerated infant weight gain. CONCLUSIONS Late prematurity was associated with higher BMI and waist ratios in adolescence, but only the association with BMI was mediated by infant weight gain, suggesting vulnerability to metabolic risk in late premature births may arise through multiple pathways.
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Affiliation(s)
- L L Hui
- School of Public Health, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Pokfulam, Hong Kong
| | - Hugh S Lam
- Department of Paediatrics, Faculty of Medicine, the Chinese University of Hong Kong, Pokfulam, Hong Kong
| | - Gabriel M Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Pokfulam, Hong Kong
| | - Catherine M Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Pokfulam, Hong Kong
- CUNY School of Public Health and Hunter College, New York, USA
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van Poelje MW, van de Lagemaat M, Lafeber HN, Van Weissenbruch MM, Rotteveel J. Relationship between fat mass measured by dual-energy X-ray absorptiometry and leptin in preterm infants between term age and 6 months' corrected age. Horm Res Paediatr 2015; 82:405-10. [PMID: 25531233 DOI: 10.1159/000369393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 10/24/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS In term subjects, fat mass (FM) is positively associated with leptin, whereas studies in preterm infants show conflicting results. However, none of these studies measured FM by dual-energy X-ray absorptiometry (DEXA). This study aims to relate FM measured by DEXA in relation to leptin and growth in preterm infants. METHODS In 139 preterm infants, weight (kg) and length (cm) were measured at birth, term age, and 6 months' corrected age (CA). FM (kg), measured by whole-body DEXA, and leptin (µg/l) were measured at term age and 6 months' CA. RESULTS At term age and 6 months' CA, FM was associated with leptin (β = 1.94, 95% CI: 1.51-2.36, and β = 0.37, 95% CI: 0.26-0.48, respectively; p < 0.001). Gain in weight standard deviation score (SDS) between term age and 6 months' CA was associated with FM and leptin at 6 months' CA (β = 0.24, 95% CI: 0.18-0.30, and β = 0.25, 95% CI: 0.16-0.33, respectively; p < 0.001). CONCLUSION In preterm infants, FM measured by DEXA is associated with leptin, which indicates that leptin is a marker of body FM during the first 6 months after term age. Gain in weight SDS between term age and 6 months' CA results in higher FM and higher leptin at 6 months' CA.
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Affiliation(s)
- Merel W van Poelje
- Pediatrics Department, VU University Medical Center, Amsterdam, The Netherlands
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