scholarly journals SP3 Evaluating the impact of concentrated standardised parenteral nutrition on growth of preterm infants

2020 ◽  
Vol 105 (9) ◽  
pp. e2.1-e2
Author(s):  
Lucy Stachow ◽  
T’ng Chang Kwok ◽  
Ramune Snuggs ◽  
Rowan Toyer ◽  
Emmanuel Oyewole ◽  
...  
Keyword(s):  
Parenteral Nutrition ◽  
Preterm Infants ◽  
Gestational Age ◽  
Head Circumference ◽  
Growth Failure ◽  
Neonatal Unit ◽  
Extremely Low Birth Weight ◽  
Z Score ◽  
Early Nutrition ◽  
Growth Outcomes

Background and AimConcentrated standardised parenteral nutrition (CSPN) may reduce the delay in commencing parenteral nutrition (PN) in preterm infants compared with conventional individualised PN. Optimisation of early nutrition, with emphasis on earlier commencement of PN to include amino acids and addition of lipids within 24 hours of birth, ameliorates early postnatal growth failure.1 2 Cumulative nutritional deficit often seen in significantly preterm infants may lead to poor neurodevelopmental outcome.3 4 CSPN was introduced in our neonatal unit in December 2017 with the objective of improving early nutrition. The aim of this service evaluation was to assess the suitability of CSPN and its impact on the growth of preterm infants in our tertiary level neonatal unit.MethodsIn December 2017, the neonatal PN provided was switched from individualised PN to CSPN based on a modified ‘SCAMP’ regimen. Retrospective and prospective growth parameter data was collected for infants receiving PN within 24 hours of birth born between September to November 2017 (individualised PN arm) and from September to November 2018 (CSPN arm). Infants were excluded if they died or transferred out of the local neonatal service before day 28 of life, or died before transitioning from PN to full enteral feeds. Weight and head circumference at birth, 28 days old and 36 weeks corrected gestation/discharge were converted to z scores using the LMS method. The Mann-Whitney test was used to compare continuous data. Annual PN expenditure, and wastage of ordered PN, before and after the switch to CSPN, was calculated using the pharmacy stock management system, pharmacist and finance records.Results20 infants (mean gestational age 28 weeks) and 21 infants (mean gestational age 29.6 weeks) were included in the CSPN and individualised PN groups respectively. There were no differences in demographic data of each group. CSPN was commenced earlier (median 8 hours old (n=20)) than individualised PN (median 25 hours old (n=19)), (U=42, p<0.0001). There was no statistical difference in the change in weight z score from birth at 28 days old (median -0.47 (n=20) CSPN vs -0.66 (n=19) individualised PN, U=178.5, p=0.75) and at 36 weeks corrected gestation/discharge (median -0.72 (n=20) CSPN vs -0.86 (n=21) individualised PN, U=106, p=0.7). There was insufficient data collected to analyse effect on head circumference. Replacing individualised PN with CSPN resulted in a 37% reduction in procurement costs, despite an increase in the wastage of ordered PN from 7.2% to 8.5%.ConclusionA PN strategy using concentrated standardised PN can be implemented successfully in a tertiary neonatal unit setting in the United Kingdom and allows earlier commencement of PN. Use of CSPN appeared to have no adverse effect on weight gain, although small sample size may account for the lack of statistical significance in improvement of weight z score seen. Improved rates of head circumference documentation for our patients are required. Introducing CSPN resulted in a considerable reduction in procurement costs, and identifying strategies to minimise wastage of CSPN bags would further improve cost-effectiveness.ReferencesMorgan C, McGowan P, Herwitker S, et al. Postnatal head growth in preterm infants: a randomised controlled parenteral nutrition study. Pediatrics 2014;133:e120–8.Moyses HE, Johnson MJ, Leaf AA, et al. Early parenteral nutrition and growth outcomes in preterm infants: a systematic review and meta-analysis. Am J Clin Nutr 2013;97:816–26.Ehrenkranz RA, Dusick AM, Vohr BR, et al. Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants. Pediatrics 2006;117:1253–61.Dusick AM, Poindexter BB, Ehrenkranz RA, et al. Growth failure in the preterm infant: can we catch up?Semin Perinatol 2003;27:302–10.

scholarly journals Aggressive nutrition in extremely low birth weight infants: impact on parenteral nutrition associated cholestasis and growth

PeerJ ◽  
2016 ◽  
Vol 4 ◽  
pp. e2483 ◽  
Author(s):  
Andreas Repa ◽  
Ruth Lochmann ◽  
Lukas Unterasinger ◽  
Michael Weber ◽  
Angelika Berger ◽  
...  
Keyword(s):  
Body Weight ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Parenteral Nutrition ◽  
Head Circumference ◽  
Postnatal Growth ◽  
The Body ◽  
Extremely Low Birth Weight ◽  
Secondary Outcome ◽  
Z Score

BackgroundParenteral nutrition associated cholestasis (PNAC) is a frequently observed pathology in extremely low birth weight (ELBW) infants. Its pathogenesis is determined by the composition and duration of parenteral nutrition (PN) as well as the tolerance of enteral feeds (EF). “Aggressive” nutrition is increasingly used in ELBW infants to improve postnatal growth. Little is known about the effect of “aggressive” nutrition on the incidence of PNAC. We analyzed the influence of implementing an “aggressive” nutritional regimen on the incidence of PNAC and growth in a cohort of ELBW infants.MethodsELBW infants were nourished using a “conservative” (2005–6;n= 77) or “aggressive” (2007–9;n= 85) nutritional regimen that differed in the composition of PN after birth as well as the composition and timing of advancement of EFs. We analyzed the incidence of PNAC (conjugated bilirubin > 1.5 mg/dl (25 µmol/l)) corrected for confounders of cholestasis (i.e., NEC and/or gastrointestinal surgery, sepsis, birth weight, Z-score of birth weight, time on PN and male sex), growth until discharge (as the most important secondary outcome) and neonatal morbidities.ResultsThe incidence of PNAC was significantly lower during the period of “aggressive” vs. “conservative “nutrition (27% vs. 46%,P< 0.05; adjusted OR 0.275 [0.116–0.651],P< 0.01). Body weight (+411g), head circumference (+1 cm) and length (+1 cm) at discharge were significantly higher. Extra-uterine growth failure (defined as a Z-score difference from birth to discharge lower than −1) was significantly reduced for body weight (85% vs. 35%), head circumference (77% vs. 45%) and length (85% vs. 65%) (P< 0.05). The body mass index (BMI) at discharge was significantly higher (11.1 vs. 12.4) using “aggressive” nutrition and growth became more proportionate with significantly less infants being discharged below the 10th BMI percentile (44% vs. 9%), while the percentage of infants discharged over the 90th BMI percentile (3% vs. 5%) did not significantly increase.Discussion“Aggressive” nutrition of ELBW infants was associated with a significant decrease of PNAC and marked improvement of postnatal growth.

Human Milk Hormone Intake in the First Month of Life and Physical Growth Outcomes in Preterm Infants

2021 ◽  
Author(s):  
Kyoung Eun Joung ◽  
Camilia R Martin ◽  
Sara Cherkerzian ◽  
Mark Kellogg ◽  
Mandy Brown Belfort
Keyword(s):  
Weight Gain ◽  
Human Milk ◽  
Preterm Infants ◽  
Head Circumference ◽  
Physical Growth ◽  
Calorie Intake ◽  
Preterm Neonates ◽  
Z Score ◽  
Growth Outcomes ◽  
Milk Hormones

Abstract Context Human milk contains hormones that regulate metabolism. Extrauterine growth restriction remains common among preterm infants, but the effect of ingesting milk hormones on preterm infant growth is poorly understood. Objective To quantify associations of longitudinal exposure to leptin, adiponectin, and insulin in milk with physical growth of preterm infants. Design/Methods In 50 preterm neonates (median gestational age 29.4 weeks), we sampled maternal milk on day-of-life 7, 14, 21, and 28 and measured hormone levels in whole milk by ELISA. Milk leptin levels were available for a subset of 18 infants. We calculated milk hormone doses by multiplying the hormone level by the milk volume ingested on each day and estimated the area under the curve (AUC) to reflect longitudinal exposure. We analyzed associations of milk hormone exposure with growth outcomes in generalized estimated equations. Main Outcome Measures Weight gain velocity and z-scores in weight, length, head circumference, and body mass index at 36 weeks’ postmenstrual age (PMA). Results Higher leptin intake was associated with greater weight gain (2.17g/kg/day [95% CI, 1.31, 3.02]) and weight z-score at 36 weeks’ PMA (0.30 [0.08, 0.53] higher z-score per tertile). Higher adiponectin intake was associated with greater length z-score (0.41 [0.13, 0.69]), however, this association was nullified after adjustment of protein and calorie intake. Higher adiponectin was associated with smaller head circumference z-score (−0.36 [−0.64, −0.07]). Insulin was not associated with growth outcomes. Conclusions Milk leptin and adiponectin exposures may affect growth of preterm infants. The long-term effects of milk hormones warrant further investigation.

Is intravenous fish oil associated with the neurodevelopment of extremely low birth weight preterm infants on parenteral nutrition?

2021 ◽  
Author(s):  
Chiara Biagetti ◽  
Alessio Correani ◽  
Rita D’Ascenzo ◽  
Enrica Ferretti ◽  
Cecilia Proietti ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Parenteral Nutrition ◽  
Fish Oil ◽  
Preterm Infants ◽  
Extremely Low Birth Weight

scholarly journals Single-course antenatal corticosteroids is related to faster growth in very-low-birth-weight infant

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jiajia Jing ◽  
Yiheng Dai ◽  
Yanqi Li ◽  
Ping Zhou ◽  
Xiaodong Li ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Preterm Infants ◽  
Gestational Age ◽  
Very Low Birth Weight ◽  
Postnatal Growth ◽  
Weight Increase ◽  
Antenatal Corticosteroids ◽  
Lung Maturation ◽  
Growth Outcomes

Abstract Background Antenatal corticosteroids (ACS) treatment is critical to support survival and lung maturation in preterm infants, however, its effect on feeding and growth is unclear. Prior preterm delivery, it remains uncertain whether ACS treatment should be continued if possible (repeated course ACS), until a certain gestational age is reached. We hypothesized that the association of single-course ACS with feeding competence and postnatal growth outcomes might be different from that of repeated course ACS in very-low-birth-weight preterm infants. Methods A multicenter retrospective cohort study was conducted in very-low-birth-weight preterm infants born at 23–37 weeks’ gestation in South China from 2011 to 2014. Data on growth, nutritional and clinical outcomes were collected. Repeated course ACS was defined in this study as two or more courses ACS (more than single-course). Infants were stratified by gestational age (GA), including GA < 28 weeks, 28 weeks ≤ GA < 32 weeks and 32 weeks ≤ GA < 37 weeks. Multiple linear regression and multilevel model were applied to analyze the association of ACS with feeding and growth outcomes. Results A total of 841 infants were recruited. The results, just in very-low-birth-weight preterm infants born at 28–32 weeks’ gestation, showed both single and repeated course of ACS regimens had shorter intubated ventilation time compared to non-ACS regimen. Single-course ACS promoted the earlier application of amino acid and enteral nutrition, and higher rate of weight increase (15.71; 95%CI 5.54–25.88) than non-ACS after adjusting for potential confounding factors. No associations of repeated course ACS with feeding, mean weight and weight increase rate were observed. Conclusions Single-course ACS was positively related to feeding and growth outcomes in very-low-birth-weight preterm infants born at 28–32 weeks’ gestation. However, the similar phenomenon was not observed in the repeated course of ACS regimen.

scholarly journals Impact of size at birth and postnatal growth on metabolic and neurocognitive outcomes in prematurely born school-age children

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yoo Jinie Kim ◽  
Seung Han Shin ◽  
Eun Sun Lee ◽  
Young Hwa Jung ◽  
Young Ah Lee ◽  
...  
Keyword(s):  
Birth Weight ◽  
Preterm Infants ◽  
Gestational Age ◽  
Growth Velocity ◽  
Postnatal Growth ◽  
School Age ◽  
Z Score ◽  
Neurodevelopmental Outcomes ◽  
Neurocognitive Outcomes ◽  
Size At Birth

AbstractPrematurity, size at birth, and postnatal growth are important factors that determine cardiometabolic and neurodevelopmental outcomes later in life. In the present study, we aimed to investigate the associations between the size at birth and growth velocity after birth with cardiometabolic and neurodevelopmental outcomes in preterm infants. Fifty-six preterm infants born at < 32 weeks of gestation or having a birth weight of < 1500 g were enrolled and categorized into small for gestational age (SGA) and appropriate for gestational age (AGA) groups. Anthropometric and cardiometabolic parameters were assessed at school-age, and the Korean Wechsler Intelligence Scale for Children, fourth edition (K-WISC-IV) was used for assessing the intellectual abilities. The growth velocity was calculated by changes in the weight z-score at each time period. Multivariate analysis was conducted to investigate the associations of growth velocity at different periods with cardiometabolic and neurodevelopmental outcomes. Forty-two (75%) were classified as AGA and 25% as SGA. At school-age, despite the SGA children showing significantly lower body weight, lean mass index, and body mass index, there were no differences in the cardiometabolic parameters between SGA and AGA groups. After adjusting for gestational age, birth weight z-score, weight z-score change from birth to discharge and sex, change in weight z-score beyond 12 months were associated with a higher systolic blood pressure, waist circumference, and insulin resistance. Full-scale intelligent quotient (β = 0.314, p = 0.036) and perceptional reasoning index (β = 0.456, p = 0.003) of K-WISC-IV were positively correlated with postnatal weight gain in the neonatal intensive care unit. Although cardiometabolic outcomes were comparable in preterm SGA and AGA infants, the growth velocity at different time periods resulted in different cardiometabolic and neurocognitive outcomes. Thus, ensuring an optimal growth velocity at early neonatal period could promote good neurocognitive outcomes, while adequate growth after 1 year could prevent adverse cardiometabolic outcomes in preterm infants.

Prolonged empiric antibiotics and time to full enteral feed in preterm infants less than 29 weeks of gestational age

2021 ◽  
pp. 1-5
Author(s):  
M.R. Alturk ◽  
H. Salama ◽  
H. Al Rifai ◽  
M. Al Qubaisi ◽  
S. Alobaidly
Keyword(s):  
Parenteral Nutrition ◽  
Preterm Infants ◽  
Antibiotic Treatment ◽  
Gestational Age ◽  
Late Onset ◽  
Blood Cultures ◽  
Hospital Death ◽  
Late Onset Sepsis ◽  
Empiric Antibiotic ◽  
Antibiotic Courses

BACKGROUND: Early empiric antibiotic exposure appears to negatively influence feeding tolerance in preterm infants. However, the effect of prolonged antibiotic treatment is unknown. The objective of this study was to investigate whether prolonged antibiotics impact the time to full enteral feed in infants less than 29 weeks of gestational age with negative blood cultures. METHODS: Retrospective data for infants less than 29 weeks gestation age were retrieved from the PEARL-Peristat perinatal registry in Qatar. Exclusion criteria were major congenital anomalies, conditions requiring surgery in the first 10 days of life, positive blood cultures in the first 48 hours of life, and death within the first week of life. Antibiotic courses were categorized as prolonged if continued more than 48 hours. The primary outcome was the duration of total parenteral nutrition. RESULTS: Of 199 study infants, 185 (92.9%) underwent antibiotic treatment for >  48 hours despite negative blood cultures. The median duration of parenteral nutrition was not significantly different between the prolonged and short antibiotic groups (25 and 22 days, respectively; p = 0.139). Infants with prolonged antibiotic courses experienced non-significantly higher levels of necrotizing enterocolitis (7.1% and 18.4%, respectively), bronchopulmonary dysplasia (28.6% and 45.4%, respectively), and retinopathy of prematurity (14.3% and 38.4%, respectively). There were no differences in the late-onset sepsis rate (78.6% and 82.1%, respectively) and the in-hospital death rate (7.1% and 7.6%, respectively). CONCLUSIONS: Prolonged antibiotic treatment in infants less than 29 weeks gestation with negative blood cultures has no significant impact on the time to full enteral feed.

Abstract 17071: Growth Asymmetry, Head Circumference and Neurodevelopmental Outcomes in Infants with Single Ventricles

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Thomas A Miller ◽  
Victor Zak ◽  
Peter Shrader ◽  
Chitra Ravishankar ◽  
Victoria L Pemberton ◽  
...  
Keyword(s):  
Gestational Age ◽  
Head Circumference ◽  
Single Ventricle ◽  
Univariate Analysis ◽  
Somatic Growth ◽  
Z Score ◽  
Neurodevelopmental Outcomes ◽  
Head Growth ◽  
Developmental Index ◽  
Asymmetric Growth

Poor somatic growth is common in infants with single ventricle (SV) physiology and has been linked to increased morbidity and impaired neurodevelopment. Asymmetry in somatic growth, a potential brain-sparing adaptation, is important in predicting outcomes in premature and small for gestational age (SGA) infants. Objectives: To assess variability in growth asymmetry and its associations with neurodevelopment in infants with SV. Methods: We analyzed growth asymmetry (weight for age z-score (WAZ) minus head circumference for age z-score (HCAZ)), relative head growth (change in cm/change in kg), HCAZ, and change in HCAZ from baseline to pre-Glenn in subjects prospectively enrolled in the Pediatric Heart Network Infant Single Ventricle (ISV) trial. Associations between these indices and results of the Psychomotor Developmental Index (PDI) and Mental Developmental Index (MDI) of the Bayley Scales of Infant Development-II (BSID) at 14 months were assessed. Results: Of the 230 patients enrolled in ISV, complete biometric data and BSID results were available in 168 (73%). For this cohort, age at enrollment was 21±9 days, age at pre-Glenn was 167±52 days, gestational age was 38.3±1.4 weeks, and 71% were male. Growth asymmetry varied across the cohort at enrollment (0.43 ±1.02, range -2.85 to 4.84) and the pre-Glenn visit (-0.23 ±1.21, range -4.45 to 3.00) as did the relative head growth (2.40±0.86, range 0.50 to 8.00). BSID scores were not associated with indices of growth asymmetry. In univariate analysis, larger pre-Glenn HCAZ correlated with higher MDI (r=0.21, p=0.006) and PDI (r=0.38, p<0.001) and greater increase in HCAZ from enrollment to pre-Glenn was associated with higher PDI (r=0.15, p=0.049). In multivariable modeling adjusting for site, serious adverse events, stage 1 length of stay, and height at 14 months, pre-Glenn HCAZ was an independent predictor of PDI (p=0.03), but not MDI. For each one unit Z-score increase in pre-Glenn HCAZ, the predicted PDI score increased by 2.5 points. Conclusions: In infants with SV, BSID scores were associated with pre-Glenn HCAZ but not with the degree of asymmetric growth. Future studies should explore why asymmetric growth that seems important in premature and SGA infants appears less relevant in infants with SV.

scholarly journals Longitudinal evaluation of energy expenditure in preterm infants with birth weight less than 1000 g

2003 ◽  
Vol 89 (4) ◽  
pp. 533-537 ◽  
Author(s):  
Jacqueline Bauer ◽  
Kathrin Maier ◽  
Gerald Hellstern ◽  
Otwin Linderkamp
Keyword(s):  
Weight Gain ◽  
Birth Weight ◽  
Energy Expenditure ◽  
Energy Intake ◽  
Preterm Infants ◽  
Gestational Age ◽  
Open Circuit ◽  
Extremely Low Birth Weight ◽  
Postnatal Life ◽  
Low Birth Weight Infants

The aim of the present study was to obtain serial values of O2 consumption (VO2), CO2 production (VCO2) and energy expenditure (EE) in healthy but extremely-low-birth-weight infants (birth weight <1000 g), during the first 5 weeks after birth. A total of seventeen spontaneously breathing and appropriate-for-gestational-age (birth weight and body length above the 10th and below the 90th percentile) preterm infants with gestational age 25–28 weeks and birth weight 590–990 g were enrolled in the study. Calorimetry was performed using an open-circuit calorimeter on days 6, 12, 18, 24, 30 and 36 of postnatal life. During the 5 weeks of observation, VO2 increased from 4·7 (SD 0·5) TO 9·1 (sd 1·0) ml/kg per min, VCO2 from 4·5 (sd 0·4) to 8·3 (SD 0·6) ml/kg per min and EE from 115 (sd 12) to 310 (sd 71) kJ/kg per d. The energy intake was always higher than EE, even at days 6 and 12. The RER decreased from 0·99 (sd 0·09) at day 12 to 0·91 (SD 0·05) at day 30. On all study days, there were highly significant positive correlations between energy intake and weight gain, EE and weight gain, and EE and energy intake (P<0·05). Multiple regression analysis showed that on most study days EE was more affected by energy intake than by weight gain. We conclude that in healthy preterm infants with birth weight <1000 g, EE increases by about 150 % in the first 5 weeks after birth, and that the EE values are related to energy intake and weight gain independent of postnatal age.

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