Laura Morlacchi

Implementation of Nutritional Strategies Decreases Postnatal Growth Restriction in Preterm Infants

Background Prevention of postnatal growth restriction of very preterm infants still represents a challenge for neonatologists. As standard feeding regimens have proven to be inadequate. Improved feeding strategies are needed to promote growth. Aim of the present study was to evaluate whether a set of nutritional strategies could limit the postnatal growth restriction of a cohort of preterm infants. Methodology/Principal Findings We performed a prospective non randomized interventional cohort study. Growth and body composition were assessed in 102 very low birth weight infants after the introduction of a set of nutritional practice changes. 69 very low birth weight infants who had received nutrition according to the standard nutritional feeding strategy served as a historical control group. Weight was assessed daily, length and head circumference weekly. Body composition at term corrected age was assessed using an air displacement plethysmography system. The cumulative parenteral energy and protein intakes during the first 7 days of life were higher in the intervention group than in the historical group (530±81 vs 300±93 kcal/kg, p<0.001 and 21±2.9 vs 15±3.2 g/kg, p<0.01). During weaning from parenteral nutrition, the intervention group received higher parental/enteral energy and protein intakes than the historical control group (1380±58 vs 1090±70 kcal/kg; 52.6±7 vs 42.3±10 g/kg, p<0.01). Enteral energy (kcal/kg/d) and protein (g/kg/d) intakes in the intervention group were higher than in the historical group (130±11 vs 100±13; 3.5±0.5 vs 2.2±0.6, p<0.01). The negative changes in z score from birth to discharge for weight and head circumference were significantly lower in the intervention group as compared to the historical group. No difference in fat mass percentage between the intervention and the historical groups was found. Conclusions The optimization and the individualization of nutritional intervention promote postnatal growth of preterm infants without any effect on percentage of fat mass.

Growth and Fat-Free Mass Gain in Preterm Infants After Discharge: A Randomized Controlled Trial

OBJECTIVE: To investigate whether the consumption of a nutrient-enriched formula after hospital discharge determines different growth and weight gain composition in preterm infants according to intra- and extrauterine growth pattern. METHODS: Two hundred seven preterm infants were randomized at term-corrected age to receive treatment A (term formula) or B (nutrient-enriched formula) up to 6 months of corrected age, using 2 computer-generated randomization lists, 1 for adequate for gestational age (AGA) and 1 for small for gestational age (SGA) infants. Infants were weaned according to our clinical practice after 6 months’ corrected age. Anthropometric parameters and body composition by an air displacement plethysmography system were assessed at term and 1, 3, and 6 months’ corrected age. Anthropometric parameters were also assessed at 12 months. RESULTS: Protein intakes were higher in infants receiving treatment B than in infants receiving treatment A at each study point. There were no differences between the feeding groups in weight and length SD scores in either the AGA and SGA group through the study. The mean head circumference values were higher in AGA infants receiving treatment B than in AGA infants receiving treatment A at 6 and 12 months, whereas at 6 months, the percentage of fat mass was lower. No difference in body composition was detected among SGA infants through the study. CONCLUSIONS: This randomized controlled trial demonstrates the beneficial effect of the consumption of a nutrient-enriched formula after hospital discharge by AGA infants both in terms of head circumference growth and fat-free mass gain.

Quality Of Growth In Exclusively Breast-Fed Infants In the First Six Months Of Life: An Italian Study

Nutrition in early life, growth, and subsequent health over a lifetime are significantly interrelated. The aim of this study was to assess body composition changes in exclusively breast-fed infants from birth up to 6 mo of age. An observational, prospective, cohort study was conducted. Fifty-nine full-term, healthy, exclusively breast-fed infants underwent assessment of growth and body composition, using air-displacement plethysmograph (i.e. PEA POD) by Life Measurement, Inc. (Concord, CA). Body composition was assessed at birth, 2 wk, and 1, 2, 3, 4, 5, and 6 mo of age. Mean birth weight (g) and gestational age (wk) of the infants were 3170 ± 420 and 39.21 ± 1.29, respectively. Percentage of fat mass increased significantly over the first 4 mo (p < 0.001), both in boys and girls, with no differences detected between boys and girls at any time point. This article provides preliminary in-depth data on whole-body composition, in exclusively breast-fed infants during the first months of life. Further studies assessing larger sample sizes are desirable to develop reference body composition data.

Postnatal growth failure in preterm infants : Recovery of growth and body composition after term

BACKGROUND Many preterm infants are significantly growth restricted at hospital discharge and are at increased risk for long-term growth failure. AIMS To compare growth and weight gain composition after term between preterm infants who were growth retarded and those who were not. STUDY DESIGN An observational longitudinal study was conducted. SUBJECTS 35 preterm infants who showed growth retardation at term (group 1) and 26 preterm infants who did not (group 2). OUTCOME MEASURES Growth and body composition were assessed at term and at 1, 2, 3, 4 and 5 months of corrected age. RESULTS At term, and at 1, 2, and 3 months of corrected age, growth-retarded infants showed significantly lower body weight and fat mass than infants who did not develop growth retardation. The mean energy and protein intakes did not differ significantly between the two groups. Daily increases in body weight and fat mass between term and three months did not differ between the groups. However, during the fourth and fifth months, daily gains of body weight and fat mass were significantly greater in growth-retarded than in non-growth-retarded infants, and as a result, body weight and fat mass were comparable between the two groups at 4 and 5 months of corrected age. CONCLUSIONS In terms of growth parameters and body composition, growth-retarded preterm infants recovered from postnatal growth failure within the fourth month of corrected age.

Boys who are born preterm show a relative lack of fat-free mass at 5 years of age compared to their peers

Prematurity is associated with features of metabolic syndrome in young adulthood. We investigated the body composition and blood pressure of children born preterm.

Body composition in late preterm infants according to percentile at birth

Background:The data on body composition of late preterm infants, evaluated according to percentile at birth, are scarce. The study aimed to investigate body composition of late preterm infants, according to percentile at birth, and to compare their body composition with that of term newborns.Methods:A total of 122 (99 appropriate and 23 small for gestational age (SGA)) late preterm infants underwent growth and body composition assessment using an air displacement plethysmography system on the fifth day of life and at term. The reference group was composed of 42 healthy, term, breast-fed infants.Results:At birth, appropriate and SGA late preterm infants had lower fat mass and fat-free mass indexes than term newborns. The fat mass and fat-free mass content increased significantly throughout the study, irrespective of percentile at birth. At term, fat mass index, but not fat-free mass index, was higher in both appropriate and SGA late preterm infants than in term newborns.Conclusion:Late preterm infants, irrespective of their percentile at birth, show postnatal growth characterized by predominant fat mass accretion. The potential long-term health clinical implications of these findings need to be further elucidated.

Does Human Milk Modulate Body Composition in Late Preterm Infants at Term-Corrected Age?

(1) Background: Late preterm infants account for the majority of preterm births and are at risk of altered body composition. Because body composition modulates later health outcomes and human milk is recommended as the normal method for infant feeding, we sought to investigate whether human milk feeding in early life can modulate body composition development in late preterm infants; (2) Methods: Neonatal, anthropometric and feeding data of 284 late preterm infants were collected. Body composition was evaluated at term-corrected age by air displacement plethysmography. The effect of human milk feeding on fat-free mass and fat mass content was evaluated using multiple linear regression analysis; (3) Results: Human milk was fed to 68% of the infants. According to multiple regression analysis, being fed any human milk at discharge and at term-corrected and being fed exclusively human milk at term-corrected age were positively associated with fat-free mass content(β = −47.9, 95% confidence interval (CI) = −95.7; −0.18; p = 0.049; β = −89.6, 95% CI = −131.5; −47.7; p < 0.0001; β = −104.1, 95% CI = −151.4; −56.7, p < 0.0001); (4) Conclusion: Human milk feeding appears to be associated with fat-free mass deposition in late preterm infants. Healthcare professionals should direct efforts toward promoting and supporting breastfeeding in these vulnerable infants.

Nutritional and metabolic programming during the first thousand days of life

The latest scientific acquisitions are demonstrating what has already been hypothesized for more than twenty years about the development of the state of health/illness of individuals. Indeed, certain stimuli, if applied to a sensible phase of development, are able to modify, through epigenetic mechanisms, gene expression of DNA, resulting in adaptive modifications of phenotype to the environment, which may reflect negatively on the health of every individual. This concept, applied to nutrition, has opened up important prospects for research in this area. The nutritional history of an individual, linked to the development of a healthy state, would begin very early. In fact, since the pregnancy and for the next two years (for a total of about 1000 days), the maternal eating habits, the type of breastfeeding and then the main stages of nutrition in the evolutionary phase represent those sensitive moments, essential for the development of important endocrine, metabolic, immunological alterations, better known as metabolic syndrome. This condition would represent the physiopathogenetic basis for explaining a series of disorders, known as non communicable diseases (NCDs) such as obesity, diabetes, hypertension, cardiovascolar disease and all those conditions that today affect the health of most industrialized countries and through the years are emerging especially in developing countries (South America, Asia), where new environmental conditions and increased food availability are changing food habits, with far-reaching public health impacts. This paper analyzes these new nutritional perspectives and the main implications of what has been termed the 1000-day theory.

Correction to: Clinical evaluation of two different protein content formulas fed to full-term healthy infants: a randomized controlled trial

Following the publication of the original article [1], it was brought to our attention that the authors’ names and surnames were erroneously interchanged.

Introducing complementary foods in the first year of life

Introduction of solid foods is a fundamental step in the development of an individual. There are many implications that weaning contains not only on a nutritional plan, but also on the contingent and long-term health of an individual. Over time this nutritional passage has evolved through the acquisition of new knowledge about maturation of anatomical and neurosensory structures involved in all the phases of such a complex process. The understanding of a maturing taste of infant and cultural changes is another key to understand the evolution of introduction of solid foods in infants. What is contained in this text encapsulates thus the evolutionary path of weaning in recent years, showing current trends in the light of cultural changes and new scientific acquisitions.