scholarly journals Weaning and complementary feeding in preterm infants: management, timing and health outcome

2017 ◽  
Author(s):  
Roberta Barachetti ◽  
Elisabetta Villa ◽  
Mario Barbarini
Keyword(s):  
Preterm Infants ◽  
Exclusive Breastfeeding ◽  
European Society ◽  
Solid Food ◽  
Dietary Intakes ◽  
Positive Serology ◽  
Term Infants ◽  
Pediatric Allergy ◽  
Nutritional Needs ◽  
Current Guidelines

The introduction of solid food is necessary for any infant in order to provide adequate nutrition because when they grow up milk is insufficient for their nutritional needs. Infants born preterm have increased nutritional requirements. The high nutrient demands as well as the organ immaturity of preterm infants combine to render it difficult to achieve dietary intakes that will allow preterm infants to match their in utero growth rates. Current guidelines for the introduction of solid food to term infants cannot be directly translated to preterm infants. For preterm infants such guidelines are lacking. Based on the limited available evidence, it could be concluded that a corrected age of 3 months (13 weeks) may be an appropriate age to start introducing solid food for most preterm infants. About celiac disease (CD), gluten may be introduced into the infant’s diet anytime between 4 and 12 completed months of age. In children at high risk for CD, earlier introduction of gluten (4 vs 6 months or 6 vs 12 months) is associated with earlier development of CD autoimmunity (defined as positive serology) and CD, but the cumulative incidence of each in later childhood is similar. Relatively to weaning and allergies, the European Society of Pediatric Allergy and Clinical Immunology and the European Society for Paediatric Gastroenterology Hepatology and Nutrition have produced joint guidelines. They recommend exclusive breastfeeding for 4–6 months or use of hypoallergenic formulas if exclusive breastfeeding is not possible. In addition, The American Academy of Pediatrics recommendations now state that there is no evidence to recommend maternal dietary restrictions during pregnancy or breastfeeding. However, there is no evidence that delaying introduction of solids including allergenic foods after 4–6 months is protective.

scholarly journals Complementary Feeding in the Preterm Infants: Summary of Available Macronutrient Intakes and Requirements

Nutrients ◽  
2020 ◽  
Vol 12 (12) ◽  
pp. 3696
Author(s):  
Guglielmo Salvatori ◽  
Ludovica Martini ◽  
Keyword(s):  
Preterm Infants ◽  
Reference Values ◽  
Complementary Feeding ◽  
Italian Population ◽  
Dietary Intakes ◽  
Limited Data ◽  
Term Infants ◽  
Dietary Reference Values ◽  
Nutritional Needs ◽  
Nutrient Reference Values

Limited data are available regarding the nutritional needs for preterm infants. In most cases, guidelines refer to the acquisition of neuromotor skills, adequate weight and corrected chronological age. While waiting for the establishment of specific nutritional indications for premature infants we proposed the weaning recommendations for term infants of the Italian Society of Human Nutrition with LARNs (Reference intake Levels of Nutrients and energy for the Italian population) of 2014, the Dietary Reference Values for nutrients of European Food Safety Authority (EFSA) of 2017 and the Nutrient Reference Values for Australia and New Zealand Including Recommended Dietary Intakes of 2017.

scholarly journals INVESTIGATING THE PHOTOTHERAPY THRESHOLDS IN PRETERM INFANTS

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e28-e28 ◽  
Author(s):  
Thivia Jegathesan ◽  
Michael Sgro ◽  
Vibhuti Shah ◽  
Aidan Campbell ◽  
Douglas Campbell
Keyword(s):  
Preterm Infants ◽  
Gestational Age ◽  
Chart Review ◽  
Age Groups ◽  
Retrospective Chart Review ◽  
Term Infants ◽  
Treatment Thresholds ◽  
Weight Outcomes ◽  
The Mean ◽  
Current Guidelines

Abstract BACKGROUND Currently there are limited guidelines for the management of hyperbilirubinemia in preterm infants. Current guidelines are limited to individual sites and are consensus-based opinions. The current decrease in chronic bilirubin encephalopathy in preterm infants is a result of liberal use of phototherapy that are not based on evidence from a large dataset of preterm infants. The pattern of bilirubin levels in preterm is unclear and currently based on clinical judgement. Nomograms in term infants has been proven to be beneficial and effective in reducing unnecessary treatment of hyperbilirubinemia. A nomogram designed for preterm infants would allow health professionals to quantify risk based on evidence based methods and reduce the number of test done on preterm infants. OBJECTIVES The objectives of this study are 1) To determine photherapy thresholds in preterm infants and 2) To determine the normative pattern of bilirubin values in preterm infants. DESIGN/METHODS A multi-site retrospective chart review of preterm infants ≤ 35 weeks gestation born between January 2012- November 2017 was conducted. The following data was collected; all TSB, postnatal hours of age, duration of phototherapy, infant characteristics (gestational age, birth weight, outcomes) and maternal history (inter and anter partum medication). TSB samples prior to the initiation of phototherapy were analyzed per hour and stratified by gestational age groups. RESULTS A total of 330 preterm infants were included in the retrospective review (50 24-28 weeks gestation, 100 29-32 weeks gestation, and 180 33–35 weeks gestation). The mean peak bilirubin in infants 33-35 week gestation was 198 umol/L at 4 days. These infants were started on phototherapy at a mean age of 89 hours. At 24 hours of age these infants’ bilirubin was 104 umol/L (72-189umol/L). The mean peak bilirubin in infants 29–32 weeks gestation was 181umol/L at 5 days. At 24 hours of age the mean bilirubin was 109 umol/L. Finally in infants 24–28 weeks gestation the mean peak bilirubin was 127 umol/L at 4 days. These infants were started on phototherapy at 44 hours of age. CONCLUSION Bilirubin values in preterm infants is hetergenous across gestional ages. Phototherapy treatment thresholds are lower in preterm infants between 24–28 weeks gestation. A nomogram for preterm infants maybe possible in infants between 29–35 weeks. Further research is required to determine hour specific bilirubin levels in preterm infants.

Privacy, Early Colostrum, and Gestational Age are Associated with Exclusive Breastfeeding in Preterm and Sick Term Infants

2021 ◽  
Vol 225 (04) ◽  
pp. 346-352
Author(s):  
Eva Heine ◽  
Katrin Mehler ◽  
Michiko Schöpping ◽  
Lisa Ganesh ◽  
Ruth Klein ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Preterm Infants ◽  
Gestational Age ◽  
Exclusive Breastfeeding ◽  
Phase 1 ◽  
Emergency Evacuation ◽  
Late Preterm ◽  
Term Infants ◽  
Late Preterm Infants

AbstractOur study was designed to assess the rates of exclusive breastfeeding (defined as direct breastfeeding) and the use of mother’s own milk (MOM) in preterm infants and sick term infants at discharge and to identify potential influencing factors such as gestational age, early colostrum, and privacy. The study was conducted at a German level III neonatal department. All preterm and sick term infants admitted to the neonatal intensive care unit, the pediatric intensive care unit, the intermediate care unit, and the low care ward were included in the study. Infants were recruited between March and October 2015 (phase 1) and April to July 2016 (phase 2). Due to an emergency evacuation, privacy was limited during the first phase. Breastfeeding and the use of MOM were assessed daily using a self-designed score. In total, 482 infants of 452 mothers were included. More than 90% initiated breastfeeding and one-third were exclusively breastfed at discharge. Extremely immature infants and late preterm infants were less likely to be exclusively breastfed at discharge. Privacy (p<0.001) and early colostrum (p=0.002) significantly increased exclusive breastfeeding. Conclusion Extremely immature and late preterm infants were least likely to be exclusively breastfed at discharge and need special support. Interventions such as privacy and early colostrum should be promoted to increase breastfeeding.

scholarly journals Current practice in the introduction of solid foods for preterm infants

2019 ◽  
Vol 23 (1) ◽  
pp. 94-101 ◽  
Author(s):  
Jane Cleary ◽  
Sayne MC Dalton ◽  
Alexandra Harman ◽  
Ian M Wright
Keyword(s):  
Preterm Infants ◽  
Maternal Education ◽  
Solid Food ◽  
Structured Interviews ◽  
Term Infants ◽  
Prospective Longitudinal Study ◽  
Solid Foods ◽  
Eastern Australia ◽  
Solid Food Introduction ◽  
Prospective Longitudinal

AbstractObjective:The present study compared the age of first solid foods in a cohort of preterm infants with term infants and identified factors influencing timing of solid food introduction.Design:Structured interviews on infant feeding practices, growth and medical status at term equivalence and at 3, 6, 9 and 12 months corrected postnatal age. The age of solid food introduction was compared between term and preterm infants, and the influence of maternal, infant and milk feeding factors was assessed.Setting:This prospective longitudinal study recruited primary carers of preterm and term infants from a regional metropolitan referral hospital in eastern Australia.Participants:One hundred and fifty infants (preterm, n 85; term, n 65).Results:When corrected for prematurity, preterm infants received solid foods before the recommended age for the introduction of solid foods for term infants. Median introduction of solid foods for preterm infants was 14 weeks corrected age (range 12–17 weeks). This was significantly less than 19 weeks (range 17–21 weeks) for term infants (P < 0·001). Lower maternal education and male gender were associated with earlier introduction of solid foods among preterm infants.Conclusions:Preterm infants are introduced to solid foods earlier than recommended for term infants, taking account of their corrected age. Further research is needed to assess any risk or benefit associated with this pattern and thus to develop clear evidence-based feeding guidelines for preterm infants.

scholarly journals Supplementation of Vitamins and Minerals During Lactation

2018 ◽  
Vol 17 (2) ◽  
pp. 54-57
Author(s):  
Magdalena Makowska-Donajska ◽  
Lidia Hirnle
Keyword(s):  
Exclusive Breastfeeding ◽  
European Society ◽  
Energy Demand ◽  
World Health ◽  
Lactation Period ◽  
Scientific Societies ◽  
Balanced Diet ◽  
The World ◽  
Nutritional Needs ◽  
Health Organization

Abstract Introduction. During the lactation period, energy demand and nutritional needs increase in woman. The basis of proper nutrition should consist of a balanced diet and concomitant vitamins and minerals supplementation in doses recommended by major scientific societies. Lactation has a priority over metabolic processes in mother. It absorbs 400-670 kcal per day and increases in case of multiples. Breastfeeding is the best method of feeding infants during their first 6 months of life, therefore it should be promoted among mothers and supported by qualified specialists. According to The World Health Organization (WHO) and The European Society for Paediatric Gastroenterology Hepatology and Nutrition [ESPGHAN], the percentage of women continuing breastfeeding at the child’s age of six months is low and in Poland it is 4-9% for exclusive breastfeeding and 63% for partial breastfeeding. In Europe, only in four countries the percentage of women continuing exclusive breastfeeding at infant’s 6 months of age exceeds 30% (Hungary, Malta, Portugal, Slovakia). Aim. The following article is a collection of current recommendations on vitamins and minerals supplementation during lactation. In addition to the recommendations, practical aspects of successful lactation and its impact on the health of infants and mothers have been described.

scholarly journals Bone Mineral Density, Body Composition, and Metabolic Health of Very Low Birth Weight Infants Fed in Hospital Following Current Macronutrient Recommendations during the First 3 Years of Life

Nutrients ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 1005
Author(s):  
Walter Mihatsch ◽  
Izaskun Dorronsoro Martín ◽  
Vicente Barrios-Sabador ◽  
María L. Couce ◽  
Gabriel Á. Martos-Moreno ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Health Outcome ◽  
Body Composition ◽  
Preterm Infants ◽  
Bone Mineral ◽  
Very Low Birth Weight ◽  
Metabolic Health ◽  
Mineral Density ◽  
Term Infants ◽  
Vlbw Infants

The present study longitudinally evaluated growth, bone mineral density, body composition, and metabolic health outcome in very low birth weight (VLBW) infants whose in-hospital target nutrient intake was within recent recommendations. From six months to three years, bone mineral density (dual-energy X-ray absorptiometry, DXA), body composition, and metabolic health outcome were compared with a reference group of term infants. The aim was to test whether in-hospital achieved weight gain until 36 weeks of gestation (light or appropriate for term equivalent age; LTEA or ATEA) predicts later growth, bone mineral density (BMD), abdominal obesity, or metabolic health outcomes such as insulin resistance, relative to term infants, during the first three years of life. Target in-hospital energy and protein intake was not achieved. Growth in weight, length and head circumference, mid arm circumference, adiposity, fat free mass (FFM), and bone mineralization in VLBW infants was less than those in term infants and influenced by nutritional status at discharge. Preterm infants had poorer motor and cognitive outcomes. Post-discharge body composition patterns indicate FFM proportional to height but lower fat mass index in LTEA preterm infants than term infants, with no evidence of increased truncal fat in preterm infants. The hypothesis of early BMD catch-up in VLBW infants after discharge was not supported by the present data. The clinical significance of these findings is unclear. The data may suggest a reduced obesity risk but an increased osteoporosis risk. Since postnatal growth restriction may have permanent negative health effects, LTEA VLBW infants would especially appear to benefit from targeted preventive interventions. Further follow-up of the infants is required.

scholarly journals Neonatal and Postneonatal Pulmonary Hypertension

Children ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. 131
Author(s):  
Satyan Lakshminrusimha
Keyword(s):  
Pulmonary Hypertension ◽  
Preterm Infants ◽  
Ductus Arteriosus ◽  
Right Ventricular Dysfunction ◽  
Fold Increase ◽  
Pulmonary Vein Stenosis ◽  
Term Infants ◽  
Pulmonary Vasodilators ◽  
Non Invasive Ventilation ◽  
Early Closure

During transition at birth with ventilation of the lungs, pulmonary vascular resistance (PVR) decreases from high fetal values, leading to an 8 to 10-fold increase in pulmonary blood flow (Qp). In some infants, this transition does not occur, resulting in pulmonary hypertension (PH). In infants, PH can present as: (a) primary PH in term neonates (idiopathic), (b) PH secondary to lung disease or hypoplasia in term infants, (c) acute PH in preterm infants with respiratory distress syndrome (RDS), (d) chronic PH with bronchopulmonary dysplasia (BPD) in preterm infants and (e) post-neonatal PH. A hemodynamically significant patent ductus arteriosus (PDA) can exacerbate PH in preterm infants due to increased Qp. Pulmonary vein stenosis (PVS) can complicate BPD with PH. Diagnosis of PH is based on clinical features, echocardiography and, in some intractable cases, cardiac catheterization. Therapy of PH includes oxygen, invasive or non-invasive ventilation, correction of acidosis, surfactant and selective and non-selective pulmonary vasodilators such as inhaled nitric oxide and sildenafil, respectively. Early closure of a hemodynamically significant PDA has the potential to limit pulmonary vascular remodeling associated with BPD and PH. The role of thiamine in pathogenesis of PH is also discussed with the recent increase in thiamine-responsive acute pulmonary hypertension in early infancy. Recognition and prompt therapy of PH can prevent right ventricular dysfunction, uncoupling and failure.

Infant–Father Attachment in Infants Born Preterm - A Brief Report

2021 ◽  
pp. 1-6
Author(s):  
Ruediger Kissgen ◽  
Sebastian Franke ◽  
Nino Jorjadze ◽  
Bernhard Roth ◽  
Angela Kribs
Keyword(s):  
Preterm Infants ◽  
Full Term ◽  
Strange Situation ◽  
Term Infants ◽  
Attachment Quality ◽  
Attachment Research ◽  
Neurodevelopmental Problems ◽  
Strange Situation Procedure ◽  
Father Attachment

This study examines the infant–father attachment in infants born preterm (<  1500 g at birth and/or <  37 weeks gestation) in comparison to full-term infants. The infant–father attachment was assessed using the Strange Situation Procedure at a (corrected) age of 15 months. We found at least half of preterm and full-term infants (50.0% and 56.5 % respectively) securely attached to their fathers, and no significant overall difference was observed concerning the distribution of attachment quality comparing the two groups. In light of the fact that preterm infants tend to have numerous neurodevelopmental problems, it is encouraging that significant differences were not found in the distribution of the attachment quality among the groups. Therefore, from the perspective of attachment research, it would be highly beneficial to include fathers in the care of their preterm infants.

scholarly journals Introduction and feeding practices of solid food in preterm infants born in Salzburg!

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Edda Hofstätter ◽  
Verena Köttstorfer ◽  
Patricia Stroicz ◽  
Sebastian Schütz ◽  
Lorenz Auer-Hackenberg ◽  
...  
Keyword(s):  
Celiac Disease ◽  
Preterm Infants ◽  
Complementary Feeding ◽  
Study Group ◽  
Early Weaning ◽  
Structured Interviews ◽  
Term Infants ◽  
The Mean ◽  
The Difference

Abstract Background It is shown that meeting the increased nutritional demand of preterm infants from birth is not only important for survival but essentially contributes to the infants` overall development and long-term health. While there are established guidelines for weaning term infants, evidence regarding preterm infants is scarce and less precise. The aim of this study was to identify the current practices on introducing solids to preterm infants amongst caregivers in Salzburg and determine potential reasons for early weaning. Methods Altogether 68 infants born between 24 0/7 and 36 6/7 weeks were recruited and detailed structured interviews with the caregivers were conducted at 17 weeks corrected age. Weight, height and head circumference were collected. Results 52% of the study group received solids before the recommended 17 weeks corrected age. For this group the mean age being 13.77 ± 1.11 weeks corrected age. Premature introduction of solids significantly correlates with exclusively and early formula-feeding. 34% were weaned due to recommendation by their paediatrician. 23% of the preterm infants even received solids before 12 weeks corrected age, putting them at risks for developing obesity, celiac disease and diabetes. Conclusions This study shows the necessity for clear guidelines regarding the introduction of complementary feeding in preterm infants as well as the importance of their implementation. Caregivers should receive information on this topic early enough and they should fully understand the difference between chronological and corrected age.

scholarly journals Delivery Room Management of Asphyxiated Term and Near-Term Infants

Neonatology ◽  
2021 ◽  
pp. 1-13
Author(s):  
Marlies Bruckner ◽  
Gianluca Lista ◽  
Ola D. Saugstad ◽  
Georg M. Schmölzer
Keyword(s):  
Preterm Infants ◽  
Newborn Infants ◽  
Neonatal Resuscitation ◽  
Birth Asphyxia ◽  
Delivery Room ◽  
Temperature Management ◽  
Term Infants ◽  
Term Newborn ◽  
Resuscitation Guidelines ◽  
Delivery Room Management

Approximately 800,000 newborns die annually due to birth asphyxia. The resuscitation of asphyxiated term newly born infants often occurs unexpected and is challenging for healthcare providers as it demands experience and knowledge in neonatal resuscitation. Current neonatal resuscitation guidelines often focus on resuscitation of extremely and/or very preterm infants; however, the recommendations for asphyxiated term newborn infants differ in some aspects to those for preterm infants (i.e., respiratory support, supplemental oxygen, and temperature management). Since the update of the neonatal resuscitation guidelines in 2015, several studies examining various resuscitation approaches to improve the outcome of asphyxiated infants have been published. In this review, we discuss current recommendations and recent findings and provide an overview of delivery room management of asphyxiated term newborn infants.

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