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.

Don't Forget the Bones: Incidence and Risk Factors of Metabolic Bone Disease in a Cohort of Preterm Infants.

Metabolic bone disease of prematurity (MBD) is a condition of reduced bone mineral content (BMC) compared to that expected for gestational age (GA). Preterm birth interrupts the physiological process of calcium (Ca) and phosphorus (P) deposition that occurs mostly in the third trimester of pregnancy, leading to an inadequate bone mineralization during intrauterine life (IUL). After birth, an insufficient intake of Ca and P carries on this alteration, resulting in overt disease. If MBD is often a self-limited condition, in some cases it could hesitate the permanent alteration of bone structures with growth faltering and failure to wean off mechanical ventilation due to excessive chest wall compliance. Despite advances in neonatal intensive care, MBD is still frequent in preterm infants, with an incidence of 16−23% in very-low-birth-weight (VLBW, birth weight <1500 g) and 40−60% in extremely low-birth-weight (ELBW, birth weight <1000 g) infants. Several risk factors are associated with MBD (e.g., malabsorption syndrome, parenteral nutrition (PN), pulmonary bronchodysplasia (BPD), necrotizing enterocolitis (NEC), and some chronic medications). The aim of this study was to evaluate the rate of MBD in a cohort of VLBWI and the role of some risk factors. We enrolled 238 VLBWIs (107 male). 52 subjects were classified as increased risk (G1) and 186 as standard risk (G2) according to serum alkaline phosphatase (ALP) and phosphorus (P) levels. G1 subjects have lower GA (p < 0.01) and BW (p < 0.001). Moreover, they need longer PN support (p < 0.05) and invasive ventilation (p < 0.01). G1 presented a higher rate of BPD (p = 0.026). At linear regression analysis, BW and PN resulted as independent predictor of increased risk (p = 0.001, p = 0.040, respectively). Preventive strategies are fundamental to prevent chronic alteration in bone structures and to reduce the risk of short stature. Screening for MBD based on serum ALP could be helpful in clinical practice to identify subjects at increased risk.

Effects of early intervention on feeding behavior in preterm infants: A randomized controlled trial.

BACKGROUND: Although highly beneficial, human milk feeding is challenging in preterm infants due to adverse NICU factors for the infant and mother. AIM: To investigate the effects of an early intervention in promoting infant's human milk feeding and acquisition of full oral feeding. METHODS: This study is part of a RCT. We included preterm infants born between 25+0 and 29+6 weeks of gestational age (GA) without severe morbidities, and their parents. Infants were randomized to either receive early intervention (EI) or standard care (SC). EI included PremieStart and parental training to promote infant massage and visual attention according to a detailed protocol. SC, in line with NICU protocols, included Kangaroo Mother Care. The time of acquisition of full oral feeding and human milk consumption at discharge were recorded. RESULTS: Seventy preterm (EI n = 34, SC n = 36) infants were enrolled. Thirteen were excluded according to the protocol. Fifty-seven (EI n = 29, SC n = 28) infants were evaluated at discharge. The two groups were comparable for parent and infant characteristics. A significantly higher rate of infants fed with any human milk was observed in the EI group (75.9%) compared with the SC group (32.1%) (p = 0.001), and EI infants were four times more likely to be fed exclusively with human milk. Full oral feeding was achieved almost one week earlier in EI infants (mean postmenstrual age 36.8 ±â€¯1.6 vs 37.9 ±â€¯2.4 weeks in EI vs SC, p = 0.04). CONCLUSIONS: Early interventions promoting mother self-efficacy and involvement in multisensory stimulation have beneficial effects on human milk feeding in preterm infants.