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1.
N Engl J Med ; 381(15): 1434-1443, 2019 10 10.
Artigo em Inglês | MEDLINE | ID: mdl-31597020

RESUMO

BACKGROUND: Observational data have shown that slow advancement of enteral feeding volumes in preterm infants is associated with a reduced risk of necrotizing enterocolitis but an increased risk of late-onset sepsis. However, data from randomized trials are limited. METHODS: We randomly assigned very preterm or very-low-birth-weight infants to daily milk increments of 30 ml per kilogram of body weight (faster increment) or 18 ml per kilogram (slower increment) until reaching full feeding volumes. The primary outcome was survival without moderate or severe neurodevelopmental disability at 24 months. Secondary outcomes included components of the primary outcome, confirmed or suspected late-onset sepsis, necrotizing enterocolitis, and cerebral palsy. RESULTS: Among 2804 infants who underwent randomization, the primary outcome could be assessed in 1224 (87.4%) assigned to the faster increment and 1246 (88.7%) assigned to the slower increment. Survival without moderate or severe neurodevelopmental disability at 24 months occurred in 802 of 1224 infants (65.5%) assigned to the faster increment and 848 of 1246 (68.1%) assigned to the slower increment (adjusted risk ratio, 0.96; 95% confidence interval [CI], 0.92 to 1.01; P = 0.16). Late-onset sepsis occurred in 414 of 1389 infants (29.8%) in the faster-increment group and 434 of 1397 (31.1%) in the slower-increment group (adjusted risk ratio, 0.96; 95% CI, 0.86 to 1.07). Necrotizing enterocolitis occurred in 70 of 1394 infants (5.0%) in the faster-increment group and 78 of 1399 (5.6%) in the slower-increment group (adjusted risk ratio, 0.88; 95% CI, 0.68 to 1.16). CONCLUSIONS: There was no significant difference in survival without moderate or severe neurodevelopmental disability at 24 months in very preterm or very-low-birth-weight infants with a strategy of advancing milk feeding volumes in daily increments of 30 ml per kilogram as compared with 18 ml per kilogram. (Funded by the Health Technology Assessment Programme of the National Institute for Health Research; SIFT Current Controlled Trials number, ISRCTN76463425.).


Assuntos
Deficiências do Desenvolvimento/prevenção & controle , Nutrição Enteral/métodos , Fórmulas Infantis , Doenças do Prematuro/prevenção & controle , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Leite Humano , Pré-Escolar , Nutrição Enteral/efeitos adversos , Enterocolite Necrosante/prevenção & controle , Seguimentos , Humanos , Recém-Nascido , Recém-Nascido Prematuro/crescimento & desenvolvimento , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Unidades de Terapia Intensiva Neonatal , Tempo de Internação , Sepse/prevenção & controle
2.
Artigo em Inglês | MEDLINE | ID: mdl-31416171

RESUMO

BACKGROUND: This study was carried out to evaluate enteral feeding advancement and tolerance in preterm infants receiving one of two marketed formulas: intact protein preterm formula (IPF) or extensively hydrolyzed formula (EHF) for the first 14 feeding days. METHODS: Primary outcome was days to full enteral feeding (≥140 mL/kg/day). Per protocol analyses included the following: all participants who met study entrance criteria and completed study feeding (primary) and those who received ≥75% enteral intake from study formula (subset). Mothers were encouraged to provide their breast milk. RESULTS: Of the 65 enrolled (IPF: n = 32; EHF: n = 33), 60 completed study feeding per protocol (IPF: n = 30; EHF: n = 30), 37 (62%) received predominantly breast milk, and 23 (38%) received ≥75% study formula intake (IPF: n = 11; EHF: n = 12). No group differences were detected in tolerance measures. No necrotizing enterocolitis (NEC) was reported. Median time to achievement of full enteral feeding was significantly shorter for the IPF vs. EHF group (day 10 vs. 14, p < 0.05) (subset analysis). Mean enteral intake significantly increased by day 14 for the IPF group (p < 0.05), reflecting group divergence as achieved feeding volumes increased. CONCLUSIONS: Results suggest shorter time to full enteral feeding and higher feeding volume achieved by study end in preterm infants receiving intact protein preterm formula versus extensively hydrolyzed formula.


Assuntos
Nutrição Enteral/métodos , Fórmulas Infantis/química , Recém-Nascido Prematuro/crescimento & desenvolvimento , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Leite Humano/química , Feminino , Humanos , Lactente , Recém-Nascido , Itália , Fatores de Tempo
3.
PLoS One ; 14(5): e0216048, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31063464

RESUMO

OBJECTIVE: To test whether the assessment of growth in very low birth weight infants during the hospital stay using z-score differences (Zdiff) is confounded by gestational age (GA), birth weight percentiles (BW%ile), and length of the observation period (LOP). We hypothesize that Zdiff calculated from growth charts based on birth weight data introduces a systematic statistical error leading to falsely classified growth as restricted in infants growing similarly to the 50th percentile. METHODS: This observational study included 6,926 VLBW infants from the German Neonatal Network (2009 to 2015). Inclusion criterion was discharge between 37 and 41 weeks postmenstrual age. For each infant, Zdiff, weight gain velocity, and reference growth rate (50th percentile Fenton) from birth to discharge were calculated. To account for gestational age dependent growth rates, assessment of growth was standardized calculating the weight gain ratio (WGR) = weight gain velocity/reference growth rate. The primary outcome is the variation of the Zdiff-to-WGR relationship. RESULTS: Zdiff and WGR showed a weak agreement with a Zdiff of -0.74 (-1.03, -0.37) at the reference growth rate of the 50th percentile (WGR = 1). A significant proportion (n = 1,585; 23%) of infants with negative Zdiff had weight gain velocity above the 50th percentile's growth rate. Zdiff to WGR relation was significantly affected by the interaction of GA x BW%ile x LOP. CONCLUSION: This study supports the hypothesis that Zdiff, which are calculated using birth weights, are confounded by skewed reference data and can lead to misinterpretation of growth rates. New concepts like individualized growth trajectories may have the potential to overcome this limitation.


Assuntos
Peso ao Nascer/fisiologia , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Estudos Transversais , Feminino , Idade Gestacional , Gráficos de Crescimento , Humanos , Recém-Nascido , Recém-Nascido Prematuro/crescimento & desenvolvimento , Masculino , Parto/fisiologia , Valores de Referência , Ganho de Peso/fisiologia
4.
Nutrients ; 11(4)2019 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-30987136

RESUMO

The influence of types of human milk (HM)-raw own mother's milk (OMM), pasteurized OMM, and donor milk (DM)-was evaluated for growth in premature infants fed exclusively HM with controlled nutritional intakes using daily individualized HM fortification (IHMF). Growth and nutritional intakes were prospectively collected in preterm infants (<32 weeks) fed IHMF and compared in infants fed predominantly (≥75%) OMM and DM. The influence of HM types (raw OMM, pasteurized OMM, and DM) on growth were also evaluated in the whole population. One-hundred and one preterm infants (birth weight 970 ± 255 g, gestational age 27.8 ± 1.9 weeks) were included. Energy (143 ± 8 vs. 141 ± 6 kcal/kg/day; p = 0.15) and protein intakes (4.17 ± 0.15 vs. 4.15 ± 0.14 g/kg/day; p = 0.51) were similar in both groups. Infants receiving predominantly OMM (n = 37), gained significantly more weight (19.8 ± 2.0 vs. 18.2 ± 2.2 g/kg/day; p = 0.002) and length (1.17 ± 0.26 vs. 0.99 ± 0.36 cm/week; p = 0.020) than those fed predominantly DM (n = 33). Stepwise multivariate analysis (n = 101) suggests that raw OMM was the major determinant of growth, contributing 22.7% of weight gain. Length gain was also related to OMM (raw + pasteurized) intakes, explaining 4.0% of length gain. In conclusion, at daily controlled similar protein and energy intakes, OMM had significant beneficial effects on weight and length versus DM in VLBW infants. This difference could be partially explained by the use of raw OMM.


Assuntos
Aleitamento Materno , Extração de Leite , Alimentos Fortificados , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido Prematuro/crescimento & desenvolvimento , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Leite Humano , Valor Nutritivo , Ganho de Peso , Peso ao Nascer , Desenvolvimento Infantil , Ingestão de Energia , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Masculino , Proteínas do Leite/administração & dosagem , Estado Nutricional , Pasteurização , Gravidez , Estudos Prospectivos , Fatores de Tempo
5.
Am J Clin Nutr ; 109(4): 1088-1097, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30982856

RESUMO

BACKGROUND: Mother's own milk (MOM) is protective against gut microbiota alterations associated with necrotizing enterocolitis (NEC) and feeding intolerance among preterm infants. It is unclear whether this benefit is preserved with donor milk (DM) feeding. OBJECTIVE: We aimed to compare microbiota development, growth, and feeding tolerance in very-low-birth-weight (VLBW) infants fed an exclusively human milk diet of primarily MOM or DM. METHODS: One hundred and twenty-five VLBW infants born at Texas Children's Hospital were enrolled and grouped into cohorts based on percentage of MOM and DM in enteral feeds. Feeds were fortified with DM-derived fortifier per unit protocol. Weekly stool samples were collected for 6 wk for microbiota analysis [16S ribosomal RNA (rRNA) sequencing]. A research nurse obtained weekly anthropometrics. Clinical outcomes were compared via Wilcoxon's rank-sum test and Fisher's exact test, as well as multivariate analysis. RESULTS: The DM cohort (n = 43) received on average 14% mothers' milk compared with 91% for the MOM cohort (n = 74). Diversity of gut microbiota across all time points (n = 546) combined was increased in MOM infants (P < 0.001). By 4 and 6 wk of life, microbiota in MOM infants contained increased abundance of Bifidobacterium (P = 0.02) and Bacteroides (P = 0.04), whereas DM-fed infants had increased abundance of Staphylococcus (P = 0.02). MOM-fed infants experienced a 60% reduction in feeding intolerance (P = 0.03 by multivariate analysis) compared with DM-fed infants. MOM-fed infants had greater weight gain than DM-fed infants. CONCLUSIONS: Compared with DM-fed infants, MOM-fed infants have increased gut microbial community diversity at the phylum and genus levels by 4 and 6 wk of life, as well as better feeding tolerance. MOM-fed infants had superior growth. The incidence of NEC and other gastrointestinal morbidity is low among VLBW infants fed an exclusively human milk diet including DM-derived fortifier. This trial was registered at clinicaltrials.gov as NCT02573779.


Assuntos
Microbioma Gastrointestinal , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Recém-Nascido de muito Baixo Peso/metabolismo , Leite Humano/metabolismo , Adulto , Bactérias/classificação , Bactérias/genética , Bactérias/isolamento & purificação , Biodiversidade , Fezes/microbiologia , Feminino , Humanos , Lactente , Saúde do Lactente , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido , Masculino , Estudos Prospectivos , Adulto Jovem
6.
Medicina (Kaunas) ; 55(4)2019 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-30925739

RESUMO

Background and Objectives: In very low birth weight (VLBW) newborns, parenteral nutrition (PN) is delivered via a peripheral venous catheter (PVC), a central venous catheter (CVC), or a peripherally inserted central venous catheter (PICC). Up to 45% of PICCs are accompanied by complications, the most common being sepsis. A PVC is an unstable PN delivery technique requiring frequent change. The growth and neurodevelopment of VLBW newborns may be disturbed because of catheters used for early PN delivery and complications thereof. The aim of the conducted study was to evaluate the effect of two PN delivery techniques (PICC and PVC) on anthropometric parameters and neurodevelopment of VLBW newborns. Materials and Methods: A prospective randomized clinical trial was conducted in VLBW (≥750⁻<1500 g) newborns that met the inclusion criteria and were randomized into two groups: PICC and PVC. We assessed short-term outcomes (i.e., anthropometric parameters from birth until corrected age (CA) 36 weeks) and long-term outcomes (i.e., anthropometric parameters from CA 3 months to 12 months as well as neurodevelopment at CA 12 months according to the Bayley II scale). Results: In total, 108 newborns (57 in the PICC group and 51 in the PVC group) were randomized. Short-term outcomes were assessed in 47 and 38 subjects, and long-term outcomes and neurodevelopment were assessed in 38 and 33 subjects of PICC and PVC groups, respectively. There were no differences observed in anthropometric parameters between the subjects of the two groups in the short- and long-term. Mental development index (MDI) < 85 was observed in 26.3% and 21.2% (p = 0.781), and psychomotor development index (PDI) < 85 was observed in 39.5% and 54.5% (p = 0.239) of PICC and PVC subjects, respectively. Conclusions: In the short- and long-term, no differences were observed in the anthropometric parameters of newborns in both groups. At CA 12 months, there was no difference in neurodevelopment in both groups.


Assuntos
Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/métodos , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/métodos , Lactente Extremamente Prematuro/crescimento & desenvolvimento , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Nutrição Parenteral/métodos , Estatura , Peso Corporal , Feminino , Seguimentos , Hospitais Universitários , Humanos , Lactente , Recém-Nascido , Lituânia , Masculino , Destreza Motora , Estudos Prospectivos , Estatísticas não Paramétricas
8.
Early Hum Dev ; 130: 109-115, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30743197

RESUMO

OBJECTIVE: To evaluate the combined prognostic value of neurological examination, head circumference and cranial ultrasound for neurodevelopmental delay (NDD) in very low birth weight (VLBW, <1500 g) preterm infants. METHODS: Prospective follow-up study. Preterm infants with VLWB were assessed for NDD using the Mullen Scales of Early Learning test at 24 months of corrected age. Abnormal neurological examination (≥2 deviant items of Hammersmith neurological examination), microcephaly and major ultrasound abnormalities, each performed at term age, were evaluated as predictors of NDD in a multivariable Poisson model. RESULTS: 35/132 infants (26.5%) had NDD. In the multivariable analysis, microcephaly (RR, 3.2; 95% CI, 1.6-6.7) and major ultrasound abnormalities (RR, 2.7; 95% CI, 1.3-5.7) were associated to NDD. The combination of the two tests showed the highest positive predictive value (100%; 95% CI, 51%-100%), while the combination of normal neurological examination, no major US findings and normal head size at term showed the highest negative predictive value (89%; 95% CI, 78%-95%). The maximum under receiver operating characteristic curve area was for microcephaly or major ultrasound abnormalities (AUC 0.74 (0.65-0.83)). CONCLUSION: The combination of head circumference, cranial ultrasound and neurological examination at term age is useful to predict NDD in VLBW preterm infants.


Assuntos
Deficiências do Desenvolvimento/diagnóstico , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Deficiências do Desenvolvimento/epidemiologia , Feminino , Humanos , Recém-Nascido , Masculino , Exame Neurológico/normas , Valor Preditivo dos Testes , Ultrassonografia/normas
9.
Neonatal Netw ; 38(1): 7-16, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30679251

RESUMO

Expressed breast milk (EBM) is the gold standard of infant nutrition, but is not always available for use for preterm infants in the NICU setting. Donor breast milk (DBM) is often a preferred alternative for preterm and very low birth weight (VLBW) infants when maternal milk is not available. This article discusses the composition of DBM, reviews its advantages compared to formula, discusses challenges related to its long-term use, and identifies strategies to utilize DBM in the context of total nutritional management of preterm and VLBW infants. We will use a framework of WHO, WHAT, WHERE, WHEN, and WHY to answer the questions: who gets DBM, why use DBM, where does DBM come from, what is in DBM, and when may DBM use be challenged.


Assuntos
Fórmulas Infantis , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Bancos de Leite , Leite Humano , Administração dos Cuidados ao Paciente/métodos , Feminino , Humanos , Fórmulas Infantis/análise , Fórmulas Infantis/química , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido , Recém-Nascido Prematuro/crescimento & desenvolvimento , Recém-Nascido Prematuro/fisiologia , Doenças do Prematuro/prevenção & controle , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Recém-Nascido de muito Baixo Peso/fisiologia , Masculino , Bancos de Leite/organização & administração , Bancos de Leite/normas , Leite Humano/química , Leite Humano/fisiologia
10.
Breastfeed Med ; 14(1): 63-68, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30484683

RESUMO

BACKGROUND: This study aimed to compare the effects of adjustable fortification (AF), targeted fortification (TF), and standard fortification (SF) methods on the early growth of very low birth weight infants. MATERIALS AND METHODS: Sixty infants <32 weeks of gestational age and weighing <1,500 g were selected. These infants were exclusively fed with breast milk and were randomized into three fortification groups: SF, AF, and TF. SF consists of adding a fixed amount of fortifier to maternal milk. Blood urea nitrogen levels are used to adjust fortifier in AF. In TF, breast milk is analyzed and fortified accordingly based on the macronutrient content to achieve the targeted intake. RESULTS: A total of 76 preterm infants were eligible for the study. Sixty infants were randomized into three groups. At the end of the fourth week of fortification period, median daily weight gain of the infants was similar in the AF [23.5 g/(kg·d)] and TF groups [25.5 g/(kg·d)], and significantly higher in both groups than in SF group [12 g/(kg·d)] (AF versus SF group, p < 0.001 and TF versus SF group, p < 0.001). Weight, head circumference, and length were compared across the three groups regarding percentile. Significant improvement in the percentile groups of weight and head circumference was observed in the AF and TF groups. In the SF group, a significant decline in the percentile groups of weight, head circumference, and length was detected. Daily protein and energy intakes in AF and TF groups were significantly higher than those in SF group (SF versus AF, p < 0.001 and SF versus TF, p < 0.001). CONCLUSIONS: Fortifying breast milk with AF and TF methods was found to improve body weight, length, and head circumference percentiles of preterm infants, whereas SF method was found unsatisfactory. To provide optimum growth for preterm babies, breast milk that has been fortified by using AF and TF strategies should be recommended in neonatal intensive care units.


Assuntos
Nutrição Enteral/métodos , Alimentos Fortificados , Recém-Nascido Prematuro/crescimento & desenvolvimento , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Leite Humano , Ganho de Peso , Biomarcadores/sangue , Nitrogênio da Ureia Sanguínea , Feminino , Idade Gestacional , Cabeça/crescimento & desenvolvimento , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro/sangue , Recém-Nascido de muito Baixo Peso/sangue , Masculino , Estudos Prospectivos , Turquia
11.
Pediatr Neonatol ; 60(2): 135-140, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-29784603

RESUMO

BACKGROUND: The aim of the study was to analyse body composition of preterm infants fed with either breast milk or formula compared to a control group of full-term newborns. METHODS: Fifty-three newborns were enrolled: a group of 34 very low birth weight (VLBW) preterm newborns subdivided into a formula-fed (n = 23; group A) and breast milk-fed (n = 11; group B) group, and a control group of 19 full-term infants (group C). Their body composition was assessed by a bioelectrical impedance analysis (BIA) either at the estimated time of birth in the VLBW group or during the 1st week of life in the full-term group. RESULTS: There was no difference in body weight or length between any of the three studied groups. However, we discovered that fat free mass (% FFM) was lower (83.5% vs. 85.5%; p < 0.01), while fat mass (% FM) was higher (16.4% vs.14.5%; p < 0.01) in group A compared to full-term newborns. There were no such differences in FFM (84.3% vs. 85.5%; p = 0.13) or FM (15.7% vs. 14.5%; p = 0.13) between group B and control. CONCLUSION: To sum up, the VLBW infants fed with breast milk shared similar body composition with the full-term infants, while the formula-fed VLBW developed higher amounts of adipose tissue and lower amounts of fat-free mass. This is the first study to expose differences in fat tissue content attributed to type of provided nutrition, which has become significant as early as estimated time of birth despite the comparable weight.


Assuntos
Composição Corporal , Aleitamento Materno , Fórmulas Infantis , Recém-Nascido de muito Baixo Peso/metabolismo , Impedância Elétrica , Humanos , Recém-Nascido , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Estudos Prospectivos
12.
Brain Dev ; 41(4): 313-319, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30527841

RESUMO

AIM: To clarify the influence of intra- and extra-uterine growth on subsequent psychomotor development in very-low-birth-weight (VLBW) infants. METHODS: Two hundred and eighty VLBW infants (28.4 ±â€¯2.6 weeks, 1000 ±â€¯294 g) were enrolled. Psychomotor development was determined at 37.1 ±â€¯2.1 months after birth using the Kyoto Scale of Psychological Development (KSPD), which includes Postural-Motor (P-M), Cognitive-Adaptive (C-A) and Language-Social (L-S) subscales. Subjects were divided into two groups based on whether each developmental quotient (DQ) was ≥85, and the perinatal variables that contributed to a DQ of ≥85 (for each DQ) were determined. The twelve variables that were evaluated included the z scores for body weight (zBW), body length (zBL), head circumference (zHC), which were obtained at birth and at term. RESULTS: The median P-M, C-A, L-S values and total DQ were 92, 83, 81 and 83, respectively, and the percentage of patients with a DQ of ≥85 were 53%, 44%, 35% and 39%, respectively. A multivariate analysis revealed significant associations between the following variables and the DQs: P-M ≥ 85, GA [odds ratio; OR = 1.11] and zBL at term [OR = 1.26]; C-A ≥ 85, male gender [OR = 0.30], GA [OR = 1.14] and zHC at term [OR = 1.84]; L-S ≥ 85, male gender [OR = 0.55], GA [ OR = 1.20] and zHC at term [OR = 1.45]; total DQ ≥ 85, male gender [OR = 0.39], GA [OR = 1.19] and zBL at term [OR = 1.69]. CONCLUSION: In addition to less prematurity and female gender, a longer body length and larger head circumference at term were important indicators that influenced better psychomotor development in VLBW infants at three years of chronological age.


Assuntos
Desenvolvimento Infantil/fisiologia , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Recém-Nascido de muito Baixo Peso/fisiologia , Biomarcadores , Peso ao Nascer/fisiologia , Estatura , Peso Corporal , Pesos e Medidas Corporais/métodos , Feminino , Cabeça/crescimento & desenvolvimento , Humanos , Lactente , Recém-Nascido , Japão , Estudos Longitudinais , Masculino , Transtornos Psicomotores , Estudos Retrospectivos
13.
Nutr Clin Pract ; 34(3): 450-458, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30320413

RESUMO

BACKGROUND: We evaluated tolerance of hydrolyzed liquid protein (LP) supplement added to fortified human milk (HM) to optimize protein intake in preterm infants. METHODS: A prospective observational study of 31 subjects compared with 31 historic controls, receiving mothers own milk (MOM) and/or donor milk (DM) to assess LP tolerance, growth, and risk for morbidities was conducted. Milk was analyzed for nutrient content. Feeding intolerance, defined as cessation of feedings for ≥48 hours, abdominal distension and/or residuals, necrotizing enterocolitis (NEC), and metabolic acidosis were used to assess safety, while weight and head circumference (HC) were used to evaluate growth. RESULTS: LP added to powder-fortified HM had no impact on feeding intolerance and NEC. Biochemical parameters showed no metabolic acidosis: blood urea nitrogen levels (first week: median, 13 mg/dL; interquartile range [IQR], 9-16; last week: median, 13 mg/dL; IQR, 10.3-14; P = .94), bicarbonate levels (first week: median, 26.3 mEq/L; IQR, 24-28; last week: median, 28 mEq/L; IQR, 26.3-29.8; P = .10), and pH levels (first week: median, 7.4; IQR, 7.3-7.4; last week: median, 7.4; IQR, 7.37-7.40; P = .5). Weight and HC were not statistically significant. HM analysis showed lower protein and caloric content, respectively (MOM: 0.88 vs DM: 0.77 g/100 mL; P < .0001 and MOM: 18.68 vs DM: 17.96 kcal/oz; P = .02). CONCLUSIONS: Hydrolyzed LP is well tolerated in preterm infants with no difference in growth rates. Clinicians should focus on the need to maximize both protein and energy to optimize growth.


Assuntos
Nutrição Enteral/métodos , Alimentos Fortificados , Recém-Nascido Prematuro/crescimento & desenvolvimento , Leite Humano , Hidrolisados de Proteína/administração & dosagem , Ingestão de Energia , Feminino , Intolerância Alimentar/etiologia , Idade Gestacional , Humanos , Lactente , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido , Doenças do Recém-Nascido , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Terapia Intensiva Neonatal , Masculino , Leite Humano/química , Estudos Prospectivos , Hidrolisados de Proteína/efeitos adversos
14.
Nutr Clin Pract ; 34(3): 436-443, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30421458

RESUMO

OBJECTIVE: To assess the incidence of extrauterine growth restriction (EUGR) in very low-birth-weight infants (VLBWIs) and evaluate the nutrition factors in VLBWIs associated with inadequate nutrient intakes during hospitalization. METHODS: A total of 128 VLBWIs were divided into an EUGR group (n = 87) and a non-EUGR group (n = 41). Growth and parenteral nutrition (PN) and enteral nutrition (EN) practices were analyzed. Actual energy and protein intakes were subtracted from recommended energy (120 kcal/kg/d) and protein (3.75 g/kg/d) intakes, and nutrition deficits were calculated. RESULTS: Growth restriction was 21.9% at birth and 68.0% at discharge. Compared with established guidelines, PN was started late, and the maximum amino acid intake was low in both groups. EN interruption rate was higher in the EUGR group. The average energy intake in the first day after PN termination was lower in the EUGR group. There were significant differences in actual energy and protein intakes in the 2 groups for several weeks during hospitalization. The cumulative energy and protein deficits were significantly higher in the first 8 weeks and during the third to seventh weeks in the EUGR group, respectively. Step regression analysis showed that there was a significant negative correlation between the cumulative deficit of energy and changes of weight z-scores (r = -0.001, P < .05): as the energy deficit loss increased by 100 kcal, the weight z-scores dropped by 0.1 SD. CONCLUSION: Inadequate nutrition intake aggravated the occurrence of EUGR in VLBWIs, especially the energy intake.


Assuntos
Transtornos do Crescimento/terapia , Doenças do Prematuro/terapia , Recém-Nascido Prematuro/crescimento & desenvolvimento , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Apoio Nutricional/métodos , Estudos de Coortes , Proteínas na Dieta/administração & dosagem , Ingestão de Energia , Nutrição Enteral , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Necessidades Nutricionais , Nutrição Parenteral , Estudos Retrospectivos
15.
Early Hum Dev ; 128: 6-11, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30392918

RESUMO

BACKGROUND: The assessment of long-term outcomes in survivors born with extremely low birth weights (ELBWs) has become increasingly important. However, little has been reported on the physical fitness of non-disabled school-aged children born with ELBWs. AIMS: To assess the physical fitness of non-disabled school-aged children born with ELBWs. STUDY DESIGN: Retrospective cohort study. SUBJECTS: We analyzed 169 ELBW infants without cerebral palsy or intellectual disability (based on the Wechsler Intelligence Scale for Children-Third Edition (WISC-III) Full Scale intelligence quotient (IQ) test < 70). OUTCOME MEASURES: Physical fitness was assessed using the grip strength, sit-up repetitions, sit & reach, side steps, standing long jump, and softball throw tests. T-scores were calculated using national survey data. RESULTS: The T-scores for the grip strength, sit-up repetitions, sit & reach, side steps, standing long jump, softball throw tests, and the overall T-score were 43.7 ±â€¯7.5, 44.2 ±â€¯10.5, 46.0 ±â€¯9.7, 40.9 ±â€¯8.0, 40.0 ±â€¯9.8, 42.4 ±â€¯8.1, and 42.9 ±â€¯5.5, respectively. After adjusting for other age-related factors, the height (SD score), WISC-III Performance IQ score, and percent predicted forced vital capacity (FVC) independently predicted the overall T-scores. Their standardized partial regression coefficients (ß) were 0.334 (p = 0.009), 0.190 (p = 0.022), and 0.187 (p = 0.032), respectively. CONCLUSIONS: Our cohort's physical fitness at approximately 8 years of age was significantly impaired compared to average Japanese children of the same age. Height, FVC, and Performance IQ independently predicted physical fitness, with height being the strongest predictor.


Assuntos
Desenvolvimento Infantil , Lactente Extremamente Prematuro/crescimento & desenvolvimento , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Aptidão Física , Criança , Feminino , Força da Mão , Humanos , Recém-Nascido , Locomoção , Masculino , Respiração
16.
J Matern Fetal Neonatal Med ; 32(14): 2310-2318, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29357769

RESUMO

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.


Assuntos
Composição Corporal/fisiologia , Recém-Nascido Prematuro/crescimento & desenvolvimento , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Urina/química , Estudos de Casos e Controles , Colina/urina , Humanos , Lactente , Fenômenos Fisiológicos da Nutrição do Lactente/fisiologia , Recém-Nascido , Imagem por Ressonância Magnética , Espectroscopia de Ressonância Magnética , Metabolômica , Projetos Piloto , Estudos Prospectivos
17.
J Matern Fetal Neonatal Med ; 32(1): 129-142, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28274153

RESUMO

OBJECTIVE: To evaluate the role of kangaroo mother care (KMC) on growth and breast feeding rates in very low birth weight (VLBW) neonates. MATERIALS AND METHODS: A literature search was done to identify eligible studies using various electronic database searches including PubMed and EMBASE, various Web of Science including Scopus, Index Copernicus, African Index Medicus (AIM), Thomson Reuters (ESCI), Chemical Abstracts Service (CAS), SCIWIN (Scientific World Index), Google Scholar, Latin American and Caribbean Health Sciences Information System (LILACS), Index Medicus for the Eastern Mediterranean Region (IMEMR), Index Medicus for the South-East Asian Region (IMSEAR), and Western Pacific Region Index Medicus (WPRIM) and various clinical trial registries. RESULTS: Thirteen studies that evaluated the role of KMC in VLBW infants in improvement of growth outcome (weight/length/head circumference) or breast feeding rates as their primary or secondary outcome, were included in this systematic review. Seven studies evaluated both growth and breast feeding rates, four studies evaluated breast feeding rates and two studies evaluated growth outcome. All included studies except one either showed positive effect or no effect on growth and breast feeding rates. CONCLUSIONS: KMC has a positive effect on growth of the VLBW infants and also leads to increase in the breast-feeding rates. KMC should be an integral part of neonatal care and should be promoted as an essential newborn care component.


Assuntos
Aleitamento Materno , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Método Canguru , Humanos , Recém-Nascido
18.
Wien Med Wochenschr ; 169(3-4): 71-81, 2019 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-29030727

RESUMO

BACKGROUND: Parenteral and enteral nutrition are essential for both growth and development of preterm infants. Based on the results of many studies, the rate of nutritional growth and the amount of substrate delivered parenterally are under debate. OBJECTIVE: The main aim of this study was to assess parenteral nutrition in very and extremely immature preterm infants, i.e. very low birth weight (VLBW, birth weight <1500g) and extremely low birth weight (ELBW, birth weight <1000g) neonates, and to compare the amount of parenterally delivered substrate in our neonatal intensive care unit (NICU) to current German guidelines. METHODS: Retrospective audit at our tertiary NICU at the University Children's Hospital of Saarland, Homburg, Germany between 1 January 2009 and 31 December 2010. RESULTS: In total, 100 premature neonates were included. The mean gestational age was 29.6 weeks (range 24.4-34.1 weeks) and the mean birth weight was 1119 g ± 260 g (range 570 g-1490 g). Comparing the amount of fluids, glucose, amino acids, lipids and kcals with the current guidelines of the German Society for Nutritional Medicine in preterm infants, only glucose was adequately given; however, a substantial number of weight-dependent (more often in ELBW neonates) episodes of hyperglycemia requiring insulin treatment were also seen. During the first 3 weeks of life a substantial drop in body weight, length and head circumference occurred in our study cohort. In contrast, at 2 years corrected age, catch-up growth was seen in our cohort with anthropometric data now comparable to healthy term infants. Using the Bayley II test for developmental outcome assessment, at 2 years corrected age 78.6% (33/42) of infants demonstrated normal development. CONCLUSIONS: This retrospective data analysis demonstrated inadequate provision of parenteral nutrition in our NICU, which was often not in line with current German guidelines. This was associated with inadequate growth in our cohort, most notably during the first 3 weeks of life; however, implementation of current guidelines is impeded by metabolic disturbances in this cohort, most notably in ELBW neonates. Whether adherence to published guidelines will result in better early ex utero growth, and whether this normalized growth pattern will translate into better long-term outcome on a metabolic and neurological level, remains unclear.


Assuntos
Fenômenos Fisiológicos da Nutrição do Lactente/fisiologia , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Nutrição Parenteral , Ganho de Peso , Peso ao Nascer , Criança , Nutrição Enteral , Alemanha , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro/crescimento & desenvolvimento , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Unidades de Terapia Intensiva Neonatal , Estudos Retrospectivos
19.
J Matern Fetal Neonatal Med ; 32(10): 1664-1672, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-29212397

RESUMO

AIM: The aim of this study is to evaluate a feeding regimen routinely providing >180 ml/kg/d fortified human milk to very preterm infants and impact on in-hospital growth, osteopenia, and neurodevelopment. METHOD: Retrospective population-based descriptive study of infants <30-week gestation admitted within 24 h of birth and discharged during the 6-year period 2005-2010. Growth and neurodevelopment was assessed until 2 years corrected age, and cerebral palsy up to 4 years corrected age Results: Ninety-nine infants below 30-week gestation were admitted within 24 h of birth during the 6-year period, of which 84 (85%) survived to discharge. Two infants had surgical necrotizing enterocolitis, both survived to 2 years follow up. Seventy-eight infants (mean 27 weeks) had complete growth data until discharge. Full enteral feeds were tolerated after mean 10 d. Average milk volumes were 193 ml/kg/d from 15 to 42 d of life. Rates of weight below 10th centile were 10% at birth and 14% at discharge. Head circumference Z-scores were stable from birth to discharge. Blood values did not indicate osteopenia. Increasing head circumference Z-scores were associated with improved language development. CONCLUSIONS: This high enteral feeding volume regimen was associated with low rates of in-hospital growth restriction and good head growth. High enteral volume intake seems safe and may improve nutritional status of very preterm infants.


Assuntos
Nutrição Enteral/métodos , Lactente Extremamente Prematuro/crescimento & desenvolvimento , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/prevenção & controle , Unidades de Terapia Intensiva Neonatal , Modelos Lineares , Masculino , Leite Humano , Transtornos do Neurodesenvolvimento/prevenção & controle , Estado Nutricional , Gravidez , Estudos Retrospectivos
20.
J Clin Res Pediatr Endocrinol ; 11(1): 104-108, 2019 02 20.
Artigo em Inglês | MEDLINE | ID: mdl-30154070

RESUMO

Recent studies have shown that small for gestational age (SGA) term infants undergo catch-up growth during infancy but there is limited studies on early growth outcomes of extreme premature SGA infants. The aim of this study was to compare factors associated during birth in extremely premature infants less than 28 weeks' gestation who were born SGA (<10th percentile for gestational age) with those who were born appropriate-for-gestational age (AGA) (10th-89th percentile) and to determine whether there was catch-up growth at term equivalence. One hundred fifty-three extreme premature infants (89 males) born below 28 weeks' gestation were prospectively recruited. All infants had auxological measurements undertaken and prospective data on pregnancy, maternal factors, perinatal and postnatal data obtained. SGA infants at birth had significantly higher Clinical Risk Index for Babies scores and mortality, lower birth weight, smaller head circumference, smaller mid arm circumference and shorter leg length at time of birth compared with AGA infants. However, at term equivalence, weight and leg length of were not significant between AGA and SGA infants born at extreme prematurity. Our study shows that extreme premature SGA infants have appropriate catch-up growth by the time they reach term equivalence suggesting that postnatal nutrition and care are important determinants of catch-up growth in SGA infants.


Assuntos
Peso ao Nascer/fisiologia , Recém-Nascido Prematuro/crescimento & desenvolvimento , Recém-Nascido Pequeno para a Idade Gestacional/crescimento & desenvolvimento , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Antropometria/instrumentação , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Perna (Membro)/anatomia & histologia , Perna (Membro)/crescimento & desenvolvimento , Masculino , Estudos Prospectivos
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