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.

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 Growth of Very Preterm Infants in a Low-Resourced Rural Setting after Affiliation with a Human Milk Bank

Children ◽  
2022 ◽  
Vol 9 (1) ◽  
pp. 80
Author(s):  
Chia-Huei Chen ◽  
Hui-Ya Chiu ◽  
Szu-Chia Lee ◽  
Hung-Yang Chang ◽  
Jui-Hsing Chang ◽  
...  
Keyword(s):  
Human Milk ◽  
Preterm Infants ◽  
Rural Areas ◽  
Z Score ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Growth Outcomes ◽  
Milk Bank ◽  
Human Milk Bank ◽  
Milk Banks

The extrauterine growth restriction (EUGR) of very preterm infants has been associated with long-term complications and neurodevelopmental problems. EUGR has been reported at higher rates in low resource settings. There is limited research investigating how metropolitan human milk banks contribute to the growth outcomes of very preterm infants cared in rural areas. The setting of this study is located at a rural county in Taiwan and affiliated with the Taiwan Southern Human Milk Bank. Donor human milk was provided through a novel supplemental system. A renewal nutritional protocol was initiated as a quality improvement project after the affiliated program. This study aimed to compare the clinical morbidities and growth outcome at term equivalent age (TEA) of preterm infants less than 33 weeks of gestational age before (Epoch-I, July 2015–June 2018, n = 40) and after the new implementation (Epoch-II, July 2018–December 2020, n = 42). The Epoch-II group significantly increased in bodyweight z-score at TEA ((−0.02 ± 1.00) versus Epoch-I group (−0.84 ± 1.08), p = 0.002). In multivariate regression models, the statistical difference between two epochs in bodyweight z-score changes from birth to TEA was still noted. Modern human milk banks may facilitate the nutritional protocol renewal in rural areas and improve the growth outcomes of very preterm infants cared for. Establishing more distribution sites of milk banks should be encouraged.

scholarly journals Diet, weight gain, and head growth in hospitalized US very preterm infants: a 10-year observational study

2019 ◽  
Vol 109 (5) ◽  
pp. 1373-1379 ◽  
Author(s):  
Mandy B Belfort ◽  
Erika M Edwards ◽  
Lucy T Greenberg ◽  
Margaret G Parker ◽  
Danielle Y Ehret ◽  
...  
Keyword(s):  
Weight Gain ◽  
Human Milk ◽  
Infant Formula ◽  
Preterm Infants ◽  
Z Score ◽  
Score Change ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Head Growth ◽  
Formula Diets

ABSTRACT Background The benefits of human milk for hospitalized preterm infants are well documented, but the extent to which current human milk diets adequately support growth is uncertain. Objectives 1) To quantify differences in weight gain and head growth between very preterm infants fed human milk compared with infant formula; and 2) to describe trends in the magnitude of these differences over time Methods We studied infants from 777 US NICUs in the Vermont Oxford Network database. We included all surviving infants 23–29 weeks of gestation or 401–1500 g birth weight (maximum gestational age 32 wk) and excluded infants discharged >42 weeks of gestation or with congenital anomalies. In diet-growth analyses, we included infants born 2012–2016 (n = 138,703) to reflect current practice. In trend analyses, we included a 10-y cohort (n = 263,367). We categorized diet at NICU discharge/transfer as: 1) human milk only (no formula or fortifier); 2) human milk with formula or fortifier (mixed); or 3) infant formula only. Outcomes were weight and head circumference z-score change from birth to discharge relative to a fetal reference. Results Diet at discharge/transfer was human milk only for 18,274 (6.6%), mixed for 121,621 (44%), and formula only for 137,067 (49%). Weight deviated more from the fetal reference for infants fed both human milk diets compared with formula only (weight z-score change for infants fed human milk only, −0.88; mixed, −0.82; formula only −0.80; P < 0.0001 for diet overall). There were also differences by diet in head z-score change (human milk only, −0.52; mixed, −0.49; formula only, −0.45; P < 0.0001 for diet overall). The magnitude of these differences has diminished substantially over 10 y. Conclusions Very preterm infants receiving human milk compared with infant formula diets have a slower weight gain and head growth at hospital discharge.

scholarly journals The efficacy of fortified human milk compared to human milk alone for the growth of low birth weight infants

2016 ◽  
Vol 43 (5) ◽  
pp. 177 ◽  
Author(s):  
Dewi Kumara Wati Ketut ◽  
Soetjiningsih Soetjiningsih ◽  
Suandi IKG ◽  
Hamid H A
Keyword(s):  
Adverse Effect ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Human Milk ◽  
Premature Infants ◽  
Head Circumference ◽  
Controlled Trial ◽  
Calorie Intake ◽  
Low Birth Weight Infants ◽  
Length Increment

Objective To evaluate the growth of low birth weight infants fedby fortified human milk (FHM) compared to human milk (HM) alone.Methods Sixty premature infants enrolled in this study and ran-domly assigned to have FHM and HM delivered by infusofeedpump,in parallel, non-blinded controlled trial. All patients were followeduntil day 30 or until discharge, whichever came first. The weightgain was recorded daily, while length and head circumference in-crement were recorded weekly.Results The FHM group gained more weight than the HM group(335.0+55.5 g vs. 290.6+108.4 g, p=0.000, 95%CI -170.2;-81.2),larger length increment (1.9+1.1cm vs. 1.2+0.4cm, p=0.000, 95%CI-1.37;-0.55), and larger head increment (1.87+1.1cm vs.0.91+0.43cm, 95%CI -1.37;-0.55). A similar result was found whenthe group was divided into subgroup of 1000-1499 g and 1500-1999 g birth weight. The larger calorie intake in the FHM groupwas the reason for better growth. No adverse effect related to theintervention was found.Conclusion The study shows the benefit of FHM in growth of lowbirth weight infants, which is consistent when the group is dividedinto 1000-1499 g birth weight and 1500-1999 g birth weight subgroups. Better growth is achieved through higher calorie intake inthe FHM group. No adverse effect is found as a consequence ofintervention

scholarly journals Associations of birth size, infancy, and childhood growth with intelligence quotient at 5 years of age: a Danish cohort study

2020 ◽  
Vol 112 (1) ◽  
pp. 96-105 ◽  
Author(s):  
Helene Kirkegaard ◽  
Sören Möller ◽  
Chunsen Wu ◽  
Jonas Häggström ◽  
Sjurdur Frodi Olsen ◽  
...  
Keyword(s):  
Weight Gain ◽  
Head Circumference ◽  
Access To Health Care ◽  
Intelligence Quotient ◽  
Positive Association ◽  
Path Model ◽  
Birth Size ◽  
Free Access ◽  
Z Score ◽  
Infancy And Childhood

ABSTRACT Background The correlates of prenatal and postnatal growth on Intelligence Quotient (IQ) in childhood in term-born children living in high-income countries are not well known. Objectives We examined how birth size and growth in infancy and childhood were associated with IQ at age 5 y in term-born children using path analysis. Methods The study sample comprised 1719 children from the Danish National Birth Cohort who participated in a substudy in which psychologists assessed IQ using the Wechsler Primary and Preschool Scales of Intelligence–Revised. Measured weight, length/height, and head circumference at birth, 5 mo, 12 mo, and 5 y were included in a path model to estimate their total, indirect, and direct effects on IQ. All growth measures were included in the model as sex- and age-standardized z-scores. Results After adjusting for potential confounders, a positive association between birth weight and IQ was observed, and 88% of the association was direct. Weight gain in infancy was associated with IQ [per z-score increase from 5 to 12 mo, IQ increased by 1.53 (95% CI: 0.14; 2.92) points] whereas weight gain from 12 mo to 5 y was not associated with IQ. Height and head circumference growth in childhood was associated with IQ [per z-score increase from 12 mo to 5 y, IQ increased by 0.98 (95% CI: 0.17; 1.79) and 2.09 (95% CI: 0.78; 3.41) points, respectively]. Conclusions In children born at term in an affluent country with free access to health care, higher IQ was seen with greater size at birth and greater weight gain in infancy. Also, greater growth in height and head circumference throughout the first 5 y of life was associated with higher childhood IQ whereas greater weight gain after the first year of life was not.

scholarly journals Protein use and weight-gain quality in very-low-birth-weight preterm infants fed human milk or formula

2018 ◽  
Vol 107 (2) ◽  
pp. 195-200 ◽  
Author(s):  
Laura Morlacchi ◽  
Paola Roggero ◽  
Maria Lorella Giannì ◽  
Beatrice Bracco ◽  
Debora Porri ◽  
...  
Keyword(s):  
Weight Gain ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Human Milk ◽  
Preterm Infants ◽  
Very Low Birth Weight

Effect of cumulative dexamethasone dose in preterm infants on neurodevelopmental and growth outcomes: a Western Australia experience

2020 ◽  
Vol 106 (1) ◽  
pp. 69-75
Author(s):  
Ashok Kumar Buchiboyina ◽  
Chi Seong Andrew Yip ◽  
Rolland Kohan ◽  
Elizabeth A Nathan ◽  
Damber Shrestha ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Western Australia ◽  
Cumulative Dose ◽  
System Level ◽  
High Dose ◽  
Z Score ◽  
Lower Growth ◽  
Growth Measurement ◽  
Growth Outcomes

ObjectiveComparing the long-term neurodevelopmental and growth outcomes of lower and higher cumulative dexamethasone exposure in preterm infants ventilated for a minimum cumulative duration of 7 days.DesignA retrospective cohort medical chart review of infants born in Western Australia <29 weeks’ gestation between January 2007 and May 2016 who were mechanically ventilated >7 days.InterventionNo dexamethasone (controls) or a total cumulative dexamethasone dose of <2 mg/kg (lower) and ≥2 mg/kg (higher).Main outcome measuresLong-term disability at 2 and 5 years and growth measurement outcomes at 2 years of age.ResultsDexamethasone was given to 104 infants (66 with cumulative dose <2 mg/kg; 38 with cumulative dose ≥2 mg/kg), and 324 infants were controls. There was no difference in odds of long-term disability in infants with any dexamethasone exposure compared with controls (aOR: 0.90, 95% CI 0.34 to 2.02, p=0.784). No difference in long-term disability was found between the lower and higher groups (p=0.494). The prevalence of cerebral palsy (Gross Motor Functional Classification System level ≥2) between the control, lower and high-dose groups did not differ significantly (5.8% vs 4.0% vs 0%). The higher dose group had lower mean weight z-score (mean effect: −0.83, 95% CI: −1.54 to −0.01, p=0.023), height z-score (mean effect: −0.63, 95% CI: −12.5 to −0.01, p=0.048) and head circumference z-score (mean effect: −0.65, 95% CI: −1.25 to −0.05, p=0.035) compared with controls.ConclusionsIn our cohort, dexamethasone use was not associated with increased odds of long-term disability. Dexamethasone use was associated with lower growth measurements compared with controls.

scholarly journals The effects of nutritional support for premature babies with ELBW and VLBW with hypoxic damage to the central nervous system

2020 ◽  
Vol 4 (Issue 2) ◽  
pp. 45
Author(s):  
Gulban Abdullayeva ◽  
Shayhslam Batyrhanov ◽  
Stalbek Akhunbaev ◽  
Orozaly Uzakov
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Body Weight ◽  
Weight Gain ◽  
Preterm Infants ◽  
Head Circumference ◽  
Nutritional Support ◽  
Body Weight Gain ◽  
The Central Nervous System ◽  
Neurological Prognosis

Objective: Effect of nutritional support for preterm infants with very low (VLBW) and extremely low body (ELBW) weight with hypoxic damage of the central nervous system (CNS) of varying severity is not well elucidated.  The aim of this investigation is to study clinical, laboratory, neurosonography and electroencephalography characteristics of preterm infants with VLBW and ELBW with hypoxic of CNS on complex comprehensive nutritional support, diagnostic criteria of which were infants body weight gain,  increase in growth and head circumference Methods: Criteria of including into the study were VLBW and ELBW of an infant at birth and hypoxic damage to the CNS. Overall, 254 preterm infants born at the term of 23-24 weeks of gestation with body weight at birth less than 1500 grams were included into the prospective study.  All patients underwent anthropometric and clinical observation of height, weight, head circumference and body mass index till 50 weeks of postconceptual age with following evaluation by central curves; standard laboratory and biochemical blood analyses, neurosonography and electroencephalography. Data analysis of further growth of observed infants after discharge from hospital was made in 2017-2019 years on the basis of studying of stationary cards. Results: In the ELBW group with severe level of hypoxic damage to the CNS, optimum gain was 20-22 g/kg/daily, which allowed to avoid complications on the alimentary tract; in the VLBW group with severe degree it was 16-18g/kg/daily during the first three months of life. In  the ELBW and VLBW groups of children with moderate degree of hypoxic damage the desired gain did not differ and was at the level of 20-25 g/kg/daily. Physiological body weight gain in infants with VLBW and ELBW according to gestational time is connected with favorable somatic and neurological prognosis in these infants. Calculation of calorie intake, selection of the type of feeding for infants with ELBW and with VLBW according to recommendations made by ESPGHAN (2010) ensures positive anthropometric data dynamics without metabolic disruptions. Conclusion: Physiological body weight gain according to gestation period is connected with favorable somatic and neurological prognosis in these infants.

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