A survey among healthcare professionals from seven countries reported diverse nutritional practices of late preterm infants.

AIM: To gain insight into nutritional practices and expected growth outcomes of infants born between 34 and 36 gestational weeks defined as late preterm infants (LPT). METHODS: An anonymous online survey among paediatricians and neonatologists from Bangladesh, Indonesia, Mexico, Nigeria, Malaysia, Singapore and Taiwan was conducted from March until October 2020. The questionnaire consisted of 40 questions on the nutritional management and expected growth outcomes of LPT in and after-hospital care. RESULTS: Healthcare professionals from low to high Human Development (HDI) countries (n = 322) and very high HDI countries (n = 169) participated in the survey. Human milk was the preferred feeding, resulting in an adequate growth of LPT (weight, length and occipitofrontal circumference), according to a majority of respondents (low to high HDI, 179/265, 68% vs. very high HDI, 73/143, 51%; p = 0.002). The expected growth outcome was higher after-hospital discharge. Less than half of healthcare professionals started enteral feeding during the 1st hour of life. Lactation difficulties, limited access to human milk fortifiers and donor human milk, especially among low to high HDI countries, were reported as major hurdles. CONCLUSION: Human milk is the first feeding choice for LPT. The diverse opinions on nutritional practices and expected growth outcomes among healthcare professionals indicate the necessity to develop general nutritional guidelines for LPT.

The Importance of Lactose in the Human Diet: Outcomes of a Mexican Consensus Meeting.

Lactose is a unique component of breast milk, many infant formulas and dairy products, and is widely used in pharmaceutical products. In spite of that, its role in human nutrition or lactose intolerance is generally not well-understood. For that reason, a 2-day-long lactose consensus meeting with health care professionals was organized in Mexico to come to a set of statements for which consensus could be gathered. Topics ranging from lactase expression to potential health benefits of lactose were introduced by experts, and that was followed by a discussion on concept statements. Interestingly, lactose does not seem to induce a neurological reward response when consumed. Although lactose digestion is optimal, it supplies galactose for liver glycogen synthesis. In infants, it cannot be ignored that lactose-derived galactose is needed for the synthesis of glycosylated macromolecules. At least beyond infancy, the low glycemic index of lactose might be metabolically beneficial. When lactase expression decreases, lactose maldigestion may lead to lactose intolerance symptoms. In infancy, the temporary replacing of lactose by other carbohydrates is only justified in case of severe intolerance symptoms. In those who show an (epi)genetic decrease or absence of lactase expression, a certain amount (for adults mostly up to 12 g per portion) of lactose can still be consumed. In these cases, lactose shows beneficial intestinal-microbiota-shaping effects. Avoiding lactose-containing products may imply a lower intake of other important nutrients, such as calcium and vitamin B12 from dairy products, as well as an increased intake of less beneficial carbohydrates.

[Echocardiographic screening vs. symptomatic diagnosis for patent ductus arteriosus in preterms]. / Pesquisa o diagnóstico sintomático por ecocardiografía en la persistencia del conducto arterioso en prematuros.

BACKGROUND: The persistence of ductus arteriosus, the aim of this study is to evaluate the possible benefit in the treatment for ductus closure when an early (less than 72 hours of life) echocardiographic screening is done versus when the echocardiographic diagnosis is realized only in present of associated symptoms. METHODS: Preterm without malformation followed by two strategies: patent ductus arteriosus (PDA) screening or echocardiographic study on suspected PDA for symptoms (control group). We analyzed the ductus characteristics, the presence of pulmonary hypertension and the treatments for their closure. We analyze the result in relation of the premature age as late preterm (34 to 36 gestational age weeks), moderate (30 to 33) and extreme (< 30). RESULTS: There was no difference in the proportion of newborns diagnosed with PDA among the strategies (screening 18.6 % [101/543] vs 18.1 % [55/304], p = 0.92). In the control group, 53 % were diagnosed after 72 hours of life. There were no differences in relation of the ductus characteristic among the groups. The closure treatment were similar in the two strategies among the moderate and late preterm, but was more aggressive in the control group in the extreme preterms. CONCLUSIONS: The echocardiographic screening for PDA in extreme preterm newborns reduces the time to detect it, and allow to give less aggressive treatment. We do not recommend their use in moderate o late preterm newborn.

Introducción: el objetivo es evaluar el posible beneficio en el tratamiento en el cierre de la persistencia del conducto arterioso cuando se realiza una pesquisa (< 72 horas de vida) por ecocardiograma, que cuando se realiza solo ante la presencia de síntomas asociados. Métodos: niños pretérmino sin malformaciones en dos estrategias diagnósticas: por pesquisa (asintomáticos) y por sintomatología asociada a la persistencia del conducto arterioso (PCA). Se analizaron las características del conducto, la presencia de hipertensión pulmonar y el tratamiento recibido. Se compararon los resultados entre: tardíos (34 a 36 semanas de gestación [SEG]), moderados (30 a 33 SEG) y extremos (< 30 SEG). Resultados: no hubo diferencias en las proporciones de diagnósticos de PCA por estrategias (pesquisa 18.6 % [101/543] contra 18.1 % [55/304], p = 0.92). Sin pesquisa, el 53 % se diagnosticó después de las 72 horas de vida. No hubo diferencias en las características del conducto entre los grupo. El tratamiento recibido no difirió entre las estrategias en los prematuros moderados y tardíos, pero sí fue más agresivo en los extremos. Conclusiones: la pesquisa de una PCA por ecocardiografía en los infantes pretérmino extremos acorta el tiempo de detección y permite un tratamiento menos agresivo. No lo recomendamos en pretérminos moderados y tardíos.

Clara cell protein expression in human neonates during respiratory distress syndrome.

BACKGROUND/AIMS: Clara cell protein (cc-10) has been shown to negatively regulate inflammation, protect pulmonary surfactant from degradation in the lung, and administration of this recombinant protein improves the condition of infant respiratory distress syndrome (iRDS), a disease that occurred mainly in preterm infants. In view of the possibility that altered expression of cc-10 might regulate its protective function, we attempted to characterize this protein in infants with iRDS. METHODS: Using bronchotraqueal aspirates from human infants, we analyzed cc-10 in two-dimensional gel electrophoresis (2-DE) by combining immunoprecipitation, carbonyl groups and total protein immunoblotting. RESULTS: Seven forms of cc-10 were detected with western immunoblots in infants with iRDS while only four forms were present in neonates who needed mechanical ventilation for other reasons without any lung disease (control group). The overall levels of cc-10 in iRDS were lower and differences were seen in isoform pattern and distribution. CONCLUSION: Our demonstration that cc-10 is differentially expressed in infants with iRDS may point the way towards one possible mechanism that potentially involves modifications of the protein structure with its anti-inflammatory and surfactant protective function and could be detrimental for this airway disorder.