Classification and Special Nutritional Needs of SGA Infants and Neonates of Multiple Pregnancies

Donor Human Milk Fat Content Is Associated with Maternal Body Mass Index

Introduction: Donor human milk is increasingly being utilized for both preterm and term infants when mother's milk is unavailable. With the rising prevalence of maternal overweight and obesity, it is crucial to evaluate the relationship between maternal body mass index and the fat and energy content of donor human milk. Objectives: To assess the impact of maternal body mass index on human milk fat content. Methods: A cross-sectional study was carried out using retrospective data from women who made their first human milk donation at ≥15 days postpartum at a human milk bank in São Paulo, Brazil, from January 2018 to December 2020. Data of sociodemographic, obstetric, health, and anthropometric measures were collected by the human milk bank staff. Milk fat and energy content were determined using the crematocrit test. Analysis of variance and multiple linear regression were used to compare means of crematocrit and fat. We determined the p-values using a test of heterogeneity and linear trend and presented the one with the lower p-value. Results: Most donors were between 25 and 35 years old, had higher education, were employed, and lived with a partner. At the time of milk donation, 40.9% of women were overweight or obese. The fat (1.09 g/dL) and energy (9.83 kcal/dL) content of human milk were higher in obese donor compared with eutrophic donors. Conclusions: The fat and energy content of human milk were associated with maternal body mass index, suggesting the potential value for selective use of high fat and high calorie donor milk for very low birthweight or premature infants.

Construction and SHAP interpretability analysis of a risk prediction model for feeding intolerance in preterm newborns based on machine learning

OBJECTIVE

To construct a highly accurate and interpretable feeding intolerance (FI) risk prediction model for preterm newborns based on machine learning (ML) to assist medical staff in clinical diagnosis.

METHODS

In this study, a sample of 350 hospitalized preterm newborns were retrospectively analysed. First, dual feature selection was conducted to identify important feature variables for model construction. Second, ML models were constructed based on the logistic regression (LR), decision tree (DT), support vector machine (SVM) and eXtreme Gradient Boosting (XGBoost) algorithms, after which random sampling and tenfold cross-validation were separately used to evaluate and compare these models and identify the optimal model. Finally, we apply the SHapley Additive exPlanation (SHAP) interpretable framework to analyse the decision-making principles of the optimal model and expound upon the important factors affecting FI in preterm newborns and their modes of action.

RESULTS

The accuracy of XGBoost was 87.62%, and the area under the curve (AUC) was 92.2%. After the application of tenfold cross-validation, the accuracy was 83.43%, and the AUC was 89.45%, which was significantly better than those of the other models. Analysis of the XGBoost model with the SHAP interpretable framework showed that a history of resuscitation, use of probiotics, milk opening time, interval between two stools and gestational age were the main factors affecting the occurrence of FI in preterm newborns, yielding importance scores of 0.632, 0.407, 0.313, 0.313, and 0.258, respectively. A history of resuscitation, first milk opening time ≥ 24 h and interval between stools ≥ 3 days were risk factors for FI, while the use of probiotics and gestational age ≥ 34 weeks were protective factors against FI in preterm newborns.

CONCLUSIONS

In practice, we should improve perinatal care and obstetrics with the aim of reducing the occurrence of hypoxia and preterm delivery. When feeding, early milk opening, the use of probiotics, the stimulation of defecation and other measures should be implemented with the aim of reducing the occurrence of FI.

The impact of impaired intrauterine growth on male fertility: A systematic review and meta-analysis

BACKGROUND

Adverse intrauterine environment was believed to have deleterious effects on the gonadal function. However, the association between impaired intrauterine growth and fertility in adult males has not been established.

OBJECTIVES

To compare the reproductive rates of males born small for gestational age (SGA), with low birth weight (LBW) or very low birth weight (VLBW) with control groups.

METHODS

The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement was followed to search PubMed, Web of Science, Cochrane Library, and Embase databases from inception to June 16, 2023. Cohort studies investigating the reproductive rates of males born SGA, with LBW or VLBW were included. A random or fixed effects model was used for different exposures.

RESULTS

A total of 10 studies out of 3,801 records were included. Males born SGA showed a higher risk of infertility than the control group (odds ratio, OR = 0.91, 95% confidence interval, 95% CI 0.89-0.93, p = 0.000). The reproductive rates of individuals born with LBW or VLBW were lower than the control group (OR = 0.86, 95% CI 0.78-0.94, p = 0.001; OR = 0.57, 95% CI 0.40-0.81, p = 0.002, respectively). Participants were further divided into two age groups of 18-35 and 35-45 years. In both subgroups, the reproductive rates were lower in males born SGA, with LBW or VLBW compared with controls. Sensitivity analysis showed the robustness of the pooled estimates among LBW and VLBW.

CONCLUSION

In summary, SGA, LBW, and VLBW were associated with a higher risk of male infertility in both early and middle adulthood. Achieving optimal intrauterine growth would be helpful to prevent male infertility.

Preeclampsia and Future Implications on Growth and Body Composition in Preterm Infants

BACKGROUND

Preeclampsia is associated with intrauterine growth restriction (IUGR), which can lead to impaired postnatal growth and neurodevelopment in preterm infants. Preeclampsia can also occur without IUGR and its impact on postnatal nutrition, growth, and body composition remains not fully investigated to the best of our knowledge.

METHODS

This study included infants born before 37 weeks of gestation who underwent air displacement plethysmography to measure body composition (fat-free mass [FFM] and fat mass [FM]) at term-equivalent age. We compared infants born to mothers with preeclampsia and IUGR (PE-IUGR group) and preeclampsia without IUGR (PE-non-IUGR group) to those born to mothers without preeclampsia (control group).

RESULTS

In total, 291 infants were enrolled (control: n = 227; PE-non-IUGR: n = 43; PE-IUGR: n = 21). FFM was significantly lower in the PE-IUGR (mean differences -231 g (IQR: (-373, -88); p < 0.001)) and PE-non-IUGR groups (mean differences -260 g (IQR: (-372, -149); p < 0.001)) in comparison to the control group. FM was not significantly different between the three groups.

CONCLUSIONS

This study indicates that infants of preeclamptic mothers, even without IUGR, had significantly lower FFM at term-equivalent age compared to the control group. Further research is necessary to determine if these variations can be modified.

Gestational exposure to PM2.5 disrupts fetal development by suppressing placental trophoblast syncytialization via progranulin/mTOR signaling

Recent epidemiological and animal studies have indicated that ambient fine particulate matter (PM2.5) exposure during pregnancy is closely associated with intrauterine growth restriction (IUGR). However, the underlying mechanisms remain to be revealed. In this study, we found that gestational exposure to PM2.5 significantly decreased fetal weight and crown-rump length in mice, accompanied by insufficient placental trophoblast syncytialization and increased expression of progranulin (PGRN) in mice placenta. Administering PGRN neutralizing antibody to pregnant mice alleviated growth restriction and insufficient placental trophoblast syncytialization caused by PM2.5, accompanied with suppressed activation of the mTOR signaling pathway. Furthermore, in vitro experiments using human placental BeWo cells showed that 10 μg·mL-1 PM2.5 activated PGRN/mTOR signaling and suppressed forskolin-induced cell fusion, which was blocked by knockdown of PGRN. Taken together, our results demonstrated that PM2.5 exposure during pregnancy inhibited placental trophoblast syncytialization by activating PGRN/mTOR signaling, leading to abnormal placental development and IUGR. This study reveals a novel mechanism underlying the developmental toxicity of PM2.5 exposure during pregnancy.

Bone Status and Early Nutrition in Preterm Newborns with and without Intrauterine Growth Restriction

Intrauterine growth restriction (IUGR) together with preterm birth could be harmful to bone health. The aim of the study was to examine bone status in IUGR versus non-IUGR preterms and to analyze the nutritional management best correlated with its improvement. Newborns < 34 weeks of gestational age (wGA), 75 IUGR and 75 non-IUGR, admitted to the Neonatal Intensive Care Unit of the University Hospital of Padova were enrolled and monitored from birth until 36 wGA through anthropometry (weight, length, head circumference, lower limb length (LLL)), biochemistry, bone quantitative ultrasound assessment of bone status (metacarpus bone transmission time, mc-BTT, us) and nutritional intakes monitoring during parenteral nutrition. IUGR compared to non-IUGR showed lower mean mc-BTT (0.45 vs. 0.51, p = 0.0005) and plasmatic phosphate (1.45 vs. 1.79, p < 0.001) at birth. Mc-BTT at 36 wGA, though equal between groups, correlated in IUGR newborns with basal phosphate, mean total energy of the first week and month (positively) and days to reach full enteral feeding (negatively). Lower i.v. vitamin D intake, LLL and prolonged total parenteral nutrition predicted worse mc-BTT at 36 wGA in the enrolled infants. These results suggest that preterms and in particular IUGR newborns need special nutritional care to promote bone development.

Effects of Intrauterine Growth Restriction (IUGR) on Growth and Body Composition Compared to Constitutionally Small Infants

(1) Intrauterine growth restriction (IUGR) is associated with multiple morbidities including growth restriction and impaired neurodevelopment. Small for gestational age (SGA) is defined as a birth weight <10th percentile, regardless of the etiology. The term is commonly used as a proxy for IUGR, but it may represent a healthy constitutionally small infant. Differentiating between IUGR and constitutionally small infants is essential for the nutritional management. (2) Infants born at <37 weeks of gestation between 2017 and 2022, who underwent body composition measurement (FFM: fat-free mass; FM: fat mass) at term-equivalent age, were included in this study. Infants with IUGR and constitutionally small infants (SGA) were compared to infants appropriate for gestational age (AGA). (3) A total of 300 infants (AGA: n = 249; IUGR: n = 40; SGA: n = 11) were analyzed. FFM (p < 0.001) and weight growth velocity (p = 0.022) were significantly lower in IUGR compared to AGA infants, but equal in SGA and AGA infants. FM was not significantly different between all groups. (4) The FFM Z-score was significantly lower in IUGR compared to AGA infants (p = 0.017). Being born constitutionally small compared to AGA had no impact on growth and body composition. These data showed that early aggressive nutritional management is essential in IUGR infants to avoid impaired growth and loss of FFM.