Growth and biochemical markers of preterm newborns up to six months of corrected age

Introduction: Due to advances in recent decades in maternal-foetal and neonatal medicine, a greater survival of preterm infants with progressively smaller birth weight and gestational age is observed, increasing the risk of future morbidities on those infants. Among these morbidities, alterations in growth and metabolism are found. Objective: To analyze the evolution of the growth and the metabolic profile of preterm infants’ cohort from birth at six months of corrected age (CA).Methods: A descriptive and prospective study with a sample of 107 mothers and 115 preterm infants at birth and 72 preterm infants and 68 mothers at the end of follow-up. Growth (body weight, height, cephalic perimeter) was evaluated at six time points. Plasma concentrations of cholesterol, triglycerides, glucose and insulin of premature infants were assessed during three periods, from birth to 6 months of CA. Comparative analysis of the initial sample and the sample that finished the follow-up was used in chi-square family tests. To Evaluate the growth over the 6-month period by using repeated measurements.Results: Sociodemographic variables and maternal biochemical profile without statistical differences in the comparison of the mothers of the initial sample with those who completed the follow-up. Linear growth of preterm infants at six months of CA, however without recovery of growth. Plasma concentrations of triglycerides (birth = 48.1, 6 months = 151.1) and cholesterol (birth = 82.7, 6 months = 139.9) increased during the evaluations. Glycaemia remained stable (birth 80.4, 6 months = 83.3) and insulin decreased from 11.0 to 4.2.Conclusion: Growth of preterm infants, although linear, was lower than expected for age. Lipid profiles presented an ascending curve from birth onward. Therefore, this group is prone to delayed growth and to developing cardiovascular changes throughout life.

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Levels of Neonatal Thyroid Hormone in Preterm Infants and Neurodevelopmental Outcome at 5½ Years: Millennium Cohort Study

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2010-0743 ◽

2010 ◽

Vol 95 (11) ◽

pp. 4898-4908 ◽

Cited By ~ 49

Author(s):

Caroline Delahunty ◽

Shona Falconer ◽

Robert Hume ◽

Lesley Jackson ◽

Paula Midgley ◽

...

Keyword(s):

Preterm Infants ◽

Home Environment ◽

Premature Infants ◽

Thyroid Dysfunction ◽

Neurodevelopmental Outcome ◽

Millennium Cohort Study ◽

Term Infants ◽

Follow Up Study ◽

Serum T4

Context: Transient hypothyroxinemia is the commonest thyroid dysfunction of premature infants, and recent studies have found adverse associations with neurodevelopment. The validity of these associations is unclear because the studies adjusted for a differing range of factors likely to influence neurodevelopment. Objective: The aim was to describe the association of transient hypothyroxinemia with neurodevelopment at 5.5 yr corrected age. Design: We conducted a follow-up study of a cohort of infants born in Scotland from 1999 to 2001 ≤34 wk gestation. Main Outcome Measures: We measured scores on the McCarthy scale adjusted for 26 influences of neurodevelopment including parental intellect, home environment, breast or formula fed, growth retardation, and use of postnatal drugs. Results: A total of 442 infants ≤34 wk gestation who had serum T4 measurements on postnatal d 7, 14, or 28 and 100 term infants who had serum T4 measured in cord blood were followed up at 5.5 yr. Infants with hypothyroxinemia (T4 level ≤ 10th percentile on d 7, 14, or 28 corrected for gestational age) scored significantly lower than euthyroid infants (T4 level greater than the 10th percentile and less than the 90th percentile on all days) on all McCarthy scales, except the quantitative. After adjustment for confounders of neurodevelopment, hypothyroxinemic infants scored significantly lower than euthyroid infants on the general cognitive and verbal scales. Conclusions: Our findings do not support the view that the hypothyroxinemic state, in the context of this analysis, is harmless in preterm infants. Many factors contribute both to the etiology of hypothyroxinemia and neurodevelopment; strategies for correction of hypothyroxinemia should acknowledge its complex etiology and not rely solely on one approach.

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Timing of Complementary Feeding in Preterm Infants is not Associated with Early Adiposity Rebound: Longitudinal Analysis of BMI Data from Birth to 7 Years

10.20944/preprints202006.0020.v1 ◽

2020 ◽

Author(s):

Maria Elisabetta Baldassarre ◽

Antonio Di Mauro ◽

Margherita Caroli ◽

Federico Schettini ◽

Valentina Rizzo ◽

...

Keyword(s):

Preterm Infants ◽

Parental Education ◽

Final Analysis ◽

Population Based ◽

Adiposity Rebound ◽

Prevalence Of Obesity ◽

Duration Of Breastfeeding ◽

Preterm Newborns

Background: Adiposity rebound (AR) refers to the second rise of the BMI curve that usually occurs physiologically between 5 and 7 years of age. AR timing has a great impact on children´s health, being the early adiposity rebound (EAR) associated with the development of metabolic disease later in life. Aim: We aimed to investigate the prevalence of EAR in a cohort of preterm newborns. Secondary outcomes evaluated if some determinants such as (1) gender (male/female), (2) type of delivery (caesarean/vaginal), (3) birth weight (SGA/NGA/LGA), (4) type of feeding (5) duration of breastfeeding, (6) timing of introduction of solid food, (7) parental education and (8) parental pre-pregnancy BMI can influence EAR in this cohort. Tertiary aim was to evaluate the prevalence of obesity or overweight at 7 years of age in children according to early versus timely AR. Methods: This is a perspective, population-based longitudinal study, where infants born preterm were evaluated at birth and at 1, 3, 6, 9, 12, 15, 18, 24 months and 3, 4, 5, 6, 7 years of gestational-corrected age. Weight and height data were analyzed, and BMI was calculated. AR was assessed in the growth trajectory in a body mass index (BMI) plot. Results: Of the 250 preterm newborns included, 100 completed the 7 years follow-up and entered in the final analysis. The prevalence of EAR in our cohort of preterm newborns was 54%. EAR was associated with being LGA at birth. No other factors were associated to EAR. Early adiposity rebounders have a significant higher BMI at 7 years compared to children with timely AR (17.2 ±2.7 vs 15.6 ± 2.05, p=0.021). No significant differences were found in the prevalence of obesity or overweight at 7 years of age in children with early or timely AR (29% vs 14% p=0.202). Conclusions: Clinical management of preterm infants should focus on reducing excess weight gain to prevent long-term metabolic risk. Others neonatal factors are not associated to an higher risk of EAR.

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Comparing Standardized and Parent-Reported Motor Outcomes of Extremely Preterm Infants

Children ◽

10.3390/children6080090 ◽

2019 ◽

Vol 6 (8) ◽

pp. 90

Author(s):

Maeve Morgan-Feir ◽

Andrea Abbott ◽

Anne Synnes ◽

Dianne Creighton ◽

Thevanisha Pillay ◽

...

Keyword(s):

Preterm Infants ◽

Motor Impairment ◽

Fine Motor ◽

Chi Square ◽

Increased Risk ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Ages And Stages Questionnaire ◽

Motor Outcomes

Extremely preterm infants are at increased risk of motor impairment. The Canadian Neonatal Follow-Up Network (CNFUN) afforded an opportunity to study the outcomes of extremely preterm children. The purpose of this study was to compare 18-month corrected age (CA) motor outcomes of extremely preterm infants with parent-reported functional outcomes at 3 years CA. CNFUN data of 1376 infants were used to conduct chi-square analyses to compare Bayley-III motor scores (composite, gross, and fine motor) at 18 months CA with parent-reported Ages and Stages Questionnaire motor scores (gross and fine motor) at 3 years CA. The correlation of motor scores at 18-months CA with parent-reported gross and fine motor scores at 3 years CA was also examined. We found that 1 in 5 infants scoring within or above the average range on the Bayley-III had parent-reported functional fine and gross motor difficulties at 3 years CA. Bayley-III scores were only moderately correlated with functional motor outcomes. Results of the study suggest that the Bayley-III at 18 months CA was able to detect the majority of infants with motor problems, but not all; therefore, ongoing follow-up of extremely preterm infants is required. The Bayley-III motor composite score has greater clinical utility compared to sub-scale scores.

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The High-Risk Infant Is Going Home: What Now?

Neonatal Network The Journal of Neonatal Nursing ◽

10.1891/0730-0832.23.1.43 ◽

2004 ◽

Vol 23 (1) ◽

pp. 43-47 ◽

Cited By ~ 2

Author(s):

Jennifer McMurray

Keyword(s):

Premature Infants ◽

Very Low Birth Weight ◽

Survival Rates ◽

High Risk Infant ◽

Vlbw Infants ◽

The Past ◽

Technological Advances ◽

Preterm Newborns ◽

The U.S

EACH YEAR APPROXIMATELY 460,000 infants—nearly 12 percent of all babies born in the U.S.—are born prematurely.1 Technological advances in the medical and nursing care of premature infants over the past decade have increased survival rates among preterm newborns, especially of very low birth weight (VLBW) infants. Survival rates are as high as 49 percent for infants weighing 501–750 gm at birth, 85 percent for infants weighing 751–1,000 gm, 93 percent for infants weighing 1,001–1,250 gm, and 96 percent for infants weighing 1,251–1,500 gm.2 Although 50–60 percent of VLBW infants have normal outcomes, morbidity rates range from 40 to 50 percent.3 Because of this incidence of morbidity, premature infants require comprehensive primary care follow-up after discharge from the NICU.

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Factors and survival of exclusive breastfeeding in preterm infants upon discharge at six months of age

Journal of Nursing Education and Practice ◽

10.5430/jnep.v10n8p30 ◽

2020 ◽

Vol 10 (8) ◽

pp. 30

Author(s):

Josefina Gallegos-Martínez ◽

Jaime Reyes-Hernández ◽

Fátima de San Carlos Torres-Carreón ◽

Blanca Esther Cuéllar-Miranda ◽

Adriana Leite ◽

...

Keyword(s):

Neonatal Mortality ◽

Hospital Discharge ◽

Preterm Infants ◽

Premature Infants ◽

Exclusive Breastfeeding ◽

Clinical Status ◽

Baby Friendly Hospital Initiative ◽

Post Discharge ◽

Related Factors

Introduction and objective: Reducing the neonatal mortality rate in half is an objective proposed by WHO for the year 2025 through coverage strategies from the prenatal stage, delivery, birth, and hospitalization, one of these low-cost strategies is exclusive breastfeeding (EBF) in preterm infants, that contributes to the prevention of neonatal mortality, a population that contributes in the first place to neonatal mortality. The objective of this study was to identify the frequency and survival of exclusive breastfeeding and related factors in premature infants of two referral hospitals, one of them certified as Baby-Friendly Hospital Initiative (BFHI).Methods: Follow-up study of 111 premature infants after hospital discharge with equivalent corrected age among hospitals: BFHI 36.1 ± 1.6; non-BFHI (nBFHI) 36.4 ± 1.8 weeks (p ≥ .05). Data collection carried out from February 2016 to March 2017, through records in clinical files and surveys of mothers upon hospital discharge and by telephone during follow-up after 15 days post-discharge, 3, and 6 months of extrauterine life. Kaplan-Meier analysis to determine breastfeeding survival over time, and with Pearson’s r with significance p ≤ .05, the relation was established between EBF with sociodemographic, perinatal, and clinical status factors of the child.Results: Urban maternal origin (68.1%), maternal age (25.7 ± 7.9 years), schooling < 12 years (56.6%). EBF upon discharge on 45/111 dyads (40.5%), 15 days post-discharge 35/73 (47.9%), third month 23/61 (37.7%) and sixth month 7/44 (15.9%). EBF survival was 15 days post-discharge, at this cut-off point, among the correlated factors are: “having received guidance to use Exclusive Breastfeeding until the sixth month of extrauterine life of the premature child” positively correlated with EBF (r = 0.294, p ≤ .05), “the maternal perception that her milk dried” correlated negatively with EBF (r = -0.313, p ≤ .01), if “breastfeeding caused anxiety to the mother” it positively correlated with artificial feeding (AF) (r = 0.237, p ≤ .05).Conclusions: Exclusive breastfeeding in premature infants is below WHO standard, it is favorably related to maternal orientation, and barriers are maternal perceptions of non-milk supply and anxiety. It could be encouraged through actions carried out in hospitals certified with the Baby-Friendly Hospital Initiative and follow up with post-discharge breastfeeding at least to the sixth month of life of premature infants. Similar studies should establish better monitoring mechanisms to avoid losses during the follow-up.

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Antioxidant Effect of Melatonin in Preterm Newborns

Oxidative Medicine and Cellular Longevity ◽

10.1155/2021/6308255 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Lucia Marseglia ◽

Eloisa Gitto ◽

Elisa Laschi ◽

Maurizio Giordano ◽

Carmelo Romeo ◽

...

Keyword(s):

Oxidative Stress ◽

Placebo Group ◽

Free Radical ◽

Preterm Infants ◽

Plasma Concentrations ◽

Preterm Neonates ◽

Double Blind ◽

Blood Concentrations ◽

Melatonin Administration ◽

Preterm Newborns

Introduction. Preterm infants are at risk of free radical-mediated diseases from oxidative stress (OS) injury. Increased free radical generation has been demonstrated in preterm infants during the first seven days of life. Melatonin (MEL) is a powerful antioxidant and scavenger of free radicals. In preterm neonates, melatonin deficiency has been reported. Exogenous melatonin administration appears a promising strategy in the treatment of neonatal morbidities in which OS has a leading role. Objective. The aim was to evaluate plasma MEL concentrations and OS biomarkers in preterm newborns after early administration of melatonin. Methods. A prospective, randomized double-blind placebo-controlled pilot study was conducted from January 2019 to September 2020. Thirty-six preterm newborns were enrolled. Starting from the first day of life, 21 received a single dose of oral melatonin 0.5 mg/kg once a day, in the morning (MEL group); 15 newborns received an equivalent dose of placebo (placebo group). Samples of 0.2 mL of plasma were collected at 24 and 48 hours after MEL administration. Plasma concentrations of melatonin, non-protein-bound iron (NPBI), advanced oxidation protein products (AOPP), and F2-isoprostanes (F2-Isopr) were measured. Babies were clinically followed until discharge. Results. At 24 and 48 hours after MEL administration, the MEL concentrations were significantly higher in the MEL group than in the placebo group ( 52759.30 ± 63529.09 vs. 28.57 ± 46.24 pg/mL and 279397.6 ± 516344.2 vs. 38.50 ± 44.01 pg/mL, respectively). NPBI and AOPP did not show any statistically significant differences between the groups both at 24 and 48 hours. At 48 hours, the mean blood concentrations of F2-Isopr were significantly lower in the MEL group than in the placebo group ( 36.48 ± 33.85 pg/mL vs. 89.97 ± 52.01 pg/mL). Conclusions. Early melatonin administration in preterm newborns reduces lipid peroxidation in the first days of life showing a potential role to protect high-risk newborns. Trial Registration. This trial is registered with NCT04785183, Early Supplementation of Melatonin in Preterm Newborns: the Effects on Oxidative Stress.

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Premature Birth is an Independent Risk Factor for Early Adiposity Rebound: Longitudinal Analysis of BMI Data from Birth to 7 Years

Nutrients ◽

10.3390/nu12123654 ◽

2020 ◽

Vol 12 (12) ◽

pp. 3654

Author(s):

Maria Elisabetta Baldassarre ◽

Antonio Di Mauro ◽

Margherita Caroli ◽

Federico Schettini ◽

Valentina Rizzo ◽

...

Keyword(s):

Body Mass Index ◽

Preterm Infants ◽

Body Mass ◽

Neonatal Intensive Care ◽

University Hospital ◽

Large For Gestational Age ◽

Adiposity Rebound ◽

Prevalence Of Obesity ◽

Preterm Newborns

Adiposity rebound (AR) refers to the second rise of the body mass index (BMI) curve that usually occurs physiologically between five and seven years of age. AR timing has a great impact on patients’ health, since early adiposity rebound (EAR) is associated with the development of metabolic syndrome later in life. We aimed to investigate the prevalence of EAR in a cohort of inborn preterm infants admitted to the Neonatal Intensive Care Section of the Policlinico University Hospital of Bari, Italy. Secondarily, we assessed whether some determinants such as (1) gender; (2) delivery mode; (3) birth weight and classification into small, normal, or large for gestational age; (4) type of feeding; (5) breastfeeding duration; (6) timing of introduction of solid food; (7) parental education; and (8) parental pre-pregnancy body mass index (BMI) influenced EAR in this cohort. The tertiary aim was to evaluate the prevalence of obesity or being overweight at seven years of age in children according to early versus timely AR. This is a prospective, population-based longitudinal study conducted at the Neonatal Intensive Care Section of the Policlinico University Hospital of Bari, Italy. Inborn preterm infants admitted to the neonatal ward between 2009 and 2011 were eligible. Enrolled preterm infants were evaluated at birth and at 1, 3, 6, 9, 12, 15, 18, and 24 months and 3, 4, 5, 6, and 7 years of age. Weight and height data were analyzed, and BMI was calculated. AR was assessed in the growth trajectory in a body mass index (BMI) plot. Of the 250 preterm newborns included, 100 completed the seven-year follow-up and entered the final analysis, 138 were lost during the seven-year follow-up, and in 12 cases parents withdrew over the course of the study. The prevalence of EAR in our cohort of preterm newborns was 54% at seven years of age. Early adiposity rebound was associated with being large for gestational age (LGA) at birth. No other factors were associated with EAR. Early adiposity rebounders had a significantly higher BMI at seven years compared to children with timely AR (17.2 ± 2.7 vs. 15.6 ± 2.05, p = 0.021). No significant differences were found in the prevalence of obesity or being overweight at seven years of age in children with early or timely AR (29% vs. 14%, p = 0.202). Ex-preterm infants have an increased risk of EAR. Since EAR may lead to long-term detrimental health effects with the onset of various chronic diseases (e.g., obesity, metabolic syndrome, etc.), healthcare providers should be prepared to counteract its occurrence, especially in delicate sub-populations of infants.

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Breastfeeding: making the difference in the development, health and nutrition of term and preterm newborns

Revista do Hospital das Clínicas ◽

10.1590/s0041-87812003000100010 ◽

2003 ◽

Vol 58 (1) ◽

pp. 49-60 ◽

Cited By ~ 22

Author(s):

Maria Beatriz Reinert do Nascimento ◽

Hugo Issler

Keyword(s):

Breast Milk ◽

Human Milk ◽

Preterm Infants ◽

Premature Infants ◽

Interdisciplinary Team ◽

Hospital Environment ◽

Premature Newborn ◽

Health And Nutrition ◽

The Difference ◽

Preterm Newborns

Breastfeeding is the natural and safe way of feeding small infants, providing nutritional, immunological, psychological and economic recognized and unquestionable advantages. These qualities are especially important in premature infants, because of their vulnerability. Despite highly desirable, there is, in general, little success in breastfeeding preterm infants, especially in special care neonatal units. There are evidences that a high supportive hospital environment, with an interdisciplinary team, makes possible to these infants to be breastfed. In this article, the authors present an up-to-date review about the components of human milk and its unique characteristics, as well as describes aspects that make the breast milk particularly suitable for feeding the premature newborn.

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Assisted ventilation immediately after birth with self-inflating bag versus T-piece resuscitator in preterm infants

Journal of Neonatal-Perinatal Medicine ◽

10.3233/npm-210728 ◽

2021 ◽

pp. 1-6

Author(s):

M. Khan ◽

D. Bateman ◽

R. Sahni ◽

T.A. Leone

Keyword(s):

Tidal Volume ◽

Preterm Infants ◽

Positive Pressure Ventilation ◽

Controlled Trial ◽

Assisted Ventilation ◽

The Self ◽

Target Range ◽

Positive Pressure ◽

Chi Square ◽

Preterm Newborns

OBJECTIVE: To compare proportions of target range tidal volumes achieved with the self-inflating bag vs. the T-piece in resuscitation of preterm newborns at delivery. STUDY DESIGN: This randomized controlled trial was conducted at a tertiary Children’s Hospital. 20 preterm infants≤32 weeks’ gestational age with no congenital anomalies who needed positive pressure ventilation after birth were enrolled. Positive pressure ventilation was provided with the self-inflating bag or T-piece resuscitator. The primary outcome was proportion of inflations within a target range of 4–8 ml/kg. Chi-square and logistical regression analyses were performed. RESULTS: In the self-inflating bag (SIB) group 29% of inflations (117/419) and in the T-Piece (TP) group 51% of inflations (300/590) delivered expiratory tidal volume (TVe) of 4–8 ml/kg (p < 65.001). In the SIB group 60% of all inflations (254/419), and in the TP group 35% of all inflations (204/590) delivered TVe < 4 ml/kg (p < 0.001). In the SIB group 11% of all inflations (48/419), and in the TP group, 15% of all inflations (86/590) delivered TVe > 8 ml/kg (p = 0.18). The OR of having expiratory tidal volume of 4–8 ml/kg using the T-piece was 1.8 (CI 1.1–3.1), p = 0.02. CONCLUSION: Manual inflations provided by the TP deliver expiratory tidal volumes in the range of 4–8 ml/kg more consistently than SIB.

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Assessment of plasma BMP-2, BMP-7, BMP-10, vitamin D, and TGF β1 in simple fractures among Sudanese patients

PLoS ONE ◽

10.1371/journal.pone.0247472 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0247472

Author(s):

Amin Ahmed Ali ◽

Muawia Mohamed Mukhtar ◽

Samir Shaheen ◽

Abdelrahim Osman Mohamed

Keyword(s):

Vitamin D ◽

Bone Morphogenetic Proteins ◽

Pearson Correlation ◽

Demographic Data ◽

Healing Process ◽

Plasma Concentrations ◽

Healing Time ◽

Enzyme Linked Immunosorbent Assay ◽

Chi Square

Background Bone morphogenetic proteins (BMP) are multifunctional proteins. They work as cytokines regulating osteogenesis during fracture healing process. The objectives of this study were to assess changes in BMPs during fracture and their correlations to Fracture’s healing. Methods Case-Control hospital–based study conducted from January 2018 to January 2019. Demographic data, anthropometric measurements, and blood samples were collected from patients and controls (18–65 years old). Plasma concentrations of selected BMPs and vitamin D were measured using quantitative enzyme linked immunosorbent assay (ELISA). SPSS version 25 was used to calculate frequencies, Pearson correlation tests, chi-square and unpaired t-test. Results Sixty-five patients with fractures and Sixty-five controls were studied. Means of plasma concentrations were (TGFβ1 = 21.07 ng/ml ±8.49 and 19.8 ng/ml ±7.2) (BMP-2 = 76.3 pg/ml ± 156.6 and 55.5 ng/ml ± 127.9) (BMP-7 = 13.02 pg/ml ±43.5 and 64.6pg/ml ±250) (BMP-10 = 8.14 pg/ml ±12.7 and 5.48 pg/ml ±11.3) (Vitamin D mean was 24.94 ng/ml ±13.2 and 26.2 ng/ml ±11.6) in patients and controls, respectively. Forty-five subjects were enrolled into follow up study: 30 males, 15 females. Healing time mean was 4.13± 2.6 months. No significant correlation between BMP-2/BMP-7 with healing time. Conclusions BMP-7 was significantly lowers in the plasma of patients that controls (P = 0.042). Low Vitamin D was observed among Sudanese participants.

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