1
|
Borg K, Hansen BM, Klamer A, Zachariassen G. Very preterm studies remain a challenge because of limited cohort sizes. Acta Paediatr 2024; 113:1118. [PMID: 38413549 DOI: 10.1111/apa.17173] [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: 01/17/2024] [Revised: 02/12/2024] [Accepted: 02/16/2024] [Indexed: 02/29/2024]
Affiliation(s)
- Kristine Borg
- H. C. Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Bo Mølholm Hansen
- Department of Paediatrics, Nordsjaellands Hospital, Hilleroed, Denmark
| | - Anja Klamer
- H. C. Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Gitte Zachariassen
- H. C. Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
- OPEN Explorative Network, Odense University Hospital, Odense, Region of Southern Denmark, Denmark
| |
Collapse
|
2
|
Simonsen MB, Kappel SS, Aunsholt L, Möller S, Sangild PT, Zachariassen G. Mineral supplementation for very preterm infants fed fortified human milk. J Pediatr Gastroenterol Nutr 2024. [PMID: 38587119 DOI: 10.1002/jpn3.12190] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/23/2024] [Accepted: 03/04/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVES The safety and feasibility of human milk fortification with bovine colostrum (BC) were investigated in very preterm infants (FortiColos trial, NCT03537365). The BC product contained lower calcium, phosphate, and iron levels compared to the conventional fortifier (CF). We tested whether fortification with BC plus extra phosphate was sufficient to support the infants' mineral status assessed by blood biochemistry. METHODS In a randomised controlled trial (FortiColos, NCT03537365), mineral status was compared after fortification with BC versus CF. Blood calcium, phosphate, and haemoglobin were determined before and up to 3 weeks after the start of fortification (at the mean age of 8-9 days). The maximum supplemental doses of calcium, phosphate, and iron given were retrieved from patient medical records. Results were adjusted for gestational age, birth weight, and enteral nutrition with the mother's own milk and/or donor human milk. RESULTS Blood values of calcium, phosphate, and haemoglobin were similar between groups. Infants in both groups required supplementation with calcium and phosphate, but infants fed BC required higher maximum doses of phosphate and calcium (p < 0.05) to maintain acceptable blood values. Regardless of fortification groups, the most immature (<29 weeks of gestation) and small for gestational age infants showed a higher risk for requiring additional phosphate (OR: 3.9, p < 0.001; OR: 2.14, p = 0.07, respectively). CONCLUSIONS The use of BC as a fortifier for human milk requires additional phosphate and calcium relative to a CF. Regardless of the fortification product, the most immature and small infants require additional mineral supplementation.
Collapse
Affiliation(s)
- Marie Bendix Simonsen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Susanne Soendergaard Kappel
- Section of Comparative Paediatrics and Nutrition, University of Copenhagen, Frederiksberg, Denmark
- Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lise Aunsholt
- Section of Comparative Paediatrics and Nutrition, University of Copenhagen, Frederiksberg, Denmark
- Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Per Torp Sangild
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Section of Comparative Paediatrics and Nutrition, University of Copenhagen, Frederiksberg, Denmark
- Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Gitte Zachariassen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| |
Collapse
|
3
|
Holgersen K, Rasmussen MB, Zamir I, Aunsholt L, Zachariassen G, Sangild PT. Glucose-regulatory hormones and growth in very preterm infants fed fortified human milk. Pediatr Res 2024:10.1038/s41390-024-03166-8. [PMID: 38580842 DOI: 10.1038/s41390-024-03166-8] [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: 06/14/2023] [Revised: 03/01/2024] [Accepted: 03/15/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Bovine colostrum (BC) contains a range of milk bioactive components, and it is unknown how human milk fortification with BC affects glucose-regulatory hormones in very preterm infants (VPIs). This study aimed to investigate the associations between hormone concentrations and fortification type, birth weight (appropriate/small for gestational age, AGA/SGA), milk intake, postnatal age, and body growth. METHODS 225 VPIs were randomized to fortification with BC or conventional fortifier (CF). Plasma hormones were measured before, one and two weeks after start of fortification. ΔZ-scores from birth to 35 weeks postmenstrual age were calculated. RESULTS Compared with CF, infants fortified with BC had higher plasma GLP-1, GIP, glucagon, and leptin concentrations after start of fortification. Prior to fortification, leptin concentrations were negatively associated with growth, while IGF-1 concentrations associated positively with growth during fortification. In AGA infants, hormone concentrations generally increased after one week of fortification. Relative to AGA infants, SGA infants showed reduced IGF-1 and leptin concentrations. CONCLUSION Fortification with BC increased the plasma concentrations of several glucose-regulatory hormones. Concentrations of IGF-1 were positively, and leptin negatively, associated with growth. Glucose-regulatory hormone levels were affected by birth weight, milk intake and postnatal age, but not closely associated with growth in VPIs. IMPACT Little is known about the variation in glucose-regulatory hormones in the early life of very preterm infants (VPIs). This study shows that the levels of glucose-regulatory hormones in plasma of VPIs are highly variable and modified by birth weight (appropriate or small for gestational age, AGA or SGA), the type of fortifier, enteral nutritional intake, and advancing postnatal age. The results confirm that IGF-1 levels are positively associated with early postnatal growth in VPIs, yet the levels of both IGF-1 and other glucose-regulatory hormones appeared to explain only a small part of the overall variation in growth rates.
Collapse
Affiliation(s)
- Kristine Holgersen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
- Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Martin Bo Rasmussen
- Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Itay Zamir
- Department of Clinical Sciences, Pediatrics unit, Umeå University, Umeå, Sweden
| | - Lise Aunsholt
- Department of Neonatology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Gitte Zachariassen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient data Explorative Network, Region of Southern Denmark, Odense, Denmark
| | - Per Torp Sangild
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.
- Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark.
- Department of Neonatology, Rigshospitalet, Copenhagen, Denmark.
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| |
Collapse
|
4
|
Borg K, Hansen BM, Klamer A, Zachariassen G. The ASQ did not predict low IQ scores when children born VPT were six years. Acta Paediatr 2024; 113:739-744. [PMID: 38084803 DOI: 10.1111/apa.17056] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/24/2023] [Accepted: 11/30/2023] [Indexed: 03/12/2024]
Abstract
AIM There is a need for methods that can provide valid assessment tools in a follow-up programme without great financial costs. This study assessed the accuracy of the 60-month Ages and Stages Questionnaire as a screening tool to predict a low intelligence quotient score at 6 years in children born very preterm. METHODS Totally, 54 children participated in a six-year follow-up study, which included an intelligence quotient test at 6 years of age and a 60-month Ages and Stages Questionnaire at four and a half or 5 years of age at respond. We used the receiver operating characteristic curve and evaluated the optimal cut-off score to predict a low intelligence quotient score. RESULTS At four and a half years, the optimal cut-off value for predicting a low intelligence quotient score was 242, with a sensitivity of 67% and a specificity of 59%. At 5 years, only one child had a low intelligence quotient score, and the analysis was not performed. CONCLUSION Our results did not support the use of the 60-month Ages and Stages Questionnaire as a valuable screening tool to predict a low intelligence quotient score in children born very preterm at 6 years of age.
Collapse
Affiliation(s)
- Kristine Borg
- H. C. Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Bo Mølholm Hansen
- Department of Paediatrics, Nordsjaellands Hospital, Hilleroed, Denmark
| | - Anja Klamer
- H. C. Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Gitte Zachariassen
- H. C. Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
- OPEN Explorative Network, Odense University Hospital, Odense, Denmark
| |
Collapse
|
5
|
Breindahl N, Henriksen TB, Heiring C, Bay ET, Haaber J, Salmonsen TG, Carlsen ELM, Zachariassen G, Agergaard P, Viuff ACF, Bender L, Grønnebæk Tolsgaard M, Aunsholt L. NON-pharmacological Approach Less Invasive Surfactant Administration (NONA-LISA) trial: protocol for a randomised controlled trial. Pediatr Res 2024:10.1038/s41390-023-02998-0. [PMID: 38200325 DOI: 10.1038/s41390-023-02998-0] [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: 08/25/2023] [Revised: 11/18/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024]
Abstract
INTRODUCTION Using pre-procedure analgesia with the risk of apnoea may complicate the Less Invasive Surfactant Administration (LISA) procedure or reduce the effect of LISA. METHODS The NONA-LISA trial (ClinicalTrials.gov, NCT05609877) is a multicentre, blinded, randomised controlled trial aiming at including 324 infants born before 30 gestational weeks, meeting the criteria for surfactant treatment by LISA. Infants will be randomised to LISA after administration of fentanyl 0.5-1 mcg/kg intravenously (fentanyl group) or isotonic saline solution intravenously (saline group). All infants will receive standardised non-pharmacological comfort care before and during the LISA procedure. Additional analgesics will be provided at the clinician's discretion. The primary outcome is the need for invasive ventilation, meaning mechanical or manual ventilation via an endotracheal tube, for at least 30 min (cumulated) within 24 h of the procedure. Secondary outcomes include the modified COMFORTneo score during the procedure, bronchopulmonary dysplasia at 36 weeks, and mortality at 36 weeks. DISCUSSION The NONA-LISA trial has the potential to provide evidence for a standardised approach to relief from discomfort in preterm infants during LISA and to reduce invasive ventilation. The results may affect future clinical practice. IMPACT Pre-procedure analgesia is associated with apnoea and may complicate procedures that rely on regular spontaneous breathing, such as Less Invasive Surfactant Administration (LISA). This randomised controlled trial addresses the effect of analgesic premedication in LISA by comparing fentanyl with a placebo (isotonic saline) in infants undergoing the LISA procedure. All infants will receive standardised non-pharmacological comfort. The NONA-LISA trial has the potential to provide evidence for a standardised approach to relief from discomfort or pain in preterm infants during LISA and to reduce invasive ventilation. The results may affect future clinical practice regarding analgesic treatment associated with the LISA procedure.
Collapse
Affiliation(s)
- Niklas Breindahl
- Department of Neonatal and Paediatric Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Tine Brink Henriksen
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Perinatal Research Unit, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Christian Heiring
- Department of Neonatal and Paediatric Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Emma Therese Bay
- Department of Neonatal and Paediatric Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jannie Haaber
- Department of Neonatal and Paediatric Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Tenna Gladbo Salmonsen
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Emma Louise Malchau Carlsen
- Department of Neonatal and Paediatric Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Gitte Zachariassen
- Hans Christian Andersen Children's Hospital, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Peter Agergaard
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Anne-Cathrine Finnemann Viuff
- Division of Neonatology, Department of Paediatric and Adolescent Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Lars Bender
- Division of Neonatology, Department of Paediatric and Adolescent Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Martin Grønnebæk Tolsgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Lise Aunsholt
- Department of Neonatal and Paediatric Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Veterinary and Animal Science, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
6
|
Bæk O, Rasmussen MB, Gerts T, Aunsholt L, Zachariassen G, Sangild P, Nguyen DN. Insulin-like growth factor 1 associated with altered immune responses in preterm infants and pigs. Pediatr Res 2024; 95:120-128. [PMID: 37648745 PMCID: PMC10798898 DOI: 10.1038/s41390-023-02794-w] [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] [Received: 04/01/2023] [Revised: 07/10/2023] [Accepted: 08/14/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Preterm infants show low blood levels of insulin-like growth factor 1 (IGF-1), known to be negatively correlated with Interleukin-6 (IL-6). We hypothesized that circulating IGF-1 is associated with systemic immune-markers following preterm birth and that exogenous IGF-1 supplementation modulates immune development in preterm pigs, used as model for preterm infants. METHODS Plasma levels of IGF-1 and 29 inflammatory markers were measured in very preterm infants (n = 221). In preterm pigs, systemic immune development, assessed by in vitro challenge, was compared between IGF-1 treated (2.25 mg/kg/day) and control animals. RESULTS Preterm infants with lowest gestational age and birth weight showed the lowest IGF-1 levels, which were correlated not only with IL-6, but a range of immune-markers. IGF-1 supplementation to preterm pigs reduced plasma IL-10 and Interferon-γ (IFN-γ), IL-2 responses to challenge and reduced expression of genes related to Th1 polarization. In vitro addition of IGF-1 (100 ng/mL) further reduced the IL-2 and IFN-γ responses but increased IL-10 response. CONCLUSIONS In preterm infants, plasma IGF-1 correlated with several immune markers, while supplementing IGF-1 to preterm pigs tended to reduce Th1 immune responses. Future studies should document whether IGF-1 supplementation to preterm infants affects immune development and sensitivity to infection. IMPACT Supplementation of insulin-like growth factor 1 (IGF-1) to preterm infants has been proposed to promote postnatal growth, but its impact on the developing immune system is largely unknown. In a cohort of very preterm infants, low gestational age and birth weight were the primary predictors of low plasma levels of IGF-1, which in turn were associated with plasma immune markers. Meanwhile, in immature preterm pigs, experimental supplementation of IGF-1 reduced Th1-related immune responses in early life. Supplementation of IGF-1 to preterm infants may affect the developing immune system, which needs consideration when evaluating overall impact on neonatal health.
Collapse
Affiliation(s)
- Ole Bæk
- Section for Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Martin Bo Rasmussen
- Section for Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Therese Gerts
- Section for Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lise Aunsholt
- Section for Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Gitte Zachariassen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
- Open Patient data Explorative network, Region of Southern Denmark, Odense, Denmark
| | - Per Sangild
- Section for Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Duc Ninh Nguyen
- Section for Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark.
| |
Collapse
|
7
|
Lewis AE, Kappel SS, Hussain S, Sangild PT, Zachariassen G, Aunsholt L. Trial-related blood sampling and red blood cell transfusions in preterm infants. Acta Paediatr 2023; 112:2486-2492. [PMID: 37565393 DOI: 10.1111/apa.16948] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 07/25/2023] [Accepted: 08/09/2023] [Indexed: 08/12/2023]
Abstract
AIM To determine if trial-related blood sampling increases the risk of later red blood cell (RBC) transfusion in very preterm infants, we compared the volume of clinical- and trial-related blood samples, in a specific trial and correlated to subsequent RBC transfusion. METHODS For 193 very preterm infants, participating in the FortiColos trial (NCT03537365), trial-related blood volume drawn was in accordance with ethical considerations established by the European Commission. Medical records were reviewed to assess the number and accumulated volume (mL/kg) of blood samples (both clinical- and trial-related). Data were compared with the need of RBC transfusions during the first 28 days of life. RESULTS Mean (SD) gestational age and birth weight was 28 ± 1 weeks and 1168 ± 301 g. In total, 11% of total blood volume was drawn for sampling (8.1 ± 5.1 mL/kg) and trial-related sampling accounted for 1.6 ± 0.6 mL/kg. Trial-related blood sampling had no impact on RBC transfusion (p = 0.9). CONCLUSION Clinical blood sampling in very preterm infants is associated with blood loss and subsequent need for RBC transfusions. In a specific trial requiring blood samples, we found no additional burden of trial-related blood sampling. The study suggests that trial-related sampling is safe if European criteria are followed.
Collapse
Affiliation(s)
- Anna Elisabet Lewis
- Comparative Pediatrics and Nutrition, University of Copenhagen, Copenhagen, Denmark
- Department of Neonatology, Nordsjaellands Hospital, Hillerød, Denmark
| | - Susanne S Kappel
- Comparative Pediatrics and Nutrition, University of Copenhagen, Copenhagen, Denmark
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Samya Hussain
- Comparative Pediatrics and Nutrition, University of Copenhagen, Copenhagen, Denmark
| | - Per T Sangild
- Comparative Pediatrics and Nutrition, University of Copenhagen, Copenhagen, Denmark
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Gitte Zachariassen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lise Aunsholt
- Comparative Pediatrics and Nutrition, University of Copenhagen, Copenhagen, Denmark
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
8
|
Larsen UL, Zachariassen G, Möller S, Førre WU, Grøsle I, Halken S, Herskind AM, Strøm T, Toft P, Ellebæk M, Qvist N. Early Pre- and Postoperative Enteral Nutrition and Growth in Infants with Symptomatic Congenital Diaphragmatic Hernia. Eur J Pediatr Surg 2023; 33:469-476. [PMID: 36929125 DOI: 10.1055/s-0043-1767829] [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: 03/18/2023]
Abstract
OBJECTIVES Nutritional support during the neonatal and postoperative period in congenital diaphragmatic hernia (CDH) is challenging and controversial. We aimed to report on early enteral nutritional support in symptomatic CDH patients during the pre- and postoperative period, including feasibility, associated factors with established full enteral nutrition, and weight at birth, discharge, and 18 months. METHODS We retrospectively collected data on nutrition: type and volume of enteral nutrition and parental support. Enteral feeding was introduced preoperatively from day 1 after birth, increased step-wised (breastmilk preferred), and resumed after CDH repair on the first postoperative day. Baseline data were available from our CDH database. RESULTS From 2011 to 2020, we identified 45 CDH infants. Twenty-two were girls (51.1%), 35 left sided (77.8%), and 40 underwent CDH repair (88.9%). Median (interquartile range) length of stay in the pediatric intensive care unit was 14.6 days (6.0-26.5), and 1-year mortality was 17.8%.Postoperatively, 120 and 160 mL/kg/d of enteral nutrition was achieved after a median of 6.5 (3.6-12.6) and 10.6 (7.6-21.7) days, respectively. In total, 31 (68.9%) needed supplemental parenteral nutrition in a median period of 8 days (5-18), and of those 11 had parenteral nutrition initiated before CDH repair. No complications to enteral feeding were reported. CONCLUSION Early enteral nutrition in CDH infants is feasible and may have the potential to reduce the need for parental nutrition and reduce time to full enteral nutrition in the postoperative period.
Collapse
Affiliation(s)
- Ulla Lei Larsen
- Research Unit for the Department of Anaesthesiology & Intensive Care, Odense University Hospital, University of Southern Denmark, Odense, Denmark
- Odense Patient Data Explorative Network (OPEN), Odense University Hospital and Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Gitte Zachariassen
- Odense Patient Data Explorative Network (OPEN), Odense University Hospital and Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- H.C. Andersen Children's Hospital, Odense University Hospital; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sören Möller
- Odense Patient Data Explorative Network (OPEN), Odense University Hospital and Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Wilhelmine Ursin Førre
- Research Unit for the Department of Anaesthesiology & Intensive Care, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Ingvild Grøsle
- Research Unit for the Department of Anaesthesiology & Intensive Care, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Susanne Halken
- H.C. Andersen Children's Hospital, Odense University Hospital; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anne Maria Herskind
- H.C. Andersen Children's Hospital, Odense University Hospital; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Thomas Strøm
- Research Unit for the Department of Anaesthesiology & Intensive Care, Odense University Hospital, University of Southern Denmark, Odense, Denmark
- Department of Anaesthesiology and Intensive Care, Hospital Sønderjylland, University of Southern Denmark, Odense, Denmark
| | - Palle Toft
- Research Unit for the Department of Anaesthesiology & Intensive Care, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Mark Ellebæk
- Research Unit for Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark
- Research Unit for Surgery, and Centre of Excellence in Gastrointestinal Diseases and Malformations in Infancy and Childhood (GAIN), Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Niels Qvist
- Odense Patient Data Explorative Network (OPEN), Odense University Hospital and Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Research Unit for Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark
- Research Unit for Surgery, and Centre of Excellence in Gastrointestinal Diseases and Malformations in Infancy and Childhood (GAIN), Odense University Hospital, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
9
|
Sparre S, Zachariassen G, Ellebæk MB, Husby S, Holm KG. Feeding Practice, Nutrition, and Growth in Infants with Abdominal Wall Defects and Esophageal Atresia: A Retrospective Case-Control Study. Eur J Pediatr Surg 2023; 33:367-376. [PMID: 36588282 DOI: 10.1055/s-0042-1757360] [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: 01/03/2023]
Abstract
INTRODUCTION Infants born with abdominal wall defects and esophageal atresia (EA) are at risk of impaired growth. Little is known about the optimal nutritional strategy and its impact on growth for these infants. This study aims to explore nutrition, focusing on breastfeeding, and the presumed impact on infant growth during the first year of life. MATERIALS AND METHODS We performed a registry study. The participants comprised infants born with gastroschisis, omphalocele, or EA from 2009 to 2020. Breastfed healthy infants from the Odense Child Cohort served as the control group. Descriptive statistics were applied when presenting data on nutrition. Growth data were converted to weight z-scores at birth and at discharge, and estimated weight z-scores at 6 and 12 months were calculated. Univariate regression analysis was applied. RESULTS The study included 168 infants in the study group and 403 infants in the control group. Exclusive breastfeeding rates at discharge were as follows: 55.7% (gastroschisis), 58.3% (omphalocele), 50.9% (EA), and 7.7% (long-gap EA). For the study group our data demonstrate no difference in growth at 1 year of age when comparing mother's milk to formula feeding. During the first year of life, infants in the study group showed slower growth compared with the control group. At 12 months of age, all infants had a mean weight z-score above -2. CONCLUSION Breastfeeding in infants with abdominal wall defects and EA can be established without compromising growth. Mother's milk can be recommended for infants with abdominal wall defects and EA.
Collapse
Affiliation(s)
- Signe Sparre
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense C, Denmark
- Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense C, Denmark
| | - Gitte Zachariassen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense C, Denmark
- Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense C, Denmark
- Odense Patient data Explorative Network, Odense University Hospital, Odense C, Denmark
| | - Mark Bremholm Ellebæk
- Surgical Research Unit, Odense University Hospital, Odense C, Denmark; University of Southern Denmark, Odense, Denmark
| | - Steffen Husby
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense C, Denmark
- Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense C, Denmark
| | - Kristina Garne Holm
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense C, Denmark
- Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense C, Denmark
- Odense Patient data Explorative Network, Odense University Hospital, Odense C, Denmark
| |
Collapse
|
10
|
Yan X, Pan X, Ding L, Dai Y, Chen J, Yang Y, Li Y, Hao H, Qiu H, Ye Z, Shen RL, Li Y, Ritz C, Peng Y, Zhou P, Gao F, Jiang PP, Lin HC, Zachariassen G, Sangild PT, Wu B. Bovine colostrum to supplement the first feeding of very preterm infants: The PreColos randomized controlled trial. Clin Nutr 2023; 42:1408-1417. [PMID: 37437359 DOI: 10.1016/j.clnu.2023.06.024] [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] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/16/2023] [Accepted: 06/21/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND & AIMS Gut immaturity leads to feeding difficulties in very preterm infants (<32 weeks gestation at birth). Maternal milk (MM) is the optimal diet but often absent or insufficient. We hypothesized that bovine colostrum (BC), rich in protein and bioactive components, improves enteral feeding progression, relative to preterm formula (PF), when supplemented to MM. Aim of the study is to determine whether BC supplementation to MM during the first 14 days of life shortens the time to full enteral feeding (120 mL/kg/d, TFF120). METHODS This was a multicenter, randomized, controlled trial at seven hospitals in South China without access to human donor milk and with slow feeding progression. Infants were randomly assigned to receive BC or PF when MM was insufficient. Volume of BC was restricted by recommended protein intake (4-4.5 g/kg/d). Primary outcome was TFF120. Feeding intolerance, growth, morbidities and blood parameters were recorded to assess safety. RESULTS A total of 350 infants were recruited. BC supplementation had no effect on TFF120 in intention-to-treat analysis [n (BC) = 171, n (PF) = 179; adjusted hazard ratio, aHR: 0.82 (95% CI: 0.64, 1.06); P = 0.13]. Body growth and morbidities did not differ, but more cases of periventricular leukomalacia were detected in the infants fed BC (5/155 vs. 0/181, P = 0.06). Blood chemistry and hematology data were similar between the intervention groups. CONCLUSIONS BC supplementation during the first two weeks of life did not reduce TFF120 and had only marginal effects on clinical variables. Clinical effects of BC supplementation on very preterm infants in the first weeks of life may depend on feeding regimen and remaining milk diet. TRIAL REGISTRATION http://www. CLINICALTRIALS gov: NCT03085277.
Collapse
Affiliation(s)
- Xudong Yan
- Department of Neonatology, Shenzhen People's Hospital (The Second Clinical Medical College, Ji'nan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China
| | - Xiaoyu Pan
- Comparative Pediatrics and Nutrition, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Lu Ding
- Department of Neonatology, Shenzhen People's Hospital (The Second Clinical Medical College, Ji'nan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China
| | - Yiheng Dai
- Department of Neonatology, Foshan Maternal and Child Health Hospital, Foshan, China
| | - Jun Chen
- Department of Neonatology, Shenzhen Nanshan Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Yong Yang
- Department of Neonatology, Dongguan Maternal and Child Health Care Hospital, Dongguang, China
| | - Yuefeng Li
- Department of Neonatology, Shenzhen Luohu Maternal and Child Health Hospital, Shenzhen, China
| | - Hu Hao
- Department of Neonatology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Huixian Qiu
- Department of Neonatology, Longgang District Central Hospital of Shenzhen, Shenzhen, China
| | - Zhenzhi Ye
- Department of Neonatology, University of Chinese Academy of Sciences-Shenzhen Hospital, Shenzhen, China
| | - René Liang Shen
- Comparative Pediatrics and Nutrition, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark; Department of Neonatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Yanqi Li
- Comparative Pediatrics and Nutrition, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark; NBCD A/S, Herlev, Denmark
| | - Christian Ritz
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Yueming Peng
- Department of Neonatology, Shenzhen People's Hospital (The Second Clinical Medical College, Ji'nan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China
| | - Ping Zhou
- Department of Neonatology, Bao'an Women and Children's Hospital, Shenzhen, China
| | - Fei Gao
- Comparative Pediatrics and Nutrition, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark; NEOMICS Institute, Shenzhen, China
| | - Ping-Ping Jiang
- Comparative Pediatrics and Nutrition, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Hung-Chih Lin
- Department of Pediatrics, China Medical University Children's Hospital, Taichung, Taiwan
| | - Gitte Zachariassen
- Department of Pediatrics, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Per Torp Sangild
- Comparative Pediatrics and Nutrition, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark; Department of Neonatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Pediatrics, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
| | - Benqing Wu
- Department of Neonatology, University of Chinese Academy of Sciences-Shenzhen Hospital, Shenzhen, China.
| |
Collapse
|
11
|
Ahnfeldt AM, Aunsholt L, Hansen BM, Hoest B, Jóhannsdóttir V, Kappel SS, Klamer A, Möller S, Moeller BK, Sangild PT, Skovgaard AL, van Hall G, Vibede LD, Zachariassen G. Bovine Colostrum as a Fortifier to Human Milk in Very Preterm Infants – A Randomized Controlled Trial (FortiColos). Clin Nutr 2023; 42:773-783. [PMID: 37004355 DOI: 10.1016/j.clnu.2023.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/26/2023] [Accepted: 03/08/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND Human milk for very preterm infants need fortification for optimal growth and development but the optimal fortification product remains to be identified. AIMS To investigate feasibility, safety and preliminary efficacy on growth and blood biochemistry when using intact bovine colostrum (BC) as a fortifier to human milk in very preterm infants. METHODS In an open-label, multicenter, randomized controlled pilot trial (infants 26-31 weeks' gestation), mother's own milk or donor human milk was fortified with powdered BC (n = 115) or a conventional fortifier (CF, bovine-milk-based, n = 117) until 35 weeks' postmenstrual age. Fortifiers and additional micronutrients were added to human milk according to local guidelines to achieve optimal growth (additional protein up to +1.4 g protein/100 mL human milk). Anthropometry was recorded weekly. Clinical morbidities including necrotizing enterocolitis (NEC) and late-onset sepsis (LOS) were recorded. Clinical biochemistry included plasma amino acid (AA) levels to assess protein metabolic responses to the new fortifier. RESULTS A total of 232 infants, gestational age (GA) 28.5 ± 1.4 (weeks + days), fulfilled inclusion criteria. Birthweight, GA and delta Z scores from birth to end of intervention on weight, length or head circumference did not differ between groups, nor between the subgroups of small for gestational age infants. Likewise, incidence of NEC (BC: 3/115 vs. CF: 5/117, p = 0.72, unadjusted values), LOS (BC: 23/113 vs. CF: 14/116, p = 0.08) and other morbidities did not differ. BC infants received more protein than CF infants (+10%, p < 0.05) and showed several elevated AA levels (+10-40%, p < 0.05). CONCLUSION Infants fortified with BC showed similar growth but received more protein and showed a moderate increase in plasma AA-levels, compared with CF. Adjustments in protein composition and micronutrients in BC-based fortifiers may be required to fully suit the needs for very preterm infants.
Collapse
Affiliation(s)
- Agnethe May Ahnfeldt
- Section of Comparative Pediatrics and Nutrition, University of Copenhagen, Frederiksberg, Denmark
| | - Lise Aunsholt
- Section of Comparative Pediatrics and Nutrition, University of Copenhagen, Frederiksberg, Denmark; Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Bo Moelholm Hansen
- Department of Pediatrics, Copenhagen University Hospital North Zealand, Hilleroed, Denmark
| | - Bente Hoest
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Valdís Jóhannsdóttir
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Susanne Soendergaard Kappel
- Section of Comparative Pediatrics and Nutrition, University of Copenhagen, Frederiksberg, Denmark; Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Anja Klamer
- Department of Pediatrics, Hospital Lillebaelt, Kolding, Denmark
| | - Sören Möller
- Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Bertha Kanijo Moeller
- Department of Pediatrics, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Per Torp Sangild
- Section of Comparative Pediatrics and Nutrition, University of Copenhagen, Frederiksberg, Denmark; Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Gerrit van Hall
- Clinical Metabolomics Core Facility, Clinical Biochemistry, Rigshospitalet, Copenhagen & Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Gitte Zachariassen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark; Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| |
Collapse
|
12
|
Embleton ND, Jennifer Moltu S, Lapillonne A, van den Akker CHP, Carnielli V, Fusch C, Gerasimidis K, van Goudoever JB, Haiden N, Iacobelli S, Johnson MJ, Meyer S, Mihatsch W, de Pipaon MS, Rigo J, Zachariassen G, Bronsky J, Indrio F, Köglmeier J, de Koning B, Norsa L, Verduci E, Domellöf M. Enteral Nutrition in Preterm Infants (2022): A Position Paper From the ESPGHAN Committee on Nutrition and Invited Experts. J Pediatr Gastroenterol Nutr 2023; 76:248-268. [PMID: 36705703 DOI: 10.1097/mpg.0000000000003642] [Citation(s) in RCA: 40] [Impact Index Per Article: 40.0] [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: 01/28/2023]
Abstract
OBJECTIVES To review the current literature and develop consensus conclusions and recommendations on nutrient intakes and nutritional practice in preterm infants with birthweight <1800 g. METHODS The European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee of Nutrition (CoN) led a process that included CoN members and invited experts. Invited experts with specific expertise were chosen to represent as broad a geographical spread as possible. A list of topics was developed, and individual leads were assigned to topics along with other members, who reviewed the current literature. A single face-to-face meeting was held in February 2020. Provisional conclusions and recommendations were developed between 2020 and 2021, and these were voted on electronically by all members of the working group between 2021 and 2022. Where >90% consensus was not achieved, online discussion meetings were held, along with further voting until agreement was reached. RESULTS In general, there is a lack of strong evidence for most nutrients and topics. The summary paper is supported by additional supplementary digital content that provide a fuller explanation of the literature and relevant physiology: introduction and overview; human milk reference data; intakes of water, protein, energy, lipid, carbohydrate, electrolytes, minerals, trace elements, water soluble vitamins, and fat soluble vitamins; feeding mode including mineral enteral feeding, feed advancement, management of gastric residuals, gastric tube placement and bolus or continuous feeding; growth; breastmilk buccal colostrum, donor human milk, and risks of cytomegalovirus infection; hydrolyzed protein and osmolality; supplemental bionutrients; and use of breastmilk fortifier. CONCLUSIONS We provide updated ESPGHAN CoN consensus-based conclusions and recommendations on nutrient intakes and nutritional management for preterm infants.
Collapse
Affiliation(s)
| | | | | | - Chris H P van den Akker
- the Department of Pediatrics - Neonatology, Amsterdam UMC - Emma Children's Hospital, University of Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Virgilio Carnielli
- Polytechnic University of Marche and Division of Neonatology, Ospedali Riuniti, Ancona, Ancona, Italy
| | - Christoph Fusch
- the Department of Pediatrics, Nuremberg General Hospital, Paracelsus Medical School, Nuremberg, Germany
- the Division of Neonatology, Department of Pediatrics, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Konstantinos Gerasimidis
- the Human Nutrition, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Johannes B van Goudoever
- Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Emma Children's Hospital, Amsterdam, The Netherlands
| | - Nadja Haiden
- the Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Silvia Iacobelli
- the Réanimation Néonatale et Pédiatrique, Néonatologie - CHU La Réunion, Saint-Pierre, France
| | - Mark J Johnson
- the Department of Neonatal Medicine, University Hospital Southampton NHS Trust, Southampton, UK
- the National Institute for Health Research Biomedical Research Centre Southampton, University Hospital Southampton NHS Trust and University of Southampton, Southampton, UK
| | - Sascha Meyer
- the Department of General Paediatrics and Neonatology, University Hospital of Saarland, Homburg, Germany
| | - Walter Mihatsch
- the Department of Pediatrics, Ulm University, Ulm, Germany
- the Department of Health Management, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany
| | - Miguel Saenz de Pipaon
- the Department of Pediatrics-Neonatology, La Paz University Hospital, Autonoma University of Madrid, Madrid, Spain
| | - Jacques Rigo
- the Neonatal Unit, University of Liège, CHR Citadelle, Liège, Belgium
| | - Gitte Zachariassen
- H.C. Andersen Children's Hospital, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Jiri Bronsky
- the Department of Paediatrics, University Hospital Motol, Prague, Czech Republic
| | - Flavia Indrio
- the Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Jutta Köglmeier
- the Department of Paediatric Gastroenterology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Barbara de Koning
- the Paediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Lorenzo Norsa
- the Paediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIIII, Bergamo, Italy
| | - Elvira Verduci
- the Department of Health Sciences, University of Milan, Milan, Italy
- the Department of Paediatrics, Ospedale dei Bambini Vittore Buzzi, Milan, Italy
| | - Magnus Domellöf
- the Department of Clinical Sciences, Paediatrics, Umeå University, Umeå, Sweden
| |
Collapse
|
13
|
Kappel SS, Sangild PT, Ahnfeldt AM, Jóhannsdóttir V, Soernsen LJ, Bak LB, Friborg C, Möller S, Zachariassen G, Aunsholt L. A Randomized, Controlled Study to Investigate How Bovine Colostrum Fortification of Human Milk Affects Bowel Habits in Preterm Infants (FortiColos Study). Nutrients 2022; 14:nu14224756. [PMID: 36432444 PMCID: PMC9696900 DOI: 10.3390/nu14224756] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/06/2022] [Accepted: 11/08/2022] [Indexed: 11/12/2022] Open
Abstract
Background: Human milk does not meet the nutritional needs to support optimal growth of very preterm infants during the first weeks of life. Nutrient fortifiers are therefore added to human milk, though these products are suspected to increase gut dysmotility. The objective was to evaluate whether fortification with bovine colostrum (BC) improves bowel habits compared to a conventional fortifier (CF) in very preterm infants. Methods: In an unblinded, randomized study, 242 preterm infants (26−31 weeks of gestation) were randomized to receive BC (BC, Biofiber Damino, Gesten, Denmark) or CF (FM85 PreNAN, Nestlé, Vevey, Switzerland) as a fortifier. Stools (Amsterdam Stool Scale), bowel gas restlessness, stomach appearance score, volume, and frequency of gastric residuals were recorded before each meal until 35 weeks post-menstrual age. Results: As intake of fortifiers increased, stools became harder in both groups (p < 0.01) though less in BC infants (p < 0.05). The incidence of bowel gas restlessness increased with laxative treatments and days of fortification in both groups (p < 0.01), but laxatives were prescribed later in BC infants (p < 0.01). With advancing age, stomach appearance scores improved, but more so in BC infants (p < 0.01). Conclusions: Although there are limitations, a minimally processed, bioactive milk product such as BC induced similar or slightly improved bowel habits in preterm infants.
Collapse
Affiliation(s)
- Susanne Soendergaard Kappel
- Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 1870 Copenhagen, Denmark
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark
| | - Per Torp Sangild
- Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 1870 Copenhagen, Denmark
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark
- Hans Christian Andersen Children’s Hospital, Department of Neonatology, Odense University Hospital, 5000 Odense, Denmark
| | - Agnethe May Ahnfeldt
- Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 1870 Copenhagen, Denmark
| | - Valdis Jóhannsdóttir
- Hans Christian Andersen Children’s Hospital, Department of Neonatology, Odense University Hospital, 5000 Odense, Denmark
| | - Line Juul Soernsen
- Hans Christian Andersen Children’s Hospital, Department of Neonatology, Odense University Hospital, 5000 Odense, Denmark
| | - Lene Boejgaard Bak
- Department of Neonatology, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Christel Friborg
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark
| | - Sören Möller
- Open Patient Data Explorative Network (OPEN), Department of Clinical Research, Odense University Hospital, 5000 Odense, Denmark
- Department of Clinical Research, University of Southern, 5000 Odense, Denmark
| | - Gitte Zachariassen
- Hans Christian Andersen Children’s Hospital, Department of Neonatology, Odense University Hospital, 5000 Odense, Denmark
- Department of Clinical Research, University of Southern, 5000 Odense, Denmark
| | - Lise Aunsholt
- Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 1870 Copenhagen, Denmark
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
- Correspondence: ; Tel.: +45-35-45-25-05
| |
Collapse
|
14
|
Klamer A, Toftlund LH, Grimsson K, Halken S, Zachariassen G. IQ Was Not Improved by Post-Discharge Fortification of Breastmilk in Very Preterm Infants. Nutrients 2022; 14:nu14132709. [PMID: 35807888 PMCID: PMC9268839 DOI: 10.3390/nu14132709] [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: 05/16/2022] [Revised: 06/26/2022] [Accepted: 06/28/2022] [Indexed: 02/04/2023] Open
Abstract
(1) Very preterm infants are at increased risk of cognitive deficits, motor impairments, and behavioural problems. Studies have tied insufficient nutrition and growth to an increased risk of neurodevelopmental impairment; (2) Methods: Follow-up study on cognitive and neuropsychological development at 6 years corrected age (CA) in 214 very preterm infants, including 141 breastfed infants randomised to mother’s own milk (MOM) with (F-MOM) or without (U-MOM) fortification and 73 infants fed a preterm formula (PF-group), from shortly before discharge to 4 months CA. Infants with serious congenital anomalies or major neonatal morbidities were excluded prior to intervention. The Wechsler Intelligence Scale for Children IV was used for cognitive testing, and the children’s parents completed the Five to Fifteen Questionnaire (FTF); (3) Results: Post-discharge fortification of MOM did not improve either full-scale intelligence quotient (FSIQ) with a median of 104 vs. 105.5 (p = 0.29), subdomain scores, or any domain score on the FTF questionnaire. Compared to the PF group, the MOM group had significantly better verbal comprehension score with a median of 110 vs. 106 (p = 0.03) and significantly better motor skills scores on the FTF questionnaire (p = 0.01); (4) Conclusions: The study supports breastfeeding without fortification as post-discharge nutrition in very preterm infants, and it seems superior to preterm formula.
Collapse
Affiliation(s)
- Anja Klamer
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, 5000 Odense, Denmark; (K.G.); (S.H.); (G.Z.)
- Correspondence:
| | - Line H. Toftlund
- Department of Paediatrics, Holbaek Hospital, 4300 Holbaek, Denmark;
| | - Kristjan Grimsson
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, 5000 Odense, Denmark; (K.G.); (S.H.); (G.Z.)
| | - Susanne Halken
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, 5000 Odense, Denmark; (K.G.); (S.H.); (G.Z.)
- Faculty of Health Sciences, University of Southern Denmark, 5000 Odense, Denmark
| | - Gitte Zachariassen
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, 5000 Odense, Denmark; (K.G.); (S.H.); (G.Z.)
- Faculty of Health Sciences, University of Southern Denmark, 5000 Odense, Denmark
| |
Collapse
|
15
|
Mølholm Hansen B, Cueto H, Padkaer Petersen J, Zachariassen G, Sønderby Christensen P, Breindahl M, Schiøler Kesmodel U, Brink Henriksen T. Preterm birth rates were slightly lower in Denmark during the first year of the COVID-19 pandemic compared with the previous 4 years. Acta Paediatr 2022; 111:1695-1700. [PMID: 35535429 PMCID: PMC9347617 DOI: 10.1111/apa.16401] [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: 01/16/2022] [Revised: 05/03/2022] [Accepted: 05/09/2022] [Indexed: 12/26/2022]
Abstract
Aim Our aim was to investigate the rates of preterm births, live births and stillbirths in Denmark during the first year of the COVID‐19 pandemic. Methods This was a national, cross‐sectional registry‐based study that used the Danish Newborn Quality database, which covers all births in Denmark. The proportions of preterm births were compared between the COVID‐19 pandemic period of 1 March 2020 to 28 February 2021 and the preceding 4‐year pre‐pandemic period. Results We studied 60 323 and 244 481 newborn infants from the pandemic and pre‐pandemic periods, respectively. The proportion of preterm live births and stillbirths declined slightly, from 6.29% during the pre‐pandemic period to 6.02% during the pandemic period. This corresponded to a relative risk (RR) of 0.96, with a 95% confidence interval (CI) of 0.93–0.99 during the pandemic. The RRs for extremely preterm, very preterm and moderately preterm infants were 0.88 (95% CI 0.76–1.02), 0.91 (95% CI 0.82–1.02) and 0.97 (95% CI 0.93–1.01), respectively. Conclusion This comparative study showed a small reduction in just over 4%, from 6.29 to 6.02% in the proportion of all preterm births during the pandemic period, compared with the previous four pandemic‐free years. There were no differences between subcategories of preterm births.
Collapse
Affiliation(s)
- Bo Mølholm Hansen
- Department of Paediatrics and Adolescent Medicine Nordsjaellands Hospital in Hilleroed Hilleroed Denmark
| | - Heidi Cueto
- The Danish Clinical Quality Program – National Clinical Registries (RKKP) Aarhus Denmark
| | | | - Gitte Zachariassen
- Hans Christian Andersen Children's Hospital Odense University Hospital and University of Southern Denmark Odense Denmark
| | | | - Morten Breindahl
- Department of Intensive Care for Newborns and Infants Copenhagen University Hospital, Rigshospitalet Copenhagen Denmark
| | | | - Tine Brink Henriksen
- Department of Paediatrics and Adolescent Medicine Aarhus University Hospital Aarhus Denmark
| |
Collapse
|
16
|
Nielsen CL, Zachariassen G, Holm KG. Central line-associated bloodstream infection in infants admitted to a level lllneonatal intensive care unit. Dan Med J 2022; 69:A05210463. [PMID: 35485786] [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: 06/14/2023]
Abstract
INTRODUCTION Central line (CL)-associated bloodstream infection (CLABSI) is one of the most common and yet preventable hospital-acquired infections in infants admitted to neonatal intensive care units (NICUs) and is associated with significant morbidity. The objectives of this retrospective study were to 1) determine the incidence rates of CLABSI in infants admitted to a level lll NICU and to 2) identify independent CLABSI risk factors in high-risk infants. METHODS Data were collected from patient medical records, and incidence rates were calculated per 1,000 CL days and per 1,000 patient (PT) days. Univariate analyses were performed to identify potential risk factors associated with CLABSI, and those with a p-value ≤ 0.05 were assessed in multivariate analyses. RESULTS The cohort represented 382 infants in whom 512 CLs were inserted. The CLABSI incidence rates per 1,000 CL days and per 1,000 PT days were 13.41 and 3.18, respectively. The only independent risk factor for CLABSI was prolonged CL dwell-time for the groups of umbilical catheters (adjusted odds ratio (aOR) = 1.42 per day (95% confidence interval (CI): 1.15-1.75)) and central venous catheters (aOR = 1.04 per day (95% CI: 1.01-1.07)). CONCLUSION Compared with other high-income countries, our overall incidence rate seems high. Since units of measurement and the definition used for CLABSI vary between studies, it is important to keep this in mind when comparing findings. Future research should focus on preventative measures in relation to CLs. FUNDING none Trial registration. not relevant.
Collapse
Affiliation(s)
- Camilla Littau Nielsen
- Hans Christian Andersen Children's Hospital, Odense University Hospital
- OPEN, Open Patient data Explorative Network, Odense University Hospital
| | - Gitte Zachariassen
- Hans Christian Andersen Children's Hospital, Odense University Hospital
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Denmark
| | - Kristina Garne Holm
- Hans Christian Andersen Children's Hospital, Odense University Hospital
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Denmark
| |
Collapse
|
17
|
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.
Collapse
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.)
| |
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
Honoré KD, Johansen MN, Rasmussen L, Zachariassen G. Stoma Closure Improves Head Circumference Growth in Very Preterm Infants after Necrotizing Enterocolitis. Eur J Pediatr Surg 2021; 31:504-508. [PMID: 33080629 DOI: 10.1055/s-0040-1718407] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Very preterm infants (VPIs) surgically treated for necrotizing enterocolitis (NEC) are at risk of growth retardation. The aim of this study was to demonstrate and compare growth during the first 6 years of life in VPIs with stoma after NEC surgery with VPIs without NEC surgery. MATERIALS AND METHODS We included all VPIs surgically treated due to NEC at the Odense University Hospital from August 1, 2004, to July 31, 2008. Outcome on growth was compared with a group of VPIs without NEC. The VPIs with NEC were identified searching the local database using the International Classification of Diseases, 10th Revision diagnosis of NEC (DP77.9). Data on growth were collected from medical files and if not present, the parents reported the data. RESULTS Nineteen VPIs, surgically treated due to NEC, survived to 6 years of age. Median gestational age was 283/7 weeks (245/7-313/7). Median age at NEC surgery and stoma formation was 2.3 weeks (0.1-6.3) and median age at stoma closure was 2.5 months corrected age (CA) (postmenstrual age 36 weeks to CA 6.7 months). Compared with the non-NEC group, VPIs with NEC and stoma demonstrated poor growth, especially in head circumference (HC) with no increase in growth velocity before the time of stoma closure between 2.5- and 3-month CAs. CONCLUSION Our findings demonstrate poor growth in VPIs after NEC surgery and improved HC growth after stoma closure.
Collapse
Affiliation(s)
| | | | - Lars Rasmussen
- Department of Surgery, Odense University Hospital, Odense, Denmark
| | | |
Collapse
|
20
|
Volder C, Work BJ, Hoegh SV, Eckhardt MC, Zachariassen G. Transmission of cytomegalovirus in fresh and freeze-thawed mother's own milk to very preterm infants: a cohort study. J Perinatol 2021; 41:1873-1878. [PMID: 34155328 PMCID: PMC8216583 DOI: 10.1038/s41372-021-01129-z] [Citation(s) in RCA: 3] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 04/13/2021] [Accepted: 06/02/2021] [Indexed: 01/31/2023]
Abstract
OBJECTIVES The objectives of the study were to clarify: (i) the frequency of human cytomegalovirus (HCMV) transmission, (ii) the association between the viral load in mother's own milk (MOM), the amount of fresh MOM and transmission, and (iii) the frequency of sepsis-like-symptoms (SLS) among infants born to seropositive mothers compared to infants born to seronegative mothers. STUDY DESIGN This prospective cohort study enrolled very preterm infants (gestational age <32 weeks) from Denmark. Weekly samples of fresh MOM and urine were analyzed for HCMV-DNA. RESULTS Twenty-six very preterm infants were enrolled. Four acquired an HCMV infection, of which two developed SLS. HCMV-infected infants received MOM with a significant higher viral load compared to the HCMV-uninfected infants. CONCLUSION A combination of a high viral load and an increased amount of fresh MOM increased the risk of HCMV transmission. SLS was only slightly more common among infants exposed to HCMV positive MOM.
Collapse
Affiliation(s)
- Christina Volder
- grid.10825.3e0000 0001 0728 0170Institute of Clinical Research, University of Southern Denmark, Odense, Denmark ,grid.7143.10000 0004 0512 5013OPEN—Open Patient data Explorative Network, Odense University Hospital, Region of Southern Denmark, Odense, Denmark
| | - Benedicte Juul Work
- grid.10825.3e0000 0001 0728 0170Institute of Clinical Research, University of Southern Denmark, Odense, Denmark ,grid.7143.10000 0004 0512 5013OPEN—Open Patient data Explorative Network, Odense University Hospital, Region of Southern Denmark, Odense, Denmark
| | - Silje Vermedal Hoegh
- grid.7143.10000 0004 0512 5013Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
| | - Maria-Christina Eckhardt
- grid.7143.10000 0004 0512 5013H.C. Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
| | - Gitte Zachariassen
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark. .,OPEN-Open Patient data Explorative Network, Odense University Hospital, Region of Southern Denmark, Odense, Denmark. .,H.C. Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.
| |
Collapse
|
21
|
Christensen N, Bruun S, Søndergaard J, Christesen HT, Fisker N, Zachariassen G, Sangild PT, Husby S. Breastfeeding and Infections in Early Childhood: A Cohort Study. Pediatrics 2020; 146:peds.2019-1892. [PMID: 33097658 DOI: 10.1542/peds.2019-1892] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Studies on the association between breastfeeding and infections in children beyond the first year of life reveal conflicting results. In a population-based birth cohort, we investigated whether the duration of breastfeeding was associated with the number of hospitalizations due to infection and symptoms of infection at home. METHODS In the Odense Child Cohort, text message questionnaires were used to register information on breastfeeding (weekly until end of weaning) and symptoms of infection (biweekly; 12-36 months of age). Hospitalization data were obtained from the Danish National Patient Registry. RESULTS Of the 1087 invited, 815 mother-infant pairs were included. The median duration of any breastfeeding was 7.6 (interquartile range: 3.5-10.4) months and of exclusive breastfeeding was 2.1 (interquartile range: 0.7-4.4) months. Hospitalization due to infection was seen in 207 (25.4%) infants during the first 3 years of life. The adjusted incidence rate ratio (IRR) for hospitalization due to any infection decreased with a longer duration of any breastfeeding (adjusted IRR: 0.96; 95% confidence interval 0.93-0.99; P < .001). The strongest associations between the duration of any breastfeeding and hospitalizations due to infection were found within the first year of life, for lower respiratory tract infections, and other infections (P ≤ .05). For infants exclusively breastfed, the adjusted IRR for hospitalization was 0.88 (95% confidence interval: 0.80-0.96; P = .006). No protective associations were present between breastfeeding and infection symptoms registered at home from ages 12 to 36 months. CONCLUSIONS The results suggest that increased duration of breastfeeding, especially exclusive breastfeeding, protects against infections requiring hospitalization in the first year of life but not hospitalizations or symptoms of infection at home beyond the first year.
Collapse
Affiliation(s)
- Nikolas Christensen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences and
| | - Signe Bruun
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences and.,Strategic Business Unit Pediatric, Arla Foods Ingredients Group P/S, Viby, Denmark; and
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Henrik Thybo Christesen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences and
| | - Niels Fisker
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences and
| | - Gitte Zachariassen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences and
| | - Per Torp Sangild
- Department of Clinical Research, Faculty of Health Sciences and.,Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Husby
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark; .,Department of Clinical Research, Faculty of Health Sciences and
| |
Collapse
|
22
|
Ahnfeldt AM, Bæk O, Hui Y, Nielsen CH, Obelitz-Ryom K, Busk-Anderson T, Ruge A, Holst JJ, Rudloff S, Burrin D, Nguyen DN, Nielsen DS, Zachariassen G, Bering SB, Thymann T, Sangild PT. Nutrient Restriction has Limited Short-Term Effects on Gut, Immunity, and Brain Development in Preterm Pigs. J Nutr 2020; 150:1196-1207. [PMID: 32069355 DOI: 10.1093/jn/nxaa030] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 09/30/2019] [Accepted: 01/30/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Extrauterine growth restriction (EUGR) in preterm infants is associated with higher morbidity and impaired neurodevelopment. Early nutrition support may prevent EUGR in preterm infants, but it is not known if this improves organ development and brain function in the short and long term. OBJECTIVE Using pigs as models for infants, we hypothesized that diet-induced EUGR impairs gut, immunity, and brain development in preterm neonates during the first weeks after birth. METHODS Forty-four preterm caesarean-delivered pigs (Danish Landrace × Large White × Duroc, birth weight 975 ± 235 g, male:female ratio 23:21) from 2 sows were fed increasing volumes [32-180 mL/(kg·d)] of dilute bovine milk (EUGR group) or the same diet fortified with powdered bovine colostrum for 19 d (CONT group, 50-100% higher protein and energy intake than the EUGR group). RESULTS The EUGR pigs showed reduced body growth (-39%, P < 0.01), lower plasma albumin, phosphate, and creatine kinase concentrations (-35 to 14%, P < 0.05), increased cortisol and free iron concentrations (+130 to 700%, P < 0.05), and reduced relative weights of the intestine, liver, and spleen (-38 to 19%, all P < 0.05). The effects of EUGR on gut structure, function, microbiota, and systemic immunity were marginal, although EUGR temporarily increased type 1 helper T cell (Th1) activity (e.g. more blood T cells and higher Th1-related cytokine concentrations on day 8) and reduced colon nutrient fermentation (lower SCFA concentration; -45%, P < 0.01). Further, EUGR pigs showed increased relative brain weights (+19%, P < 0.01), however, memory and learning, as tested in a spatial T-maze, were not affected. CONCLUSION Most of the measured organ growth, and digestive, immune, and brain functions showed limited effects of diet-induced EUGR in preterm pigs during the first weeks after birth. Likewise, preterm infants may show remarkable physiological adaptation to deficient nutrient supply during the first weeks of life although early life malnutrition may exert negative consequences later.
Collapse
Affiliation(s)
- Agnethe May Ahnfeldt
- Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ole Bæk
- Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Yan Hui
- Department of Food Science, Food Microbiology, University of Copenhagen, Copenhagen, Denmark
| | | | - Karina Obelitz-Ryom
- Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tilla Busk-Anderson
- Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Ruge
- Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens Juul Holst
- Department of Biomedical Sciences, Faculty of Health, University of Copenhagen, Copenhagen, Denmark
| | - Silvia Rudloff
- Institute of Nutritional Science, Justus-Liebig-University Giessen, Giessen, Germany
| | - Douglas Burrin
- Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas, USA
| | - Duc Ninh Nguyen
- Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Dennis Sandris Nielsen
- Department of Food Science, Food Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Gitte Zachariassen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Stine Brandt Bering
- Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Thymann
- Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Per Torp Sangild
- Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark.,Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| |
Collapse
|
23
|
Breindahl M, Zachariassen G, Christensen PS, Henriksen TB. Dilemmas and Priorities in the Neonatal Intensive Care Unit during the COVID-19 Pandemic. Dan Med J 2020; 67:A205021. [PMID: 32314729] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
|
24
|
Klamer A, Zachariassen G, Hvidman L, Lando A, Andersen LLT, Henriksen TB. [Perinatal care of the extremely preterm infants]. Ugeskr Laeger 2020; 182:V12190700. [PMID: 32285789] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In 2018, The Danish Society of Obstetrics and Gynecology and the Danish Paediatric Society agreed on a national consensus guideline on the treatment of imminent preterm delivery prior to 25 weeks. This review summarises the recommendations: at 22 weeks transfer to a tertiary hospital, at 23 weeks tocolysis, antenatal steroid and newborn resuscitation with parental consent, if the infant is viable, and at 24 weeks caesarean section due to foetal distress. Newborn resuscitation is standard of care, unless not indicated for other reasons at 24 weeks.
Collapse
|
25
|
Heiring C, Zachariassen G, Christensen PS, Kjærgaard S, Nielsen HV, Hansen TG, Mortensen S, Hertel SA, Breindahl M. [Interhospital transport of sick newborns in Denmark]. Ugeskr Laeger 2020; 182:V12190705. [PMID: 32285790] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Interhospital transport of sick newborn infants is dangerous, but the risk of adverse events can be reduced, when transport is being performed by trained neonatal retrieval teams. In this review, we describe the current organisation of neonatal retrieval service in Denmark. The services are based at the neonatal intensive care units of the four university hospitals. Improved cooperation and harmonisation of operations between the teams is needed, as this is a prerequisite for the development of a national clinical consensus guideline and national quality metrics enabling benchmarking both within Denmark and abroad.
Collapse
|
26
|
Zachariassen G, Høst B, Cipliene R, Aunsholt L. [Nutrition for term and preterm born infants]. Ugeskr Laeger 2020; 182:V10190591. [PMID: 32285793] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This review summarises the present knowledge of nutrition for infants. Breastfeeding and mother's own milk is recommended for both term and preterm born infants. Much research has been centred on providing optimal nutrition in very preterm infants to improve both their short- and long-term outcomes. Growth charts are very important for all those taking care of and treating both term and preterm born infants. In very preterm infants, the optimal growth velocity remains uncertain. Growth failure is harmful, but rapid weight gain may be harmful as well. Growth can in both term and preterm born infants be evaluated by using WHO growth standards 2006 and 2017.
Collapse
|
27
|
Petersen JP, Mølholm B, Cueto HTØ, Pryds OA, Trautner S, Zachariassen G, Henriksen TB. [Neonatal survival and health in Denmark]. Ugeskr Laeger 2020; 182:V12190707. [PMID: 32285788] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This review gives a summary of Danish preterm care, which has been defined by national adaptation of antenatal corticosteroids in the 1970ies and continuous positive airway pressure in the 1980ies. Today, preterm survival in Denmark is high, by international standards, but lower than in the neighbouring countries Sweden and Norway. The lack of a national neonatal quality database may offer an explanation to this. Starting in 2019, the Danish Newborn Quality Database reports complete population-based measures of newborn survival and health and may help improve standards of care in the future.
Collapse
|
28
|
Løgavlen VV, Mikkelsen MS, Zachariassen G. Improved survival of very preterm born infants from 2000 to 2013 in Denmark. Dan Med J 2019; 66:A5579. [PMID: 31791481] [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
INTRODUCTION Survival has improved among very preterm born infants, but improved treatment strategies might be associated with increasing rates of neonatal morbidity. The aim of this study was to assess survival and major morbidities among very and extremely preterm born infants treated in a Danish neonatal intensive care unit. METHODS This was an observational cohort study including very preterm infants (gestational age (GA) < 32 weeks) born between year 2000 and 2013. Because of changes in three standard treatments from 2008, we aimed to compare survival and major neonatal morbidity between two birth-year periods: 2000-2007 and 2008-2013. RESULTS The overall survival rate increased from 81.6% to 85.0%. In GA group 26-27 weeks, survival increased from 65% to 89% (p = 0.02). A total of 31/412 (7.5%) in the first time period and 30/280 (10.7%) in the second time period were diagnosed with bronchopulmonary dysplasia. No difference was found for necrotising entrocolitis or intraventricular haemorhage. Antibiotic treatment was similar in the two time periods, though antibiotic treatment for suspected clinical infection increased in the second time period (35.1% versus 44.1%). CONCLUSIONS We found a significant increase in the survival rate in GA group 26-27 weeks, but no significant increase in any major morbidity when comparing the two time periods. TRIAL REGISTRATION not relevant. FUNDING none.
Collapse
|
29
|
Toftlund LH, Halken S, Agertoft L, Zachariassen G. Early nutrition and signs of metabolic syndrome at 6 y of age in children born very preterm. Am J Clin Nutr 2019; 107:717-724. [PMID: 29722837 DOI: 10.1093/ajcn/nqy015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 01/18/2018] [Indexed: 11/14/2022] Open
Abstract
Background In term-born infants, the risk of developing metabolic syndrome (MetS) has been shown to be associated with formula feeding and early rapid growth. Breastfeeding, however, seems to be associated with a lower risk of MetS among term-born infants. Objective The possible association between type of early nutrition, early growth, and possible influence on different metabolic outcomes at 6 y of age was investigated in very-preterm-born children. Design This study is a 6-y follow-up of 281 very-preterm-born infants with a gestational age of ≤32 wk. Infants breastfed at discharge from the hospital were randomly assigned to receive unfortified or fortified mother's milk, whereas those who were not breastfed received a preterm formula. The intervention lasted until 4 mo of corrected age. At 6 y of age, height, weight, and body mass index were measured and a dual-energy X-ray absorptiometry scan and blood sampling were performed. Results In total, 239 children participated in the follow-up. No differences were found between the 2 breastfed groups. Formula-fed children were more often predisposed to obesity and from families with a lower social status than were children who were breastfed only. Early rapid growth (crossing of weight percentiles with >1 SD in either direction) was seen in 53% of the children from 34 wk of postmenstrual age and until 2 mo of corrected age and was significantly correlated with several metabolic outcomes at 6 y of age. Conclusions Children fed a preterm formula postdischarge more often showed early rapid growth than did breastfed children, and early rapid growth was correlated with early signs of MetS at 6 y of age. However, all of the values were within normal ranges. This trial was registered at as NCT02078687.
Collapse
Affiliation(s)
- Line Hedegaard Toftlund
- Hans Christian Andersen Children's Hospital, Odense University Hospital, and Faculty of Health, University of Southern Denmark, Odense, Denmark
| | - Susanne Halken
- Hans Christian Andersen Children's Hospital, Odense University Hospital, and Faculty of Health, University of Southern Denmark, Odense, Denmark
| | - Lone Agertoft
- Hans Christian Andersen Children's Hospital, Odense University Hospital, and Faculty of Health, University of Southern Denmark, Odense, Denmark
| | - Gitte Zachariassen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, and Faculty of Health, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
30
|
Suffolk R, Agertoft L, Johansen M, Zachariassen G. Late-onset group B streptococcus infections and severe bronchopulmonary dysplasia in an extremely preterm born infant. BMJ Case Rep 2019; 12:12/7/e229255. [DOI: 10.1136/bcr-2019-229255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This case report is about a boy born extremely preterm at gestational age of 24 weeks, with extremely low birth weight, developing severe bronchopulmonary dysplasia and in need of mechanical ventilation for 155 days. He also had five recurrent infections with group B streptococcus (GBS) within 4 months from birth, and his respiratory condition clearly deteriorated with every GBS infection. It was difficult to wean him from mechanical ventilation. Finally he was extubated when he was 7 months old and kept out of mechanical ventilation after receiving high-dose methylprednisolone, given according to international recommendations. After GBS was cultured for the fifth time, he received oral rifampicin along with intravenous penicillin and after this treatment, GBS did not occur again. At the age of 22 months, the boy no longer needed any respiratory support and he was about 6 months late in his neurological development.
Collapse
|
31
|
Ahnfeldt AM, Hyldig N, Li Y, Kappel SS, Aunsholdt L, Sangild PT, Zachariassen G. FortiColos - a multicentre study using bovine colostrum as a fortifier to human milk in very preterm infants: study protocol for a randomised controlled pilot trial. Trials 2019; 20:279. [PMID: 31118098 PMCID: PMC6530095 DOI: 10.1186/s13063-019-3367-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 09/27/2018] [Accepted: 04/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Very preterm infants (< 32 weeks gestation) have a relatively high nutrient requirement for growth and development. The composition of human milk is often inadequate to ensure optimal growth so it is common to fortify human milk for very preterm infants with nutrient fortifiers based on bovine milk. However, there are concerns that bovine milk-based fortifiers may increase the risk of feeding intolerance, necrotizing enterocolitis and late-onset sepsis. We hypothesize that a bovine colostrum-based product is a suitable alternative to bovine milk-based products when used as a fortifier to human milk in very preterm infants. METHODS/DESIGN In an open-label multicentre randomised controlled pilot trial, 200 very preterm infants (26 + 0 to 30 + 6 weeks gestation at birth) will be randomly allocated to a bovine colostrum-based or a bovine milk-based fortifier added to mother's own milk and/or human donor milk. Outcomes are growth rate, incidence of necrotizing enterocolitis and late-onset sepsis, a series of paraclinical endpoints, and practical feasibility of using the novel fortifier for very preterm infants. DISCUSSION The optimal enteral diet and feeding regimen for very preterm infants remain debated; this clinical trial will document the feasibility, safety and preliminary efficacy of using bovine colostrum, rich in nutrients and bioactive factors, as a novel fortifier for human milk to very preterm infants. Data on infant growth, metabolism, gut function and immunity will be assessed from clinical data as well as blood and stool samples. TRIAL REGISTRATION Registered retrospectively 25 May 2018 at ClinicalTrials.gov: NCT03537365 .
Collapse
Affiliation(s)
- Agnethe M. Ahnfeldt
- Section of Comparative Pediatrics and Nutrition, IVH, University of Copenhagen, Frederiksberg, Denmark
| | - Nana Hyldig
- University of Southern Denmark, Odense, Denmark
- OPEN Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Yanqi Li
- Section of Comparative Pediatrics and Nutrition, IVH, University of Copenhagen, Frederiksberg, Denmark
| | - Susanne Soendergaard Kappel
- Section of Comparative Pediatrics and Nutrition, IVH, University of Copenhagen, Frederiksberg, Denmark
- Department of Neonatology, Rigshospitalet, Copenhagen, Denmark
| | - Lise Aunsholdt
- Department of Neonatology, Rigshospitalet, Copenhagen, Denmark
| | - Per T. Sangild
- Section of Comparative Pediatrics and Nutrition, IVH, University of Copenhagen, Frederiksberg, Denmark
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
- Department of Neonatology, Rigshospitalet, Copenhagen, Denmark
- University of Southern Denmark, Odense, Denmark
| | - Gitte Zachariassen
- Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
| |
Collapse
|
32
|
Rasmussen MK, Clemensen J, Zachariassen G, Kidholm K, Brødsgaard A, Smith AC, Holm KG. Cost analysis of neonatal tele-homecare for preterm infants compared to hospital-based care. J Telemed Telecare 2019; 26:474-481. [DOI: 10.1177/1357633x19843753] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Introduction Neonatal homecare (NH) can be used to provide parents the opportunity of bringing cardiopulmonary-stable preterm infants home for tube feeding and the establishment of breastfeeding supported by neonatal nurses visiting the home. However, home visits can be challenging for hospitals covering large regions, and, therefore, regular neonatal hospital care has remained the first choice in Denmark. As an alternative to home visits, telehealth may be used to deliver NH. Thus, neonatal tele-homecare (NTH) was developed. Positive infant outcomes and the optimization of family-centred care have been described, but the costs of telehealth in the context of NH remain unknown. This study aims to assess the costs of NTH compared to regular neonatal hospital care, from the health service perspective. Methods The cost analysis was based on an observational study of NTH in Denmark (run from November 2015 to December 2016) and followed the Consolidated Health Economic Evaluation Reporting Standards. The intervention group were the families of preterm infants receiving NTH ( n = 96). The control group comprised a historic cohort of families with preterm infants, receiving standard care in the neonatal intensive care unit (NICU) ( n = 278). NTH infants and the historical group were categorized according to gestational age at birth at/under and over 32 weeks. The outcomes were NTH resource utilization, in-NICU hospital bed days, re-admissions and total costs on average per infant. The time horizon was from birth to discharge. Results The costs of NTH resource utilization were, on average, €695 per infant, and the total costs per infant, on average, were €12,200 and €4200 for infants at/under and over 32 weeks, respectively. The corresponding costs of the control group were €14,300 and €4400. The difference in total costs showed statistical significance for the group of infants under 32 weeks ( p < 0.001). Discussion The cost analysis showed that NTH was less costly compared to regular hospital care, especially for infants born with gestational age at/under 32 weeks. NTH is an appropriate model of care for preterm infants and their families, is clinically effective and less expensive than similar services delivered in the hospital.
Collapse
Affiliation(s)
- Maja K Rasmussen
- Centre for Innovative Medical Technology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Jane Clemensen
- Centre for Innovative Medical Technology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
- Hans Christian Andersen Children’s Hospital Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Gitte Zachariassen
- Hans Christian Andersen Children’s Hospital Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Kristian Kidholm
- Centre for Innovative Medical Technology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Anne Brødsgaard
- Department of Paediatrics, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
- Section for Nursing, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Anthony C Smith
- Centre for Innovative Medical Technology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
- Centre for Online Health, The University of Queensland, Brisbane, Australia
| | - Kristina G Holm
- Centre for Innovative Medical Technology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
- Hans Christian Andersen Children’s Hospital Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
33
|
Toftlund LH, Agertoft L, Halken S, Zachariassen G. Improved lung function at age 6 in children born very preterm and fed extra protein post-discharge. Pediatr Allergy Immunol 2019; 30:47-54. [PMID: 30194887 DOI: 10.1111/pai.12981] [Citation(s) in RCA: 10] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/21/2018] [Accepted: 08/22/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND In very preterm-born children, alveolar maturation is challenged and lung function is often compromised during childhood. So far, very few studies have focused on type of early nutrition and lung function in children born preterm. METHODS This study is a 6 years follow-up of 281 very preterm-born infants (VPI) with a gestational age (GA) <32 + 0 weeks. Infants breastfed at discharge from hospital were randomized to unfortified (UHM) or fortified (FHM) mother's (human) milk, whereas those not breastfed received a preterm formula (PF). The intervention lasted until 4 months corrected age. At 6 years of age fractional exhaled nitric oxide (FeNO), airway resistance and occlusion measurements with reversibility were performed. Data on predisposition to asthma and allergy as well as possible allergic symptoms of the child were obtained with questionnaires. RESULTS Outcome data was fully or partially available on 160 (66.9%) of 239 children. This included 49 (30.6%) children fed UHM, 58 (36.3%) fed FHM and 53 (33.1%) fed PF. Successful FeNO measurements were obtained in 119 (74.4%) children and airway resistance measurements in 160. FeNO results were not significantly different between feeding groups. Children fed a protein-enriched diet (FMH/PF) had the lowest, for example, best, airway resistance; FHM-fed had lower values than UHM-fed (P = 0.042) before, and PF-fed had significantly lower values than UHM-fed after beta-2-agonist inhalation (P = 0.050). The tendency of lower airway resistance when protein enriched were the same in gender-specific analyses. In SGA children, the same tendency was found between PF- and UHM-fed (P = 0.007 before and P = 0.046 after beta-2-agonist inhalation). All values were within reference limits. CONCLUSIONS Lung function in very preterm-born children may improve when fed a protein-enriched nutrition post-discharge.
Collapse
Affiliation(s)
- Line Hedegaard Toftlund
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Faculty of health, University of Southern Denmark, Odense, Denmark
| | - Lone Agertoft
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Faculty of health, University of Southern Denmark, Odense, Denmark
| | - Susanne Halken
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Faculty of health, University of Southern Denmark, Odense, Denmark
| | - Gitte Zachariassen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Faculty of health, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
34
|
Holm KG, Clemensen J, Brødsgaard A, Smith AC, Maastrup R, Zachariassen G. Growth and breastfeeding of preterm infants receiving neonatal tele-homecare compared to hospital-based care. J Neonatal Perinatal Med 2019; 12:277-284. [PMID: 30856122 DOI: 10.3233/npm-18143] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Neonatal tele-homecare implies that parents of clinically stable preterm infants can manage tube feeding and establishment of oral feeding in the home. Support is provided from the neonatal intensive care unit (NICU) through a telehealth service. The aim of this study was to compare growth and breastfeeding rates amongst infants being managed in the NICU (conventional care) and by neonatal tele-homecare. METHODS A total of 96 preterm infants with tube feeding requirements participated in the observational study of neonatal tele-homecare. Retrospective data in 278 preterm infants receiving standard care in the same neonatal intensive care unit prior to implementation of neonatal tele-homecare were used for comparison. Rates of breastfeeding and growth were monitored during neonatal tele-homecare. Infant weights were converted to standard deviation weight-for-age z-scores based on a reference. RESULTS There was no significant difference in rates of exclusive breastfeeding between the neonatal tele-homecare infants and the controls. Among the very preterm singleton infants more neonatal tele-homecare infants were exclusively breastfed at discharge compared to the controls (p = 0.04). There was no significant difference in median weight for age z-scores at discharge. CONCLUSION This study demonstrates that neonatal tele-homecare may be an appropriate model of care for the management of preterm infants outside of the hospital environment; with the added benefit of higher rates of breastfeeding at time of discharge for very preterm infants.
Collapse
Affiliation(s)
- Kristina Garne Holm
- Hans Christian Andersen Hospital for Children and Adolescents,, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- OPEN, Odense Patient Explorative Network, Odense University Hospital, Odense, Denmark
| | - Jane Clemensen
- Hans Christian Andersen Hospital for Children and Adolescents,, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Center for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | - Anne Brødsgaard
- Department of Pediatrics, Amager Hvidovre Hospital, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Public Health, Department of Science in Nursing, Aarhus University, Aarhus, Denmark
| | - Anthony C Smith
- Center for Online Health, University of Queensland, Brisbane, Australia
| | - Ragnhild Maastrup
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Gitte Zachariassen
- Hans Christian Andersen Hospital for Children and Adolescents,, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
35
|
Abstract
INTRODUCTION Neonatal homecare for preterm infants is a method of supporting families and monitoring infant growth in the home setting. Telehealth may be used to deliver specialist neonatal care remotely, using online communication methods. This study explored parental experiences with neonatal tele-homecare (NTH). METHODS Semi-structured interviews were conducted with 49 parents whose preterm infants had received NTH from a neonatal intensive care unit (NICU) in Denmark. Interview transcripts were analysed using Malterud's systematic text condensation. RESULTS Parents experienced NTH as a personalised method for linking to specialist staff in the NICU. NTH promoted the parent's role as the primary care provider, further strengthening the parent-infant relationship. DISCUSSION From the perspective of parents with preterm infants requiring specialist care, NTH is a useful method of supporting families in the home. Telehealth provides effective communication links with NICU specialists and encourages family-centred care.
Collapse
Affiliation(s)
- Kristina Garne Holm
- 1 Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,2 Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Anne Brødsgaard
- 3 Department of Pediatrics, Copenhagen University Hospital Amager Hvidovre, Capital Region of Denmark, Denmark.,4 Department of Nursing Science, Faculty of Public Health, Aarhus University, Denmark
| | - Gitte Zachariassen
- 1 Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,2 Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Anthony C Smith
- 5 Centre for Online Health, University of Queensland, Brisbane, Australia
| | - Jane Clemensen
- 1 Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,2 Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,6 Centre of Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| |
Collapse
|
36
|
Juul Ladegaard PB, Rasmussen L, Zachariassen G. [Necrotising enterocolitis]. Ugeskr Laeger 2018; 180:V04170341. [PMID: 29804563] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Necrotising enterocolitis (NEC) is a serious complication of prematurity and strikes prematurely in all weight groups. The incidence has been almost unchanged during the latest decades suggesting a limited success with current diagnostic and preventative strategies. Researchers have been looking for novel diagnostic tools to lower the incidence of NEC. Researchers have suggested splitting up NEC in smaller entities to target the preventive strategies, yet no revolutionary tool has been presented. This review is a short overview of the latest knowledge concerning diagnostic strategies.
Collapse
|
37
|
Ladegaard PBJ, Rasmussen L, Zachariassen G. [Intrauterine necrotizing enterocolitis in premature newborns]. Ugeskr Laeger 2018; 180:V04170340. [PMID: 29393025] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Necrotizing enterocolitis (NEC) is a severe disorder associated with increased morbidity and mortality when found in premature infants. This report is about two cases of NEC initiated in utero but without a prior knowledge to neither parents nor health professionals. Both cases had similar courses postnatally, which included abdominal distension and nutritional problems. The surgical findings: case I was a classical NEC in 20-25 cm of distal ileum, and case II was a 1.5-cm necrosis with perforation in proximal ileum. The proposed aetiology was somehow dissimilar in the two cases, which led to the suggestion that the cases represented two various disease entities.
Collapse
|
38
|
Toftlund LH, Halken S, Agertoft L, Zachariassen G. Catch-Up Growth, Rapid Weight Growth, and Continuous Growth from Birth to 6 Years of Age in Very-Preterm-Born Children. Neonatology 2018; 114:285-293. [PMID: 30011395 DOI: 10.1159/000489675] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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: 12/06/2017] [Accepted: 04/28/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Breastfeeding promotes healthy growth in very-preterm-born infants (VPI), but extra nutritional supply is needed to ensure catch-up growth and brain development. OBJECTIVES To investigate how different types of post-discharge nutrition affect growth until 6 years of age in children born VPI. METHODS This was a 6-year follow-up study of 281 VPI. Median gestational age (GA) was 30 + 0 weeks (range 24-32 weeks). When breastfed at discharge, they were randomized to unfortified human milk (UHM) or fortified human milk (FHM). If not breastfed at discharge, they received a preterm formula (PF). The intervention lasted until 4 months of corrected age (CA). At 6 years CA, their height and weight were measured. RESULTS A total of 239 children participated in the follow-up. UHM-feeding compared to both PF- and FHM-feeding resulted in a slower but continuous catch-up growth until 6 years of age. Participants born small-for-GA compared to appropriate-for-GA more often demonstrated continuous catch-up growth until 6 years of age (p = 0.018). Rapid weight growth (a change in z score > 1 SD during a short time period) was found to be most pronounced from 34 weeks post-menstrual age to 2 months CA, and especially among those fed PF (p = 0.002 vs. UHM, p = 0.07 vs. FHM). CONCLUSIONS Catch-up growth occurred mainly before discharge, regardless of the feeding group. UHM-fed infants demonstrated catch-up growth that was slower, but extended until 6 years of age. Rapid weight growth was most pronounced shortly after discharge and especially if PF-fed.
Collapse
Affiliation(s)
- Line Hedegaard Toftlund
- Hans Christian Andersen Children's Hospital, Odense University Hospital, and Faculty of Health, Odense, .,University of Southern Denmark, Odense,
| | - Susanne Halken
- Hans Christian Andersen Children's Hospital, Odense University Hospital, and Faculty of Health, Odense, Denmark.,University of Southern Denmark, Odense, Denmark
| | - Lone Agertoft
- Hans Christian Andersen Children's Hospital, Odense University Hospital, and Faculty of Health, Odense, Denmark.,University of Southern Denmark, Odense, Denmark
| | - Gitte Zachariassen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, and Faculty of Health, Odense, Denmark.,University of Southern Denmark, Odense, Denmark
| |
Collapse
|
39
|
Bruun S, Buhl S, Husby S, Jacobsen LN, Michaelsen KF, Sørensen J, Zachariassen G. Breastfeeding, Infant Formula, and Introduction to Complementary Foods-Comparing Data Obtained by Questionnaires and Health Visitors' Reports to Weekly Short Message Service Text Messages. Breastfeed Med 2017; 12:554-560. [PMID: 28832183 DOI: 10.1089/bfm.2017.0054] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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] [Indexed: 12/30/2022]
Abstract
BACKGROUND Studies on prevalence and effects of breastfeeding call for reliable and precise data collection to optimize infant nutrition, growth, and health. Data on breastfeeding and infant nutrition are at risk of, for example, recall bias or social desirability bias. OBJECTIVE The aim of the present analysis was to compare data on infant nutrition, that is, breastfeeding, use of infant formula, and introduction to complementary foods, obtained by four different methods. We assumed that weekly short message service (SMS) questions were the most reliable method, to which the other methods were compared. DESIGN The study population was part of the Odense Child Cohort. The four methods used were: (a) self-administered questionnaire 3 months postpartum, (b) self-administered questionnaire 18 months postpartum, (c) registrations from health visitors visiting the families several times within the first year of life, and (d) weekly SMS questions introduced shortly after birth. RESULTS In total, 639 singleton mothers with data from all four methods were included. The proportion of mothers initiating breastfeeding varied from 86% to 97%, the mean duration of exclusive breastfeeding from 12 to 19 weeks, and the mean age when introduced to complementary foods from 19 to 21 weeks. The mean duration of any breastfeeding was 33 weeks across methods. CONCLUSIONS Compared with the weekly SMS questions, the self-administered questionnaires and the health visitors' reports resulted in a greater proportion of mothers with an unknown breastfeeding status, a longer duration of exclusive breastfeeding and later introduction to complementary foods, while the duration of any breastfeeding did not differ.
Collapse
Affiliation(s)
- Signe Bruun
- 1 Strategic Business Unit Pediatric , Arla Foods Ingredients Group P/S, Viby J, Denmark .,2 Hans Christian Andersen Children's Hospital, Odense University Hospital , Odense, Denmark .,3 Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark , Odense, Denmark
| | - Susanne Buhl
- 4 Odense City Government and Administration , Department for Child and Family, Centre for Health, Odense, Denmark
| | - Steffen Husby
- 2 Hans Christian Andersen Children's Hospital, Odense University Hospital , Odense, Denmark .,3 Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark , Odense, Denmark .,5 OPEN, Odense Patient Data Explorative Network, Odense University Hospital , Odense, Denmark
| | | | - Kim F Michaelsen
- 6 Department of Nutrition, Exercise and Sports, University of Copenhagen , Copenhagen, Denmark
| | - Jan Sørensen
- 7 Department of Public Health, Centre of Health Economics Research (COHERE), University of Southern Denmark , Odense, Denmark .,8 Healthcare Outcome Research Centre, Royal College of Surgeons in Ireland , Dublin, Ireland
| | - Gitte Zachariassen
- 2 Hans Christian Andersen Children's Hospital, Odense University Hospital , Odense, Denmark .,3 Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark , Odense, Denmark
| |
Collapse
|
40
|
Simonsen AB, Hvid L, Zachariassen G, Honoré KD. [Symptomatic zinc deficiency in a breast-fed infant]. Ugeskr Laeger 2017; 179:V03170215. [PMID: 28992839] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Nutrition containing zinc is of special practical importance in infants and children. Perinatal zinc deficiency manifestations include erosive dermatitis, alopecia, diarrhoea, central nervous system dysfunction and immune system deficiency. We present a case story of an ex-preterm, exclusively breast-fed infant who presented with irritability, clinical signs of infection, an atypical rash and signs of oral candidiasis. Blood tests showed low plasma levels of zinc and subsequent analysis showed reduced zinc levels in the breast milk.
Collapse
|
41
|
Garne Holm K, Brødsgaard A, Zachariassen G, Smith AC, Clemensen J. Participatory design methods for the development of a clinical telehealth service for neonatal homecare. SAGE Open Med 2017; 5:2050312117731252. [PMID: 28975028 PMCID: PMC5613838 DOI: 10.1177/2050312117731252] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 06/06/2017] [Accepted: 08/17/2017] [Indexed: 11/20/2022] Open
Abstract
Objectives: Neonatal homecare delivered during home visits by neonatal nurses is a common method for supporting families of preterm infants following discharge. Telehealth has been introduced for the provision of neonatal homecare, resulting in positive feedback from parents of preterm infants. While the benefits are beginning to be realised, widespread uptake of telehealth has been limited due to a range of logistical challenges. Understanding user requirements is important when planning and developing a clinical telehealth service. We therefore used participatory design to develop a clinical telehealth service for neonatal homecare. Methods: The study adopted a participatory design approach to engage users in the development and design of a new telehealth service. Participatory design embraces qualitative research methods. Creative and technical workshops were conducted as part of the study. Tests of the telehealth service were conducted in the neonatal unit. Participants in this study were former and current parents of preterm infants eligible for neonatal homecare, and clinical staff (medical and nursing) from the neonatal unit. Preterm infants accompanied their parents. Results: Based on the results obtained during the workshops and subsequent testing, we developed an application (app), which was integrated into the medical record at the neonatal unit. The app was used to initiate videoconferences and chat messages between the family at home and the neonatal unit, and to share information regarding infant growth and well-being. Conclusion: Results obtained from the workshops and testing demonstrated the importance of involving users when developing new telehealth applications. The workshops helped identify the challenges associated with delivery of the service, and helped instruct the design of a new telehealth service for neonatal homecare based on the needs of parents and clinical staff.
Collapse
Affiliation(s)
- Kristina Garne Holm
- HCA Research, Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Anne Brødsgaard
- Paediatric Department, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Section for Nursing, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Gitte Zachariassen
- HCA Research, Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Anthony C Smith
- Centre for Online Health, University of Queensland, Brisbane, QLD, Australia.,Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | - Jane Clemensen
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| |
Collapse
|
42
|
Skovgaard AL, Zachariassen G. Cranial ultrasound findings in preterm infants predict the development of cerebral palsy. Dan Med J 2017; 64:A5330. [PMID: 28157062] [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: 06/06/2023]
Abstract
INTRODUCTION Our aim was to evaluate any association between gestational age, birth weight and findings on cranial ultrasounds during hospitalisation in very preterm infants and mortality and neurological outcome in childhood. METHOD This study was a retrospective cohort study based on a patient record review. The cohort consisted of very preterm born children (gestational age ≤ 32 + 0) born from 2004 to 2008. For each infant, we obtained results from all cranial ultrasounds performed during hospitalisation. In 2014, patient records were evaluated for cerebral palsy, Gross Motor Function Classification System, blindness and deafness. RESULTS A total of 249 infants were included. The mortality rate was 9.2%. In all, 217 children were evaluated at 5-9 years of age. Four children were diagnosed with germinal matrix haemorrhage - intraventricular haemorrhage grade 3 (GMH-IVH3) and periventricular haemorrhagic infarction (PVHI), of whom two developed cerebral palsy. Nine children were diagnosed with periventricular leukomalacia (PVL), of whom six developed cerebral palsy. Cerebral palsy was detected in 14 children (6.4%), and one (0.5%) child was in need of a hearing assistive device. Severe brain injury (GMH-IVH3, PVHI or PVL) (p = 0.000) and being of male gender (p = 0.03) were associated with cerebral palsy in childhood. CONCLUSION Severe brain injuries detected by neonatal cranial ultrasound in very preterm infants is associated with development of cerebral palsy in childhood. FUNDING none. TRAIL REGISTRATION: not relevant.
Collapse
|
43
|
Wiingreen R, Greisen G, Ebbesen F, Petersen JP, Zachariassen G, Henriksen TB, Mølholm Hansen B. Surfactant Need by Gestation for Very Preterm Babies Initiated on Early Nasal CPAP: A Danish Observational Multicentre Study of 6,628 Infants Born 2000-2013. Neonatology 2017; 111:331-336. [PMID: 28073106 DOI: 10.1159/000451021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 03/24/2016] [Accepted: 09/24/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND In recent years, early nasal continuous positive airway pressure (nCPAP) as respiratory support for preterm infants is being advocated as an alternative to prophylactic surfactant and treatment with mechanical ventilation. A number of infants treated with early nCPAP do not need treatment with surfactant, but few studies provide data on this. Since the 1990s, the first approach to respiratory support to preterm infants in Denmark has been early nCPAP combined with surfactant administration by the INSURE method by which the infant is intubated and surfactant administration is followed by rapid extubation to nCPAP if possible. OBJECTIVES To investigate how often surfactant was administered in preterm infants with a gestational age below 34 weeks treated with early nCPAP as a first approach to respiratory support. METHODS An observational multicentre study including all inborn infants with a gestational age below 34 weeks admitted to 1 of the 4 level 3 neonatal intensive care units in Denmark in the period from 2000 to 2013. RESULTS A total of 6,628 infants were included in this study. We found that surfactant was administered in 1,056 of 1,799 (59%; 95% CI: 57-61%), in 821 of 2,864 (29%; 95% CI: 27-31%), and in 132 of 1,796 (7%; 95% CI: 6-8%) of the infants with a gestational age from 24 to 27, 28 to 31, and 32 to 33 weeks and 6 days, respectively. CONCLUSIONS A large proportion of preterm infants treated with early nCPAP as the first approach to respiratory support was never treated with surfactant.
Collapse
|
44
|
Zachariassen G, Hyldig N, Joergensen JS, Nielsen DS, Greisen G. The half-life and exposure of cefuroxime varied in newborn infants after a Caesarean section. Acta Paediatr 2016; 105:1074-8. [PMID: 27240549 DOI: 10.1111/apa.13489] [Citation(s) in RCA: 6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 04/14/2016] [Accepted: 05/30/2016] [Indexed: 01/01/2023]
Abstract
AIM No information was available on how fast intravenous cefuroxime administered to pregnant women before a Caesarean section was cleared in newborn infants. This study investigated the drug's half-life and the exposure of healthy newborn infants after their mothers received the drug. METHODS Healthy mothers received a single dose of cefuroxime 15-60 minutes before skin incision. One blood sample was drawn from the umbilical cord, and two blood samples were drawn from the infant after delivery. Total plasma cefuroxime (μg/mL) was measured using high-pressure liquid chromatography. RESULTS Cefuroxime was given to 22 mothers, including two who had twins. The concentration of cefuroxime varied significantly among infants (p < 0.001), while the rate of decline did not (p = 0.24). The median cefuroxime half-life was 3.5 hours (range 2.9-5.5), which was approximately three times longer than in normal adults and seemed to clear within 24 hours. The median area under the concentration-time curve was 65.0 hour μg/mL (range 31.7-162.4). CONCLUSION We found that the cefuroxime half-life after a Caesarean section varied among infants and was longer than in normal adults but cleared within 24 hours. Exposure to cefuroxime in newborn infants may influence the gut microbiota and should be investigated further.
Collapse
Affiliation(s)
- G Zachariassen
- Hans Christian Andersen Children's Hospital; Odense University Hospital and University of Southern Denmark; Odense Denmark
| | - N Hyldig
- Department of Gynaecology and Obstetrics; Odense University Hospital and University of Southern Denmark; Odense Denmark
- OPEN Odense Patient data Explorative Network; Odense University Hospital; Odense Denmark
| | - JS Joergensen
- Department of Gynaecology and Obstetrics; Odense University Hospital and University of Southern Denmark; Odense Denmark
| | - DS Nielsen
- Department of Food Science; University of Copenhagen; Copenhagen Denmark
| | - G Greisen
- Neonatal Unit; Rigshospitalet and University of Copenhagen; Copenhagen Denmark
| |
Collapse
|
45
|
Garne K, Brødsgaard A, Zachariassen G, Clemensen J. Telemedicine in Neonatal Home Care: Identifying Parental Needs Through Participatory Design. JMIR Res Protoc 2016; 5:e100. [PMID: 27392576 PMCID: PMC4958140 DOI: 10.2196/resprot.5467] [Citation(s) in RCA: 16] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 04/01/2016] [Accepted: 04/03/2016] [Indexed: 11/22/2022] Open
Abstract
Background For the majority of preterm infants, the last weeks of hospital admission mainly concerns tube feeding and establishment of breastfeeding. Neonatal home care (NH) was developed to allow infants to remain at home for tube feeding and establishment of breastfeeding with regular home visits from neonatal nurses. For hospitals covering large regions, home visits may be challenging, time consuming, and expensive and alternative approaches must be explored. Objective To identify parental needs when wanting to provide neonatal home care supported by telemedicine. Methods The study used participatory design and qualitative methods. Data were collected from observational studies, individual interviews, and focus group interviews. Two neonatal units participated. One unit was experienced in providing neonatal home care with home visits, and the other planned to offer neonatal home care with telemedicine support. A total of 9 parents with preterm infants assigned to a neonatal home care program and 10 parents with preterm infants admitted to a neonatal unit participated in individual interviews and focus group interviews, respectively. Results Three overall themes were identified: being a family, parent self-efficacy, and nurse-provided security. Parents expressed desire for the following: (1) a telemedicine device to serve as a “bell cord” to the neonatal unit, giving 24-hour access to nurses, (2) video-conferencing to provide security at home, (3) timely written email communication with the neonatal unit, and (4) an online knowledge base on preterm infant care, breastfeeding, and nutrition. Conclusions Our findings highlight the importance of neonatal home care. NH provides parents with a feeling of being a family, supports their self-efficacy, and gives them a feeling of security when combined with nursing guidance. Parents did not request hands-on support for infant care, but instead expressed a need for communication and guidance, which could be met using telemedicine.
Collapse
Affiliation(s)
- Kristina Garne
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.
| | | | | | | |
Collapse
|
46
|
Bruun S, Wedderkopp N, Mølgaard C, Kyhl HB, Zachariassen G, Husby S. Using text messaging to obtain weekly data on infant feeding in a Danish birth cohort resulted in high participation rates. Acta Paediatr 2016; 105:648-54. [PMID: 26928297 DOI: 10.1111/apa.13382] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 09/15/2015] [Revised: 11/12/2015] [Accepted: 02/23/2016] [Indexed: 12/27/2022]
Abstract
AIM Our aim was to use text message questions to obtain prospective, real-time data on exclusive and partial breastfeeding and introduction to complementary foods in a Danish birth cohort. We also wanted to identify factors influencing breastfeeding initiation and cessation. METHODS This study formed part of the Odense Child Cohort and focused on mothers who gave birth to full-term singletons between April and October 2012. They received the same three to five questions, about breastfeeding, infant formula and introduction to complementary food, three days after birth and then at weekly intervals. RESULTS We recruited 499 mothers, and the response rate to the first of the weekly questions was ≥89.4% during the study. Three days after birth, 96.7% of mothers were breastfeeding, 61.2% exclusively and 30.2% partially, and 26 weeks after birth 60.2% of mothers were breastfeeding, 1.1% exclusively. Complementary food was introduced at an average age of 20 weeks. Breastfeeding cessation was associated with maternal smoking, lower maternal age and supplementation with infant formula in the first days after birth (all p < 0.05). CONCLUSION Most mothers initiated breastfeeding, but only 1.1% were exclusively breastfeeding at 26 weeks. Text messaging resulted in high response rates and was a feasible data collection method.
Collapse
Affiliation(s)
- Signe Bruun
- Hans Christian Andersen Children's Hospital; Odense University Hospital; Odense Denmark
| | - Niels Wedderkopp
- Research in Childhood Health; Faculty of Health Sciences; University of Southern Denmark; Odense Denmark
| | - Christian Mølgaard
- Hans Christian Andersen Children's Hospital; Odense University Hospital; Odense Denmark
- Department of Nutrition, Exercise and Sports; Faculty of Science; University of Copenhagen; Copenhagen Denmark
| | - Henriette B Kyhl
- Hans Christian Andersen Children's Hospital; Odense University Hospital; Odense Denmark
- Odense Patient data Explorative Network; Odense University Hospital; Odense Denmark
| | - Gitte Zachariassen
- Hans Christian Andersen Children's Hospital; Odense University Hospital; Odense Denmark
| | - Steffen Husby
- Hans Christian Andersen Children's Hospital; Odense University Hospital; Odense Denmark
| |
Collapse
|
47
|
Abstract
Epidermolysis bullosa (EB) is an inherited skin disease with four main subtypes that cannot be distinguished clinically at birth. All subtypes may present with widespread life-threatening blisters and fragile skin, making treatment and handling of the newborn with EB challenging. The prognosis of EB depends on the subtype, and therefore maximum treatment is necessary until the final diagnosis is known. In this case, it took 2 weeks before a final diagnosis was reached. In the meantime, we had several ethical discussions on the treatment level. The most important issues were management of pain and nutrition. For immediate pain relief, intranasal fentanyl worked best and gabapentin was successfully used for chronic pain. The feeding difficulties were handled first by a nasogastric feeding tube. Later a normal feeding bottle proved to be adequate.
Collapse
Affiliation(s)
| | - Anette Bygum
- Department of Dermatology and Allergy Center, University Hospital of Odense, Odense, Denmark
| | - Jens Michael Hertz
- Department of Clinical Genetics, University Hospital of Odense, Odense, Denmark
| | - Gitte Zachariassen
- Neonatal Intensive Care Unit, HC Andersen Child Hospital, Odense, Denmark
| |
Collapse
|
48
|
Moe K, Beck-Nielsen SS, Lando A, Greisen G, Zachariassen G. Administering different levels of parenteral phosphate and amino acids did not influence growth in extremely preterm infants. Acta Paediatr 2015; 104:894-9. [PMID: 26046292 DOI: 10.1111/apa.13063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 11/17/2014] [Revised: 03/27/2015] [Accepted: 06/01/2015] [Indexed: 01/01/2023]
Abstract
AIM When a new high amino acid parenteral nutrition (PN) solution was introduced to our hospital, a design error led to decreased phosphate levels. This prompted us to examine the effect of three different PN solutions on plasma phosphate, plasma calcium and weight increases on extremely preterm infants. METHOD This was a retrospective study of 186 infants with a gestational age of <28 weeks during their first month of life. They were divided into three groups based on the PN they received during hospitalisation. Group one received high levels of phosphate and low levels of amino acids. Group two received low levels of phosphate and high levels of amino acids. Group three received high levels of both phosphate and amino acids. RESULTS The lowest plasma phosphate values varied significantly between groups one (1.80 ± 0.46 mmol/L), two (1.05 ± 0.48 mmol/L) and three (1.40 ± 0.37 mmol/L) (p < 0.001), but no significant difference in weight increase was seen (p = 0.497). CONCLUSION The phosphate content of the PN influenced plasma phosphate and plasma calcium levels, but increasing the levels of both phosphate and amino acids did not improve weight gain during the first month of life.
Collapse
Affiliation(s)
- Katrine Moe
- University of Copenhagen; Copenhagen Denmark
| | | | - Ane Lando
- Department of Neonatology; JMC; Rigshospitalet - Copenhagen University Hospital; Copenhagen Denmark
| | - Gorm Greisen
- Department of Neonatology; JMC; Rigshospitalet - Copenhagen University Hospital; Copenhagen Denmark
| | - Gitte Zachariassen
- Hans Christian Andersen Children′s Hospital; Odense University Hospital; Odense Denmark
- Department of Neonatology; JMC; Rigshospitalet - Copenhagen University Hospital; Copenhagen Denmark
| |
Collapse
|
49
|
Laursen MF, Zachariassen G, Bahl MI, Bergström A, Høst A, Michaelsen KF, Licht TR. Having older siblings is associated with gut microbiota development during early childhood. BMC Microbiol 2015; 15:154. [PMID: 26231752 PMCID: PMC4522135 DOI: 10.1186/s12866-015-0477-6] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 07/06/2015] [Indexed: 12/15/2022] Open
Abstract
Background Evidence suggests that early life infections, presence of older siblings and furred pets in the household affect the risk of developing allergic diseases through altered microbial exposure. Recently, low gut microbial diversity during infancy has also been linked with later development of allergies. We investigated whether presence of older siblings, furred pets and early life infections affected gut microbial communities at 9 and 18 months of age and whether these differences were associated with the cumulative prevalence of atopic symptoms of eczema and asthmatic bronchitis at 3 years of age. Bacterial compositions and diversity indices were determined in fecal samples collected from 114 infants in the SKOT I cohort at age 9 and 18 months by 16S rRNA gene sequencing. These were compared to the presence of older siblings, furred pets and early life infections and the cumulative prevalence of diagnosed asthmatic bronchitis and self-reported eczema at 3 years of age. Results The number of older siblings correlated positively with bacterial diversity (p = 0.030), diversity of the phyla Firmicutes (p = 0.013) and Bacteroidetes (p = 0.004) and bacterial richness (p = 0.006) at 18 months. Further, having older siblings was associated with increased relative abundance of several bacterial taxa at both 9 and 18 months of age. Compared to the effect of having siblings, presence of household furred pets and early life infections had less pronounced effects on the gut microbiota. Gut microbiota characteristics were not significantly associated with cumulative occurrence of eczema and asthmatic bronchitis during the first 3 years of life. Conclusions Presence of older siblings is associated with increased gut microbial diversity and richness during early childhood, which could contribute to the substantiation of the hygiene hypothesis. However, no associations were found between gut microbiota and atopic symptoms of eczema and asthmatic bronchitis during early childhood and thus further studies are required to elucidate whether sibling-associated gut microbial changes influence development of allergies later in childhood. Electronic supplementary material The online version of this article (doi:10.1186/s12866-015-0477-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Martin Frederik Laursen
- Division of Diet, Disease Prevention and Toxicology, National Food Institute, Technical University of Denmark, Mørkhøj Bygade 19, DK-2860, Søborg, Denmark.
| | - Gitte Zachariassen
- H.C. Andersen Children's Hospital, Odense University Hospital, Sdr. Boulevard 29, DK-5000, Odense C, Denmark.
| | - Martin Iain Bahl
- Division of Diet, Disease Prevention and Toxicology, National Food Institute, Technical University of Denmark, Mørkhøj Bygade 19, DK-2860, Søborg, Denmark.
| | - Anders Bergström
- Division of Diet, Disease Prevention and Toxicology, National Food Institute, Technical University of Denmark, Mørkhøj Bygade 19, DK-2860, Søborg, Denmark. .,Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 30, DK-1958, Frederiksberg C, Denmark.
| | - Arne Høst
- H.C. Andersen Children's Hospital, Odense University Hospital, Sdr. Boulevard 29, DK-5000, Odense C, Denmark.
| | - Kim F Michaelsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 30, DK-1958, Frederiksberg C, Denmark.
| | - Tine Rask Licht
- Division of Diet, Disease Prevention and Toxicology, National Food Institute, Technical University of Denmark, Mørkhøj Bygade 19, DK-2860, Søborg, Denmark
| |
Collapse
|
50
|
Zachariassen G, Hansen BM. Head circumference growth among extremely preterm infants in Denmark has improved during the past two decades. Dan Med J 2015; 62:A5094. [PMID: 26183042] [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: 06/04/2023]
Abstract
INTRODUCTION Treatment of extremely preterm and low birth weight infants is still evolving and improving. In this study, we evaluated if growth has improved from birth to two years of corrected age (CA) among extremely low birth weight (BW) and preterm born infants in Denmark. METHODS This was an observational study with comparison of head circumference (HC), weight and length growth in two Danish cohorts of extremely preterm (gestational age (GA) < 28 weeks) and extremely low birth weight (ELBW with a BW < 1,000 g) infants (A: 1994-1995 and B: 2004-2008). RESULTS Infants in cohort A (n = 198) and B (n = 64) had a median GA and BW of 27 + 2 weeks and 948 g in A, and 27 + 3 weeks and 934 g in B. At discharge, infants in B compared with A had increased more in HC (p = 0.000), length (p = 0.008) and weight (p = 0.000). At two years CA, HC was still significantly larger in cohort B than A (p = 0.03), while no significant difference was recorded for length or weight. CONCLUSION Growth during hospitalisation seems to have improved among extremely preterm and low birth weight infants from 1994-1995 to 2004-2008. This may be a result of improved nutrition in combination with improved intensive care during hospitalisation. FUNDING Collection of data in the 2004-2008 cohort was supported by the Institute of Regional Health Services Research, the Egmont Foundation and the University of Southern Denmark. Collection of data from birth to two years of age in the 1994-1995 cohort was without financial support. TRIAL REGISTRATION For the 1994-1995 study, all eight regional Research Ethics Committees in Denmark at that time approved the study. The 2004-2008 study was approved by the Danish National Committee on Biomedical Research Ethics, and handling of data and registrations were approved by the Danish Data Protection Agency.
Collapse
Affiliation(s)
- Gitte Zachariassen
- H.C. Andersen Børnehospital, Odense Universitetshospital, Sdr. Boulevard 29, indgang 60, 5000 Odense C, Denmark.
| | | |
Collapse
|