Metabolic analysis of infants with bronchopulmonary dysplasia under early nutrition therapy: An observational cohort study

To assess the amino acid and fatty acid metabolite patterns between infants with and without bronchopulmonary dysplasia in different nutritional stages after birth and identify metabolic indicators of bronchopulmonary dysplasia. This was an observational cohort of preterm infants born at a gestational age ≤32 + 6 weeks and with a body weight ≤2000 g. Amino acid and carnitine profiles were measured in dried blood spots (DBSs) during the early nutrition transitional phase using tandem mass spectrometry. Bronchopulmonary dysplasia was defined as oxygen dependence at 36 weeks of postmenstrual age or 28 days after birth. Metabolomic analysis was employed to define metabolites with significant differences, map significant metabolites into pathways, and identify metabolic indicators of bronchopulmonary dysplasia. We evaluated 45 neonates with and 40 without bronchopulmonary dysplasia. Four amino acids and three carnitines showed differences between the groups. Three carnitines (C0, C2, and C6:1) were high in the bronchopulmonary dysplasia group mostly; conversely, all four amino acids (threonine, arginine, methionine, and glutamine (Gln)) were low in the bronchopulmonary dysplasia group. Pathway analysis of these metabolites revealed two pathways with significant changes (p < 0.05). ROC analysis showed Gln/C6:1 at total parenteral nutrition phase had both 80% sensitivity and specificity for predicting the development of bronchopulmonary dysplasia, with an area under the curve of 0.81 (95% confidence interval 0.71–0.89). Amino acid and fatty acid metabolite profiles changed in infants with bronchopulmonary dysplasia after birth during the nutrition transitional period, suggesting that metabolic dysregulation may participate in the development of bronchopulmonary dysplasia. Our findings demonstrate that metabolic indicators are promising for forecasting the occurrence of bronchopulmonary dysplasia among preterm neonates.

Realising the potential human development returns to investing in early and maternal nutrition: The importance of identifying and addressing constraints over the life course

The benefits of interventions which improve early nutrition are well recognised. These benefits, however, only accrue to the extent that later life circumstances allow. Consequently, in adverse contexts many of the benefits will never be realised, particularly for the most vulnerable, exacerbating inequality. Returns to investment in early nutrition could be improved if we identified contextual factors constraining their realisation and interventions to weaken these. We estimate cost and impact of scaling 10 nutrition interventions for a cohort of South African children born in 2021. We estimate associated declines in malnutrition and mortality, and improvements in years of schooling and future earnings. To examine the role of context over the life-course we estimate benefits with and without additional improvements in school quality and employment opportunities by socio-economic quintile. Scale up reduces national stunting (height for age < = -2SD) rates among children at 24 months by 3.18 percentage points, implying an increase in mean height for age z-score (HAZ) of 0.10, and 53,000 years of additional schooling. Quintile 1 (the poorest) displays the largest decline in stunting, and largest increase in mean HAZ. Estimated total cost of increasing coverage of the interventions for the cohort is US$90 million. The present value of the additional years of schooling is estimated at close to US$2 billion. Cost-benefit ratios suggest the highest return occurs in quintile 5 (1:23). Reducing inequality in school quality closes the gap between quintile 5 and the lower quintiles. If school quality and labour force participation were equal the highest returns are in quintile 1(1:31). An enabling environment is key to maximising human development returns from investing in early nutrition, and to avoid exacerbating existing inequality. Therefore, particularly for children in adverse conditions, it is essential to identify and implement complementary interventions over the life course.

Effects of Early Nutrition of Hatched Chicks on Welfare and Growth Performance: A Pilot Study

This study aimed to investigate the possibility of rearing newly hatched chicks with immediate access to feed and water in the same hatching unit one week prior to transferring them to the conventional broiler house with special regards to foot pad health and growth performance. Two trials were performed with a total of 6900/6850 (trials 1/2) broiler chickens (ROSS 308). A total of 3318/3391 chicks (trials 1/2) were transported from the hatchery (duration of about 3 h) and reared in a conventional broiler house (control group: delayed nutrition on-hatchery hatched). The control group did not receive any form of nutrition until they were taken to conventional broiler housing. Additionally, a total of 3582/3459 (trials 1/2) embryonated eggs (d 18) were obtained from the same parent flock of the same commercial hatchery and taken to the farm facility. After on-farm hatch, the chicks had immediate access to water and feed (experimental group: early nutrition on-farm hatched). After d 6/7 of life, the on-farm hatched chicks (trials 1/2) were transferred to the broiler house on the same facility. The delayed nutrition on-hatchery hatched groups displayed a significantly lower dry matter content in the litter compared to the early nutrition on-farm hatched groups (two-factorial analysis) at d 6/7 and d 14 of life. However, thereafter, no significant differences were noted. Based upon two-factorial analysis, the early nutrition on-farm hatched groups revealed lower foot pad lesions from d 14 of life onwards and showed a higher body weight (BW) throughout the rearing period compared to the delayed nutrition on-hatchery hatched groups (p < 0.05). Overall, early nutrition on-farm hatched chickens is of critical importance together with using new litter at d 7 to maintain healthy foot pads as well as to enhance nutrient utilization and optimize the growth performance.

Is E-Learning the Way Forward to Ensure the Provision of Accurate, Consistent and Up-To-Date Nutrition-Related Messages Across Population Groups?

<b>Background:</b> Every encounter a healthcare professional has with new or expecting parents offers an opportunity for addressing improved early nutrition and lifestyle. Evidence-based qualification programmes via e-learning offer valuable tools for attenuating the world’s huge double burden of both under- and overnutrition in early childhood. We evaluated use and learner satisfaction of a global e-learning programme on early nutrition and lifestyle addressing international healthcare professional. <b>Methods:</b> We implemented the Early Nutrition Specialist Programme (ENS) with six interactive e-learning courses on early nutrition building on more than ten years of experience with global e-learning platforms, expert knowledge and an international network in the subject field. We collected descriptive and explorative evaluation data on usage and learner satisfaction with a questionnaire and log data over three years among 4003 learners from 48 countries. <b>Results:</b> Results show high completion of the ENS programme, with 85.5% of learners finalizing the programme after enrollment into the first of six courses. Very good results were provided for learner satisfaction with the courses (96.7% of users), for increasing understanding of the topic (97.4%) and matching the indicated time investment (94.4%). Most predominant themes in the open text fields of user feedback questionnaires were “Increase interactivity or number of audio-visuals”, “Content suggestions or more examples” and “Technical (quality) issues or navigation problems”. <b>Conclusions:</b> The ENS programme evaluation shows high completion rates and level of satisfaction by learners from numerous countries. The different needs for Continuing Medical Education (CME) of healthcare professionals in diverse healthcare system settings can be met by a joint e-learning qualification programme. Further optimizations will be implemented based on user feedback. More research with a learning analytics approach may help to further identify the most effective and efficient didactic and pedagogic elements of e-learning.