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Boscarino G, Carducci C, Conti MG, Podagrosi M, Gigliello A, Di Chiara M, Bartolucci M, Brunelli R, Parisi P, Angeloni A, Terrin G. Early Energy Intake and Amino Acid Profile in Preterm Newborns: A Quasi-Experimental Study. Nutrients 2023; 15:2917. [PMID: 37447243 PMCID: PMC10343583 DOI: 10.3390/nu15132917] [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: 05/29/2023] [Revised: 06/23/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
(1) Background: An increased protein intake via parenteral nutrition (PN) in early life is associated with an improvement of the nitrogen balance in preterm newborns. However, the role of energy intake on amino acid (AA) utilization provided by PN remains to be defined. We investigated the effects of energy intake on blood AA levels and profiles. (2) Methods: Quasi-experimental study including preterm very low birth weight newborns who received an energy enhanced PN (Cohort A) or an energy standard PN (Cohort B), with a similar protein amount in the first week of life. Blood AA levels were measured between three and seven days of life (T0) and at fifteen days of life (T1) and compared between the two study cohorts. (3) Results: AA levels of 40 newborns from each group were analyzed. No difference was found for total essential and non-essential blood AA concentration at T0 between the two study cohorts. At T1, we found a significantly higher blood concentration of leucine, isoleucine and proline, and a significantly lower concentration of tyrosine in Cohort B. However, multivariate analysis did not confirm this result. (4) Conclusions: An enhanced PN protocol in terms of energy but not of protein did not influence AA levels and profiles. Considering the high risk of side effects, we suggest exercising caution when administering high energy intake via PN in the first week of life.
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Affiliation(s)
- Giovanni Boscarino
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy (R.B.)
| | - Claudia Carducci
- Department of Experimental Medicine, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy
| | - Maria Giulia Conti
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy (R.B.)
| | - Maria Podagrosi
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy (R.B.)
| | - Annamaria Gigliello
- Department of Experimental Medicine, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy
| | - Maria Di Chiara
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy (R.B.)
| | - Monica Bartolucci
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy (R.B.)
| | - Roberto Brunelli
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy (R.B.)
| | - Pasquale Parisi
- Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine and Psychology, Sant Andrea Hospital University, Sapienza University of Rome, 00189 Rome, Italy
| | - Antonio Angeloni
- Department of Experimental Medicine, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy
| | - Gianluca Terrin
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy (R.B.)
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Delayed Macronutrients' Target Achievement in Parenteral Nutrition Reduces the Risk of Hyperglycemia in Preterm Newborn: A Randomized Controlled Trial. Nutrients 2023; 15:nu15051279. [PMID: 36904278 PMCID: PMC10005207 DOI: 10.3390/nu15051279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/21/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023] Open
Abstract
Hyperglycemia (HG) is an independent risk factor of mortality and morbidity in very low birth weight newborns (VLBW). Achievement of high nutritional intakes in the first days of life (DoL) by parenteral nutrition (PN) increases the risk of HG. We aim to assess if a delayed achievement of the PN macronutrient target dose could reduce the occurrence of HG in VLBW. We enrolled 353 VLBW neonates in a randomized controlled clinical trial comparing two PN protocols that differed in the timing of energy and amino acid target dose achievement: (1) early target dose achievement (energy within 4-5 DoL; amino acids within 3-4 DoL) vs. (2) late target dose achievement (energy within 10-12 DoL; amino acids within 5-7 DoL). The primary outcome was the occurrence of HG during the first week of life. An additional endpoint was long-term body growth. We observed a significant difference in the rate of HG between the two groups (30.7% vs. 12.2%, p = 0.003). Significant differences were observed in terms of body growth at 12 months of life between the two groups (weight Z-Score: -0.86 vs. 0.22, p = 0.025; length: -1.29 vs. 0.55, p < 0.001). Delayed achievement of energy and amino acid intake may be useful to reduce the risk of HG along with an increase of growth parameters in VLBW neonates.
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De Nardo MC, Petrella C, Di Chiara M, Di Mario C, Deli G, Travaglia E, Baldini L, Russo A, Parisi P, Fiore M, Terrin G. Early nutritional intake influences the serum levels of nerve growth factor (NGF) and brain-derived neurotrophic factor in preterm newborns. Front Neurol 2022; 13:988101. [PMID: 36324384 PMCID: PMC9620475 DOI: 10.3389/fneur.2022.988101] [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: 07/06/2022] [Accepted: 09/16/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction Parenteral nutrition (PN) may have detrimental effects on neurodevelopment in preterm newborns. Moreover, enteral nutrition (EN) seems to be protective. To understand the mechanisms of how neurological development can be influenced by the route of administration of nutritional intake, we investigated the relationship between the serum levels of the nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) and nutritional intake received in early life by preterm newborns. Materials and methods Specimens of blood were obtained at 28 days of life (DOL) for NGF/BDNF determination in neonates <32 weeks of gestation and/or with birth weight <1,500 g, consecutively observed in the neonatal intensive care unit. We analyzed the relation between amino acid content and energy intake and NGF/BDNF measurements at 28 DOL. PN protein intake was referred to as the total amounts of amino acid intake received daily. Results We enrolled 20 newborns (gestational age 30.45 ± 1.76 weeks, birth weight 1,340 ± 352.63 g). Serum NGF value at 28 DOL was positively correlated with enteral protein and energy intake (r = 0.767; r = 0.746, p < 0.001), whereas, negatively correlated with parenteral amino acid and energy intake (r = −0.652, p < 0.001; r = −0.466, p < 0.05). Similar significant correlations were described between BDNF level at 28 DOL and enteral energy intake (r = 0.493, p < 0.05). Multivariate regression analysis showed that NGF level at 28 DOL depends on enteral protein and energy intake administrated in the 1st week of life. Conclusion Neurotrophin values varied according to the route of nutrition administration in preterm newborns. NGF/BDNF serum levels are influenced positively and negatively by EN and PN, respectively.
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Affiliation(s)
- Maria Chiara De Nardo
- Department of Maternal and Child Health Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Carla Petrella
- Institute of Biochemistry and Cell Biology (IBB) of the National Research Council (CNR), Rome, Italy
| | - Maria Di Chiara
- Department of Maternal and Child Health Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Chiara Di Mario
- Department of Maternal and Child Health Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Giorgia Deli
- Department of Maternal and Child Health Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Elisa Travaglia
- Department of Maternal and Child Health Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Laura Baldini
- Department of Maternal and Child Health Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Alessia Russo
- Department of Maternal and Child Health Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Pasquale Parisi
- Department of Pediatrics, Mental Health and Sense Organs (NESMOS), Faculty of Medicine and Psychology, c/o Sant'Andrea Hospital, Sapienza University, Rome, Italy
- Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine and Psychology, c/o Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Marco Fiore
- Institute of Biochemistry and Cell Biology (IBB) of the National Research Council (CNR), Rome, Italy
| | - Gianluca Terrin
- Department of Maternal and Child Health Policlinico Umberto I, Sapienza University, Rome, Italy
- *Correspondence: Gianluca Terrin
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Enteral and Parenteral Energy Intake and Neurodevelopment in Preterm Infants: a Systematic Review. Nutrition 2021; 97:111572. [DOI: 10.1016/j.nut.2021.111572] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/26/2021] [Accepted: 12/12/2021] [Indexed: 11/18/2022]
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Boscarino G, Conti MG, Pagano F, Di Chiara M, Pannucci C, Onestà E, Prota R, Deli G, Dito L, Regoli D, Oliva S, Terrin G. Complementary Feeding and Growth in Infants Born Preterm: A 12 Months Follow-Up Study. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8121085. [PMID: 34943281 PMCID: PMC8700469 DOI: 10.3390/children8121085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 10/23/2021] [Accepted: 11/22/2021] [Indexed: 12/18/2022]
Abstract
Evidences demonstrated that timing of weaning influences long-term growth in full term infants. However, studies on preterm infants are still lacking, and the international guidelines are focused only on healthy full-term newborn, without consensus for preterms. We aimed at evaluating, in a cohort study, the consequences of different timing of weaning on auxological outcomes up to 12 months of corrected age in a population of neonates born with gestational age < 32 weeks or birth weight < 1500 g. We divided the enrolled neonates in two cohorts according to the timing of weaning: (i) Early Weaning: introduction of complementary food before 6 months of corrected age; (ii) Late Weaning: complementary food introduced after 6 months of corrected age. Growth parameters (weight, length, body mass index, and ponderal index) were measured at 12 months of life. The two groups were statistically comparable for baseline clinical characteristics, and differences on growth parameters were not reported between the two study groups. These results were confirmed in linear and binary logistic regression multivariate models. Timing of weaning is not related to growth of preterm newborns in the first 12 months of corrected age. Studies are needed to reach consensus for the appropriate nutritional approach for preterm babies after discharge.
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Affiliation(s)
- Giovanni Boscarino
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (G.B.); (M.G.C.); (F.P.); (M.D.C.); (C.P.); (E.O.); (R.P.); (G.D.); (L.D.); (D.R.); (S.O.)
| | - Maria Giulia Conti
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (G.B.); (M.G.C.); (F.P.); (M.D.C.); (C.P.); (E.O.); (R.P.); (G.D.); (L.D.); (D.R.); (S.O.)
- Department of Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Federica Pagano
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (G.B.); (M.G.C.); (F.P.); (M.D.C.); (C.P.); (E.O.); (R.P.); (G.D.); (L.D.); (D.R.); (S.O.)
| | - Maria Di Chiara
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (G.B.); (M.G.C.); (F.P.); (M.D.C.); (C.P.); (E.O.); (R.P.); (G.D.); (L.D.); (D.R.); (S.O.)
| | - Chiara Pannucci
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (G.B.); (M.G.C.); (F.P.); (M.D.C.); (C.P.); (E.O.); (R.P.); (G.D.); (L.D.); (D.R.); (S.O.)
| | - Elisa Onestà
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (G.B.); (M.G.C.); (F.P.); (M.D.C.); (C.P.); (E.O.); (R.P.); (G.D.); (L.D.); (D.R.); (S.O.)
| | - Rita Prota
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (G.B.); (M.G.C.); (F.P.); (M.D.C.); (C.P.); (E.O.); (R.P.); (G.D.); (L.D.); (D.R.); (S.O.)
| | - Giorgia Deli
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (G.B.); (M.G.C.); (F.P.); (M.D.C.); (C.P.); (E.O.); (R.P.); (G.D.); (L.D.); (D.R.); (S.O.)
| | - Lucia Dito
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (G.B.); (M.G.C.); (F.P.); (M.D.C.); (C.P.); (E.O.); (R.P.); (G.D.); (L.D.); (D.R.); (S.O.)
| | - Daniela Regoli
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (G.B.); (M.G.C.); (F.P.); (M.D.C.); (C.P.); (E.O.); (R.P.); (G.D.); (L.D.); (D.R.); (S.O.)
| | - Salvatore Oliva
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (G.B.); (M.G.C.); (F.P.); (M.D.C.); (C.P.); (E.O.); (R.P.); (G.D.); (L.D.); (D.R.); (S.O.)
| | - Gianluca Terrin
- Department of Maternal and Child Health, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (G.B.); (M.G.C.); (F.P.); (M.D.C.); (C.P.); (E.O.); (R.P.); (G.D.); (L.D.); (D.R.); (S.O.)
- Correspondence: ; Tel.: +39-064-997-2536
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Early Enteral Feeding Improves Tolerance of Parenteral Nutrition in Preterm Newborns. Nutrients 2021; 13:nu13113886. [PMID: 34836137 PMCID: PMC8621891 DOI: 10.3390/nu13113886] [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] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/26/2021] [Accepted: 10/28/2021] [Indexed: 01/05/2023] Open
Abstract
(1) Background: The tolerance of preterm newborns for the high nutritional intakes given by parenteral nutrition (PN) is still debated because of the risk of metabolic complications. Despite enteral nutrition (EN) being the preferred route of nutrition, an exclusive enteral feeding is not always possible, as in preterm newborns, the gut is immature and less tolerant of EN. We aimed to study the impact of a minimal enteral feeding (MEF) on the possible early metabolic complications of PN in a cohort of preterms with gestational age at birth GA ≤ 29 + 6/7 weeks of postmenstrual age. (2) Methods: We divided the study sample in two cohorts: 1) Late-Feeding (cohort 1), newborns who received MEF starting from the 8th day of age, and (2) Early-Feeding (cohort 2), newborns who received MEF, consisting of the administration of at least 4–5 mL/kg/day by the enteral route, in the first 7 days of age. The primary outcome of the study was the rate of at least one metabolic complication, including hyperglycemia, hypertriglyceridemia, or metabolic acidosis. (3) Results: We enrolled 80 newborns (Late-Feeding cohort 51 vs. Early-Feeding cohort 29). The rate of all metabolic complications was statistically higher in the Late-Feeding cohort compared to the Early-Feeding cohort. Binary logistic regression analysis showed that late administration of MEF negatively influenced the rate of all metabolic complications. (4) Conclusions: Early minimal administration of EN is associated with less frequent PN-related metabolic side effects and a higher rate of survival in critically ill newborns.
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Boscarino G, Di Chiara M, Cellitti R, De Nardo MC, Conti MG, Parisi P, Spalice A, Di Mario C, Ronchi B, Russo A, De Luca F, Pangallo I, Terrin G. Effects of early energy intake on neonatal cerebral growth of preterm newborn: an observational study. Sci Rep 2021; 11:18457. [PMID: 34531489 PMCID: PMC8445990 DOI: 10.1038/s41598-021-98088-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/27/2021] [Indexed: 12/21/2022] Open
Abstract
Current guidelines for preterm newborns recommend high energy nutrition soon after birth in order to limit growth retardation. However, long-term effects of this nutritional approach are still debated, and it has been demonstrated that cerebral growth depends on protein intake in early life. A negative impact of early high energy intake by parenteral nutrition (PN) has been reported for patients in critically ill conditions, observed in intensive care unit. We aimed at evaluating the impact of energy intake on cerebral growth in preterm neonates early in life. We included preterm newborns with gestational age < 32 weeks or birth weight (BW) < 1500 g. Measurement of cerebral structures was performed by cranial Ultrasonography (cUS) between 3 and 7 days of life (DOL, T0) and at 28 DOL (T1). We evaluated the relation between energy intake and cerebral growth in the first 28 DOL. We observed in 109 preterm newborns a significant (p < 0.05) negative correlation between energy intake received by PN and right caudate head growth (r = - 0.243*) and a positive correlation between total energy intake and transverse cerebellum diameter (r = 0.254*). Multivariate analysis showed that energy intake administered by enteral nutrition (EN), independently increased growth of left caudate head (β = 0.227*) and height cerebellar vermis (β = 0.415*), while PN independently affected growth of both right and left caudate head (β = - 0.164* and β = - 0.228*, respectively) and cerebellum transverse diameter (β = - 0.849*). The route of energy administration may exert different effects on cerebral growth in early life. High energy intake administered through EN seems to be positively correlated to cerebral growth; conversely, PN energy intake results in a poorer cerebral growth evaluated with cUS.
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Affiliation(s)
- Giovanni Boscarino
- Department of Maternal and Child Health, Sapienza University of Rome-Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Maria Di Chiara
- Department of Maternal and Child Health, Sapienza University of Rome-Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Raffaella Cellitti
- Department of Maternal and Child Health, Sapienza University of Rome-Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Maria Chiara De Nardo
- Department of Maternal and Child Health, Sapienza University of Rome-Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Maria Giulia Conti
- Department of Maternal and Child Health, Sapienza University of Rome-Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Pasquale Parisi
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Alberto Spalice
- Department of Maternal and Child Health, Sapienza University of Rome-Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Chiara Di Mario
- Department of Maternal and Child Health, Sapienza University of Rome-Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Benedetta Ronchi
- Department of Maternal and Child Health, Sapienza University of Rome-Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Alessia Russo
- Department of Maternal and Child Health, Sapienza University of Rome-Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Francesca De Luca
- Department of Maternal and Child Health, Sapienza University of Rome-Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Ida Pangallo
- Department of Maternal and Child Health, Sapienza University of Rome-Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Gianluca Terrin
- Department of Maternal and Child Health, Sapienza University of Rome-Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy.
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Boscarino G, Conti MG, Gasparini C, Onestà E, Faccioli F, Dito L, Regoli D, Spalice A, Parisi P, Terrin G. Neonatal Hyperglycemia Related to Parenteral Nutrition Affects Long-Term Neurodevelopment in Preterm Newborn: A Prospective Cohort Study. Nutrients 2021; 13:1930. [PMID: 34199741 PMCID: PMC8227040 DOI: 10.3390/nu13061930] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/25/2021] [Accepted: 06/02/2021] [Indexed: 02/07/2023] Open
Abstract
(1) Background: Recent evidence reported a reduced tolerance of macronutrient parenteral intakes in subjects in critically ill conditions. We designed a prospective cohort study to evaluate the effects of hyperglycemia (HG) related to parenteral nutrition (PN) on neurodevelopment (NDV) in survived preterm newborns. (2) Methods: Enrolled newborns with gestational age < 32 weeks or birth weight < 1500 g, were divided in two cohorts: (A) exposed to moderate or severe HG (glucose blood level > 180 mg/dL) in the first week of life; (B) not exposed to HG. We considered as the primary outcome the rate of preterm newborns survived without NDV delay at 24 months of life, evaluated with Bayley Scales of Infants Development III edition. (3) Results: We analyzed 108 (A 32 vs. B 76) at 24 months of life. Newborns in cohort A showed a higher rate of cognitive and motor delay (A 44% vs. B 22 %, p = 0.024; A 38% vs. B 8%, p < 0.001). When adjusting for background characteristics, HG remained a risk factor for motor delay. (4) Conclusions: High nutritional intakes through PN soon after birth increase the risk of HG. The consequences of this severe metabolic complication affect long-term NDV and survival in preterm newborns.
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Affiliation(s)
- Giovanni Boscarino
- Department of Maternal and Child Health, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy; (G.B.); (M.G.C.); (C.G.); (E.O.); (F.F.); (L.D.); (D.R.); (A.S.)
| | - Maria Giulia Conti
- Department of Maternal and Child Health, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy; (G.B.); (M.G.C.); (C.G.); (E.O.); (F.F.); (L.D.); (D.R.); (A.S.)
- Department of Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Corinna Gasparini
- Department of Maternal and Child Health, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy; (G.B.); (M.G.C.); (C.G.); (E.O.); (F.F.); (L.D.); (D.R.); (A.S.)
| | - Elisa Onestà
- Department of Maternal and Child Health, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy; (G.B.); (M.G.C.); (C.G.); (E.O.); (F.F.); (L.D.); (D.R.); (A.S.)
| | - Francesca Faccioli
- Department of Maternal and Child Health, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy; (G.B.); (M.G.C.); (C.G.); (E.O.); (F.F.); (L.D.); (D.R.); (A.S.)
| | - Lucia Dito
- Department of Maternal and Child Health, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy; (G.B.); (M.G.C.); (C.G.); (E.O.); (F.F.); (L.D.); (D.R.); (A.S.)
| | - Daniela Regoli
- Department of Maternal and Child Health, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy; (G.B.); (M.G.C.); (C.G.); (E.O.); (F.F.); (L.D.); (D.R.); (A.S.)
| | - Alberto Spalice
- Department of Maternal and Child Health, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy; (G.B.); (M.G.C.); (C.G.); (E.O.); (F.F.); (L.D.); (D.R.); (A.S.)
| | - Pasquale Parisi
- NESMOS Department, Faculty of Medicine & Psychology, c/o Sant’ Andrea Hospital, Sapienza University, 00189 Rome, Italy;
| | - Gianluca Terrin
- Department of Maternal and Child Health, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy; (G.B.); (M.G.C.); (C.G.); (E.O.); (F.F.); (L.D.); (D.R.); (A.S.)
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Boscarino G, Gasparini C, Conti MG, Di Chiara M, Terrin G. Zinc levels in neonatal life influence long-term neurodevelopment. J Perinatol 2021; 41:1196-1197. [PMID: 33758400 DOI: 10.1038/s41372-021-01012-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 01/27/2021] [Accepted: 02/16/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Giovanni Boscarino
- Department of Maternal and Child Health, Sapienza University of Rome, Roma, Italy
| | - Corinna Gasparini
- Department of Maternal and Child Health, Sapienza University of Rome, Roma, Italy
| | - Maria Giulia Conti
- Department of Maternal and Child Health, Sapienza University of Rome, Roma, Italy
| | - Maria Di Chiara
- Department of Maternal and Child Health, Sapienza University of Rome, Roma, Italy
| | - Gianluca Terrin
- Department of Maternal and Child Health, Sapienza University of Rome, Roma, Italy.
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Intravenous Lipid Emulsions Affect Respiratory Outcome in Preterm Newborn: A Case-Control Study. Nutrients 2021; 13:nu13041243. [PMID: 33918860 PMCID: PMC8070203 DOI: 10.3390/nu13041243] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/02/2021] [Accepted: 04/07/2021] [Indexed: 12/13/2022] Open
Abstract
(1) Background: Hypertriglyceridemia (HiTG) is a metabolic complication of intravenous lipid emulsions (ILEs) infusion. We aimed to evaluate the influence of HiTG on the respiratory outcome of preterm babies; (2) Methods: We enrolled, in a case-control study, newborns with gestational age <32 weeks or birth weight <1500 g, over a 3-year period. They were divided into cases and controls; cases were defined by the detection of HiTG defined as serum triglycerides (TG) value >150 mg/dL; (3) Results: We enrolled 40 cases and 105 controls. Cases had an increased incidence of bronchopulmonary dysplasia (30.0% vs. 14.3%, p < 0.05) and longer duration of invasive mechanical ventilation (7 days, 95% CI 4-10 days vs. 4 days, 95% CI 1-7 days, p < 0.01) compared to controls. Multivariate analysis confirmed that HiTG independently influenced the duration of invasive mechanical ventilation, also in the subgroups with gestational age ≤28 + 6/7 weeks or birth weight ≤1000 g; (4) Conclusion: Newborns with HiTG related to ILEs had a longer duration of invasive mechanical ventilation. Temporary suspension or reduction in ILEs in the case of HiTG is associated with an improvement of respiratory outcome.
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Terrin G, Boscarino G, Gasparini C, Di Chiara M, Faccioli F, Onestà E, Parisi P, Spalice A, De Nardo MC, Dito L, Regoli D, Di Mario C, De Curtis M. Energy-enhanced parenteral nutrition and neurodevelopment of preterm newborns: A cohort study. Nutrition 2021; 89:111219. [PMID: 33836427 DOI: 10.1016/j.nut.2021.111219] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 02/11/2021] [Accepted: 02/17/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Preterm births are at higher risk for neurodevelopment (NDV) disabilities. To limit long-term consequences, guidelines recommend aggressive parenteral nutrition (PN) soon after birth. The aim of this study was to examine the effects of energy-enhanced PN in the first week of life on long-term NDV in preterm neonates. METHODS We compared two cohorts of newborns (group A: energy-enhanced PN and group B: energy-standard PN) with different energy intake in the first 7 d of life (DoL) given by PN with the same protein amount, to study the influences of an energy-enhanced PN on NDV at 24 mo of life evaluated with the Bayley Scale of Infant Development-III edition. RESULTS We analyzed 51 newborns (A: n = 24 versus B: n = 27). The two cohorts were similar in baseline characteristics (gestational age group A 29 wk, 95% confidence interval [CI], 28-30 wk versus group B 29 wk, 95% CI, 28-30 wk; birth weight A: 1214 g, 95% CI, 1062-1365 g versus B 1215 g, 95% CI, 1068-1363 g; boys A 62.5% versus B 55.6%). Infants in cohort B showed significantly (P < 0.05) better gross motor, total scaled, and total composite motor scores (A: 8 (1) versus B 9 (2); A 17 (4) versus B 19 (5); A 91 (12) versus B 97 (15); respectively). Cohort A showed a higher percentage of infants with delayed socioemotional competence (A 30.4% versus B 7.7%, P < 0.05). No differences were found in growth parameters at 24 mo of life. Linear regression analysis showed that socioemotional competence and motor score were negatively associated with energy intake of the first 7 DoL given by PN. CONCLUSIONS A more aggressive PN strategy results in lower motor score and socioemotional competence performance at 24 mo of life. More caution might be advocated for an energy-enhanced PN protocol, particularly in neonates with lower birth weight, for long-term NDV in preterm neonates.
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Affiliation(s)
- Gianluca Terrin
- Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy.
| | - Giovanni Boscarino
- Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy
| | - Corinna Gasparini
- Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy
| | - Maria Di Chiara
- Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy
| | - Francesca Faccioli
- Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy
| | - Elisa Onestà
- Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy
| | - Pasquale Parisi
- Child Neurology, NESMOS Department, Faculty of Medicine & Psychology, University of Rome La Sapienza, Rome, Italy
| | - Alberto Spalice
- Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy
| | - Maria Chiara De Nardo
- Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy
| | - Lucia Dito
- Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy
| | - Daniela Regoli
- Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy
| | - Chiara Di Mario
- Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy
| | - Mario De Curtis
- Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy
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Terrin G, Di Chiara M, Boscarino G, Metrangolo V, Faccioli F, Onestà E, Giancotti A, Di Donato V, Cardilli V, De Curtis M. Morbidity associated with patent ductus arteriosus in preterm newborns: a retrospective case-control study. Ital J Pediatr 2021; 47:9. [PMID: 33446244 PMCID: PMC7809822 DOI: 10.1186/s13052-021-00956-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 01/04/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Association between persistency of a patent ductus arteriosus (PDA) and morbidity in preterm newborns is still controversial. We aimed to investigate the relation between PDA and morbidity in a large retrospective study. METHODS A case-control study including neonates consecutively admitted to the Neonatal Intensive Care Unit (NICU), with gestational age (GA) < 32 weeks or body birth weight (BW) < 1500 g, over a 5-year period. Newborns were divided into Cases and Controls, according with the presence or absence of a hemodynamically significant PDA (hs-PDA). RESULTS We enrolled 85 Cases and 193 Controls. Subjects with hs-PDA had significantly (p < 0.001) lower GA (26.7 w, 95%CI 27.1-28.0 vs. 30.1 w, 95%CI 29.7-30.4), BW (1024 g, 95% CI 952-1097 vs. 1310 g 95%CI 1263-1358) and an increased morbidity (60.0% vs. 18.7%). In a sub-group of extremely preterm newborns (GA ≤ 28 weeks and BW ≤ 1000 g), the rate of bronchopulmonary dysplasia (BPD) was significantly increased in Cases (31.7%) compared with Controls (5.9%, p = 0.033). Multivariate analysis showed that morbidity significantly depended on hs-PDA, GA and BW, and that, in extremely preterms, the hs-PDA represented an independent risk factor for BPD. CONCLUSIONS Occurrence of the main morbidities of prematurity depended by hs-PDA, in association with GA, BW, and use of prenatal steroids. In extremely premature babies, hs-PDA is a risk factor for BPD, one of the most important morbidity of prematurity, independently by other confounding variables.
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Affiliation(s)
- Gianluca Terrin
- Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy.
| | - Maria Di Chiara
- Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy
| | - Giovanni Boscarino
- Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy
| | - Valentina Metrangolo
- Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy
| | - Francesca Faccioli
- Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy
| | - Elisa Onestà
- Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy
| | - Antonella Giancotti
- Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy
| | - Violante Di Donato
- Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy
| | - Viviana Cardilli
- Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy
| | - Mario De Curtis
- Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy
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Terrin G, De Nardo MC, Boscarino G, Di Chiara M, Cellitti R, Ciccarelli S, Gasparini C, Parisi P, Urna M, Ronchi B, Russo A, Sabatini G, De Curtis M. Early Protein Intake Influences Neonatal Brain Measurements in Preterms: An Observational Study. Front Neurol 2020; 11:885. [PMID: 32982918 PMCID: PMC7479306 DOI: 10.3389/fneur.2020.00885] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/10/2020] [Indexed: 01/03/2023] Open
Abstract
Introduction: To limit extrauterine growth restriction, recent guidelines on nutrition of preterm neonates recommended high protein intake since the first day of life (DOL). The impact of this nutritional strategy on the brain is still controversial. We aimed to evaluate the effects of protein intake on early cerebral growth in very low birth weight newborns. Materials and Methods: We performed serial cranial ultrasound (cUS) scans at 3–7 DOL and at 28 DOL in very low birth weight newborns consecutively observed in the neonatal intensive care unit. We analyzed the relation between protein intake and cerebral measurements at 28 DOL performed by cUS. Results: We enrolled 100 newborns (gestational age 29 ± 2 weeks, birth weight 1,274 ± 363 g). A significant (p < 0.05) positive correlation between enteral protein intake and biparietal diameter (r = 0.490**), occipital–frontal diameter (r = 0.608**), corpus callosum (length r = 0.293*, genu r = 0.301*), caudate head (right r = 0.528**, left r = 0.364**), and cerebellum (transverse diameter r = 0.440**, vermis height r = 0.356**, vermis width r = 0.377**) was observed at 28 DOL. Conversely, we found a significant negative correlation of protein intake given by parenteral nutrition (PN) with biparietal diameter (r = −0.524**), occipital–frontal diameter (r = −0.568**), body of corpus callosum (r = −0.276*), caudate head (right r = −0.613**, left r = −0.444**), and cerebellum (transverse diameter r = −0.403**, vermis height r = −0.274*, vermis width r = −0.462**) at 28 DOL. Multivariate regression analysis showed that measurements of occipital–frontal diameter, caudate head, and cerebellar vermis at 28 DOL depend positively on protein enteral intake (r = 0.402*, r = 0.305*, and r = 0.271*) and negatively by protein parenteral intake (r = −0.278*, r = −0.488*, and r = −0.342*). Conclusion: Brain development in neonatal life depends on early protein intake. High protein intake affects cerebral structures' measurements of preterm newborn when administered by PN. Positive impact on brain development encourages the administration of recommended protein intake mainly by enteral nutrition.
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Affiliation(s)
- Gianluca Terrin
- Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy
| | - Maria Chiara De Nardo
- Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy
| | - Giovanni Boscarino
- Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy
| | - Maria Di Chiara
- Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy
| | - Raffaella Cellitti
- Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy
| | - Simona Ciccarelli
- Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy
| | - Corinna Gasparini
- Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy
| | - Pasquale Parisi
- Child Neurology, NESMOS Department, Faculty of Medicine & Psychology, Sapienza University, Rome, Italy
| | - Matteo Urna
- Child Neurology, NESMOS Department, Faculty of Medicine & Psychology, Sapienza University, Rome, Italy
| | - Benedetta Ronchi
- Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy
| | - Alessia Russo
- Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy
| | - Giulia Sabatini
- Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy
| | - Mario De Curtis
- Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy
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Terrin G, Di Chiara M, Boscarino G, Versacci P, Di Donato V, Giancotti A, Pacelli E, Faccioli F, Onestà E, Corso C, Ticchiarelli A, De Curtis M. Echocardiography-Guided Management of Preterms With Patent Ductus Arteriosus Influences the Outcome: A Cohort Study. Front Pediatr 2020; 8:582735. [PMID: 33409261 PMCID: PMC7779760 DOI: 10.3389/fped.2020.582735] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/23/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction: Echocardiography (ECHO) with color flow Doppler is considered as the gold standard to identify a hemodynamic patent ductus arteriosus (hs-PDA). However, the optimal diagnostic and therapeutic management for newborns with hs-PDA is still controversial. We aimed to investigate two clinical strategies: (1) targeted treatment based on ECHO criteria and (2) treatment based on ECHO criteria in addition to clinical signs and symptoms. Materials and Methods: This is a cohort study including all neonates consecutively admitted in the Neonatal Intensive Care Unit of University La Sapienza in Rome, with gestational age <32 weeks or body birth weight <1,500 g and with a diagnosis of hs-PDA as confirmed by ECHO evaluation performed within 72 h of life. We classified the babies in two cohorts: (A) pharmacological treatment immediately after ECHO screening and (B) pharmacological therapy for PDA was administered when the relevance of a hs-PDA was associated with clinical signs of hemodynamic instability. Results: We considered as primary outcome newborns who survived without any morbidities (A: 48.1% vs. B: 22.2%, p = 0.022). In particular, we found that the rate of intraventricular hemorrhage stage ≥2 was increased in cohort B (A: 3.7% vs. B 24.4%, p = 0.020). A multivariate analysis showed that assignment to cohort A independently influences the primary outcome. Conclusions: Adopting an hs-PDA management option based on ECHO-directed therapy regardless of symptoms may reduce the morbidity and improve the survival of very low birth weight infants.
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Affiliation(s)
- Gianluca Terrin
- Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy
| | - Maria Di Chiara
- Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy
| | - Giovanni Boscarino
- Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy
| | - Paolo Versacci
- Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy
| | - Violante Di Donato
- Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy
| | - Antonella Giancotti
- Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy
| | - Elisabetta Pacelli
- Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy
| | - Francesca Faccioli
- Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy
| | - Elisa Onestà
- Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy
| | - Chiara Corso
- Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy
| | | | - Mario De Curtis
- Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy
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