Comparative Analysis of Docosahexaenoic Acid (DHA) Content in Mother's Milk of Term and Preterm Mothers.

Objectives and Study: Docosahexaenoic acid (DHA) plays an essential role in infants' development. Maternal diet and breastmilk are the primary DHA sources for newborns. This single-center observational study aimed to compare the DHA content in mother's milk of preterm mothers with that of term ones, and to investigate the changes in mother's milk DHA content according to the week of the gestational age. Methods: A food frequency questionnaire (FFQ) was submitted to each mother to estimate the DHA intake during the last trimester of pregnancy, and the mother's milk was collected between 24 and 96 h post-partum. Results: Women who gave birth prematurely showed a lower content of mother's milk DHA than the term ones (0.51; IQR 0.38−0.6% FA vs. 0.71; IQR 0.52−0.95% FA; p = 0.001). In the multivariate linear regression analyses, for each additional week of gestational age, there was an increase in DHA content in the mother's milk (0.046% FA; CI 95% 0.018−0.074; p < 0.001). Conclusions: Our results suggest that breast milk may not be sufficient to fully satisfy the recommended DHA intake in preterm infants. This study may represent a starting point to investigate new possible DHA supplementation strategies, especially for the late and moderate preterm infants.

Overview of Important Micronutrients Supplementation in Preterm Infants after Discharge: A Call for Consensus.

Preterm infants have a lower level of nutrient body stores and immature body systems, resulting in a higher risk of malnutrition. Imbalanced complementary feeding could lead to further risk of nutritional deficits and excesses. However, evidence on their nutritional requirements following hospital discharge is limited. When planning complementary feeding, appropriate micronutrient intake should be considered for their critical role in supporting various body functions. This narrative review summarizes the need for iron, zinc, vitamin D, calcium, phosphate and long-chain polyunsaturated fatty acids (LCPUFAs) supplementation in preterm infants during complementary feeding. Regarding iron and vitamin D, the scientific community is reaching an agreement on supplementation in some categories of prematures. On the contrary, there is still not enough evidence to detail possible recommendations for LCPUFAs, zinc, calcium and phosphorus supplementation. However, these micronutrients are paramount for preterms' health: LCPUFAs can promote retinal and brain development while calcium and phosphorus supplementation is essential to prevent preterms' metabolic bone disease (MBD). Waiting for a consensus on these micronutrients, it is clear how the knowledge of the heterogeneity of the prematures population can help adjust the nutritional planning regarding the growth rate, comorbidities and comprehensive clinical history of the preterm infant.

Postbiotic Supplementation for Children and Newborn's Health.

It is now well known how the microbiota can positively or negatively influence humans health, depending on its composition. The microbiota's countless beneficial effects have allowed it to be defined as a genuine symbiont for our species. In an attempt to positively influence the microbiota, research has focused on probiotics and prebiotics. Probiotics are viable beneficial bacteria of various strains. Prebiotics are specific substances able to favor the development of advantageous bacteria strains. Postbiotics are a new category of compounds capable of affecting the microbiota. According to the different definitions, postbiotics include both nonviable bacteria and substances deriving from bacterial metabolism. Postbiotics are particularly promising in pediatric settings, as they offer some advantages over probiotics, including the absence of the risk of intestinal translocation or worsening of local inflammation. For these reasons, their use in fragile population categories such as newborns, and even more prematures, seems to be the best solution for improving microbiota's health in this population. This narrative review aims to collect the research conducted so far on postbiotics' potential in the first stages of life.

Is the body composition development in premature infants associated with a distinctive nuclear magnetic resonance metabolomic profiling of urine?

OBJECTIVE: Preterm infants' body composition at term-corrected age differs from that of term infants but appears to be similar at the age of 3 months. The aim of this study was to compare the metabolomic pattern of preterm infants at term and at 3 months with that of term infants and to determine its association with body composition development. METHOD: We designed a pilot study. Growth and body composition were evaluated by an air displacement plethysmography system in 13 preterm infants and seven term newborns at term and at 3 months of corrected age. Urine samples were collected at the same time points and analysed by nuclear magnetic resonance. RESULTS: At term-corrected age, preterm infants showed a higher fat mass percentage compared with that of term newborns, whereas at 3 months of corrected age, the body composition parameters were similar between the groups. At the first time point, nuclear magnetic resonance analysis showed a urinary increase in choline/phosphocholine, betaine and glucose in preterm infants. At the second time point, the preterm group exhibited a urinary increase in choline/phosphocholine and a decrease in betaine. CONCLUSIONS: The increased urinary excretion of choline, a betaine precursor, could reflect a potential altered metabolism in preterm infants.

The influence of a formula supplemented with dairy lipids and plant oils on the erythrocyte membrane omega-3 fatty acid profile in healthy full-term infants: a double-blind randomized controlled trial.

BACKGROUND: Human milk is the optimal nutrition for infants. When breastfeeding is not possible, supplementation of infant formula with long chain polyunsaturated fatty acids appears to promote neurodevelopmental outcome and visual function. Plant oils, that are the only source of fat in most of infant formulas, do not contain specific fatty acids that are present in human and cow milk and do not encounter milk fat triglyceride structure. Experimental data suggest that a mix of dairy lipids and plant oils can potentiate endogenous synthesis of n-3 long chain polyunsaturated fatty acids. This trial aims to determine the effect of an infant formula supplemented with a mixture of dairy lipids and plant oils on the erythrocyte membrane omega-3 fatty acid profile in full-term infants (primary outcome). Erythrocyte membrane long chain polyunsaturated fatty acids and fatty acids content, the plasma lipid profile and the insulin-growth factor 1 level, the gastrointestinal tolerance, the changes throughout the study in blood fatty acids content, in growth and body composition are evaluated as secondary outcomes. METHODS/DESIGN: In a double-blind controlled randomized trial, 75 healthy full-term infants are randomly allocated to receive for four months a formula supplemented with a mixture of dairy lipids and plant oils or a formula containing only plant oils or a formula containing plant oils supplemented with arachidonic acid and docosahexaenoic acid. Twenty-five breast-fed infants constitute the reference group. Erythrocyte membrane omega-3 fatty acid profile, long chain polyunsaturated fatty acids and the other fatty acids content, the plasma lipid profile and the insulin-growth factor 1 level are measured after four months of intervention. Gastrointestinal tolerance, the changes in blood fatty acids content, in growth and body composition, assessed by means of an air displacement plethysmography system, are also evaluated throughout the study. DISCUSSION: The achievement of an appropriate long chain polyunsaturated fatty acids status represents an important goal in neonatal nutrition. Gaining further insight in the effects of the supplementation of a formula with dairy lipids and plant oils in healthy full-term infants could help to produce a formula whose fat content, composition and structure is more similar to human milk. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT01611649.

Small for gestational age preterm infants: nutritional strategies and quality of growth after discharge.

Infants born preterm are at high risk for poor growth achievement. Small for gestational age (SGA (birth weight below the 10th percentile) preterm infants are even more prone to develop postnatal growth retardation in the early neonatal period, as they do not have a large storage of protein/energy. Both SGA and appropriate for gestational age (AGA: birth weight between the 10th and 90th percentiles) infants show persistent postnatal growth failure after discharge. Although the available data clearly demonstrate that preterm infants, especially if born SGA, exhibit postnatal growth retardation at the time of hospital discharge, the importance of the nutritional post discharge management has not been sufficiently taken into account. We have recently conducted a randomized controlled trial to assess whether infants born SGA may benefit from an enriched post discharge formula. This study suggests that the growth pattern in SGA preterm infants is not affected by the consumption of an enriched post discharge formula. The ponderal and linear growth of these infants does not accelerate to achieve early catch up growth. However, as far as the quality of growth is concerned, the fat mass accretion after term decelerates, so that an increase of fat free mass accretion takes place. Future research effort should be directed toward longer follow up and personalized nutrition management.