Maria Lorella Giannì

Is term newborn body composition being achieved postnatally in preterm infants

BACKGROUNDnThe American Academy of Pediatrics (AAP) recommends that preterm infants growth duplicates fetal growth rates and that body composition replicates in utero body composition.nnnAIMSnTo compare the total body fat mass between preterm infants assessed at term corrected age and full-term newborns, and to investigate the effects of gestational age, gender, weight increase, being breast fed on total adiposity.nnnSTUDY DESIGNnProspective observational study.nnnSUBJECTSnOne hundred and ten preterm infants [mean (SD) gestational age: 29.9 (2.3) weeks; birth weight: 1118 (274) g], and 87 full term [mean (SD) 38.6 (1.21) weeks, 3203 (385) g], breastfed infants.nnnOUTCOME MEASURESnGrowth and body composition by means of a pediatric air displacement system were assessed at term corrected age in preterm infants and on day 3 of life in full term infants.nnnRESULTSnWeight, length and head circumference were smaller in the preterm group as compared to the term group. Mean (SD) percentage of fat mass in preterm infants was significantly higher as compared to term infants [14.8 (4.4) vs 8.59 (3.71), P<0.0001]. Fat mass was negatively correlated with gestational age (P<0.001), and positively associated with weight increase (P< 0.05).nnnCONCLUSIONSnOur data suggest that body composition, in terms of fat mass, in preterm infants at term corrected age is different from that of full term newborns.

F2-isoprostanes and total radical-trapping antioxidant potential in preterm infants receiving parenteral lipid emulsions.

OBJECTIVEnWe assessed the effects of three different parenteral lipid emulsions (long-chain triacylglycerols, medium-chain/long-chain triacylglycerols, olive oil) on lipid peroxidation in preterm infants. The hypothesis to be tested was that preterm infants receiving the olive oil-based lipid emulsion would undergo less peroxidation than preterm infants receiving lipid emulsions based on long- or medium-chain triacylglycerols. The secondary aim was to evaluate whether the lipid peroxidation persists beyond the cessation of parenteral nutrition (PN).nnnMETHODSnA randomized controlled trial was designed. Thirty-six consecutive preterm infants (gestational age 28-33 wk) were enrolled in the study. Preterm infants were randomized to receive one of the three emulsions within the first 24h of life. Plasma F2-isoprostanes (F2-Ip) and total radical-trapping antioxidant potential (TRAP) were determined at baseline, on day 7 of PN, and on day 7 after stopping PN.nnnRESULTSnThe F2-Ip and TRAP concentrations were not statistically different within and among the three groups at any time of the study. No significant interaction effect between the type of lipid emulsion administered and the repeated values of F2-Ip and TRAP was found. F2-Ip values showed a trend to decrease throughout the study in all the three groups.nnnCONCLUSIONnNo significant difference in oxidative stress of preterm infants was detected according to the type of lipid emulsion received.

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.

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

BACKGROUNDnMany preterm infants are significantly growth restricted at hospital discharge and are at increased risk for long-term growth failure.nnnAIMSnTo compare growth and weight gain composition after term between preterm infants who were growth retarded and those who were not.nnnSTUDY DESIGNnAn observational longitudinal study was conducted.nnnSUBJECTSn35 preterm infants who showed growth retardation at term (group 1) and 26 preterm infants who did not (group 2).nnnOUTCOME MEASURESnGrowth and body composition were assessed at term and at 1, 2, 3, 4 and 5 months of corrected age.nnnRESULTSnAt 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.nnnCONCLUSIONSnIn 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.

Human milk: composition and health benefits

Breastfeeding is widely acknowledged as the normal and unequalled method for feeding infants due to its associated health benefits, both for the infant and the mother. The World Health Organization recommends that infants are exclusively breastfed up to the completion of six months of age, withxa0 breastfeeding continuing to be an important part of the diet until the infant is at least two years old. The several health benefits associated with breastfeeding are driven by the combined action of the nutritional and bioactive components in human milk and the magnitude of the majority of the ascertained biological effects is directly dependent on breastfeeding duration.This review briefly summarizes the current knowledge on the composition of human milk and provides an overview on its functional effects on health outcomes, focusing on the latest researchxa0results.

Facilitators and barriers of breastfeeding late preterm infants according to mothers’ experiences

BackgroundLate preterm infants account for the majority of preterm births. They are at an increased risk of neonatal mortality and morbidity and are less likely to initiate breastfeeding and to be exclusively breastfed at discharge compared to infants born at term. The aim of this study was to identify the facilitators and barriers to breastfeeding during hospital stays according to the experiences of mothers of late preterm infants.MethodsWe conducted a cross-sectional questionnaire survey. Mothers who intended to breastfeed and had given birth to a newborn admitted to level I and II care, with a gestational age of 34 0/7 to 36 6/7xa0weeks, were enrolled. Sociodemographic data, neonatal variables, mode of feeding and feeding status at discharge were also collected.ResultsA total of 92 mothers who had given birth to 121 infants were enrolled. At discharge, any human milk was fed to 94xa0% of infants, with exclusively human milk being fed in 43xa0% of cases; exclusively formula was fed to 6xa0% of infants. In the multivariate analysis, having expressed breast milk was independently associated with an increased risk of being fed with either any human milk or formula only (ORu2009=u20092.73, 95xa0% CI 1.05–7.1, pu2009=u20090.039), whereas being encouraged to practice kangaroo mother care tended to have a protective effect (ORu2009=u20090.46, 95xa0% CI 0.2–1.06, pu2009=u20090.07).ConclusionsBased on the present findings, health care professionals should strive to fully implement breastfeeding support for mothers of late preterm infants who intend to breastfeed, in particular optimizing breast milk expression and promoting kangaroo mother care. Further studies are needed to gain further insight into the complex interplay of the factors that modulate breastfeeding outcome in late preterm infants.

Is nutritional support needed in late preterm infants

BackgroundLate preterm birth accounts for 70xa0% of all preterm births. While the impact of feeding problems in very preterm infants has been widely investigated, data on late preterm infants’ feeding issues are scarce. The aim of the present study was to investigate the need of nutritional support during hospital stay in a cohort of late preterm infants and to identify the factors that most contribute to its occurrence.MethodsWe analyzed the medical records of late preterm infants, born 2011–2013, admitted to a single institution. Neonatal data, the need for nutritional support, defined as the need for parenteral nutrition or intravenous fluids or tube feeding, and the feeding status at discharge were retrieved. The occurrence of respiratory distress syndrome, congenital malformations/chromosomal diseases, cardiac diseases, sepsis, hypoglycemia, poor feeding and the need for surgical intervention were also collected.ResultsA total of 1768 late preterm infants were included. Among the 592 infants requiring a nutritional support, 228 developed a respiratory distress syndrome, two developed a sepsis, one presented with a cardiac disease, 24 underwent a surgical intervention, eight had a chromosomal disease/congenital malformation, 80 had hypoglycemia. In addition, 100 infants required nutritional support due to poor feeding and 149 were born small for gestational age. Birth weight ≤2000xa0g (adjusted ORu2009=u200912.2, 95xa0% CI 7.5-19.9, pu2009<u20090.0001), gestational age of 34xa0weeks (adjusted ORu2009=u20094.08, 95xa0% CI 2.8-5.9, pu2009<u20090.0001), being small for gestational age (adjusted ORu2009=u20092.17, 95xa0% CI 2.8-5.9, p=0.001), having a respiratory distress syndrome (adjusted ORu2009=u200979.6, 95xa0% CI 47.2-134.3, pu2009<u20090.0001) and the need of surgical intervention (adjusted ORu2009=u200949.4, 95xa0% CI 13.9-174.5, pu2009<u20090.0001) were associated with a higher risk of need of nutritional support during hospital stay.ConclusionsLate preterm infants are at relatively high risk of requiring nutritional support during hospital stay, especially if they have a birth weight ≤2000xa0g, a gestational age of 34xa0weeks, are born small for gestational age, develop a respiratory distress syndrome and require a surgical intervention. The present findings add to the knowledge of late preterm infants’ feeding issues and may contribute to tailoring nutritional approaches for these infants.

Breastfeeding Determinants in Healthy Term Newborns

Breastfeeding is the normative standard for infant feeding. Despite its established benefits, different factors can affect breastfeeding rates over time. The purpose of this study was to evaluate breastfeeding determinants in healthy term newborns during the first three months of life. A prospective, observational, single-center study was conducted in the nursery of Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico in Milan, Italy. The mother-baby dyads that were admitted to the Clinic in January and February 2017 were enrolled. Only healthy term babies with birth weight ≥10th percentile for gestational age were included. Data were collected through medical records and questionnaires administered during the follow-up period. Then, we fitted univariate and multivariate logistic models and calculated odds ratios. 746 dyads were included but 640 completed the study. The factors found to be favoring breastfeeding were a previous successful breastfeeding experience, a higher level of education of the mother, attending prenatal classes, no use of pacifier, rooming in practice, and breastfeeding on demand. Factors acting negatively on breastfeeding were advanced maternal age, non-spontaneous delivery, perception of low milk supply, mastitis, and nipple fissures. This study highlights the need to individualize the assistance provide to breastfeeding mothers, paying special attention to personal experiences.

Does parental involvement affect the development of feeding skills in preterm infants? A prospective study

BACKGROUNDnFeeding difficulties frequently occur in preterm infants, thus contributing to delayed growth and hospital discharge.nnnAIMSnTo evaluate the effect of Kangaroo mother care implementation and parental involvement in infants feeding on the timing of achievement of full oral feeding in preterm infants.nnnSTUDY DESIGNnProspective, observational, single-centre study.nnnSUBJECTSnA total of 81 infants born at a gestational age ≤32weeks, consecutively admitted to a tertiary neonatal unit between June 2014 and May 2015.nnnOUTCOME MEASURESnThe timing of the achievement of full oral feeding of preterm infants.nnnRESULTSnFull oral feeding was achieved at a mean postmenstrual age of 35.5±2.1weeks. A multiple linear regression analysis showed that a low birth weight, the occurrence of bronchopulmonary dysplasia, and the need for gastrointestinal surgical procedures were associated with a higher postmenstrual age at achievement of full oral feedings. By contrast, the earlier that parents fed their infants and the earlier that Kangaroo mother care was started, the lower the postmenstrual age at the achievement of full oral feeding.nnnCONCLUSIONSnThese findings indicate that an early start of Kangaroo mother care and early parental involvement in infants feeding positively affect the achievement of independent oral feeding.