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Alexander T, Asadi S, Meyer M, Harding JE, Jiang Y, Alsweiler JM, Muelbert M, Bloomfield FH. Nutritional Support for Moderate-to-Late-Preterm Infants - A Randomized Trial. N Engl J Med 2024; 390:1493-1504. [PMID: 38657245 DOI: 10.1056/nejmoa2313942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND Most moderate-to-late-preterm infants need nutritional support until they are feeding exclusively on their mother's breast milk. Evidence to guide nutrition strategies for these infants is lacking. METHODS We conducted a multicenter, factorial, randomized trial involving infants born at 32 weeks 0 days' to 35 weeks 6 days' gestation who had intravenous access and whose mothers intended to breast-feed. Each infant was assigned to three interventions or their comparators: intravenous amino acid solution (parenteral nutrition) or dextrose solution until full feeding with milk was established; milk supplement given when maternal milk was insufficient or mother's breast milk exclusively with no supplementation; and taste and smell exposure before gastric-tube feeding or no taste and smell exposure. The primary outcome for the parenteral nutrition and the milk supplement interventions was the body-fat percentage at 4 months of corrected gestational age, and the primary outcome for the taste and smell intervention was the time to full enteral feeding (150 ml per kilogram of body weight per day or exclusive breast-feeding). RESULTS A total of 532 infants (291 boys [55%]) were included in the trial. The mean (±SD) body-fat percentage at 4 months was similar among the infants who received parenteral nutrition and those who received dextrose solution (26.0±5.4% vs. 26.2±5.2%; adjusted mean difference, -0.20; 95% confidence interval [CI], -1.32 to 0.92; P = 0.72) and among the infants who received milk supplement and those who received mother's breast milk exclusively (26.3±5.3% vs. 25.8±5.4%; adjusted mean difference, 0.65; 95% CI, -0.45 to 1.74; P = 0.25). The time to full enteral feeding was similar among the infants who were exposed to taste and smell and those who were not (5.8±1.5 vs. 5.7±1.9 days; P = 0.59). Secondary outcomes were similar across interventions. Serious adverse events occurred in one infant. CONCLUSIONS This trial of routine nutrition interventions to support moderate-to-late-preterm infants until full nutrition with mother's breast milk was possible did not show any effects on the time to full enteral feeding or on body composition at 4 months of corrected gestational age. (Funded by the Health Research Council of New Zealand and others; DIAMOND Australian New Zealand Clinical Trials Registry number, ACTRN12616001199404.).
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Affiliation(s)
- Tanith Alexander
- From Liggins Institute (T.A., S.A., J.E.H., M. Muelbert, F.H.B.), the Department of Statistics, Faculty of Science (Y.J.), and the Department of Paediatrics, Child and Youth Health (J.M.A.), University of Auckland, and the Neonatal Unit, Kidz First, Middlemore Hospital, Te Whatu Ora Counties Manukau (T.A., M. Meyer), Auckland, and Newborn Services, Starship Child Health, Te Toka Tumai Auckland, Te Whatu Ora (J.M.A.) - all in New Zealand
| | - Sharin Asadi
- From Liggins Institute (T.A., S.A., J.E.H., M. Muelbert, F.H.B.), the Department of Statistics, Faculty of Science (Y.J.), and the Department of Paediatrics, Child and Youth Health (J.M.A.), University of Auckland, and the Neonatal Unit, Kidz First, Middlemore Hospital, Te Whatu Ora Counties Manukau (T.A., M. Meyer), Auckland, and Newborn Services, Starship Child Health, Te Toka Tumai Auckland, Te Whatu Ora (J.M.A.) - all in New Zealand
| | - Michael Meyer
- From Liggins Institute (T.A., S.A., J.E.H., M. Muelbert, F.H.B.), the Department of Statistics, Faculty of Science (Y.J.), and the Department of Paediatrics, Child and Youth Health (J.M.A.), University of Auckland, and the Neonatal Unit, Kidz First, Middlemore Hospital, Te Whatu Ora Counties Manukau (T.A., M. Meyer), Auckland, and Newborn Services, Starship Child Health, Te Toka Tumai Auckland, Te Whatu Ora (J.M.A.) - all in New Zealand
| | - Jane E Harding
- From Liggins Institute (T.A., S.A., J.E.H., M. Muelbert, F.H.B.), the Department of Statistics, Faculty of Science (Y.J.), and the Department of Paediatrics, Child and Youth Health (J.M.A.), University of Auckland, and the Neonatal Unit, Kidz First, Middlemore Hospital, Te Whatu Ora Counties Manukau (T.A., M. Meyer), Auckland, and Newborn Services, Starship Child Health, Te Toka Tumai Auckland, Te Whatu Ora (J.M.A.) - all in New Zealand
| | - Yannan Jiang
- From Liggins Institute (T.A., S.A., J.E.H., M. Muelbert, F.H.B.), the Department of Statistics, Faculty of Science (Y.J.), and the Department of Paediatrics, Child and Youth Health (J.M.A.), University of Auckland, and the Neonatal Unit, Kidz First, Middlemore Hospital, Te Whatu Ora Counties Manukau (T.A., M. Meyer), Auckland, and Newborn Services, Starship Child Health, Te Toka Tumai Auckland, Te Whatu Ora (J.M.A.) - all in New Zealand
| | - Jane M Alsweiler
- From Liggins Institute (T.A., S.A., J.E.H., M. Muelbert, F.H.B.), the Department of Statistics, Faculty of Science (Y.J.), and the Department of Paediatrics, Child and Youth Health (J.M.A.), University of Auckland, and the Neonatal Unit, Kidz First, Middlemore Hospital, Te Whatu Ora Counties Manukau (T.A., M. Meyer), Auckland, and Newborn Services, Starship Child Health, Te Toka Tumai Auckland, Te Whatu Ora (J.M.A.) - all in New Zealand
| | - Mariana Muelbert
- From Liggins Institute (T.A., S.A., J.E.H., M. Muelbert, F.H.B.), the Department of Statistics, Faculty of Science (Y.J.), and the Department of Paediatrics, Child and Youth Health (J.M.A.), University of Auckland, and the Neonatal Unit, Kidz First, Middlemore Hospital, Te Whatu Ora Counties Manukau (T.A., M. Meyer), Auckland, and Newborn Services, Starship Child Health, Te Toka Tumai Auckland, Te Whatu Ora (J.M.A.) - all in New Zealand
| | - Frank H Bloomfield
- From Liggins Institute (T.A., S.A., J.E.H., M. Muelbert, F.H.B.), the Department of Statistics, Faculty of Science (Y.J.), and the Department of Paediatrics, Child and Youth Health (J.M.A.), University of Auckland, and the Neonatal Unit, Kidz First, Middlemore Hospital, Te Whatu Ora Counties Manukau (T.A., M. Meyer), Auckland, and Newborn Services, Starship Child Health, Te Toka Tumai Auckland, Te Whatu Ora (J.M.A.) - all in New Zealand
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Kulmaganbetov M, Leung M, Alsweiler JM, Black J, Bloomfield FH, Gamble GD, Harding JE, Jiang Y, Poppe T, Tottman AC, Wouldes TA, Thompson B. Associations between neonatal nutrition and visual outcomes in 7-year-old children born very preterm. Ophthalmic Physiol Opt 2024; 44:347-355. [PMID: 38069619 DOI: 10.1111/opo.13260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 11/10/2023] [Accepted: 11/25/2023] [Indexed: 02/08/2024]
Abstract
PURPOSE There is uncertainty about the effect of increased neonatal protein intake on neurodevelopmental outcomes following preterm birth. The aim of this study was to assess the effect of a change in neonatal nutrition protocol at a major tertiary neonatal intensive care unit intended to increase protein intake on ophthalmic and visual development in school-age children born very preterm. METHODS The study cohort comprised children (n = 128) with birthweight <1500 g or gestational age < 30 weeks born at Auckland City Hospital before (OldPro group, n = 55) and after (NewPro group, n = 73) a reformulation of parenteral nutrition that resulted in increased total protein intake during the first postnatal week and decreased carbohydrate, total parenteral fluid and sodium intake. Clinical and psychophysical vision assessments were completed at 7 years' corrected age, including visual acuity, global motion perception (a measure of dorsal stream function), stereoacuity, ocular motility and ocular health. Composite measures of favourable overall visual, binocular and functional visual outcomes along with individual vision measures were compared between the groups using logistic and linear regression models. RESULTS Favourable overall visual outcome did not differ between the two groups. However, global motion perception was better in the NewPro group (p = 0.04), whereas the OldPro group were more likely to have favourable binocular visual outcomes (60% vs. 36%, p = 0.02) and passing stereoacuity (p = 0.02). CONCLUSIONS These results indicate subtle but complex associations between early neonatal nutrition after very preterm birth and visual development at school age.
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Affiliation(s)
- Mukhit Kulmaganbetov
- Centre for Eye and Vision Research (CEVR), 17W Hong Kong Science Park, Hong Kong, Hong Kong
- Kazakh Eye Research Institute, Almaty, Kazakhstan
| | - Myra Leung
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
- Discipline of Optometry and Vision Science, University of Canberra, Canberra, Australian Capital Territory, Australia
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Jane M Alsweiler
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
- Newborn Services, National Women's Health, Auckland City Hospital, Auckland, New Zealand
| | - Joanna Black
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | | | - Greg D Gamble
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Jane E Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Yannan Jiang
- Department of Statistics, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Tanya Poppe
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Anna C Tottman
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Trecia A Wouldes
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Benjamin Thompson
- Centre for Eye and Vision Research (CEVR), 17W Hong Kong Science Park, Hong Kong, Hong Kong
- Liggins Institute, University of Auckland, Auckland, New Zealand
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada
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3
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Devane D, Ariff S, Battin MR, Biesty L, Bloomfield FH, Daly M, Healy P, Haas DM, Kirkham JJ, Kibet V, Koskei S, Meher S, Molloy EJ, Niaz M, Bhraonáin EN, Okaronon CO, Parkes MJ, Tabassum F, Walker K, Webbe JWH, Quirke FA. Optimising research for neonates with encephalopathy: the role of core outcome sets. Pediatr Res 2024; 95:869-870. [PMID: 38195940 PMCID: PMC10920186 DOI: 10.1038/s41390-023-03006-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 12/15/2023] [Indexed: 01/11/2024]
Affiliation(s)
- Declan Devane
- Health Research Board - Trials Methodology Research Network (HRB-TMRN), University of Galway, Galway, Ireland.
- Evidence Synthesis Ireland, University of Galway, Galway, Ireland.
- Cochrane Ireland, University of Galway, Galway, Ireland.
| | - Shabina Ariff
- Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan
| | - Malcolm R Battin
- Department of Newborn Services, Auckland District Health Board, Auckland, New Zealand
| | - Linda Biesty
- Evidence Synthesis Ireland, University of Galway, Galway, Ireland
| | - Frank H Bloomfield
- Liggins Institute, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Mandy Daly
- Advocacy and Policymaking, Irish Neonatal Health Alliance, Wicklow, Ireland
| | - Patricia Healy
- Evidence Synthesis Ireland, University of Galway, Galway, Ireland
| | - David M Haas
- Department of Obstetrics and Gynecology, Indiana University, Indianapolis, IN, USA
| | - Jamie J Kirkham
- Centre for Biostatistics, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | | | | | - Shireen Meher
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Eleanor J Molloy
- Health Research Board Neonatal Encephalopathy PhD Training Network (NEPTuNE), Dublin, Ireland
- Department of Paediatrics and Child Health, Trinity College Dublin, Dublin, Ireland
- Department of Neonatology, Children's Hospital Ireland at Crumlin and Tallaght, Dublin, Ireland
- Department of Neonatology, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Maira Niaz
- Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan
| | | | | | - Matthew J Parkes
- Centre for Biostatistics, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre (MAHSC), Manchester, UK
| | - Farhana Tabassum
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Karen Walker
- Department of Newborn Care, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- The George Institute for Global Health, Sydney, NSW, Australia
- Council of International Neonatal Nurses, Sydney, NSW, Australia
| | - James W H Webbe
- Academic Neonatal Medicine, Imperial College London, London, UK
| | - Fiona A Quirke
- Health Research Board - Trials Methodology Research Network (HRB-TMRN), University of Galway, Galway, Ireland
- Health Research Board Neonatal Encephalopathy PhD Training Network (NEPTuNE), Dublin, Ireland
- School of Medicine, University of Limerick, Limerick, Ireland
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Quirke FA, Ariff S, Battin MR, Bernard C, Biesty L, Bloomfield FH, Daly M, Finucane E, Healy P, Haas DM, Kirkham JJ, Kibet V, Koskei S, Meher S, Molloy EJ, Niaz M, Bhraonáin EN, Okaronon CO, Parkes MJ, Tabassum F, Walker K, Webbe JWH, Devane D. COHESION: a core outcome set for the treatment of neonatal encephalopathy. Pediatr Res 2024; 95:922-930. [PMID: 38135724 PMCID: PMC10920183 DOI: 10.1038/s41390-023-02938-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 08/24/2023] [Accepted: 09/18/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Heterogeneity in outcomes reported in trials of interventions for the treatment of neonatal encephalopathy (NE) makes evaluating the effectiveness of treatments difficult. Developing a core outcome set for NE treatment would enable researchers to measure and report the same outcomes in future trials. This would minimise waste, ensure relevant outcomes are measured and enable evidence synthesis. Therefore, we aimed to develop a core outcome set for treating NE. METHODS Outcomes identified from a systematic review of the literature and interviews with parents were prioritised by stakeholders (n = 99 parents/caregivers, n = 101 healthcare providers, and n = 22 researchers/ academics) in online Delphi surveys. Agreement on the outcomes was achieved at online consensus meetings attended by n = 10 parents, n = 18 healthcare providers, and n = 13 researchers/ academics. RESULTS Seven outcomes were included in the final core outcome set: survival; brain injury on imaging; neurological status at discharge; cerebral palsy; general cognitive ability; quality of life of the child, and adverse events related to treatment. CONCLUSION We developed a core outcome set for the treatment of NE. This will allow future trials to measure and report the same outcomes and ensure results can be compared. Future work should identify how best to measure the COS. IMPACT We have identified seven outcomes that should be measured and reported in all studies for the treatment of neonatal encephalopathy. Previously, a core outcome set for neonatal encephalopathy treatments did not exist. This will help to reduce heterogeneity in outcomes reported in clinical trials and other studies, and help researchers identify the best treatments for neonatal encephalopathy.
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Affiliation(s)
- Fiona A Quirke
- Health Research Board Neonatal Encephalopathy PhD Training Network (NEPTuNE), Dublin, Ireland.
- Health Research Board - Trials Methodology Research Network (HRB-TMRN), University of Galway, Galway, Ireland.
- School of Medicine, University of Limerick, Limerick, Ireland.
| | - Shabina Ariff
- Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan
| | - Malcolm R Battin
- Department of Newborn Services, Auckland District Health Board, Auckland, New Zealand
| | - Caitlin Bernard
- Department of Obstetrics and Gynecology, Indiana University, Indianapolis, IN, US
| | - Linda Biesty
- Evidence Synthesis Ireland, University of Galway, Galway, Ireland
| | - Frank H Bloomfield
- Liggins Institute, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Mandy Daly
- Advocacy and Policymaking, Irish Neonatal Health Alliance, Wicklow, Ireland
| | - Elaine Finucane
- Evidence Synthesis Ireland, University of Galway, Galway, Ireland
| | - Patricia Healy
- Evidence Synthesis Ireland, University of Galway, Galway, Ireland
| | - David M Haas
- Department of Obstetrics and Gynecology, Indiana University, Indianapolis, IN, US
| | - Jamie J Kirkham
- Centre for Biostatistics, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | | | | | - Shireen Meher
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Eleanor J Molloy
- Health Research Board Neonatal Encephalopathy PhD Training Network (NEPTuNE), Dublin, Ireland
- Department of Paediatrics and Child Health, Trinity College Dublin, Dublin, Ireland
- Department of Neonatology, Children's Hospital Ireland at Crumlin and Tallaght, Dublin, Ireland
- Department of Neonatology, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Maira Niaz
- Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan
| | | | | | - Matthew J Parkes
- Centre for Statistics in Medicine; Nuffield Dept of Orthopaedics Rheumatology and Musculoskeletal Science, University of Oxford, Oxfordshire, UK
| | - Farhana Tabassum
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Karen Walker
- Department of Newborn Care, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- The George Institute for Global Health, Sydney, NSW, Australia
- Council of International Neonatal Nurses, Sydney, NSW, Australia
| | - James W H Webbe
- Academic Neonatal Medicine, Imperial College London, London, UK
| | - Declan Devane
- Health Research Board - Trials Methodology Research Network (HRB-TMRN), University of Galway, Galway, Ireland
- Evidence Synthesis Ireland, University of Galway, Galway, Ireland
- Cochrane Ireland, University of Galway, Galway, Ireland
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Nyakotey DA, Clarke AM, Cormack BE, Bloomfield FH, Harding JE. Postnatal growth and neurodevelopment at 2 years' corrected age in extremely low birthweight infants. Pediatr Res 2024:10.1038/s41390-024-03054-1. [PMID: 38337041 DOI: 10.1038/s41390-024-03054-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 11/28/2023] [Accepted: 01/17/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Faltering postnatal growth in preterm babies is associated with adverse neurodevelopment. However, which growth reference is most helpful for predicting neurodevelopment is unknown. We examined associations between faltering growth and developmental delay in extremely low birthweight (ELBW) infants. METHODS We categorized faltering growth (z-score decrease ≥0.8 for weight/length, >1 for head circumference) between birth, 4 weeks, 36 weeks' postmenstrual age and 2 years' corrected age using fetal (Fenton, UK-WHO and Olsen) and healthy preterm (INTERGROWTH-21st) references. Associations between faltering growth and developmental delay were examined using binary logistic regression and area under the receiver operating curve (AUC). RESULTS In 327 infants, Olsen charts identified the highest prevalence of faltering growth (weight 37%, length 63%, head 45%). Agreement in classification was higher amongst fetal references (kappa coefficient, ĸ = 0.46-0.94) than between INTERGROWTH-21st and fetal references (ĸ = 0.10-0.81). Faltering growth in all measures between 4-36 weeks (odds ratio, OR 2.0-4.7) compared with other time intervals (OR 1.7-2.7) were more strongly associated with developmental delay, particularly motor delay (OR 2.0-4.7). All growth references were poorly predictive of developmental delay at 2 years (AUC ≤ 0.62). CONCLUSIONS Faltering postnatal growth in ELBW infants is associated with, but is poorly predictive of, developmental delay at 2 years. IMPACT In babies born preterm, different growth references result in wide variation in categorization of faltering postnatal growth. Faltering growth in weight, length, and head circumference from 4 weeks to 36 weeks' postmenstrual age are associated with developmental delay at 2 years' corrected age, particularly motor delay. However, postnatal growth is a poor predictor of later developmental delay in extremely low birthweight infants irrespective of the growth reference used.
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Affiliation(s)
- David A Nyakotey
- Liggins Institute, University of Auckland, Auckland, 1023, New Zealand
| | - Angelica M Clarke
- Liggins Institute, University of Auckland, Auckland, 1023, New Zealand
| | - Barbara E Cormack
- Liggins Institute, University of Auckland, Auckland, 1023, New Zealand
- Starship Child Health, Auckland City Hospital, Auckland, 1023, New Zealand
| | | | - Jane E Harding
- Liggins Institute, University of Auckland, Auckland, 1023, New Zealand.
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Caljé E, Groom KM, Dixon L, Marriott J, Foon R, Oyston C, Bloomfield FH, Jordan V. Intravenous iron versus blood transfusion for postpartum anemia: a systematic review and meta-analysis. Syst Rev 2024; 13:9. [PMID: 38169415 PMCID: PMC10759729 DOI: 10.1186/s13643-023-02400-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 11/22/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Intravenous iron (IV-iron) is used as an alternative to, or alongside, red blood cell transfusion (RBC-T) to treat more severe postpartum anemia (PPA), although optimal treatment options remain unclear. No previous systematic reviews have examined IV-iron and RBC-T, including patient-reported outcomes and hematological responses. METHODS A systematic review and meta-analysis of randomized trials comparing IV-iron and RBC-T with each other, oral iron, no treatment, and placebo for the treatment of PPA. Key inclusion criteria were PPA (hemoglobin < 12 g/dL) and IV-iron or RBC-T as interventions. Key exclusion criteria were antenatal IV-iron or RBC-T. Fatigue was the primary outcome. Secondary outcomes included hemoglobin and ferritin concentrations, and adverse events. From 27th August 2020 to 26th September 2022, databases, registries, and hand searches identified studies. A fixed-effect meta-analysis was undertaken using RevMan (5.4) software. The quality of the studies and the evidence was assessed using the Cochrane Risk of Bias table, and Grading of Recommendations, Assessment, Development, and Evaluation. This review is registered with the Prospective Register of Systematic Reviews (CRD42020201115). RESULTS Twenty studies and 4196 participants were included: 1834 assigned IV-iron, 1771 assigned oral iron, 330 assigned RBC-T, and 261 assigned non-intervention. Six studies reported the primary outcome of fatigue (1251 participants). Only studies of IV-iron vs. oral iron (15 studies) were available for meta-analysis. Of these, three reported on fatigue using different scales; two were available for meta-analysis. There was a significant reduction in fatigue with IV-iron compared to oral iron (standardized mean difference - 0.40, 95% confidence interval (CI) - 0.62, - 0.18, I2 = 0%). The direction of effect also favored IV-iron for hemoglobin (mean difference (MD) 0.54 g/dL, 95% confidence interval (CI) 0.47, 0.61, I2 = 91%), ferritin, (MD 58.07 mcg/L, 95% CI 55.74, 60.41, I2 = 99%), and total adverse events (risk-ratio 0.63, 95% CI 0.52, 0.77, I2 = 84%). The overall quality of the evidence was low-moderate. DISCUSSION For all outcomes, the evidence for RBC-T, compared to IV-iron, non-intervention, or dose effects of RBC-T is very limited. Further research is needed to determine whether RBC-T or IV-iron for the treatment of PPA is superior for fatigue and hematological outcomes.
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Affiliation(s)
- E Caljé
- Liggins Institute, University of Auckland, Auckland, New Zealand.
| | - K M Groom
- Liggins Institute, University of Auckland, Auckland, New Zealand
- National Women's Health, Auckland City Hospital, Auckland, New Zealand
| | - L Dixon
- New Zealand College of Midwives, Christchurch, New Zealand
| | - J Marriott
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - R Foon
- Waikato Hospital, Hamilton, New Zealand
| | - C Oyston
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
- Middlemore Hospital, Auckland, New Zealand
| | - F H Bloomfield
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - V Jordan
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
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7
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Meiliana M, Alexander T, Bloomfield FH, Cormack BE, Harding JE, Walsh O, Lin L. Nutrition guidelines for preterm infants: A systematic review. JPEN J Parenter Enteral Nutr 2024; 48:11-26. [PMID: 37855274 DOI: 10.1002/jpen.2568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/21/2023] [Accepted: 10/16/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND There is no consensus on optimal nutrition for preterm infants, leading to substantial practice variation. We aimed to assess the quality of nutrition guidelines for preterm infants, the consistency of recommendations, and the gaps in recommendations. METHODS We searched databases and websites for nutrition guidelines for preterm infants before first hospital discharge, which were endorsed, prepared, or authorized by a regional, national, or international body, written in English, and published between 2012 and 2023. Two reviewers independently screened articles and extracted the recommendations. Four reviewers appraised the included guidelines using Appraisal of Guidelines, Research, and Evaluation II. RESULTS A total of 7051 were identified, with 27 guidelines included, 26% of which were high in quality. Most guidelines lacked stakeholder involvement and rigor of development. We found considerable variation in recommendations, many of which lacked details on certainty of evidence and strength of recommendation. Recommendations for type of feed and breastmilk fortification were consistent among high-quality guidelines, but recommendations varied for intakes of almost all nutrients and monitoring of nutrition adequacy. Different guidelines gave different certainty of evidence for the same recommendations. Most gaps in recommendations were due to very low certainty of evidence. CONCLUSION Future development of nutrition guidelines for preterm infants should follow the standard guideline development method and ensure the rigorous process, including stakeholders' involvement, to improve the reporting of strength of recommendation, certainty of evidence, and gaps in recommendation. Evidence is needed to support recommendations about macro and micronutrient intakes, breastmilk fortification, and markers on adequacy of intake of different nutrients.
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Affiliation(s)
| | - Tanith Alexander
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Neonatal Unit, Kidz First, Middlemore Hospital, Auckland, New Zealand
| | | | | | - Jane E Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Orla Walsh
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Luling Lin
- Liggins Institute, University of Auckland, Auckland, New Zealand
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8
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Molloy EJ, Branagan A, Hurley T, Quirke F, Devane D, Taneri PE, El-Dib M, Bloomfield FH, Maeso B, Pilon B, Bonifacio SL, Wusthoff CJ, Chalak L, Bearer C, Murray DM, Badawi N, Campbell S, Mulkey S, Gressens P, Ferriero DM, de Vries LS, Walker K, Kay S, Boylan G, Gale C, Robertson NJ, D'Alton M, Gunn A, Nelson KB. Neonatal encephalopathy and hypoxic-ischemic encephalopathy: moving from controversy to consensus definitions and subclassification. Pediatr Res 2023; 94:1860-1863. [PMID: 37573378 DOI: 10.1038/s41390-023-02775-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/09/2023] [Accepted: 05/24/2023] [Indexed: 08/14/2023]
Affiliation(s)
- Eleanor J Molloy
- Discipline of Paediatrics, Trinity College Dublin, the University of Dublin, Dublin, Ireland.
- Trinity Translational Medicine Institute (TTMI), St James Hospital & Trinity Research in Childhood Centre (TRiCC), Dublin, Ireland.
- Neurodisability, Children's Hospital Ireland (CHI) at Tallaght, Dublin, Ireland.
- Neonatology, CHI at Crumlin, Dublin, Ireland.
- Paediatrics, The Coombe Hospital, Dublin, Ireland.
| | - Aoife Branagan
- Discipline of Paediatrics, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity Translational Medicine Institute (TTMI), St James Hospital & Trinity Research in Childhood Centre (TRiCC), Dublin, Ireland
- Paediatrics, The Coombe Hospital, Dublin, Ireland
- Health Research Board Neonatal Encephalopathy PhD Training Network (NEPTuNE), Dublin, Ireland
| | - Tim Hurley
- Discipline of Paediatrics, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity Translational Medicine Institute (TTMI), St James Hospital & Trinity Research in Childhood Centre (TRiCC), Dublin, Ireland
- Health Research Board Neonatal Encephalopathy PhD Training Network (NEPTuNE), Dublin, Ireland
| | - Fiona Quirke
- Health Research Board Neonatal Encephalopathy PhD Training Network (NEPTuNE), Dublin, Ireland
- Health Research Board-Trials Methodology Research Network (HRB-TMRN), University of Galway, Galway, Ireland
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
| | - Declan Devane
- Health Research Board-Trials Methodology Research Network (HRB-TMRN), University of Galway, Galway, Ireland
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
- Evidence Synthesis Ireland, University of Galway, Galway, Ireland
- Cochrane Ireland, University of Galway, Galway, Ireland
| | - Petek E Taneri
- Health Research Board-Trials Methodology Research Network (HRB-TMRN), University of Galway, Galway, Ireland
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
| | - Mohamed El-Dib
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Beccy Maeso
- James Lind Alliance, School of Healthcare Enterprise and Innovation, University of Southampton, Southampton, UK
| | | | - Sonia L Bonifacio
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Lina Chalak
- Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Cynthia Bearer
- Division of Neonatology, Department of Pediatrics, Rainbow Babies & Children's Hospital, Cleveland, OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Deirdre M Murray
- INFANT Research Centre, Cork, Ireland
- Department of Pediatrics and Child Health, University College Cork, Cork, Ireland
| | - Nadia Badawi
- Cerebral Palsy Alliance Research Institute, Specialty of Child & Adolescent Health, Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, Sydney, NSW, Australia
- Grace Centre for Newborn Intensive Care, Sydney Children's Hospital Network, The University of Sydney, Westmead, NSW, Australia
| | - Suzann Campbell
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Sarah Mulkey
- Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA
- Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Pierre Gressens
- Université Paris Cité, NeuroDiderot, Inserm, F-75019, Paris, France
| | - Donna M Ferriero
- Department of Pediatrics and Neurology, University of California San Francisco, Weill Institute for Neurosciences, San Francisco, CA, 94158, USA
| | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Karen Walker
- Department of Newborn Care, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | | | - Geraldine Boylan
- INFANT Research Centre, Cork, Ireland
- Department of Pediatrics and Child Health, University College Cork, Cork, Ireland
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Chelsea and Westminster Campus, Imperial College London, London, UK
| | - Nicola J Robertson
- Institute for Women's Health, University College London, London, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Mary D'Alton
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - Alistair Gunn
- Departments of Physiology and Paediatrics, School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - Karin B Nelson
- National Institutes of Health, National Institute of Neurological Diseases and Stroke, Bethesda, MD, USA
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9
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Quirke FA, Battin MR, Bernard C, Biesty L, Bloomfield FH, Daly M, Finucane E, Haas DM, Healy P, Hurley T, Koskei S, Meher S, Molloy EJ, Niaz M, Bhraonáin EN, Okaronon CO, Tabassum F, Walker K, Webbe JRH, Parkes MJ, Kirkham JJ, Devane D. Multi-Round versus Real-Time Delphi survey approach for achieving consensus in the COHESION core outcome set: a randomised trial. Trials 2023; 24:461. [PMID: 37468987 DOI: 10.1186/s13063-023-07388-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 05/18/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Delphi surveys are commonly used to prioritise critical outcomes in core outcome set (COS) development. This trial aims to compare a three-round (Multi-Round) Delphi (MRD) with a Real-Time Delphi (RTD) in the prioritisation of outcomes for inclusion in a COS for neonatal encephalopathy treatments and explore whether 'feedback', 'iteration', and 'initial condition' effects may occur in the two survey methods. METHODS We recruited 269 participants (parents/caregivers, healthcare providers and researchers/academics) of which 222 were randomised to either the MRD or the RTD. We investigated the outcomes prioritised in each survey and the 'feedback', 'iteration', and 'initial condition' effects to identify differences between the two survey methods. RESULTS In the RTD, n = 92 participants (83%) fully completed the survey. In the MRD, n = 60 participants (54%) completed all three rounds. Of the 92 outcomes presented, 26 (28%) were prioritised differently between the RTD and MRD. Significantly fewer participants amended their scores when shown stakeholder responses in the RTD compared to the MRD ('feedback effect'). The 'iteration effect' analysis found most experts appeared satisfied with their initial ratings in the RTD and did not amend their scores following stakeholder response feedback. Where they did amend their scores, ratings were amended substantially, suggesting greater convergence. Variance in scores reduced with subsequent rounds of the MRD ('iteration effect'). Whilst most participants did not change their initial scores in the RTD, of those that did, later recruits tended to align their final score more closely to the group mean final score than earlier recruits (an 'initial condition' effect). CONCLUSION The feedback effect differed between the two Delphi methods but the magnitude of this difference was small and likely due to the large number of observations rather than because of a meaningfully large difference. It did not appear to be advantageous to require participants to engage in three rounds of a survey due to the low change in scores. Larger drop-out through successive rounds in the MRD, together with a lesser convergence of scores and longer time to completion, indicate considerable benefits of the RTD approach. TRIAL REGISTRATION NCT04471103. Registered on 14 July 2020.
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Affiliation(s)
- Fiona A Quirke
- Health Research Board Neonatal Encephalopathy PhD Training Network (NEPTuNE), Dublin, Ireland.
- Health Research Board - Trials Methodology Research Network (HRB-TMRN), Galway, Ireland.
- School of Nursing and Midwifery, University of Galway, Galway, Ireland.
| | - Malcolm R Battin
- Department of Newborn Services, Auckland District Health Board, Auckland, New Zealand
| | - Caitlin Bernard
- Department of Obstetrics and Gynecology, Indiana University, Indianapolis, IN, USA
| | - Linda Biesty
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
- Evidence Synthesis Ireland, University of Galway, Galway, Ireland
- Qualitative Research in Trials Centre (QUESTS), University of Galway, Galway, Ireland
| | - Frank H Bloomfield
- Liggins Institute, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Mandy Daly
- Advocacy and Policymaking, Irish Neonatal Health Alliance, Wicklow, Ireland
| | - Elaine Finucane
- Evidence Synthesis Ireland, University of Galway, Galway, Ireland
| | - David M Haas
- Department of Obstetrics and Gynecology, Indiana University, Indianapolis, IN, USA
| | - Patricia Healy
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
- Evidence Synthesis Ireland, University of Galway, Galway, Ireland
| | - Tim Hurley
- Health Research Board Neonatal Encephalopathy PhD Training Network (NEPTuNE), Dublin, Ireland
- Department of Paediatric and Child Health, Trinity College Dublin, Tallaght University Hospital (TUH), Dublin, Ireland
| | | | - Shireen Meher
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Eleanor J Molloy
- Health Research Board Neonatal Encephalopathy PhD Training Network (NEPTuNE), Dublin, Ireland
- Paediatrics and Child Health, Trinity College Dublin, Dublin, Ireland
- Department of Neonatology, Children's Hospital Ireland at Crumlin and Tallaght, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Maira Niaz
- Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan
| | | | | | - Farhana Tabassum
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Karen Walker
- Department of Newborn Care, Royal Prince Alfred Hospital, Sydney, Australia
- University of Sydney, Sydney, Australia
- The George Institute for Global Health, Sydney, Australia
- Council of International Neonatal Nurses, Sydney, Australia
| | - James R H Webbe
- Academic Neonatal Medicine, Imperial College London, London, UK
| | - Matthew J Parkes
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Science, University of Oxford, Oxfordshire, UK
| | - Jamie J Kirkham
- Centre for Biostatistics, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Declan Devane
- Health Research Board Neonatal Encephalopathy PhD Training Network (NEPTuNE), Dublin, Ireland
- Health Research Board - Trials Methodology Research Network (HRB-TMRN), Galway, Ireland
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
- Cochrane Ireland, University of Galway, Galway, Ireland
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10
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May RW, Maso Talou GD, Clark AR, Mynard JP, Smolich JJ, Blanco PJ, Müller LO, Gentles TL, Bloomfield FH, Safaei S. From fetus to neonate: A review of cardiovascular modeling in early life. WIREs Mech Dis 2023:e1608. [DOI: 10.1002/wsbm.1608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 01/31/2023] [Accepted: 03/03/2023] [Indexed: 04/03/2023]
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11
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Aoyama T, Alexander T, Asadi S, Harding JE, Meyer MP, Jiang Y, Bloomfield FH. Determinants of handgrip strength at age 2 years in children born moderate and late preterm and associations with neurodevelopmental outcomes. Early Hum Dev 2023; 180:105750. [PMID: 37003126 DOI: 10.1016/j.earlhumdev.2023.105750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Handgrip strength (HGS) indicates current and future health. Although preterm infants have an increased risk of poor grip strength in later life, its determinants and relationship with neurodevelopment are not well understood. AIMS To determine HGS in children born preterm and explore the relationship of HGS with demography, anthropometry, nutritional factors, and neurodevelopmental outcomes. STUDY DESIGN A prospective cohort study of moderate-late preterm babies enrolled in a randomised trial of nutritional support strategies, the DIAMOND trial. SUBJECTS A total of 116 children born between 32 and 35 weeks' gestation, whose HGS was measured at 2 years' corrected age. OUTCOME MEASURES HGS was measured using a dynamometer, and neurodevelopment was assessed using the Bayley Scales of Infant Development-III. Anthropometry and body composition were assessed at birth, discharge, and at 4 months' and 2 years' corrected age. Information on demographics and breastfeeding practices, including type of milk at discharge and duration of exclusive breastfeeding, was collected using questionnaires. RESULTS The mean (standard deviation) HGS was 2.26 (1.07) kg. The Bayley scores were < 85 (-1 standard deviation) in 6 %, 20 %, and 1 % for the cognitive, language, and motor scales, respectively. Multiple regression analysis revealed that HGS was positively associated with language and motor scores (p < .05) after adjusting for confounding factors. HGS was not associated with sex, anthropometry, body composition, or breastfeeding practices. Maternal education was independently associated with HGS (p < .01). CONCLUSIONS HGS at age 2 years in children born moderate-late preterm is associated with language and motor development and maternal education level.
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Affiliation(s)
- Tomoko Aoyama
- Liggins Institute, University of Auckland, Auckland, New Zealand; National Institutes of Biomedical Innovation, Health and Nutrition, Japan.
| | - Tanith Alexander
- Liggins Institute, University of Auckland, Auckland, New Zealand; Neonatal Unit, Kidz First, Middlemore Hospital, Auckland, New Zealand
| | - Sharin Asadi
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Jane E Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Michael P Meyer
- Neonatal Unit, Kidz First, Middlemore Hospital, Auckland, New Zealand
| | - Yannan Jiang
- Department of Statistics, Faculty of Science, University of Auckland, New Zealand
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12
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Lin L, St Clair S, Gamble GD, Crowther CA, Dixon L, Bloomfield FH, Harding JE. Nitrate contamination in drinking water and adverse reproductive and birth outcomes: a systematic review and meta-analysis. Sci Rep 2023; 13:563. [PMID: 36631499 PMCID: PMC9834225 DOI: 10.1038/s41598-022-27345-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/30/2022] [Indexed: 01/13/2023] Open
Abstract
Exposure to low levels of nitrate in drinking water may have adverse reproductive effects. We reviewed evidence about the association between nitrate in drinking water and adverse reproductive outcomes published to November 2022. Randomized trials, cohort or case-control studies published in English that reported the relationship between nitrate intake from drinking water and the risk of perinatal outcomes were included. Random-effect models were used to pool data. Three cohort studies showed nitrate in drinking water is associated with an increased risk of preterm birth (odds ratio for 1 mg/L NO3-N increased (OR1) = 1.01, 95% CI 1.00, 1.01, I2 = 23.9%, 5,014,487 participants; comparing the highest versus the lowest nitrate exposure groups pooled OR (ORp) = 1.05, 95% CI 1.01, 1.10, I2 = 0%, 4,152,348 participants). Case-control studies showed nitrate in drinking water may be associated with the increased risk of neural tube defects OR1 = 1.06, 95% CI 1.02, 1.10; 2 studies, 2196 participants; I2 = 0%; and ORp = 1.51, 95% CI 1.12, 2.05; 3 studies, 1501 participants; I2 = 0%). The evidence for an association between nitrate in drinking water and risk of small for gestational age infants, any birth defects, or any congenital heart defects was inconsistent. Increased nitrate in drinking water may be associated with an increased risk of preterm birth and some specific congenital anomalies. These findings warrant regular review as new evidence becomes available.
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Affiliation(s)
- Luling Lin
- grid.9654.e0000 0004 0372 3343Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Sophie St Clair
- grid.9654.e0000 0004 0372 3343Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Greg D. Gamble
- grid.9654.e0000 0004 0372 3343Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Caroline A. Crowther
- grid.9654.e0000 0004 0372 3343Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Lesley Dixon
- New Zealand College of Midwives, 376 Manchester Street, Richmond, Christchurch, 8014 New Zealand
| | - Frank H. Bloomfield
- grid.9654.e0000 0004 0372 3343Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Jane E. Harding
- grid.9654.e0000 0004 0372 3343Liggins Institute, University of Auckland, Auckland, New Zealand
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13
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Oliver MH, Jaquiery AL, Connor KL, Phua HH, Harding JE, Thorstensen EB, Bloomfield FH. Effect of maternal periconceptional undernutrition in sheep on cortisol regulation in offspring from mid-late gestation, through to adulthood. Front Endocrinol (Lausanne) 2023; 14:1122432. [PMID: 36817600 PMCID: PMC9932192 DOI: 10.3389/fendo.2023.1122432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/20/2023] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Maternal periconceptional undernutrition (PCUN) alters fetal hypothalamic-pituitary-adrenal axis (HPAA) function and placental glucocorticoid metabolism in sheep. The effects of PCUN on HPAA function in adult life are not known. We investigated the effects of PCUN on fetal adrenal development across gestation and on cortisol regulation in adult offspring. METHODS Ewes were undernourished from 61 days before to 30 days after conception ('PCUN') or fed ad libitum ('N'). mRNA expression in the fetal adrenal gland of ACTH receptor (ACTHR), steroidogenic acute regulatory protein (STAR), cytochrome P450 17A1 (CYP17A1), 11beta-hydroxysteroid-dehydrogenase type 2 (11βHSD2), insulin-like growth factor-2 (IGF2), and in the fetal hippocampus of 11βHSD1, 11βHSD2, mineralocorticoid receptor (MR) and glucocorticoid receptor (GR) was determined at 50 (adrenal only), 85, 120 and 131 days of gestation (term=148 days). In adult offspring (≥ 3 years, N; 10 female, 5 male, PCUN; 10 female, 10 male) a combined arginine vasopressin (AVP, 0.1 μg/kg) and corticotropin-releasing hormone (CRH, 0.5 μg/kg) challenge and a metyrapone (40 mg/kg) challenge were undertaken. mRNA expression of ACTHR, STAR and CYP17A1 were determined in adult adrenals. RESULTS Fetal adrenal STAR, CYP17A1 and IGF2 mRNA expression were not different between groups in early gestation but were higher in PCUN than N at 131 days' gestation (all p<0.01). PCUN reduced fetal hippocampal MR and GR mRNA expression by 50% at 85 day, but not in later gestation. Adult offspring plasma cortisol responses to AVP+CRH or metyrapone were not different between groups. Plasma ACTH response to AVP+CRH was lower in PCUN males but ACTH response to metyrapone was not different between groups. Adult adrenal ACTHR, STAR, and CYP17A1 mRNA expression were not affected by PCUN. CONCLUSIONS We conclude that the effects of PCUN on fetal HPAA function that became apparent in late gestation, are not reflected in adrenal cortisol secretion in mid-adulthood.
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Affiliation(s)
- Mark H. Oliver
- Liggins Institute, University of Auckland, Auckland, New Zealand
- *Correspondence: Mark H. Oliver,
| | - Anne L. Jaquiery
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Kristin L. Connor
- Department of Health Sciences, Carleton University, Ottawa, ON, Canada
| | - Hui Hui Phua
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Jane E. Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
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14
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Abstract
BACKGROUND Whether higher parenteral amino acid intake improves outcomes in infants with extremely low birth weight is unclear. METHODS In this multicenter, parallel-group, double-blind, randomized, placebo-controlled trial, we assigned infants with birth weights of less than 1000 g at 8 neonatal intensive care units to receive amino acids at a dose of 1 g per day (intervention group) or placebo in addition to usual nutrition for the first 5 days after birth. The primary outcome was survival free from neurodisability as assessed with the Bayley Scales of Infant and Toddler Development and neurologic examination at 2 years, corrected for gestational age at birth. Secondary outcomes were the components of the primary outcome as well as the presence or absence of neonatal disorders, the rate of growth, and nutritional intake. RESULTS We enrolled 434 infants (217 per group) in this trial. Survival free from neurodisability was observed in 97 of 203 children (47.8%) in the intervention group and in 102 of 205 (49.8%) in the placebo group (adjusted relative risk, 0.95; 95% confidence interval [CI], 0.79 to 1.14; P = 0.56). Death before the age of 2 years occurred in 39 of 217 children (18.0%) in the intervention group and 42 of 217 (19.4%) in the placebo group (adjusted relative risk, 0.93; 95% CI, 0.63 to 1.36); neurodisability occurred in 67 of 164 children (40.9%) in the intervention group and 61 of 163 (37.4%) in the placebo group (adjusted relative risk, 1.16; 95% CI, 0.90 to 1.50). Neurodisability was moderate to severe in 27 children (16.5%) in the intervention group and 14 (8.6%) in the placebo group (adjusted relative risk, 1.95; 95% CI, 1.09 to 3.48). More children in the intervention group than in the placebo group had patent ductus arteriosus (adjusted relative risk, 1.65; 95% CI, 1.11 to 2.46). In a post hoc analysis, refeeding syndrome occurred in 42 of 172 children in the intervention group and 26 of 166 in the placebo group (adjusted relative risk, 1.64; 95% CI, 1.09 to 2.47). Eight serious adverse events occurred. CONCLUSIONS In infants with extremely low birth weight, extra parenteral amino acids at a dose of 1 g per day for 5 days after birth did not increase the number who survived free from neurodisability at 2 years. (Funded by the New Zealand Health Research Council and others; ProVIDe Australian New Zealand Clinical Trials Registry number, ACTRN12612001084875.).
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Affiliation(s)
- Frank H Bloomfield
- From the Liggins Institute (F.H.B., Y.J., J.E.H., C.A.C., B.E.C.) and the Department of Statistics, (Y.J.), University of Auckland, and Newborn Services, Auckland City Hospital (F.H.B., B.E.C.) - all in Auckland, New Zealand
| | - Yannan Jiang
- From the Liggins Institute (F.H.B., Y.J., J.E.H., C.A.C., B.E.C.) and the Department of Statistics, (Y.J.), University of Auckland, and Newborn Services, Auckland City Hospital (F.H.B., B.E.C.) - all in Auckland, New Zealand
| | - Jane E Harding
- From the Liggins Institute (F.H.B., Y.J., J.E.H., C.A.C., B.E.C.) and the Department of Statistics, (Y.J.), University of Auckland, and Newborn Services, Auckland City Hospital (F.H.B., B.E.C.) - all in Auckland, New Zealand
| | - Caroline A Crowther
- From the Liggins Institute (F.H.B., Y.J., J.E.H., C.A.C., B.E.C.) and the Department of Statistics, (Y.J.), University of Auckland, and Newborn Services, Auckland City Hospital (F.H.B., B.E.C.) - all in Auckland, New Zealand
| | - Barbara E Cormack
- From the Liggins Institute (F.H.B., Y.J., J.E.H., C.A.C., B.E.C.) and the Department of Statistics, (Y.J.), University of Auckland, and Newborn Services, Auckland City Hospital (F.H.B., B.E.C.) - all in Auckland, New Zealand
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15
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Poindexter BB, Cormack BE, Bloomfield FH. [Abordaje del retraso en el crecimiento]. World Rev Nutr Diet 2022; 122:336-349. [PMID: 36174524 DOI: 10.1159/000526529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Brenda B Poindexter
- Division of Neonatology, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Barbara E Cormack
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Newborn Services, Starship Child Health, Auckland City Hospital, Auckland, New Zealand
| | - Frank H Bloomfield
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Newborn Services, Starship Child Health, Auckland City Hospital, Auckland, New Zealand
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16
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Muelbert M, Alexander T, Vickers MH, Harding JE, Galante L, Bloomfield FH. Glucocorticoids in preterm human milk. Front Nutr 2022; 9:965654. [PMID: 36238462 PMCID: PMC9552215 DOI: 10.3389/fnut.2022.965654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/29/2022] [Indexed: 11/17/2022] Open
Abstract
Background Glucocorticoids (GCs), cortisol and cortisone, are essential regulators of many physiological responses, including immunity, stress and mammary gland function. GCs are present in human milk (HM), but whether maternal and infant factors are associated with HM GC concentration following preterm birth is unclear. Materials and methods HM samples were collected on postnatal day 5 and 10 and at 4 months’ corrected age (4m CA) in a cohort of moderate- and late-preterm infants. GCs in HM were measured by liquid chromatography-tandem mass spectrometry. Relationships between GCs in HM and both maternal and infant characteristics were investigated using Spearman’s correlations and linear mixed models. Results 170 mothers of 191 infants provided 354 HM samples. Cortisol concentrations in HM increased from postnatal day 5–4m CA (mean difference [MD] 0.6 ± 0.1 ng/ml, p < 0.001). Cortisone concentration did not change across lactation but was higher than cortisol throughout. Compared to no antenatal corticosteroid (ANS), a complete course of ANS was associated with lower GC concentrations in HM through to 4m CA (cortisol: MD –0.3 ± 0.1 ng/ml, p < 0.01; cortisone MD –1.8 ± 0.4 ng/ml, p < 0.001). At 4m CA, higher maternal perceived stress was negatively associated with GC concentrations in HM (cortisol adjusted beta-coefficient [aβ] –0.01 ± 0.01 ng/ml, p = 0.05; and cortisone aβ –0.1 ± 0.03 ng/ml, p = 0.01), whereas higher postpartum depression and maternal obesity were associated with lower cortisone concentrations (aβ –0.1 ± 0.04 ng/ml p < 0.05; MD [healthy versus obese] –0.1 ± 0.04 ng/ml p < 0.05, respectively). There was a weak positive correlation between GC concentrations in HM and gestational age at birth (r = 0.1, p < 0.05). Infant birth head circumference z-score was negatively associated with cortisol concentrations (aβ –0.01 ± 0.04 ng/ml, p < 0.05). At hospital discharge, fat-free mass showed a weak positive correlation with cortisol concentrations (r = 0.2, p = 0.03), while fat mass showed a weak negative correlation with cortisone concentrations (r = –0.25, p < 0.001). Conclusion The mammary gland appears to protect the infant from cortisol through inactivation into cortisone. Maternal and infant characteristics were associated with concentration of GCs in HM, including ANS, stress and depression scores, obesity, gestational age and infant size. The effects of HM glucocorticoids on long-term health outcomes requires further research.
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Affiliation(s)
- Mariana Muelbert
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Tanith Alexander
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Neonatal Unit, Kidz First, Middlemore Hospital, Auckland, New Zealand
| | - Mark H. Vickers
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Jane E. Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Laura Galante
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Frank H. Bloomfield
- Liggins Institute, University of Auckland, Auckland, New Zealand
- *Correspondence: Frank H. Bloomfield,
| | - the DIAMOND study groupMuelbertMariana1AlexanderTanith12GalanteLaura1AsadiSharin1ChongClara Y.L.1AlsweilerJane M.34BekerFriederike56BloomfieldFrank H.13Cameron-SmithDavid1CrowtherCaroline A.1HardingJane E.1JiangYannan7MeyerMichael P.24MilanAmber18o’SullivanJustin M.1WallClare R.91Liggins Institute, University of Auckland, Auckland, New Zealand2Neonatal Unit, Kidz First, Middlemore Hospital, Auckland, New Zealand3Newborn Services, Auckland City Hospital, Auckland, New Zealand4Department of Paediatrics: Child and Youth Health.5Department of Newborn Services, Mater Mothers’ Hospital, Brisbane, QLD, Australia6Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia7Department of Statistics, Faculty of Science, University of Auckland, Auckland, New Zealand8Food and Bio-based Products, AgResearch Grasslands, Palmerston North, New Zealand9Department of Nutrition, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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17
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Quirke F, Ariff S, Battin M, Bernard C, Bloomfield FH, Daly M, Devane D, Haas DM, Healy P, Hurley T, Kibet V, Kirkham JJ, Koskei S, Meher S, Molloy E, Niaz M, Ní Bhraonáin E, Okaronon CO, Tabassum F, Walker K, Biesty L. Core outcomes in neonatal encephalopathy: a qualitative study with parents. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2022-001550. [PMID: 36053648 PMCID: PMC9328095 DOI: 10.1136/bmjpo-2022-001550] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/07/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To identify the outcomes considered important to parents or caregivers of infants diagnosed with neonatal encephalopathy, hypoxic ischaemic encephalopathy or birth asphyxia in high-income and low- to middle-income countries (LMiCs), as part of the outcome-identification process in developing a core outcome set (COS) for the treatment of neonatal encephalopathy. DESIGN A qualitative study involving 25 semistructured interviews with parents or other family members (caregivers) of infants who were diagnosed with, and treated for, neonatal encephalopathy, hypoxic ischaemic encephalopathy or birth asphyxia. SETTING Interviews were conducted in high-income countries (HiCs) (n=11) by Zoom video conferencing software and in LMiCs (n=14) by phone or face to face. FINDINGS Parents identified 54 outcomes overall, which mapped to 16 outcome domains. The domains identified were neurological outcomes, respiratory outcomes, gastrointestinal outcomes, cardiovascular outcomes, motor development, cognitive development, development (psychosocial), development (special senses), cognitive development, development (speech and social), other organ outcomes, survival/living outcomes, long-term disability, hospitalisation, parent-reported outcomes and adverse events. CONCLUSIONS This study provides insight into the outcomes that parents of infants diagnosed with neonatal encephalopathy have identified as the most important, to be considered in the process of developing a COS for the treatment of neonatal encephalopathy. We also provide description of the processes employed to ensure the inclusion of participants from LMiCs as well as HiCs.
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Affiliation(s)
- Fiona Quirke
- Health Research Board - Neonatal Encephalopathy PhD Training Network (NEPTuNE), Trinity College Dublin, Dublin, Ireland .,Health Research Board-Trials Methodology Research Network (HRB-TMRN), Galway, Ireland.,School of Nursing & Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Shabina Ariff
- Department of Pediatrics & Child Health, The Aga Khan University, Karachi, Pakistan
| | | | - Caitlin Bernard
- Department of Obstetrics and Gynecology, Indiana University, Bloomington, Indiana, USA
| | | | - Mandy Daly
- Advocacy and Policymaking Irish Neonatal Health Alliance, Wicklow, Ireland
| | - Declan Devane
- Health Research Board - Neonatal Encephalopathy PhD Training Network (NEPTuNE), Trinity College Dublin, Dublin, Ireland.,Health Research Board-Trials Methodology Research Network (HRB-TMRN), Galway, Ireland.,School of Nursing & Midwifery, National University of Ireland Galway, Galway, Ireland.,Evidence Synthesis Ireland, National University of Ireland Galway, Galway, Ireland.,Cochrane Ireland, National Univeristy of Ireland Galway, Galway, Ireland
| | - David M Haas
- Department of Obstetrics and Gynecology, Indiana University, Bloomington, Indiana, USA
| | - Patricia Healy
- School of Nursing & Midwifery, National University of Ireland Galway, Galway, Ireland.,Evidence Synthesis Ireland, National University of Ireland Galway, Galway, Ireland
| | - Tim Hurley
- Health Research Board - Neonatal Encephalopathy PhD Training Network (NEPTuNE), Trinity College Dublin, Dublin, Ireland.,Department of Paediatric and Child Health, Tallaght University Hospital (TUH), Dublin, Ireland
| | | | - Jamie J Kirkham
- Centre for Biostatistics, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | | | | | - Eleanor Molloy
- Health Research Board - Neonatal Encephalopathy PhD Training Network (NEPTuNE), Trinity College Dublin, Dublin, Ireland.,Paediatrics, Trinity College Dublin, Dublin, Ireland.,Paediatrics, Tallaght Hospital, Dublin, Ireland
| | - Maira Niaz
- Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan
| | | | | | | | - Karen Walker
- Grace Centre for Newborn Care, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,The University of Sydney, Sydney, New South Wales, Australia
| | - Linda Biesty
- School of Nursing & Midwifery, National University of Ireland Galway, Galway, Ireland.,Evidence Synthesis Ireland, National University of Ireland Galway, Galway, Ireland.,Qualitative Research in Trials Centre (QUESTS), National University of Ireland Galway, Galway, Ireland
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18
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Lawrence RL, Wall CR, Bloomfield FH. Adherence to Dietary Guidelines among Women with and without Gestational Diabetes: Evidence from the Growing up in New Zealand Study. Nutrients 2022; 14:nu14102145. [PMID: 35631286 PMCID: PMC9144046 DOI: 10.3390/nu14102145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/15/2022] [Accepted: 05/19/2022] [Indexed: 11/21/2022] Open
Abstract
Diet is thought to play a role in the development and management of gestational diabetes mellitus (GDM). Dietary guidelines provide practical recommendations for achieving nutrient requirements and mitigating the risk of chronic disease. The aim of this study was to describe the adherence to dietary guidelines by women with and without GDM and determine whether adherence is associated with the development of GDM. Adherence to Ministry of Health food group recommendations was assessed in 5391 pregnant women participating in the Growing Up in New Zealand study. A food frequency questionnaire (FFQ) administered during pregnancy provided dietary data. The presence of GDM was determined using diagnostic coding in clinical data and blood glucose results. A quarter of women did not meet any food group recommendations. There were no significant differences in the number of food group targets met by women with or those without GDM. Meeting food group recommendations was not associated with odds of having GDM in adjusted analyses. This study found adherence to dietary recommendations is poor in both women with and without GDM and no association between adherence to food group recommendations and the development of GDM. Greater support is required to assist women to achieve food and nutrition recommendations.
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Affiliation(s)
- Robyn L. Lawrence
- The Liggins Institute, The University of Auckland, Auckland 1023, New Zealand;
| | - Clare R. Wall
- Disciple of Nutrition and Dietetics, Faculty of Medical and Health Sciences, The University of Auckland, Auckland 1023, New Zealand;
| | - Frank H. Bloomfield
- The Liggins Institute, The University of Auckland, Auckland 1023, New Zealand;
- Correspondence: ; Tel.: +64-9-923-6107 (ext. 86107)
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19
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Bloomfield FH, Cormack BE. Strategies in Neonatal Care to Promote Growth and Neurodevelopment of the Preterm Infant. Nestle Nutr Inst Workshop Ser 2022; 96:13-22. [PMID: 35537425 DOI: 10.1159/000519391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 06/14/2023]
Abstract
Recommendations for nutrition of very preterm and very low birth weight infants have developed over time with our understanding of the requirements of preterm babies and the awareness of widespread poor postnatal growth. In general, the trend has been towards enhancing nutrition, but more recent recommendations have begun to raise questions with respect to the potential for high and early nutritional intakes, particularly of protein, to carry risks such as refeeding syndrome. However, large gaps in our knowledge remain for both macro- and micronutrient requirements to support optimal growth and how nutrition and growth relate to important long-term outcomes. Closing these knowledge gaps has been hampered by inconsistent reporting of nutrition intakes and growth parameters, small trials with short-term outcomes and the use of a variety of different methods of monitoring growth. The challenge now is for future research to address these issues through consensus building around the important questions that need to be answered, how to report data from neonatal nutritional trials and whether large trials answering important questions can take place through development of consortia that undertake similar trials in multiple jurisdictions with agreements to share data.
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Affiliation(s)
| | - Barbara E Cormack
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Starship Child Health, Auckland City Hospital, Auckland, New Zealand
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20
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Tottman AC, Bloomfield FH, Cormack BE, Harding JE, Taylor J, Alsweiler JM. Correction: Sex-specific relationships between early nutrition and neurodevelopment in preterm infants. Pediatr Res 2022; 91:1627. [PMID: 34040163 DOI: 10.1038/s41390-021-01582-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Anna C Tottman
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Frank H Bloomfield
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Newborn Services, Starship Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Barbara E Cormack
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Newborn Services, Starship Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Jane E Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Janice Taylor
- Child Development Unit, National Women's Health, Auckland, New Zealand
| | - Jane M Alsweiler
- Newborn Services, Starship Hospital, Auckland District Health Board, Auckland, New Zealand. .,Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.
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21
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Lin L, Gamble GD, Crowther CA, Bloomfield FH, Agosti M, Atkinson SA, Biasini A, Embleton ND, Fewtrell MS, Lamy-Filho F, Fusch C, Gianni ML, Kanmaz Kutman HG, Koo W, Litmanovitz I, Morgan C, Mukhopadhyay K, Neri E, Picaud JC, Rochow N, Roggero P, Singhal A, Stroemmen K, Tan MJ, Tandoi FM, Wood CL, Zachariassen G, Harding JE. Sex-Specific Effects of Nutritional Supplements for Infants Born Early or Small: An Individual Participant Data Meta-Analysis (ESSENCE IPD-MA) I-Cognitive Function and Metabolic Risk. Nutrients 2022; 14:418. [PMID: 35276786 PMCID: PMC8838132 DOI: 10.3390/nu14030418] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/11/2022] [Accepted: 01/14/2022] [Indexed: 02/04/2023] Open
Abstract
Neonatal nutritional supplements are widely used to improve growth and development but may increase risk of later metabolic disease, and effects may differ by sex. We assessed effects of supplements on later development and metabolism. We searched databases and clinical trials registers up to April 2019. Participant-level data from randomised trials were included if the intention was to increase macronutrient intake to improve growth or development of infants born preterm or small-for-gestational-age. Co-primary outcomes were cognitive impairment and metabolic risk. Supplementation did not alter cognitive impairment in toddlers (13 trials, n = 1410; adjusted relative risk (aRR) 0.88 [95% CI 0.68, 1.13]; p = 0.31) or older ages, nor alter metabolic risk beyond 3 years (5 trials, n = 438; aRR 0.94 [0.76, 1.17]; p = 0.59). However, supplementation reduced motor impairment in toddlers (13 trials, n = 1406; aRR 0.76 [0.60, 0.97]; p = 0.03), and improved motor scores overall (13 trials, n = 1406; adjusted mean difference 1.57 [0.14, 2.99]; p = 0.03) and in girls not boys (p = 0.03 for interaction). Supplementation lowered triglyceride concentrations but did not affect other metabolic outcomes (high-density and low-density lipoproteins, cholesterol, fasting glucose, blood pressure, body mass index). Macronutrient supplementation for infants born small may not alter later cognitive function or metabolic risk, but may improve early motor function, especially for girls.
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Affiliation(s)
- Luling Lin
- Liggins Institute, University of Auckland, Auckland 1023, New Zealand; (L.L.); (G.D.G.); (C.A.C.); (F.H.B.)
| | - Greg D. Gamble
- Liggins Institute, University of Auckland, Auckland 1023, New Zealand; (L.L.); (G.D.G.); (C.A.C.); (F.H.B.)
| | - Caroline A. Crowther
- Liggins Institute, University of Auckland, Auckland 1023, New Zealand; (L.L.); (G.D.G.); (C.A.C.); (F.H.B.)
| | - Frank H. Bloomfield
- Liggins Institute, University of Auckland, Auckland 1023, New Zealand; (L.L.); (G.D.G.); (C.A.C.); (F.H.B.)
| | - Massimo Agosti
- Neonatal Intensive Care Unit, Woman and Child Department, Ospedale Del Ponte, Insubria University, 21100 Varese, Italy; (M.A.); (F.M.T.)
| | - Stephanie A. Atkinson
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, ON L8N 3Z5, Canada; (S.A.A.); (C.F.); (N.R.)
| | - Augusto Biasini
- Donor Human Milk Bank Italian Association (AIBLUD), 20126 Milan, Italy;
| | - Nicholas D. Embleton
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK;
| | - Mary S. Fewtrell
- Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK;
| | - Fernando Lamy-Filho
- Departamento de Medicina, Universidade Federal do Maranhão (UFMA), São Luís 65080-805, MA, Brazil;
| | - Christoph Fusch
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, ON L8N 3Z5, Canada; (S.A.A.); (C.F.); (N.R.)
- Department of Pediatrics, Nuremberg General Hospital, Paracelsus Medical University, 90471 Nuremberg, Germany
| | - Maria L. Gianni
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122 Milan, Italy; (M.L.G.); (P.R.)
- Department of Clinical Sciences and Community Health, University of Milan, Via Commenda 19, 20122 Milan, Italy
| | | | - Winston Koo
- Department of Nutrition and Food Science, Wayne State University, Detroit, MI 48202, USA;
| | - Ita Litmanovitz
- Department of Neonatology, Meir Medical Center, Kfar Saba 44281, Israel;
| | - Colin Morgan
- Department of Neonatology, Liverpool Women’s Hospital, Liverpool L8 7SS, UK;
| | - Kanya Mukhopadhyay
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India;
| | - Erica Neri
- Department of Psychology, University of Bologna, 40100 Bologna, Italy;
| | - Jean-Charles Picaud
- Division of Neonatology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France;
- CarMen Laboratory, INSERM, INRA, Claude Bernard University Lyon 1, 69677 Pierre Benite, France
| | - Niels Rochow
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, ON L8N 3Z5, Canada; (S.A.A.); (C.F.); (N.R.)
- Department of Pediatrics, Nuremberg General Hospital, Paracelsus Medical University, 90471 Nuremberg, Germany
| | - Paola Roggero
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122 Milan, Italy; (M.L.G.); (P.R.)
| | - Atul Singhal
- Department of Nutrition, Institute of Child Health, London WC1N 1EH, UK;
| | - Kenneth Stroemmen
- Department of Neonatal Intensive Care, Division of Paediatric and Adolescent Medicine, Rikshospitalet, Oslo University Hospital, 0310 Oslo, Norway;
| | - Maw J. Tan
- Department of Developmental Paediatrics, Alder Hey Children’s NHS Foundation Trust, Liverpool L12 2AP, UK;
| | - Francesco M. Tandoi
- Neonatal Intensive Care Unit, Woman and Child Department, Ospedale Del Ponte, Insubria University, 21100 Varese, Italy; (M.A.); (F.M.T.)
| | - Claire L. Wood
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE1 7RU, UK;
| | - Gitte Zachariassen
- H.C. Andersen Children’s Hospital, Odense University Hospital and University of Southern Denmark, 5000 Odense, Denmark;
| | - Jane E. Harding
- Liggins Institute, University of Auckland, Auckland 1023, New Zealand; (L.L.); (G.D.G.); (C.A.C.); (F.H.B.)
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22
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Lin L, Gamble GD, Crowther CA, Bloomfield FH, Agosti M, Atkinson SA, Biasini A, Embleton ND, Lamy Filho F, Fusch C, Gianni ML, Kutman HGK, Koo W, Litmanovitz I, Morgan C, Mukhopadhyay K, Neri E, Picaud JC, Rochow N, Roggero P, Stroemmen K, Tan MJ, Tandoi FM, Wood CL, Zachariassen G, Harding JE. Sex-Specific Effects of Nutritional Supplements for Infants Born Early or Small: An Individual Participant Data Meta-Analysis (ESSENCE IPD-MA) II: Growth. Nutrients 2022; 14:nu14020392. [PMID: 35057573 PMCID: PMC8781781 DOI: 10.3390/nu14020392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/11/2022] [Accepted: 01/14/2022] [Indexed: 12/10/2022] Open
Abstract
Neonatal nutritional supplements may improve early growth for infants born small, but effects on long-term growth are unclear and may differ by sex. We assessed the effects of early macronutrient supplements on later growth. We searched databases and clinical trials registers from inception to April 2019. Participant-level data from randomised trials were included if the intention was to increase macronutrient intake to improve growth or development of infants born preterm or small-for-gestational-age. Co-primary outcomes were cognitive impairment and metabolic risk. Supplementation did not alter BMI in childhood (kg/m2: adjusted mean difference (aMD) -0.11[95% CI -0.47, 0.25], p = 0.54; 3 trials, n = 333). Supplementation increased length (cm: aMD 0.37[0.01, 0.72], p = 0.04; 18 trials, n = 2008) and bone mineral content (g: aMD 10.22[0.52, 19.92], p = 0.04; 6 trials, n = 313) in infancy, but not at older ages. There were no differences between supplemented and unsupplemented groups for other outcomes. In subgroup analysis, supplementation increased the height z-score in male toddlers (aMD 0.20[0.02, 0.37], p = 0.03; 10 trials, n = 595) but not in females, and no significant sex interaction was observed (p = 0.21). Macronutrient supplementation for infants born small may not alter BMI in childhood. Supplementation increased growth in infancy, but these effects did not persist in later life. The effects did not differ between boys and girls.
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Affiliation(s)
- Luling Lin
- Liggins Institute, University of Auckland, Auckland 1023, New Zealand; (L.L.); (G.D.G.); (C.A.C.); (F.H.B.)
| | - Greg D. Gamble
- Liggins Institute, University of Auckland, Auckland 1023, New Zealand; (L.L.); (G.D.G.); (C.A.C.); (F.H.B.)
| | - Caroline A. Crowther
- Liggins Institute, University of Auckland, Auckland 1023, New Zealand; (L.L.); (G.D.G.); (C.A.C.); (F.H.B.)
| | - Frank H. Bloomfield
- Liggins Institute, University of Auckland, Auckland 1023, New Zealand; (L.L.); (G.D.G.); (C.A.C.); (F.H.B.)
| | - Massimo Agosti
- NICU, Woman and Child Department, Ospedale Del Ponte, Insubria University, 21100 Varese, Italy; (M.A.); (F.M.T.)
| | - Stephanie A. Atkinson
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4L8, Canada; (S.A.A.); (C.F.); (N.R.)
| | - Augusto Biasini
- Donor Human Milk Bank Italian Association (AIBLUD), 20126 Milan, Italy;
| | - Nicholas D. Embleton
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK;
| | - Fernando Lamy Filho
- Departamento de Medicina, Universidade Federal do Maranhão (UFMA), São Luís 65080-805, Brazil;
| | - Christoph Fusch
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4L8, Canada; (S.A.A.); (C.F.); (N.R.)
- Department of Pediatrics, Nuremberg General Hospital, Paracelsus Medical University, 90471 Nuremberg, Germany
| | - Maria L. Gianni
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122 Milan, Italy; (M.L.G.); (P.R.)
- Department of Clinical Sciences and Community Health, University of Milan, Via Commenda 19, 20122 Milan, Italy
| | | | - Winston Koo
- Department of Nutrition and Food Science, Wayne State University, Detroit, MI 48202, USA;
| | - Ita Litmanovitz
- Department of Neonatology, Meir Medical Center, Kfar Saba 4428164, Israel;
| | - Colin Morgan
- Department of Neonatology, Liverpool Women’s Hospital, Liverpool L8 7SS, UK;
| | - Kanya Mukhopadhyay
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India;
| | - Erica Neri
- Department of Psychology, University of Bologna, 40126 Bologna, Italy;
| | - Jean-Charles Picaud
- Division of Neonatology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France;
- CarMen Laboratory, INSERM, INRA, Claude Bernard University Lyon 1, 69310 Pierre Benite, France
| | - Niels Rochow
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4L8, Canada; (S.A.A.); (C.F.); (N.R.)
- Department of Pediatrics, Nuremberg General Hospital, Paracelsus Medical University, 90471 Nuremberg, Germany
| | - Paola Roggero
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122 Milan, Italy; (M.L.G.); (P.R.)
| | - Kenneth Stroemmen
- Department of Neonatal Intensive Care, Division of Paediatric and Adolescent Medicine, Rikshospitalet, Oslo University Hospital, 0188 Oslo, Norway;
| | - Maw J. Tan
- Department of Developmental Paediatrics, Alder Hey Children’s NHS Foundation Trust, Liverpool L12 2AP, UK;
| | - Francesco M. Tandoi
- NICU, Woman and Child Department, Ospedale Del Ponte, Insubria University, 21100 Varese, Italy; (M.A.); (F.M.T.)
| | - Claire L. Wood
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4AX, UK;
| | - Gitte Zachariassen
- H.C. Andersen Children’s Hospital, Odense University Hospital and University of Southern Denmark, 5000 Odense, Denmark;
| | - Jane E. Harding
- Liggins Institute, University of Auckland, Auckland 1023, New Zealand; (L.L.); (G.D.G.); (C.A.C.); (F.H.B.)
- Correspondence: ; Tel.: +64-99236439
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Alexander T, Meyer M, Harding JE, Alsweiler JM, Jiang Y, Wall C, Muelbert M, Bloomfield FH. Nutritional Management of Moderate- and Late-Preterm Infants Commenced on Intravenous Fluids Pending Mother's Own Milk: Cohort Analysis From the DIAMOND Trial. Front Pediatr 2022; 10:817331. [PMID: 35433556 PMCID: PMC9008239 DOI: 10.3389/fped.2022.817331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 03/03/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Exclusive breastmilk is the desired enteral nutrition for babies born moderate- and late-preterm between 32+0 and 36+6 weeks' gestation; however, this goal is often difficult to achieve. METHODS A prospective cohort of babies 32+0 -35+6 weeks' gestation enrolled in the DIAMOND trial were randomized to a condition specifying that babies should receive mother's own milk (MOM) as the only enteral feed. Factors associated with the successful transition to MOM, defined as MOM being the sole enteral feeding at the time of the first cessation of intravenous (IV) fluids, were investigated by logistic regression. Time to commencement of a milk other than MOM was analyzed by Kaplan-Meier survival curves. RESULTS A total of 151 eligible babies (60% boys) were included, 93 (63%) of whom successfully transitioned from IV fluids onto MOM only. Alternative sources of milk, mostly formula, were used to transition from IV fluids onto enteral feeds more often in multiples and Māori, and was commenced earlier in Māori than other ethnicities (p = 0.007) and in late-preterm compared with moderate-preterm babies (p=0.01). Receiving exclusively breastmilk at discharge was more likely for babies who successfully transitioned from IV fluids onto MOM only [OR (95% confidence intervals) 4.9 (2.3-10.6)] and who received only MOM in the first week after birth [4.8 (2.2-10.4)], both p < 0.0001. Receiving breastmilk exclusively at discharge was less likely for Māori than Caucasian babies [0.2 (0.1-0.6), p < 0.0006]. There was no difference in the use of alternative sources of milk in babies who received parenteral nutrition or dextrose or between small-for-gestational-age and appropriate-for-gestational-age babies. CONCLUSIONS Despite an intention to provide only MOM, significant numbers of moderate- and late-preterm babies received formula to transition from IV fluids, and this differed by ethnicity. The drivers underlying these decisions require further investigation. These data highlight an urgent need for quality initiatives to support and encourage mothers of moderate- and late-preterm babies in their lactation.
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Affiliation(s)
- Tanith Alexander
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Neonatal Unit, Kidz First, Middlemore Hospital, Counties Mankau Health, Auckland, New Zealand
| | - Michael Meyer
- Neonatal Unit, Kidz First, Middlemore Hospital, Counties Mankau Health, Auckland, New Zealand
| | - Jane E Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Jane M Alsweiler
- Newborn Services, Auckland City Hospital, Auckland, New Zealand.,The Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Yannan Jiang
- Department of Statistics, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Clare Wall
- Department of Nutrition, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Mariana Muelbert
- Liggins Institute, University of Auckland, Auckland, New Zealand
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Sibbin K, Yap P, Nyaga D, Heller R, Evans S, Strachan K, Alburaiky S, Nguyen HMA, Hermann-Le Denmat S, Ganley ARD, O'Sullivan JM, Bloomfield FH. A de novo ACTB gene pathogenic variant in identical twins with phenotypic variation for hydrops and jejunal atresia. Am J Med Genet A 2021; 188:1299-1306. [PMID: 34970864 PMCID: PMC9302691 DOI: 10.1002/ajmg.a.62631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 11/11/2021] [Accepted: 12/11/2021] [Indexed: 11/05/2022]
Abstract
The beta-actin gene (ACTB) encodes a ubiquitous cytoskeletal protein, essential for embryonic development in humans. De novo heterozygous missense variants in the ACTB are implicated in causing Baraitser-Winter cerebrofrontofacial syndrome (BWCFFS; MIM#243310). ACTB pathogenic variants are rarely associated with intestinal malformations. We report on a rare case of monozygotic twins presenting with proximal small bowel atresia and hydrops in one, and apple-peel bowel atresia and laryngeal dysgenesis in the other. The twin with hydrops could not be resuscitated. Intensive and surgical care was provided to the surviving twin. Rapid trio genome sequencing identified a de novo missense variant in ACTB (NM_00101.3:c.1043C>T; p.(Ser348Leu)) that guided the care plan. The identical variant subsequently was identified in the demised twin. To characterize the functional effect, the variant was recreated as a pseudoheterozygote in a haploid wild-type S. cerevisiae strain. There was an obvious growth defect of the yACT1S348L/WT pseudoheterozygote compared to a yACT1WT/WT strain when grown at 22°C but not when grown at 30°C, consistent with the yACT1 S348L variant having a functional defect that is dominant over the wild-type allele. The functional results provide supporting evidence that the Ser348Leu variant is likely to be a pathogenic variant, including being associated with intestinal malformations in BWCFFS, and can demonstrate variable expressivity within monozygotic twins.
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Affiliation(s)
- Kristina Sibbin
- Starship Child Health, Auckland City Hospital, Auckland, New Zealand
| | - Patrick Yap
- Starship Child Health, Auckland City Hospital, Auckland, New Zealand
| | - Denis Nyaga
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Raoul Heller
- Starship Child Health, Auckland City Hospital, Auckland, New Zealand
| | - Stephen Evans
- Starship Child Health, Auckland City Hospital, Auckland, New Zealand
| | - Kate Strachan
- Starship Child Health, Auckland City Hospital, Auckland, New Zealand
| | - Salam Alburaiky
- Starship Child Health, Auckland City Hospital, Auckland, New Zealand
| | - Han M Alex Nguyen
- School of Biological Sciences, The University of Auckland, Auckland, New Zealand
| | | | - Austen R D Ganley
- School of Biological Sciences, The University of Auckland, Auckland, New Zealand
| | - Justin M O'Sullivan
- Liggins Institute, The University of Auckland, Auckland, New Zealand.,The Maurice Wilkins Centre, The University of Auckland, Auckland, New Zealand.,Australian Parkinsons Mission, Garvan Institute of Medical Research, Sydney, New South Wales, Australia.,Brain Research New Zealand, The University of Auckland, Auckland, New Zealand.,MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Frank H Bloomfield
- Starship Child Health, Auckland City Hospital, Auckland, New Zealand.,Liggins Institute, The University of Auckland, Auckland, New Zealand
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25
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Lawrence RL, Ward K, Wall CR, Bloomfield FH. New Zealand women's experiences of managing gestational diabetes through diet: a qualitative study. BMC Pregnancy Childbirth 2021; 21:819. [PMID: 34886814 PMCID: PMC8662890 DOI: 10.1186/s12884-021-04297-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 11/23/2021] [Indexed: 12/25/2022] Open
Abstract
Background For women with gestational diabetes mellitus (GDM) poor dietary choices can have deleterious consequences for both themselves and their baby. Diet is a well-recognised primary strategy for the management of GDM. Women who develop GDM may receive dietary recommendations from a range of sources that may be inconsistent and are often faced with needing to make several dietary adaptations in a short period of time to achieve glycaemic control. The aim of this study was to explore how women diagnosed with GDM perceive dietary recommendations and how this information influences their dietary decisions during pregnancy and beyond. Methods Women diagnosed with GDM before 30 weeks’ gestation were purposively recruited from two GDM clinics in Auckland, New Zealand. Data were generated using semi-structured interviews and thematic analysed to identify themes describing women’s perceptions and experiences of dietary recommendations for the management of GDM. Results Eighteen women from a diverse range of sociodemographic backgrounds participated in the study. Three interconnected themes described women’s perceptions of dietary recommendations and experiences in managing their GDM through diet: managing GDM is a balancing act; using the numbers as evidence, and the GDM timeframe. The primary objective of dietary advice was perceived to be to control blood glucose levels and this was central to each theme. Women faced a number of challenges in adhering to dietary recommendations. Their relationships with healthcare professionals played a significant role in their perception of advice and motivation to adhere to recommendations. Many women perceived the need to follow dietary recommendations to be temporary, with few planning to continue dietary adaptations long-term. Conclusions The value of empathetic, individually tailored advice was highlighted in this study. A greater emphasis on establishing healthy dietary habits not just during pregnancy but for the long-term health of both mother and baby is needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04297-0.
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Affiliation(s)
- R L Lawrence
- The Liggins Institute, The University of Auckland, Building 505, Level 2, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - K Ward
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - C R Wall
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - F H Bloomfield
- The Liggins Institute, The University of Auckland, Building 505, Level 2, 85 Park Road, Grafton, Auckland, 1023, New Zealand.
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26
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Khong TY, Sebire NJ, Heazell AEP, Ganzevoort W, Bloomfield FH, Kooi EMW, Marijnen MC, Gordijn SJ. Research Priority Setting Partnership for placental pathology. Placenta 2021; 117:154-155. [PMID: 34902727 DOI: 10.1016/j.placenta.2021.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/02/2021] [Indexed: 11/28/2022]
Affiliation(s)
- T Yee Khong
- SA Pathology, Women's and Children's Hospital, University of Adelaide, North Adelaide, Australia
| | - Neil J Sebire
- Great Ormond Street Institute of Child Health, University College London, UK
| | - Alexander E P Heazell
- Maternal & Fetal Health Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - Wessel Ganzevoort
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Elisabeth M W Kooi
- Department of Pediatrics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Mauritia C Marijnen
- Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Sanne J Gordijn
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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27
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Buckels EJ, Bloomfield FH, Oliver MH, Spiroski AM, Harding JE, Jaquiery AL. Sexually dimorphic changes in the endocrine pancreas and skeletal muscle in young adulthood following intra-amniotic IGF-I treatment of growth-restricted fetal sheep. Am J Physiol Endocrinol Metab 2021; 321:E530-E542. [PMID: 34459219 DOI: 10.1152/ajpendo.00111.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Fetal growth restriction (FGR) is associated with decreased insulin secretory capacity and decreased insulin sensitivity in muscle in adulthood. We investigated whether intra-amniotic IGF-I treatment in late gestation mitigated the adverse effects of FGR on the endocrine pancreas and skeletal muscle at 18 mo of age. Singleton-bearing ewes underwent uterine artery embolization between 103 and 107 days of gestational age, followed by 5 once-weekly intra-amniotic injections of 360-µg IGF-I (FGRI) or saline (FGRS) and were compared with an unmanipulated control group (CON). We measured offspring pancreatic endocrine cell mass and pancreatic and skeletal muscle mRNA expression at 18 mo of age (n = 7-9/sex/group). Total α-cell mass was increased ∼225% in FGRI males versus CON and FGRS males, whereas β-cell mass was not different between groups of either sex. Pancreatic mitochondria-related mRNA expression was increased in FGRS females versus CON (NRF1, MTATP6, UCP2), and FGRS males versus CON (TFAM, NRF1, UCP2) but was largely unchanged in FGRI males versus CON. In skeletal muscle, mitochondria-related mRNA expression was decreased in FGRS females versus CON (PPARGC1A, TFAM, NRF1, UCP2, MTATP6), FGRS males versus CON (NRF1 and UCP2), and FGRI females versus CON (TFAM and UCP2), with only MTATP6 expression decreased in FGRI males versus CON. Although the window during which IGF-I treatment was delivered was limited to the final 5 wk of gestation, IGF-I therapy of FGR altered the endocrine pancreas and skeletal muscle in a sex-specific manner in young adulthood.NEW & NOTEWORTHY Fetal growth restriction (FGR) is associated with compromised metabolic function throughout adulthood. Here, we explored the long-term effects of fetal IGF-I therapy on the adult pancreas and skeletal muscle. This is the first study demonstrating that IGF-I therapy of FGR has sex-specific long-term effects at both the tissue and molecular level on metabolically active tissues in adult sheep.
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Affiliation(s)
- Emma J Buckels
- The Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | - Mark H Oliver
- The Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | - Jane E Harding
- The Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Anne L Jaquiery
- The Liggins Institute, University of Auckland, Auckland, New Zealand
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28
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Poindexter BB, Cormack BE, Bloomfield FH. Approaches to Growth Faltering. World Rev Nutr Diet 2021; 122:312-324. [PMID: 34352781 DOI: 10.1159/000514877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 01/15/2021] [Indexed: 01/15/2023]
Affiliation(s)
- Brenda B Poindexter
- Division of Neonatology, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Barbara E Cormack
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Newborn Services, Starship Child Health, Auckland City Hospital, Auckland, New Zealand
| | - Frank H Bloomfield
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Newborn Services, Starship Child Health, Auckland City Hospital, Auckland, New Zealand
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29
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Galante L, Reynolds CM, Milan AM, Alexander T, Bloomfield FH, Jiang Y, Asadi S, Muelbert M, Cameron-Smith D, Pundir S, Vickers MH. Metabolic Hormone Profiles in Breast Milk From Mothers of Moderate-Late Preterm Infants Are Associated With Growth From Birth to 4 Months in a Sex-Specific Manner. Front Nutr 2021; 8:641227. [PMID: 34124118 PMCID: PMC8193224 DOI: 10.3389/fnut.2021.641227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 04/19/2021] [Indexed: 12/25/2022] Open
Abstract
Background: Differing environmental conditions experienced by mother-infant dyads may influence composition of the milk received by the infant. As a consequence, diverse milk compositional profiles may contribute to different postnatal outcomes, especially in infants facing adverse perinatal environments. We investigated whether variability in milk concentrations of key metabolic hormones is associated with different growth outcomes in infants born preterm, a perinatal complication known to impact on infant growth. Methods: Human milk samples were collected from 169 mothers of 191 infants enrolled in the DIAMOND trial, a randomized trial of nutrition for moderate-late preterm infants, at 5 and 10 days postpartum and again at 4 months' corrected age and analyzed for leptin, adiponectin and insulin-like growth factor (IGF)-1. Infant weight and body composition were measured at birth, discharge and 4 months' corrected age. Multiple linear regression models were used to examine correlations between milk hormone concentrations, weight z-scores and body composition at discharge and 4 months' corrected age, and weight gain from birth to 4 months' corrected age. Sex-specific interactions were examined. Results: Higher milk IGF-1 concentrations on day 5 after birth were associated with greater infant fat-free mass at 4 months' corrected age. Milk IGF-1 concentrations at 4 months were positively associated with fat mass and fat-free mass at 4 months in boys but not girls. Milk leptin concentrations on day 5 after birth were positively associated with fat mass at discharge from hospital, but negatively associated with fat mass at 4 months' corrected age. No significant association was found for milk adiponectin concentrations. Conclusion: Milk IGF-1 and leptin concentrations in mothers of moderate-late preterm babies are associated with different growth and body composition through to 4 months' corrected age and these associations are often different in boys and girls. The sex-specific effects of nutrient and hormone exposure during early life in preterm infants warrants further investigation to optimize the nutritional care these infants receive, particularly in hospital, where the same nutrition is provided to boys and girls.
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Affiliation(s)
- Laura Galante
- The Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Clare M Reynolds
- The Liggins Institute, University of Auckland, Auckland, New Zealand.,School of Public Health, Physiotherapy and Sports Science, Institute of Food and Health, Conway Institute, University College Dublin, Belfield, Ireland
| | - Amber M Milan
- The Liggins Institute, University of Auckland, Auckland, New Zealand.,Food Nutrition & Health Team, Food & Bio-Based Products Group, AgResearch, Palmerston North, New Zealand
| | - Tanith Alexander
- The Liggins Institute, University of Auckland, Auckland, New Zealand.,Neonatal Unit, Kidz First, Middlemore Hospital, Auckland, New Zealand
| | | | - Yannan Jiang
- The Liggins Institute, University of Auckland, Auckland, New Zealand.,Department of Statistics, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Sharin Asadi
- The Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Mariana Muelbert
- The Liggins Institute, University of Auckland, Auckland, New Zealand
| | - David Cameron-Smith
- The Liggins Institute, University of Auckland, Auckland, New Zealand.,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - Shikha Pundir
- The Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Mark H Vickers
- The Liggins Institute, University of Auckland, Auckland, New Zealand
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30
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Chong CYL, Vatanen T, Alexander T, Bloomfield FH, O'Sullivan JM. Factors Associated With the Microbiome in Moderate-Late Preterm Babies: A Cohort Study From the DIAMOND Randomized Controlled Trial. Front Cell Infect Microbiol 2021; 11:595323. [PMID: 33732655 PMCID: PMC7958882 DOI: 10.3389/fcimb.2021.595323] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 01/20/2021] [Indexed: 12/22/2022] Open
Abstract
The gut microbiota of preterm infants is affected by perinatal factors and, in turn, may impact upon infant health. In this study, we collected fecal samples at Day-10 (D10) and 4-months corrected-age (4M) from 227 moderate–late preterm (MLPT) babies enrolled in a randomized controlled trial of nutritional management. A total of 320 samples underwent 16S amplicon sequencing, and shotgun metagenomic sequencing was performed on 94 samples from the 4M time point. The microbiome of babies whose families lived in lower socioeconomic status (SES) areas exhibited a significantly higher microbial alpha diversity at D10 (Wilcoxon test, p = 0.021), greater abundance of Bifidobacterium (linear model, q = 0.020) at D10 and Megasphaera (q = 0.031) at 4M. Hospital of birth explained 5.2% of the observed variance in 4M samples (PERMANOVA, p = 0.038), with Staphylococcus aureus more abundant in fecal samples from babies born in Middlemore hospital (linear model, q = 0.016). Maternal antibiotic (Wilcoxon test, p = 0.013) and probiotic (p = 0.04) usage within the four-week period before sample collection was associated with a reduction in the alpha diversity of D10 samples. Infant probiotic intake explained 2.1% (PERMANOVA, p = 0.021) of the variance in the D10 microbial profile with increased Lactobacillus (linear model, q = 1.1 × 10−10) levels. At 4M, the microbiome of infants who were breastmilk fed had reduced alpha diversity when compared to non-breastmilk fed infants (Wilcoxon test, p < 0.05). Although causality cannot be inferred within our study, we conclude that in MLPT babies, maternal socioeconomic factors, as well as the perinatal medical environment and nutrition impact on the development of the newborn microbiome.
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Affiliation(s)
| | - Tommi Vatanen
- Liggins Institute, The University of Auckland, Auckland, New Zealand.,Infectious Disease & Microbiome Program, The Broad Institute of MIT and Harvard, Cambridge, MA, United States
| | - Tanith Alexander
- Liggins Institute, The University of Auckland, Auckland, New Zealand.,Neonatal Unit, Kidz First, Middlemore Hospital, Auckland, New Zealand
| | | | - Justin M O'Sullivan
- Liggins Institute, The University of Auckland, Auckland, New Zealand.,The Maurice Wilkins Centre, The University of Auckland, Auckland, New Zealand
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Tuohy JF, Bloomfield FH, Crowther CA, Harding JE. Maternal and neonatal glycaemic control after antenatal corticosteroid administration in women with diabetes in pregnancy: A retrospective cohort study. PLoS One 2021; 16:e0246175. [PMID: 33600450 PMCID: PMC7891747 DOI: 10.1371/journal.pone.0246175] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 01/14/2021] [Indexed: 11/24/2022] Open
Abstract
Objective To describe maternal and neonatal glycaemic control following antenatal corticosteroid administration to women with diabetes in pregnancy. Design Retrospective cohort study Setting A tertiary hospital in Auckland, New Zealand Population Women with diabetes in pregnancy who received antenatal corticosteroids from 2006–2016. Methods Corticosteroid administration, maternal and neonatal glycaemia data were retrieved from electronic patient records. Demographic data were downloaded from the hospital database. Relationships between variables were analysed using multivariate analysis. Main outcome measures Maternal hyperglycaemia and neonatal hypoglycaemia Results Corticosteroids were administered to 647 of 7317 of women with diabetes (8.8%) who gave birth to 715 babies. After an initial course of corticosteroids, 92% and 52% of women had blood glucose concentrations > 7 and > 10 mmol/L respectively. Median peak blood glucose concentration of approximately 10 mmol/L occurred 9 hours after corticosteroid administration and hyperglycaemia lasted approximately 72 hours. Thirty percent of women gave birth within 72 hours of the last dose of corticosteroids. Babies of women who were hyperglycaemic within 24 hours of birth were more likely to develop hypoglycaemia (< 2.6 mmol/L, OR 1.51 [95% CI 1.10–2.07], p = 0.01) and severe hypoglycaemia (≤ 2.0 mmol/L, OR 2.00 [95% CI 1.41–2.85], p < 0.0001) than babies of non-hyperglycaemic mothers. There was no association between maternal glycaemia within 7 days of the last dose of corticosteroids and neonatal hypoglycaemia. Conclusions Hyperglycaemia is common in women with diabetes in pregnancy following antenatal corticosteroid administration. Maternal hyperglycaemia in the 24 hours prior to birth is associated with increased risk of neonatal hypoglycaemia. Limitations included the retrospective study design, so that not all data were available for all women and babies and the glucose testing schedule was variable.
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Affiliation(s)
- Jeremy F. Tuohy
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | | | - Jane E. Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
- * E-mail:
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32
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Quirke FA, Healy P, Bhraonáin EN, Daly M, Biesty L, Hurley T, Walker K, Meher S, Haas DM, Bloomfield FH, Kirkham JJ, Molloy EJ, Devane D. Multi-Round compared to Real-Time Delphi for consensus in core outcome set (COS) development: a randomised trial. Trials 2021; 22:142. [PMID: 33588938 PMCID: PMC7885346 DOI: 10.1186/s13063-021-05074-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 01/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background The Delphi method is used in a wide variety of settings as a method of building consensus on important issues. Traditionally, the Delphi method uses multiple rounds of a survey to allow for feedback of other participants’ survey responses in between rounds. By informing participants about how others answer a question or prioritise specific topics, it allows for diverse opinions to inform the consensus process. For this reason, the Delphi method is popular as a consensus building approach in developing core outcome sets (COS), i.e. the minimum agreed set of standardised outcomes that should be measured and reported in studies on a specific health condition. In a COS setting, participants prioritise the importance of outcomes for inclusion in a COS. This usually involves participating in multiple rounds of a survey that can span several weeks or months. Challenges with participant retention have been highlighted in previous COS. We will compare a three-round with a Real-Time Delphi approach on prioritised outcomes. This trial is embedded within the COHESION study which is developing a COS for interventions treating neonatal encephalopathy. Methods One hundred and eighty stakeholders (parents/caregivers of infants diagnosed and treated with neonatal encephalopathy, healthcare providers and researchers) will be randomised using stratified randomisation to take part in either the Multi-Round or Real-Time Delphi. Stakeholders will rate the importance of the same set of outcomes in both arms. We will compare the prioritised outcomes at the end of both surveys as well as other parameters such as feedback, initial condition and iteration effects. Discussion This trial will provide evidence to inform decisions on the use of Multi-Round compared to Real-Time Delphi survey methods. Trial registration NCT04471103. Registered on 14 July 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05074-2.
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Affiliation(s)
- Fiona A Quirke
- Health Research Board Neonatal Encephalopathy PhD Training Network (NEPTuNE), Galway, Ireland. .,Health Research Board - Trials Methodology Research Network (HRB-TMRN), Galway, Ireland. .,College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland.
| | - Patricia Healy
- College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland.,School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | | | - Mandy Daly
- Advocacy and Policymaking, Irish Neonatal Health Alliance, Wicklow, Ireland
| | - Linda Biesty
- College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland.,School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland.,Qualitative Research in Trials Centre (QUESTS), National University of Ireland Galway, Galway, Ireland
| | - Tim Hurley
- Health Research Board Neonatal Encephalopathy PhD Training Network (NEPTuNE), Galway, Ireland.,Paediatrics and Child Health, Trinity College Dublin, Dublin, Ireland
| | - Karen Walker
- RPA Newborn Care, Sydney Local Health District, Sydney, Australia
| | - Shireen Meher
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - David M Haas
- Indiana University School of Medicine Department of Obstetrics and Gynecology, Indianapolis, USA
| | | | - Jamie J Kirkham
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Eleanor J Molloy
- Paediatrics and Child Health, Trinity College Dublin, Dublin, Ireland.,Department of Neonatology, Children's Hospital Ireland at Crumlin and Tallaght, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Declan Devane
- Health Research Board - Trials Methodology Research Network (HRB-TMRN), Galway, Ireland.,College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland.,School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland.,Evidence Synthesis Ireland, National University of Ireland Galway, Galway, Ireland.,Cochrane Ireland, National University of Ireland Galway, Galway, Ireland
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Quirke FA, Healy P, Bhraonáin EN, Daly M, Biesty L, Hurley T, Walker K, Meher S, Haas DM, Bloomfield FH, Kirkham JJ, Molloy EJ, Devane D. COHESION: core outcomes in neonatal encephalopathy (protocol). Trials 2021; 22:125. [PMID: 33557892 PMCID: PMC7871638 DOI: 10.1186/s13063-021-05030-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 01/06/2021] [Indexed: 12/12/2022] Open
Abstract
Background Neonatal encephalopathy is a complex syndrome in infants that predominantly affects the brain and other organs. The leading cause is a lack of oxygen in the blood reaching the brain. Neonatal encephalopathy can result in mortality or complications later in life, including seizures, movement disorders and cerebral palsy. Treatment options for neonatal encephalopathy are limited mainly to therapeutic hypothermia, although other potential treatments are emerging. However, evaluations of the effectiveness of treatments are challenging because of heterogeneity and inconsistency in outcomes measured and reported between trials. In this paper, we detail how we will develop a core outcome set to standardise outcomes measured and reported upon for interventions for the treatment of neonatal encephalopathy. Methods We will systematically review the literature to identify outcomes reported previously in randomised trials and systematic reviews of randomised trials. We will identify outcomes important to parents or caregivers of infants diagnosed with and who have received treatment for neonatal encephalopathy. We will do this by conducting in person or by video teleconferencing interviews with parents or caregivers in high-income and low- to middle-income countries. Stakeholders with expertise in neonatal encephalopathy (parents/caregivers, healthcare providers and researchers) will rate the importance of identified outcomes in an online Delphi survey using either a three-round Delphi survey or a “Real-Time” Delphi survey to which stakeholders will be allocated at random. Consensus meetings will take place by video conference to allow for an international group of stakeholder representatives to discuss and vote on the outcomes to include in the final core outcome set (COS). Discussion More research is needed on treatments for neonatal encephalopathy. Standardising outcomes measured and reported in evaluations of the effectiveness of interventions for the treatment of neonatal encephalopathy will improve evidence synthesis and improve results reported in systematic reviews and meta-analysis in this area. Overall, this COS will allow for improved treatments to be identified, heterogeneity in research to be reduced, and overall patient care to be enhanced. Trial registration This study is registered in the Core Outcome Measures for Effectiveness (COMET) database http://www.comet-initiative.org/Studies/Details/1270.
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Affiliation(s)
- Fiona A Quirke
- Health Research Board Neonatal Encephalopathy PhD Training Network (NEPTuNE), Galway, Ireland. .,Health Research Board - Trials Methodology Research Network (HRB-TMRN), Galway, Ireland. .,College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland.
| | - Patricia Healy
- College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland.,School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | | | - Mandy Daly
- Advocacy and Policymaking, Irish Neonatal Health Alliance, Wicklow, Ireland
| | - Linda Biesty
- College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland.,School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland.,Qualitative Research in Trials Centre (QUESTS), National University of Ireland Galway, Galway, Ireland
| | - Tim Hurley
- Health Research Board Neonatal Encephalopathy PhD Training Network (NEPTuNE), Galway, Ireland.,Paediatrics and Child Health, Trinity College Dublin, Dublin, Ireland
| | - Karen Walker
- RPA Newborn Care, Sydney Local Health District, Sydney, Australia
| | - Shireen Meher
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - David M Haas
- Department of Obstetrics and Gynaecology, Indiana University School of Medicine, Indianapolis, USA
| | | | - Jamie J Kirkham
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Eleanor J Molloy
- Paediatrics and Child Health, Trinity College Dublin, Dublin, Ireland.,Department of Neonatology, Children's Hospital Ireland at Crumlin and Tallaght, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Declan Devane
- Health Research Board - Trials Methodology Research Network (HRB-TMRN), Galway, Ireland.,College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland.,School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland.,Evidence Synthesis Ireland, National University of Ireland Galway, Galway, Ireland.,Cochrane Ireland, National University of Ireland Galway, Galway, Ireland
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Muelbert M, Bloomfield FH, Pundir S, Harding JE, Pook C. Olfactory Cues in Infant Feeds: Volatile Profiles of Different Milks Fed to Preterm Infants. Front Nutr 2021; 7:603090. [PMID: 33521036 PMCID: PMC7843498 DOI: 10.3389/fnut.2020.603090] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 12/11/2020] [Indexed: 01/05/2023] Open
Abstract
Background: Smell is determined by odor-active volatile compounds that bind to specific olfactory receptors, allowing us to discriminate different smells. Olfactory stimulation may assist with digestion and metabolism of feeds in the neonate by activation of the cephalic phase response of digestion. Infants' physiological responses to the smell of different milks suggest they can distinguish between breastmilk and infant formula. We aimed to describe the profile of volatile compounds in preterm breastmilk and investigate how this differed from that of other preterm infant feeding options including pasteurized donor breastmilk, breastmilk with bovine milk-based fortifier, human milk-based products and various infant formulas. Methods: Forty-seven milk samples (13 different infant formulas and 34 human milk-based samples) were analyzed. Volatile compounds were extracted using Solid Phase Micro Extraction. Identification and relative quantification were carried out by Gas Chromatography with Mass Spectrometry. Principal Component Analysis (PCA) and one-way Analysis of Variance (ANOVA) with Tukey's HSD (parametric data) or Conover's post-hoc test (non-parametric data) were used as appropriate to explore differences in volatile profiles among milk types. Results: In total, 122 compounds were identified. Breastmilk containing bovine milk-based fortifier presented the highest number of compounds (109) and liquid formula the lowest (70). The profile of volatile compounds varied with 51 compounds significantly different (adjusted p < 0.001) among milk types. PCA explained 47% of variability. Compared to preterm breastmilk, the profile of volatile compounds in breastmilk with added bovine milk-based fortifier was marked by presence of fatty acids and their esters, ketones and aldehydes; infant formulas were characterized by alkyls, aldehydes and furans, and human milk-based products presented high concentrations of aromatic hydrocarbons, terpenoids and specific fatty acids. Conclusions: Sensory-active products of fatty acid oxidation are the major contributors to olfactory cues in infant feeds. Analysis of volatile compounds might be useful for monitoring quality of milk and detection of oxidation products and environmental contaminants. Further research is needed to determine whether these different volatile compounds have biological or physiological effects in nutrition of preterm infants.
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Affiliation(s)
- Mariana Muelbert
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | - Shikha Pundir
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Jane E Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Chris Pook
- Liggins Institute, University of Auckland, Auckland, New Zealand
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Bach KP, Kuschel CA, Patterson N, Skwish H, Huth S, Phua HH, Bloomfield FH. Effect of Bias Gas Flow on Tracheal Cytokine Concentrations in Ventilated Extremely Preterm Infants: A Randomized Controlled Trial. Neonatology 2021; 118:332-339. [PMID: 33827091 PMCID: PMC8491472 DOI: 10.1159/000515364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 02/12/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The objective of this study was to determine whether ventilator bias gas flow affects tracheal aspirate (TA) cytokine concentrations in ventilated extremely preterm infants. METHODS This is a randomized controlled trial in a tertiary neonatal unit in New Zealand. Preterm infants (<28 weeks' gestation/<1,000 g) requiring intubation in the first 7 days after birth were randomized to bias gas flows of 4 or 10 L/min. Cytokine concentrations in TA and plasma were measured at 24, 72, and 120 h after the onset of ventilation. The primary outcome measure was concentration of interleukin (IL)-8 in TA 24 h after the onset of mechanical ventilation. RESULTS Baseline demographics were similar in babies randomized to 4 (n = 50) and 10 (n = 45) L/min bias gas flow. TA IL-8 concentrations were not different between groups. Plasma IL-8 concentrations decreased over time (p < 0.05). Respiratory support and incidence of bronchopulmonary dysplasia at 36 weeks' corrected gestational age were similar between groups. Fewer babies ventilated at 4 L/min developed necrotizing enterocolitis (NEC) ≥ stage 2 (n = 0 vs. n = 5; p = 0.02) and fewer died (n = 1 vs. n = 5, p = 0.06). CONCLUSIONS Lower bias gas flow in ventilated extremely preterm infants did not alter TA cytokine concentrations but the lower incidence of NEC and mortality warrants further investigation.
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Affiliation(s)
- Katinka P Bach
- Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
| | | | - Nicola Patterson
- Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand
| | - Hana Skwish
- Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts, USA
| | - Sabine Huth
- Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Hui Hui Phua
- Liggins Institute, University of Auckland, Auckland, New Zealand
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Li Y, Shen RL, Ayede AI, Berrington J, Bloomfield FH, Busari OO, Cormack BE, Embleton ND, van Goudoever JB, Greisen G, He Z, Huang Y, Li X, Lin HC, Mei J, Meier PP, Nie C, Patel AL, Sangild PT, Skeath T, Simmer K, Uhlenfeldt S, de Waard M, Ye S, Ye X, Zhang C, Zhu Y, Zhou P. Early Use of Antibiotics Is Associated with a Lower Incidence of Necrotizing Enterocolitis in Preterm, Very Low Birth Weight Infants: The NEOMUNE-NeoNutriNet Cohort Study. J Pediatr 2020; 227:128-134.e2. [PMID: 32553865 PMCID: PMC7686259 DOI: 10.1016/j.jpeds.2020.06.032] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 06/06/2020] [Accepted: 06/09/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine whether commencement of antibiotics within 3 postnatal days in preterm, very low birth weight (VLBW; ≤1500 g) infants is associated with the development of necrotizing enterocolitis (NEC). STUDY DESIGN Preplanned statistical analyses were done to study the association between early antibiotic treatment and later NEC development, using the NEOMUNE-NeoNutriNet cohort of VLBW infants from 13 neonatal intensive care units (NICUs) in 5 continents (n = 2831). NEC incidence was compared between infants who received early antibiotics and those who did not, with statistical adjustments for NICU, gestational age, birth weight, sex, delivery mode, antenatal steroid use, Apgar score, and type and initiation of enteral nutrition. RESULTS The incidence of NEC was 9.0% in the group of infants who did not receive early antibiotics (n = 269), compared with 3.9% in those who did receive early antibiotics (n = 2562). The incidence remained lower in the early antibiotic group after stepwise statistical adjustments for NICU (OR, 0.57; 95% CI, 0.35-0.94, P < .05) and other potential confounders (OR, 0.25; 95% CI, 0.12-0.47; P < .0001). CONCLUSIONS In this large international cohort of preterm VLBW infants, a small proportion of infants did not receive antibiotics just after birth, and these infants had a higher incidence of NEC. It is important to better understand the role of such variables as time, type, and duration of antibiotic treatment on NEC incidence, immune development, gut colonization, and antibiotic resistance in the NICU.
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Affiliation(s)
- Yanqi Li
- Comparative Pediatrics and Nutrition, University of Copenhagen, Copenhagen, Denmark
| | | | - Adejumoke I. Ayede
- Department of Pediatrics-Neonatology Unit, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - Janet Berrington
- Department of Neonatology, Newcastle Hospitals NHS Foundation Trust, Newcastle, UK
| | - Frank H. Bloomfield
- Liggins Institute, University of Auckland and Newborn Service, National Women’s Health, Auckland, New Zealand
| | - Olubunmi O. Busari
- Department of Pediatrics-Neonatology Unit, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - Barbara E. Cormack
- Paediatric Dietitians, Starship Child Health or Liggins Institute, University of Auckland
| | - Nicholas D. Embleton
- Department of Neonatology, Newcastle Hospitals NHS Foundation Trust, Newcastle, UK
| | - Johannes B. van Goudoever
- Department of Pediatrics, Amsterdam UMC, Vrije Universiteit, Emma Children’s Hospital, Amsterdam, The Netherlands
| | - Gorm Greisen
- Department of Neonatology, Rigshospitalet, Copenhagen, Denmark.
| | - Zhongqian He
- Department of Neonatology, Shenzhen Nanshan People’s Hospital, Shenzhen, China
| | - Yan Huang
- Department of Neonatology, Shenzhen Bao’an Maternal and Child Health Hospital, Shenzhen, China
| | - Xiaodong Li
- Department of Neonatology, Shenzhen Nanshan People’s Hospital, Shenzhen, China
| | - Hung-Chih Lin
- Department of Neonatology, Children’s Hospital of China Medical University, Taichung, Taiwan
| | - Jiaping Mei
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Paula P. Meier
- Department of Pediatrics, Section of Neonatology, Rush University Children’s Hospital, Chicago, United States of America
| | - Chuan Nie
- Department of Neonatology, Guangdong Provincial Women & Children’s Hospital, Guangzhou, China
| | - Aloka L. Patel
- Department of Pediatrics, Section of Neonatology, Rush University Children’s Hospital, Chicago, United States of America
| | - Per T. Sangild
- Comparative Pediatrics and Nutrition, University of Copenhagen, Copenhagen, Denmark,Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark,Hans Christian Andersen Children’s Hospital, Odense, Denmark
| | - Thomas Skeath
- Department of Neonatology, Newcastle Hospitals NHS Foundation Trust, Newcastle, UK
| | - Karen Simmer
- Centre for Neonatal Research and Education, University of Western Australia and King Edward Memorial Hospital, Perth, Australia
| | | | - Marita de Waard
- Department of Pediatrics, Amsterdam UMC, Vrije Universiteit, Emma Children’s Hospital, Amsterdam, The Netherlands
| | - Sufen Ye
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Xuqiang Ye
- Foshan Woman and Children’s Hospital, Foshan, China
| | - Chunyi Zhang
- Department of Neonatology, Guangdong Provincial Women & Children’s Hospital, Guangzhou, China,Jinan University, Guangzhou, China
| | - Yanna Zhu
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Ping Zhou
- Department of Neonatology, Shenzhen Bao’an Maternal and Child Health Hospital, Shenzhen, China
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Bloomfield FH, Agostoni C. The potential impact of feeding formula-fed infants according to published recommendations. Pediatr Res 2020; 88:526-528. [PMID: 32634816 DOI: 10.1038/s41390-020-1056-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/25/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Frank H Bloomfield
- Liggins Institute, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
| | - Carlo Agostoni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Intermediate Care Unit, 20122, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Hill NS, Cormack BE, Little BS, Bloomfield FH. Growth and Clinical Outcome in Very Low-Birth-Weight Infants After the Introduction of a Multicomponent Intravenous Lipid Emulsion. JPEN J Parenter Enteral Nutr 2020; 44:1318-1327. [PMID: 31989691 DOI: 10.1002/jpen.1750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 10/18/2019] [Accepted: 11/05/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Very low-birth-weight (VLBW; birth weight < 1500 g) infants are often dependent on intravenous nutrition after birth. Conventional soy-based intravenous lipid emulsions (Soy LE) are associated with inflammatory and metabolic complications that may be harmful to preterm infants. Evidence to support any clinical benefit associated with newer multicomponent emulsions (Mixed LE), remains inconsistent and unsubstantiated in appropriate studies. This retrospective study aimed to determine whether growth and clinical outcomes differed between VLBW infants given Mixed LE vs Soy LE at Auckland City Hospital. METHODS Data were collected on nutrition, growth, and neonatal morbidities for the first 4 weeks after birth. Outcomes were compared between 2 lipid cohorts, Soy LE (February 2013 - August 2014) and Mixed LE (August 2014 - December 2015), using univariate and multivariate analysis. RESULTS 207 infants (Soy LE, 105 vs Mixed LE, 102) were included in the study. Significantly fewer infants in the Mixed LE cohort developed any stage retinopathy of prematurity (Soy LE 59% vs Mixed LE 39%, P = .005) or intraventricular hemorrhage (Soy LE 27% vs Mixed LE 15%, P = .03) during their admission. Mixed LE was also associated with significantly lower mean (P = .01), minimum (P = .03), and maximum (P = .04) total bilirubin concentrations across the first 4 weeks after birth. There was no difference in growth velocity or weight, length, and head circumference z-score change. CONCLUSION SMOFlipid may represent a favorable alternative to conventional lipid emulsions in neonatal parenteral nutrition regimens; however, long-term effects should be further evaluated.
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Affiliation(s)
| | - Barbara E Cormack
- Liggins Institute, The University of Auckland, Auckland, New Zealand.,Newborn Services, Auckland City Hospital, Auckland, New Zealand
| | | | - Frank H Bloomfield
- Liggins Institute, The University of Auckland, Auckland, New Zealand.,Newborn Services, Auckland City Hospital, Auckland, New Zealand
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Cormack BE, Jiang Y, Harding JE, Crowther CA, Lynn A, Nair A, Hewson M, Meyer M, Broadbent R, Webster D, Glamuzina E, Ryder B, Bloomfield FH. Plasma ammonia concentrations in extremely low birthweight infants in the first week after birth: secondary analysis from the ProVIDe randomized clinical trial. Pediatr Res 2020; 88:250-256. [PMID: 31896121 PMCID: PMC7384986 DOI: 10.1038/s41390-019-0730-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/20/2019] [Accepted: 12/09/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND Little is known about normative ammonia concentrations in extremely low birthweight (ELBW) babies and whether these vary with birth characteristics. We aimed to determine ammonia concentrations in ELBW babies in the first week after birth and relationships with neonatal characteristics and protein intake. METHODS Arterial blood samples for the measurement of plasma ammonia concentration were collected within 7 days of birth from ProVIDe trial participants in six New Zealand neonatal intensive care units. RESULTS Three hundred and twenty-two babies were included. Median (range) gestational age was 25.7 (22.7-31.6) weeks. Median (interquartile range (IQR)) ammonia concentration was 102 (80-131) µg/dL. There were no statistically significant associations between ammonia concentrations and birthweight or sex. Ammonia concentrations were weakly correlated with mean total (Spearman's rs = 0.11, P = 0.047) and intravenous (rs = 0.13, P = 0.02) protein intake from birth, gestational age at birth (rs = -0.13, P = 0.02) and postnatal age (rs = -0.13, P = 0.02). CONCLUSIONS Plasma ammonia concentrations in ELBW babies are similar to those of larger and more mature babies and only weakly correlated with protein intake. Currently, recommended thresholds for investigation of hyperammonaemia are appropriate for ELBW babies. Protein intake should not be limited by concerns about potential hyperammonaemia.
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Affiliation(s)
- Barbara E Cormack
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Newborn Services, Auckland City Hospital, Auckland, New Zealand
| | - Yannan Jiang
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Jane E Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | - Adrienne Lynn
- Neonatal Intensive Care Unit, Christchurch Women's Hospital, Christchurch, New Zealand
| | - Arun Nair
- Newborn Intensive Care Unit, Waikato Hospital, Hamilton, New Zealand
| | - Michael Hewson
- Neonatal Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
| | - Mike Meyer
- Neonatal Unit, Middlemore Hospital, Auckland, New Zealand
| | - Roland Broadbent
- Neonatal Intensive Care Unit, Dunedin Hospital, Dunedin, New Zealand
| | - Dianne Webster
- LabPlus, Auckland District Health Board, Auckland, New Zealand
| | - Emma Glamuzina
- National Adult and Paediatric Metabolic Service, Auckland, New Zealand
| | - Bryony Ryder
- National Adult and Paediatric Metabolic Service, Auckland, New Zealand
| | - Frank H Bloomfield
- Liggins Institute, University of Auckland, Auckland, New Zealand.
- Newborn Services, Auckland City Hospital, Auckland, New Zealand.
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Leung M, Black J, Bloomfield FH, Gamble GD, Harding JE, Jiang Y, Poppe T, Thompson B, Tottman AC, Wouldes TA, Alsweiler JM. Effects of Neonatal Hyperglycemia on Retinopathy of Prematurity and Visual Outcomes at 7 Years of Age: A Matched Cohort Study. J Pediatr 2020; 223:42-50.e2. [PMID: 32711750 DOI: 10.1016/j.jpeds.2020.04.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/06/2020] [Accepted: 04/23/2020] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To determine whether neonatal hyperglycemia is associated with retinopathy of prematurity (ROP), visual outcomes, and ocular growth at 7 years of age. STUDY DESIGN Children born preterm (<30 weeks of gestational age) at a tertiary hospital in Auckland, New Zealand, who developed neonatal hyperglycemia (2 blood glucose concentrations ≥153 mg/dL [8.5 mmol/L] 4 hours apart) were matched with children who were not hyperglycemic (matching criteria: sex, gestational age, birth weight, age, socioeconomic status, and multiple birth) and assessed at 7 years of corrected age. The primary outcome, favorable overall visual outcome (visual acuity ≤0.3 logarithm of the minimum angle of resolution, no strabismus, stereoacuity ≤240 arcsec, not requiring spectacles) was compared between groups using generalized matching criteria-adjusted linear regression models. RESULTS Assessments were performed on 57 children with neonatal hyperglycemia (hyperglycemia group) and 54 matched children without hyperglycemia (control group). There were no differences in overall favorable visual outcome (OR 0.95, 95% CI 0.42-2.13, P = .90) or severe ROP incidence (OR 2.20, 95% CI 0.63-7.63, P = .21) between groups. Children with hyperglycemia had poorer binocular distance visual acuity (mean difference 0.08, 95% CI 0.03-0.14 logarithm of the minimum angle of resolution, P < .01), more strabismus (OR 6.22, 95% CI 1.31-29.45, P = .02), and thicker crystalline lens (mean difference 0.14, 95% CI 0.04-0.24 mm, P < .01). Maximum blood glucose concentration was greater in the ROP-treated group compared with the ROP-not treated and no ROP groups after adjusting for sex, gestational age, and birth weight z score (P = .02). CONCLUSIONS Neonatal hyperglycemia was not associated with overall visual outcomes at 7 years of age. However, there were between-group differences for specific outcome measures relating to interocular lens growth and binocular vision. Further follow-up is required to determine implications on long-term visual outcome.
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Affiliation(s)
- Myra Leung
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand; Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand; Department of Optometry and Vision Science, University of Canberra, Canberra, Australia
| | - Joanna Black
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | | | - Greg D Gamble
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Jane E Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Yannan Jiang
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Tanya Poppe
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Benjamin Thompson
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand; School of Optometry and Vision Science, University of Waterloo, Ontario, Canada
| | - Anna C Tottman
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Trecia A Wouldes
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Jane M Alsweiler
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand; Newborn Services, National Women's Health, Auckland City Hospital, Auckland, New Zealand
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Cormack BE, Jiang Y, Harding JE, Crowther CA, Bloomfield FH. Neonatal Refeeding Syndrome and Clinical Outcome in Extremely Low-Birth-Weight Babies: Secondary Cohort Analysis From the ProVIDe Trial. JPEN J Parenter Enteral Nutr 2020; 45:65-78. [PMID: 32458478 PMCID: PMC7891336 DOI: 10.1002/jpen.1934] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/05/2020] [Accepted: 05/19/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Refeeding syndrome (RS) following preterm birth has been linked to high intravenous (IV) protein intake in the presence of low electrolyte supply. In extremely low-birth-weight (ELBW) babies, we aimed to determine the incidence of RS and associations with birth characteristics and clinical outcomes. METHOD Prospective cohort study of ELBW ProVIDe Trial participants in 6 New Zealand neonatal intensive care units. RS was defined as serum phosphate < 1.4 mmol.L-1 and total calcium > 2.8 mmol.L-1 . Relationships between RS and other factors were explored using 2-sample tests and logistic regression adjusted for sex, gestation, and birth-weight z-score. RESULTS Of 338 babies (mean [SD] birth-weight, 780 (134) g, gestational age, 25.9 [1.7] weeks), 68 (20%) had RS. Mortality was greater in babies with RS (32% vs 11%; P < .0001). More small- than appropriate-for-gestational-age babies developed RS (22% vs 8%; P = .001). Growth from birth to 36 weeks' corrected age was not different between babies who did and did not have RS. In logistic regression, the odds of RS decreased by 70% for each 1 mmol per kg-1 .d-1 IV phosphate intake (odds ratio [OR], 0.3; CI, 0.1-0.6; P = .002) and increased by 80% for each 1 g.kg-1 .d-1 IV protein intake (OR, 1.8; CI, 1.3-2.7; P = .002). CONCLUSIONS Neonatal RS is common in this cohort of ELBW babies and is associated with increased morbidity and mortality. Optimizing phosphate and calcium intakes in IV nutrition solutions may reduce RS and its consequences.
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Affiliation(s)
- Barbara E Cormack
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Newborn Services, Auckland City Hospital, Auckland, New Zealand
| | - Yannan Jiang
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Jane E Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | - Frank H Bloomfield
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Newborn Services, Auckland City Hospital, Auckland, New Zealand
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- Liggins Institute, University of Auckland, Auckland, New Zealand
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Cormack BE, Jiang Y, Harding JE, Crowther CA, Bloomfield FH. Relationships between Neonatal Nutrition and Growth to 36 Weeks' Corrected Age in ELBW Babies-Secondary Cohort Analysis from the Provide Trial. Nutrients 2020; 12:nu12030760. [PMID: 32183057 PMCID: PMC7146349 DOI: 10.3390/nu12030760] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/03/2020] [Accepted: 03/03/2020] [Indexed: 01/03/2023] Open
Abstract
A key modifiable factor for improving neurodevelopment in extremely low birthweight (ELBW) babies may be improving growth, especially head growth, by optimising nutrition in the early neonatal period. We aimed to investigate relationships between nutrient intakes in the 4 weeks after birth, and growth from birth to 36 weeks’ corrected age (CA) in ELBW babies. We undertook a prospective cohort study of 434 participants enrolled in a randomised controlled trial (ProVIDe) in eight New Zealand and Australian neonatal intensive care units. Macronutrient intakes from birth to 4 weeks and weight, length and head circumference measurements from birth to 36 weeks’ CA were collected. From birth to 36 weeks’ CA, the median (IQR) z-score changes were: weight −0.48 (−1.09, 0.05); length −1.16 (−1.86, −0.43), and head circumference −0.82 (−1.51, −0.19). Changes in z-score to 4 weeks and 36 weeks’ CA were correlated with protein intake. Each 1 g·Kg−1·d−1 total protein intake in week 2 was associated with 0.26 z-score increase in head circumference at 36 weeks’ CA. Both nutritional intake and change in z-scores to 36 weeks’ CA differed widely amongst sites. Correlations between nutrition and growth, and differences in these amongst sites, indicate there may be potential to improve growth with enhanced nutrition practices.
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Affiliation(s)
- Barbara E. Cormack
- Liggins Institute, University of Auckland, 1142 Auckland, New Zealand; (B.E.C.); (Y.J.); (J.E.H.); (C.A.C.)
- Newborn Services, Starship Child Health, Auckland City Hospital, 1142 Auckland, New Zealand
| | - Yannan Jiang
- Liggins Institute, University of Auckland, 1142 Auckland, New Zealand; (B.E.C.); (Y.J.); (J.E.H.); (C.A.C.)
| | - Jane E. Harding
- Liggins Institute, University of Auckland, 1142 Auckland, New Zealand; (B.E.C.); (Y.J.); (J.E.H.); (C.A.C.)
| | - Caroline A. Crowther
- Liggins Institute, University of Auckland, 1142 Auckland, New Zealand; (B.E.C.); (Y.J.); (J.E.H.); (C.A.C.)
| | - Frank H. Bloomfield
- Liggins Institute, University of Auckland, 1142 Auckland, New Zealand; (B.E.C.); (Y.J.); (J.E.H.); (C.A.C.)
- Newborn Services, Starship Child Health, Auckland City Hospital, 1142 Auckland, New Zealand
- Correspondence: ; Tel.: +64-9-923-6107
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Tuohy JF, Bloomfield FH, Harding JE, Crowther CA. Patterns of antenatal corticosteroid administration in a cohort of women with diabetes in pregnancy. PLoS One 2020; 15:e0229014. [PMID: 32106249 PMCID: PMC7046227 DOI: 10.1371/journal.pone.0229014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/28/2020] [Indexed: 01/13/2023] Open
Abstract
Antenatal corticosteroids administered to the mother prior to birth decrease the risk of mortality and major morbidity in infants born at less than 35 weeks’ gestation. However, the evidence relating to women with diabetes in pregnancy is limited. Clinical guidelines for antenatal corticosteroid administration recommend that women with diabetes in pregnancy are treated in the same way as women without diabetes, but there are no recent descriptions of whether contemporary practice complies with this guidance. This study is a retrospective review of antenatal corticosteroid administration at a New Zealand tertiary hospital in women with diabetes in pregnancy. We found that in this cohort, for both an initial course at less than 35 weeks’ gestation and repeat courses at less than 33 weeks’, the administration of antenatal corticosteroid to women with diabetes in pregnancy is largely consistent with current Australian and New Zealand recommendations. However, almost 25% of women received their last dose of antenatal corticosteroid at or beyond the latest recommended gestation of 35 weeks’ gestation. Pre-existing diabetes and planned caesarean section were independently associated with an increased rate of antenatal corticosteroid administration. We conclude that diabetes in pregnancy does not appear to be a deterrent to antenatal corticosteroid administration. The high rates of administration at gestations beyond recommendations, despite the lack of evidence of benefit in this group of women, highlights the need for further research into the risks and benefits of antenatal corticosteroid administration to women with diabetes in pregnancy, particularly in the late preterm and early term periods.
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Affiliation(s)
- Jeremy F. Tuohy
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | - Jane E. Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
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Anthony R, Riviere D, McKinlay CJ, Bloomfield FH. Adaptation for life after birth: a review of neonatal physiology. Anaesthesia & Intensive Care Medicine 2020. [DOI: 10.1016/j.mpaic.2019.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cloete E, Gentles TL, Bloomfield FH. introduce nationwide pulse oximetry screening for the detection of critical congenital heart disease and other hypoxaemic conditions in the newborn. N Z Med J 2020; 133:111-117. [PMID: 31945047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The mortality risk for infants with critical congenital heart disease (CCHD) unrecognised at the time of birth is high. Pulse oximetry has been utilised as a screening tool for the detection of these anomalies in the newborn as the majority will have a degree of hypoxaemia. This screening strategy has a moderate sensitivity and excellent specificity for the detection of CCHD, and a low false-positive rate. Respiratory and infective diseases are responsible for a large number of positive test results. The early recognition of these diseases can also improve health outcomes. Different approaches have been taken to introduce screening, ranging from hospital-led initiatives to mandatory state-wide policies. A study conducted in New Zealand demonstrated that sector-led screening initiatives are unlikely to result in equitable outcomes. In this midwifery-led maternity setting a nationwide pulse oximetry screening programme with adequate human and material resources should be introduced.
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Affiliation(s)
- Elza Cloete
- Senior Research Fellow, Liggins Institute, University of Auckland, Auckland
| | - Thomas L Gentles
- Paediatric Cardiologist, Director Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland
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Lawrence RL, Wall CR, Bloomfield FH. Dietary Patterns and Dietary Adaptations in Women with and without Gestational Diabetes: Evidence from the Growing Up in New Zealand Study. Nutrients 2020; 12:nu12010227. [PMID: 31952314 PMCID: PMC7019595 DOI: 10.3390/nu12010227] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 01/13/2020] [Indexed: 12/18/2022] Open
Abstract
Diet is a cornerstone of the management of gestational diabetes (GDM). We investigated differences in dietary patterns and dietary adaptations among pregnant women with and without GDM participating in the Growing Up in New Zealand study. Presence of GDM was determined using coded clinical data and plasma glucose results meeting the New Zealand Society for the Study of Diabetes diagnostic criteria. Women answered a food frequency questionnaire and questions regarding dietary changes and information received during pregnancy. Women with GDM had lower adherence scores than those without GDM for 'Junk' (mean (SD) score -0.28 (0.95) versus 0.02 (1.01) p < 0.0005) and 'Traditional/White bread' dietary patterns (-0.18 (0.93) versus 0.01 (1.01) p = 0.002). More women with GDM reported avoiding foods high in fat or sugar (25.3% versus 5.7%, p < 0.05) compared to women without GDM. A greater proportion of women with GDM compared with those without GDM received information from dietitians or nutritionists (27.0% versus 1.7%, p < 0.05) or obstetricians (12.6% versus 7.5%, p < 0.05). More women diagnosed before the antenatal interview received advice from dietitians or nutritionists compared with those diagnosed after (46.9% versus 6.0%, p < 0.05). Women with GDM appear to make positive changes to their diet in response to advice received from health care professionals.
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Affiliation(s)
- Robyn L. Lawrence
- The Liggins Institute, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand;
| | - Clare R. Wall
- Discipline of Nutrition and Dietetics, School of Medical Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand;
| | - Frank H. Bloomfield
- The Liggins Institute, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand;
- Correspondence: ; Tel.: +64-9-923-6107
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Cloete E, Bloomfield FH, Cassells SA, Laat MWM, Sadler L, Gentles TL. Newborn pulse oximetry screening in the context of a high antenatal detection rate of critical congenital heart disease. Acta Paediatr 2020; 109:93-99. [PMID: 31332832 PMCID: PMC6972642 DOI: 10.1111/apa.14946] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/09/2019] [Accepted: 07/18/2019] [Indexed: 12/26/2022]
Abstract
AIM Assess the potential additional benefit from pulse oximetry screening in the early detection of critical congenital heart disease in a country with a well-developed antenatal ultrasound screening programme. METHODS Live-born infants, pregnancy terminations and stillbirths from 20 weeks' gestational age, between 2013 and 2015, with critical cardiac defects defined as primary or secondary targets of pulse oximetry screening were identified. Critical defects were those resulting in the death of a fetus or an infant in the first 28 days after birth, or a defect requiring intervention in the first 28 days. RESULTS Two hundred and sixty-eight infants and Fetuses were identified. Antenatal detection rates improved from 69% to 77% over the study period. An associated co-morbidity improved antenatal detection rates. Twenty-seven live-born infants were diagnosed after discharge: 15 aortic arch obstruction (AAO); 10 d-loop transposition of the great arteries (d-TGA), and two total anomalous pulmonary venous drainage (TAPVD). Of these, five with AAO, nine with d-TGA and likely both with TAPVD could potentially have been detected with oximetry screening. CONCLUSION The antenatal detection of critical cardiac anomalies continues to improve in New Zealand. Despite high antenatal detection rates for most lesions, universal postnatal oximetry screening has the potential to improve early detection.
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Affiliation(s)
- Elza Cloete
- Liggins Institute University of Auckland Auckland New Zealand
| | | | - Sharnie A. Cassells
- Faculty of Medical and Health Sciences University of Auckland Auckland New Zealand
| | | | - Lynn Sadler
- Women’s Health Auckland City Hospital Auckland New Zealand
| | - Thomas L. Gentles
- Paediatric and Congenital Cardiac Services Starship Children’s Hospital Auckland New Zealand
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Cloete E, Gentles TL, Webster DR, Davidkova S, Dixon LA, Alsweiler JM, Bloomfield FH. Pulse oximetry screening in a midwifery-led maternity setting with high antenatal detection of congenital heart disease. Acta Paediatr 2020; 109:100-108. [PMID: 31298757 PMCID: PMC6972617 DOI: 10.1111/apa.14934] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 06/14/2019] [Accepted: 07/09/2019] [Indexed: 01/29/2023]
Abstract
Aim To assess local and individual factors that should be considered in the design of a pulse oximetry screening strategy in New Zealand's midwifery‐led maternity setting. Methods An intervention study was conducted over 2 years. Three hospitals and four primary maternity units participated in the study. Post‐ductal saturation levels were measured on well infants with a gestation of ≥35 weeks. Infant activity and age (hours) at the time of the test were recorded. Results Screening was performed on 16 644 of 27 172 (61%) eligible infants. The age at which the screening algorithm was initiated varied significantly among centres. The probability of achieving a pass result (saturations ≥95%) in the context of no underlying pathology ranged from .94 for an unsettled infant screened <4 hours of age to .99 (P < .001) when the test was performed after 24 hours on a settled infant. Forty‐eight (0.3%) infants failed to reach saturation targets: 37 had significant pathology of which three had cardiac disease. Conclusion Screening practices were influenced by the setting in which it was undertaken. Infant activity and age at the time of testing can influence saturation levels. Screening is associated with the identification of significant non‐cardiac pathology.
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Affiliation(s)
- Elza Cloete
- Liggins Institute University of Auckland Auckland New Zealand
| | - Thomas L. Gentles
- Paediatric and Congenital Cardiac Services Starship Children's Hospital Auckland New Zealand
| | - Dianne R. Webster
- Newborn Metabolic Screening Unit Auckland City Hospital Auckland New Zealand
| | - Sarka Davidkova
- Department of Paediatrics Rotorua Hospital Rotorua New Zealand
| | | | - Jane M. Alsweiler
- Department of Paediatrics, Child and Youth Health University of Auckland Auckland New Zealand
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Alexander T, Conlon CA, Gamble G, von Hurst PR, van Dorp L, Ichhpuniani B, Housh R, Ke P, Bloomfield FH. Body composition of New Zealand-born term babies differs by ethnicity, gestational age and sex. Early Hum Dev 2019; 140:104924. [PMID: 31739266 DOI: 10.1016/j.earlhumdev.2019.104924] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/31/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Body composition provides important information on nutrition and future metabolic risk. New Zealand has a diverse ethnic population for which there are no newborn body composition data. AIM To determine body composition in a cohort of New Zealand-born term babies. STUDY DESIGN Observational study. SUBJECTS Healthy, term infants between 37+0 and 41+6 weeks' gestation in two hospitals in Auckland, New Zealand. OUTCOME MEASURES Body composition by air displacement plethysmography and anthropometry measured within 5 days of birth. Parent-identified ethnicity was prioritised according to Ministry of Health criteria. Data were analysed using t-test, ANOVA with Tukey post-hoc tests, quantile regression and are mean(SD). RESULTS 440 babies (54% male) were included. Pacific Island/Māori (PI/M) were heavier at birth than Asian/Middle Eastern/Latin American/African (Asian+) babies (3403(506) vs 3181(485) g, p < .05). PI/M and European (E) babies were longer with larger head and waist circumferences than Asian+ babies (all p < .05). Absolute fat mass (FM) was not different amongst ethnicities (E, 365(156), PI/M, 347(183), Asian+, 357(188) g) but PI/M babies had significantly lower FM% than Asian+ (9.8(4.3) vs 10.9(4.5) %, p < .05). Fat-free mass (FFM) was greater in PI/M (3056(400) g) than E (2952(345) g (p < .05) and both PI/M and E had greater FFM than Asian+ (2824(363) g, p < .05). Early term babies had less FFM than term and late-term babies (2732(370), 3012(352), 3173(302)g, p < .001) respectively. CONCLUSIONS Asian+ babies were the smallest babies with the least FFM yet had similar FM and the highest FM%, indicative of a thin, fat phenotype from birth.
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Affiliation(s)
- T Alexander
- Liggins Institute, University of Auckland, Auckland, New Zealand; Neonatal Unit, Kidz First, Middlemore Hospital, Auckland, New Zealand.
| | - C A Conlon
- School of Sport, Exercise & Nutrition, Massey University, Auckland, New Zealand
| | - G Gamble
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - P R von Hurst
- School of Sport, Exercise & Nutrition, Massey University, Auckland, New Zealand
| | - L van Dorp
- School of Sport, Exercise & Nutrition, Massey University, Auckland, New Zealand
| | - B Ichhpuniani
- School of Sport, Exercise & Nutrition, Massey University, Auckland, New Zealand
| | - R Housh
- College of Health & Rehabilitation Sciences: Sargent College, Boston University, Boston, United States
| | - P Ke
- College of Health & Rehabilitation Sciences: Sargent College, Boston University, Boston, United States
| | - F H Bloomfield
- Liggins Institute, University of Auckland, Auckland, New Zealand
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Harding JE, Bloomfield FH. Seminars in Perinatology-Neonatal nutrition. Semin Perinatol 2019; 43:151161. [PMID: 31296391 DOI: 10.1053/j.semperi.2019.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- J E Harding
- Liggins Institute, University of Auckland, Private Bag 92019, Auckland, New Zealand.
| | - F H Bloomfield
- Liggins Institute, University of Auckland, Private Bag 92019, Auckland, New Zealand
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