Claudio Fabris

Neonatal Anthropometric Charts: The Italian Neonatal Study Compared With Other European Studies

Background and Objective: This was a nationwide prospective study carried out in Italy between 2005 and 2007, involving 34 centers with a neonatal intensive care unit. The study reports the Italian Neonatal Study charts for weight, length, and head circumference of singletons born between 23 and 42 gestational weeks, comparing them with previous Italian data and with the most recent data from European countries. Patients and Methods: Single live born babies with ultrasound assessment of gestational age within the first trimester, and with both parents of Italian origin. Only fetal hydrops and major congenital anomalies diagnosed at birth were excluded. The reference set consists of 22,087 girls and 23,375 boys. Results: At each gestational age, boys are heavier than girls by about 4%. Later-born neonates are heavier than firstborn neonates by about 3%. The effects of sex and birth order on length and head circumference are milder. No differences were observed between babies born in central-north Italy and southern Italy. A large variability emerged among European neonatal charts, resulting in huge differences in the percentage of Italian Neonatal Study neonates below the 10th centile, which is traditionally used to define small-for-gestational-age babies. In the last 2 decades prominent changes in the distribution of birth weight emerged in Italy and in the rest of Europe, in both term and preterm neonates. Conclusions: The existing European neonatal charts, based on more or less recent data, were found to be inappropriate for Italy. Until an international standard is developed, the use of national updated reference charts is recommended.

Efficacy of donkey's milk in treating highly problematic cow's milk allergic children: An in vivo and in vitro study

Successful therapy in cows milk protein allergy rests on completely eliminating cows milk proteins from the childs diet: it is thus necessary to provide a replacement food. This prospective study investigated tolerance of donkeys milk in a population of 46 selected children with cows milk protein allergy, for whom it was not possible to use any cows milk substitute. Thirty‐eight children (82.6%) liked and tolerated donkeys milk at the challenge and for the entire duration of follow‐up. Catch‐up growth was observed in all subjects with growth deficit during cows milk proteins challenge. The degree of cross‐reactivity of immunoglobulin E (IgE) with donkeys milk proteins was very weak and aspecific. Donkeys milk was found to be a valid alternative to both IgE‐mediated and non‐IgE‐mediated cows milk proteins allergy, including in terms of palatability and weight‐height gain.

Preterm Milk Oligosaccharides During the First Month of Lactation

OBJECTIVE: Oligosaccharides represent one of the main components of human milk, and they have been assigned important biological functions for newborns. Qualitatively and quantitatively, their presence in milk is strictly related to the expression of the mothers Se and/or Le genes, on the basis of which 4 different milk groups have been described. The aim of the study was to provide new data on the oligosaccharide composition of preterm milk in relation to the 4 groups. METHODS: High-pH anion-exchange chromatography was used to quantify levels of 23 oligosaccharides and lactose in 252 milk samples collected from 63 mothers during the first month of lactation and to identify the 4 milk groups. RESULTS: Substantial differences in oligosaccharide contents were found within the groups and were strictly related to the presence or absence of specific fucosyl-oligosaccharides. The highest concentration was found in group 1 (>20 g/L), the lowest level was found in group 4 (∼10 g/L), and intermediate values were observed in groups 2 and 3. No statistically significant differences in lactose concentrations were observed among the groups. CONCLUSIONS: Our data confirm lower lactose concentrations in preterm milk, compared with term milk, and they provide the first detailed characterization of oligosaccharides in preterm milk, demonstrating important differences in oligosaccharide contents in the 4 groups. These differences might exert an influence on several biological functions that are particularly important for preterm infants and currently are attributed to milk oligosaccharides.

Galacto-oligosaccharides are bifidogenic and safe at weaning: a double-blind randomized multicenter study.

Objectives: The primary objective of this study was to determine the bifidogenic effect of galacto-oligosaccharides (GOS) in a follow-on formula and the effects on other intestinal bacteria. Secondary objectives were the effects on stool characteristics, growth, and general well-being. Participants and Methods: In a multicenter, double-blind study, 159 healthy infants, formula-fed at enrollment (at 4–6 months), were randomized to an experimental follow-on formula supplemented with 5 g/L (GOS) (77 infants), or to a standard follow-on formula (control, 82 infants). Infants were evaluated at enrollment (study day 1 = sd1), after 6 weeks (study day 2 = sd2), and after an additional 12 weeks (study day 3 = sd3). At each study day, a fresh stool sample for the bacterial counts was collected, and the growth parameters were measured. At sd2, urinary specimens were collected for the evaluation of urinary osmolarity. Results: At sd2 and sd3, the GOS group had a higher median number (colony-forming units per gram of stool) of bifidobacteria than did the control group (sd2 GOS 9.2 × 109 vs control 4.4 × 109, P = 0.012); (sd3 GOS 7.2 × 109 vs control 2.4 × 109, P = 0.027). Other bacteria did not show any significant differences between the 2 groups at all study days. The GOS produced softer stools but had no effect on stool frequency. The urinary osmolarity (mOsm/L) at sd2 was comparable in both groups. Supplementation had no influence on the incidence of gastrointestinal side effects or on the growth of the infants. Conclusions: These data indicate that the addition of GOS (5 g/L) to a follow-on formula positively influences the bifidobacteria flora and the stool consistency in infants during the supplementation period at weaning. No local or systemic side effects were recorded.

Postnatal weight increase and growth velocity of very low birthweight infants

Background: Only a few studies have dealt with postnatal growth velocity of very low birthweight (VLBW) infants. Objective: To analyse weight growth kinetics of VLBW infants from birth to over 2 years of age. Patients: A total of 262 VLBW infants were selected; inaccurate estimate of gestational age, major congenital anomalies, necrotising enterocolitis, death, and loss to follow up within the first year were the exclusion criteria. Methods: Body weight was recorded daily up to 28 days or up to discontinuation of parenteral nutrition, weekly up to discharge, then at 1, 3, 6, 9, 12, 18, and 24 months of corrected age. Individual growth profiles were fitted with a seven constant, exponential-logistic function suitable for modelling weight loss and weight recovery, two peaks, and the subsequent slow decrease in growth velocity. Results: After a postnatal weight loss, all infants showed a late neonatal peak of growth velocity between the 7th and 21st weeks; most also experienced an early neonatal peak between the 2nd and 6th week. VLBW infants who were small for gestational age and those with major morbidities grew less than reference VLBW infants who were the appropriate size for gestational age without major morbidities: at 2 years of age, the difference in weight was about 860 g. The more severe growth impairment seen in VLBW infants with major morbidities is almost entirely due to the reduced height of the late neonatal peak of velocity. Conclusions: The growth model presented here should be a useful tool for evaluating to what extent different pathological conditions or nutritional and medical care protocols affect growth kinetics.

Necrotizing enterocolitis: risk factor analysis and role of gastric residuals in very low birth weight infants.

Objective: Necrotizing enterocolitis (NEC) usually occurs in very low birth weight infants and is the most common gastrointestinal emergency in the neonatal intensive care unit. Inasmuch as NEC mortality and morbidity are extremely high, early diagnosis becomes essential. Increased gastric residuals are used to define NEC stage, but studies on qualitative and quantitative residual features as markers of NEC risk are still lacking. The primary goal of this analysis was evaluation of the role of gastric residuals in early identification of patients at risk for NEC. The secondary goal was investigation of NEC risk factors, besides prematurity and birth weight. Methods: In a case-control study, NEC patients were matched with control infants by gestational age and birth weight. Feeding tolerance was assessed by maximum gastric residual volume, maximum residual as percentage of previous feeding, and residual appearance. Mortality and NEC risk factors were also evaluated. Results: In all, 844 very low birth weight infants were admitted to the neonatal intensive care unit during the study period, with an overall mortality before discharge of 14.6%. NEC frequency was 2%. Patent ductus arteriosus was significantly associated with NEC. Mean maximum residual from birth to NEC onset and maximum residual as percentage of the corresponding feed volume were significantly higher in patients than in control infants, as was the percentage of infants with hemorrhagic residuals. Conclusions: Gastric residuals are a marker of feeding intolerance, and bloody residuals seem to be the best predictor for NEC. For early detection of very low birth weight infants at risk for NEC, both gastric residual volumes and bloody residuals represent an early relevant marker.

Human proteome enhancement: High-recovery method and improved two-dimensional map of colostral fat globule membrane proteins

The human milk fat globule membrane protein composition is still largely unknown, although it counts for 2 – 4% of the total milk protein content and contains several important biologically active components. The aim of this work was to create a two‐dimensional electrophoresis (2‐DE) map of the human milk fat globule membrane proteins, both integral and membrane‐associated, and to identify and characterize as many protein components as possible. A new protocol for the solubilization and extraction of the human milk fat globule membrane proteins with a double extraction procedure is presented, and the results compared with the extraction methods reported in the literature. The proteins were separated, in the first dimension, by isoelectric focusing (IEF) in the pH range 3 – 10 on strips of 13 cm length and, in the second dimension, by Sodium dodecyl sulfate‐polyacrylamide gel electrophoresis (SDS‐PAGE) on 11.5% T homogeneous gels. A reproducible 2‐DE map of integral and membrane‐associated proteins was obtained and the first 23 spots, representing the major components, were identified by matrix assisted laser desorption/ionization‐time of flight (MALDI‐TOF) mass spectrometric analysis and/or by amino acid sequencing.

Fetal growth velocity: kinetic, clinical, and biological aspects.

With the aim of determining fetal growth kinetics, prenatal data were analysed which had been longitudinally collected in the framework of a perinatal growth survey. The sample comprised 238 singleton normal pregnancies, selected in Genoa and Turin (between 1987 and 1990), and repeatedly assessed by ultrasound scans (five to nine per pregnancy). Five morphometric traits were considered: BPD (biparietal diameter), OFD (occipitofrontal diameter), HC (head circumference), FDL (femur diaphysis length) and AC (abdomen circumference). Growth rate seemed to increase in the early part of the second trimester, and decrease subsequently: velocity peaks were steeper and earlier for head diameters and circumference (about 18 weeks) than for femur length (20 weeks) and abdomen circumference (22 weeks). Velocity standards were traced using a longitudinal two-stage linear model: this ensures unbiased description of the shape of the growth curve, even when growth kinetics are asynchronous, and efficient estimation of the outer centiles--the most useful for diagnostic purposes.

Neonatal anthropometric charts: what they are, what they are not.

Over 40 years have elapsed since Lubchenco et al 1 proposed an anthropometric classification of neonates based on the so-called intrauterine growth charts—that is, birth weight-for-gestational age charts. The use of charts, such as those given by Lubchenco et al ,1 based on the distribution of measurements taken on neonates with different gestational age, should be restricted to the auxological assessment of babies at birth. These charts, now called neonatal anthropometric charts, must not be confused with the intrauterine growth charts, which are a tool for monitoring fetal growth, based on ultrasound measurements of anthropometric traits during pregnancy: preterm births are abnormal events and preterm neonates cannot be equated to fetuses of the same gestational age who will be born at term.2 When fetal growth studies are longitudinal, both distance and velocity intrauterine growth charts may be traced.3,4 Strictly speaking, only charts derived from longitudinal studies should be called growth charts, growth being a process extended over time. The terms SGA and intrauterine growth restriction (IUGR) are often used as synonyms, although they reflect two different concepts. SGA refers to a statistical definition, based on an auxological cross-sectional evaluation (prenatal or neonatal), and denotes a fetus or a neonate whose anthropometric variables (usually weight) are lower than a given threshold value computed on a set of infants having the same gestational age. SGA includes infants who have not achieved their own growth potential, because of maternal, uterine, placental and fetal factors,5,6 as well as small but otherwise healthy infants. IUGR refers to a clinical and functional condition and denotes fetuses unable to achieve their own growth potential: a fetus with IUGR would have been larger, without adverse environmental or genetic factors affecting growth. Such a condition can be assessed by ultrasonography during pregnancy by …

Effect of two pasteurization methods on the protein content of human milk.

The Holder method is the recommended pasteurization method for human milk banks, as it ensures the microbiological safety of human milk (HM). The loss of some biologically active milk components, due to the heat treatment, is a main limit to the diffusion of donor HM. High-temperature short-time (HTST) pasteurization may be an alternative to maintain the nutritional and immunological quality of HM. The aim of the present study was to compare the impact of Holder and HTST pasteurization on the HM protein profile. The protein patterns of HTST-treated milk and raw milk were similar. The Holder method modified bile salt-stimulated lipase, lactoferrin and components of the immune system. The HTST method preserved the integrity of bile salt-stimulated lipase, lactoferrin and, to some extent, of IgAs. Holder pasteurization decreased the amount of bile salt-stimulated lipase and inactivated the remaining molecules, while the HTST method did not alter its activity. Pasteurization increased the bioavailable lysine quantity. HTST pasteurization seems to better retain the protein profile and some of the key active components of donor HM.