Miguel Sáenz de Pipaón

Influence of prematurity and growth restriction on the adipokine profile, IGF1, and ghrelin levels in cord blood: relationship with glucose metabolism

OBJECTIVEnTo determine the influence of gestational age and fetal growth restriction on the cord blood adipokine profile, IGF1, and ghrelin levels, and their relationship with glucose metabolism.nnnSTUDY DESIGNnOne hundred and ninety newborns (99 preterm and 91 full term) were studied and, according to their anthropometry at birth, classified as small (SGA) or adequate for gestational age (AGA).nnnMETHODSnVenous cord blood serum levels of IGF1, IGF binding protein 3 (IGFBP-3), adiponectin, resistin, leptin, soluble leptin receptor (sOB-R), tumoral necrosis factor-alpha, interleukin 6 (IL-6), total ghrelin, and acylated ghrelin were determined and compared between preterm and full-term, as well as between SGA and AGA, newborns. Correlations with newborn weight, gestational age, and homeostatic model assessment (HOMA) index, as an index of insulin resistance, were determined.nnnRESULTSnPreterm newborns had higher HOMA, sOB-R, resistin, and IL-6 and lower IGF1, IGFBP-3, leptin, and adiponectin levels than full-term newborns. SGA had lower IGF1, IGFBP-3, leptin, IL-6, and adiponectin and higher sOB-R and total ghrelin than AGA newborns. Adiponectin and HOMA showed independent positive and negative correlations with gestational age respectively, but not with neonatal weight. Birth weight was correlated positively with IGF1 and leptin levels and negatively with total ghrelin ones.nnnCONCLUSIONSnOur findings suggest that the lack of proper acquisition of adipose tissue by the fetus either due to prematurity or to fetal growth restriction is associated with changes in the cord blood adipokine profile that may contribute to the impairment of glucose metabolism.

Effect of minimal enteral feeding on splanchnic uptake of leucine in the postabsorptive state in preterm infants.

We conducted a controlled, randomized trial to study the effect of minimal enteral feeding on leucine uptake by splanchnic tissues, as an indicator of maturation of these tissues, in preterm infants in the first week of life. Within a few hours after birth, while receiving only glucose, a primed constant infusion of [1-13C]-leucine was started and continued for 5 h via the nasogastric tube, whereas 5,5,5 D3-leucine was infused intravenously (for both tracers, priming dose 2 mg/kg, continuous infusion 2 mg/kg/h). Patients were thereafter randomized to receive solely parenteral nutrition (C), parenteral nutrition and 20 mL breast milk/kg/d (BM), or parenteral nutrition and 20 mL formula/kg/d (F). On d 7, the measurements were repeated, after discontinuing the oral intake for 5 h. Fourteen infants were included in group C, 12 in group BM, and 12 in group F. There was no difference in energy intake or nitrogen balance at any time. On d 1, plasma enrichment for the nasogastric tracer was lower than for the intravenous tracer for all three groups, both for leucine and for α-keto-isocaproic acid. On d 7, the enrichment for leucine and α-keto-isocaproic acid for the nasogastric tracer was lower than for the intravenous tracer for the groups BM and F (BM: 3.65 ± 1.20 nasogastric versus 4.64 ± 0.64 i.v.; F: 4.37 ± 1.14 nasogastric versus 5.21 ± 0.9 i.v.). In the control group, there was no difference between tracers. The lower plasma enrichment for the nasogastric tracer compared with the intravenous tracer suggests uptake of leucine by the splanchnic tissues. We conclude that minimal enteral feeding—even in low volumes of 20 mL/kg/d—increases the leucine uptake by the splanchnic tissue. We speculate that this reflects a higher protein synthesis of splanchnic tissues in the groups receiving enteral nutrition.

Growth in Preterm Infants until 36 Weeks' Postmenstrual Age Is Close to Target Recommendations

Objective: To establish the determinants of weight, length and head circumference changes during their initial hospitalization in very-low-birth-weight preterm infants. Subjects/Methods: A prospective cohort study was performed. Weight z-score and percentage of target dietary intakes (TDIs) were prospectively determined daily during the first 5 weeks of life in a group of preterm infants (n = 111, birth weight <1,500 g, gestational age <34 weeks). Weight, length and head circumference at 36 weeks postmenstrual age (PMA) were recorded. A mixed effects regression model was used to evaluate changes in weight z-score during the first 5 weeks of life. Simple Pearson correlations and stepwise logistic regression were used to determine the relationship between fetal growth, illness severity, nutritional intake and growth at 36 weeks PMA. Results: Weight z-score decreased significantly in all infants during the first 5 weeks of life from -0.92 ± 0.66 at birth to -1.89 ± 0.65 at 5 weeks. The variation of weight z-score during the first 5 weeks of life was influenced by weight z-score at birth, energy and protein intakes and gestational age. Mean energy and protein intakes were 95.5 and 86.4% of TDIs. Weight z-score fell to -2.05 ± 0.64 at 36 weeks PMA. Birth weight z-score was significantly correlated with weight z-score at 36 weeks (R2 = 0.71; p < 0.001). Severity of illness influenced the weight z-score at 36 weeks. Conclusion: Despite achieving a protein and energy intake close to the described target intake, the rate of growth in our infants was lower than indicated by the intrauterine growth curve. Lower gestational age, lower birth weight and severe illness had a negative effect on growth.

Predicting Full Enteral Feeding in the Postoperative Period in Infants with Congenital Diaphragmatic Hernia.

Introduction The objective of the study is to examine the factors associated with time to achieve full enteral feeding after repair of congenital diaphragmatic hernia. Materials and Methods Demographic, clinical, and therapeutic data were retrospectively assessed, and uni‐ and multivariate Cox regression were performed to examine factors predictive of achieving full enteral feeding that was defined as time to achieve120 mL/kg/d after surgical repair. Results Of 78 infants, 66 underwent intervention before hospital discharge. All infants who survived had reached full enteral feeding at the time of hospital discharge by a median of 22 days (range: 2‐119 days) after surgery and 10 days (range: 1‐91) after initiation of postoperative enteral feedings. Independent risk factors associated with a longer time to reach full enteral feeding achievement included gastroesophageal reflux and days of antibiotics in the postoperative period. Daily stool passage preoperatively predicted earlier enteral tolerance. Conclusion Infants who survive congenital diaphragmatic hernia generally are able to achieve full enteral feedings after surgical repair. A longer time to full feeding is needed in the most severe cases, but some specific characteristics can be used to help identify patients at higher risk. Although some of these characteristics are unavoidable, others including rational antibiotic usage and active gastroesophageal reflux prevention and treatment are feasible and may improve enteral tolerance.

Need to Optimize Nutritional Support in Very-Low-Birth-Weight Infants

would be equivalent to their third trimester. Because nutrition is one of the key factors for normal cell growth, providing the right amount and quality of nutrients could prove pivotal for development. In this period, one of the goals of the neonatal intensive care unit team is to provide nutrition to achieve a similar growth rate as that in intrauterine life. Implementation of early PN during the first 24 h improves weight gain. However, advancement of nutritional intake is often limited by the inability to metabolize nutrients. Our study showed that protein and energy delivery close to current nutritional practice recommendations is inadequate to maintain weight, length and head circumference z-scores. The nutritional policy in our Department is based on the most recent recommendations. Indeed, VLBW infants have a gut that is too immature to digest milk in sufficient quantity to meet requirements. Hence, target intakes for energy (120 kcal/ kg/day for enteral nutrition, 90 kcal/kg/day for PN) and protein (3.7 g/kg/day for enteral nutrition, 3 g/kg/day for PN) in this study are in accordance with current recDear Editor, We appreciate Prof. Senterre’s [1] interest in our study [2] . He is concerned about a discrepancy between the nutritional targets in our study and current recommendations [3, 4] . Neonatologists understand that whereas targeted nutritional intakes are considered reasonable, a high degree of uncertainty about these values remains. Moreover, in a recent report by Senterre and Rigo [5] , an intake of 120 kcal/kg/day and 3.8 g/kg/day, consistent with our target energy and protein intakes, was considered. The same authors [6] recommended in 2011 that parenteral nutrition (PN) be initiated in the first hours of life with additional amino acids added on subsequent days, similar to our treatment regimen. Current nutritional practice recommendations are clearly inadequate to mimic fetal growth rates in all very-low-birth-weight (VLBW) infants. Additional macronutrient sources are being evaluated to ameliorate growth failure [7] . We believe that results of the studies by Senterre and Rigo [5, 6] are consistent with the need to optimize nutritional support. VLBW infants remain in the neonatal intensive care unit for the time that Received: July 22, 2014 Accepted: August 25, 2014 Published online: November 14, 2014

Fat Loss in Continuous Enteral Feeding of the Preterm Infant: How Much, What and When Is It Lost?

Human milk fat is a concentrated source of energy and provides essential and long chain polyunsaturated fatty acids. According to previous experiments, human milk fat is partially lost during continuous enteral nutrition. However, these experiments were done over relatively short infusion times, and a complete profile of the lost fatty acids was never measured. Whether this loss happens considering longer infusion times or if some fatty acids are lost more than others remain unknown. Pooled breast milk was infused through a feeding tube by a peristaltic pump over a period of 30 min and 4, 12 and 24 h at 2 mL/h. Adsorbed fat was extracted from the tubes, and the fatty acid composition was analyzed by gas chromatography-mass spectrometry. Total fat loss (average fatty acid loss) after 24 h was 0.6 ± 0.1%. Total fat loss after 24 h infusion was 0.6 ± 0.1% of the total fat infused, although the highest losses occur in the first 30 min of infusion (13.0 ± 1.6%). Short-medium chain (0.7%, p = 0.15), long chain (0.6%, p = 0.56), saturated (0.7%, p = 0.4), monounsaturated (0.5%, p = 0.15), polyunsaturated fatty (0.7%, p = 0.15), linoleic (0.7%, p = 0.25), and docosahexaenoic acids (0.6%, p = 0.56) were not selectively adsorbed to the tube. However, very long chain fatty (0.9%, p = 0.04), alpha-linolenic (1.6%, p = 0.02) and arachidonic acids (1%, p = 0.02) were selectively adsorbed and, therefore, lost in a greater proportion than other fatty acids. In all cases, the magnitude of the loss was clinically low.

Study on the nutritional status and feeding habits in school-children in Madrid City (Spain) during the economic crisis

INTRODUCTIONnthe recent economic and financial crisis has affected most Western countries, especially families of low socioeconomic classes.xa0We speculate that worsening of socioeconomic condition associated with the crisis would increase obesity, mainly in disadvantaged families.nnnMATERIAL AND METHODSncross-sectional study of the 290,111 children aged three to 12 years old attending public school during the termxa02014-2015 in Madrid City, by means of a stratified weighted sample randomly chosen, taking into account age (grade), city district and schools. The questionnaire included weight and height (auto-reported), dietary report (weekly frequency of intake), as well as socioeconomic variables.nnnRESULTSn1,208 questionnaires were evaluated from 64 classes. Half of participants were boys; 42% were younger than five years old, 35% werebetween six and eight years old, and 23% older than eight. Undernutrition was present in 5.0%, and excess of weight (overweight + obesity) inxa036.7%. Undernutrition was higher in children under the age of six (9.1%). No relationship was found between undernutrition and the characteristicsxa0of the families but was slightly higher in families where both parents were unemployed. Excess of weight was higher in children of non-Spaniardxa0parents (44% vs 32%, p < 0.0001), as well as in those families with economic problems (41% vs 31%, p = 0.0005). Only for meat, grains andxa0dairy, the weekly intake was close to the recommendations.nnnCONCLUSIONSnchildren from lower income households were at a higher risk of being overweight compared with their peers. Participation in axa0school-based food aid program may reduce food insecurity for children and their families.

How Should We Define Postnatal Growth Restriction in Preterm Infants

Background: Postnatal growth restriction is very common among preterm infants. Growth restriction might be associated with neurodevelopment impairment. The definition of postnatal growth restriction varies among studies. It has often been based on statistical parameters, but we lack biological data to support this definition. Objectives: The aim here was to study the association between neurodevelopment and postnatal growth restriction defined applying 2 different strategies. Methods: Bayley Scales of Infant Development-II was performed at 2 years corrected age in 168 preterm infants. Postnatal growth restriction was defined as a weight z-score at 36 weeks <–1.5 or treated as a continuous variable (fall in weight z-scores from birth to 36 weeks postmenstrual age). Results: Weight z-scores fell in almost all patients (98.8%), and 44.1% had z-scores <–1.5 at 36 weeks. After adjusting for gestational age and small for gestational age at birth, every 1-point fall in weight z-score was associated with a 5.6 point (95% CI 1.7 to 9.4) decrease in the Mental Developmental Index. A weight z-score <–1.5 at 36 weeks was not associated with a worse mental or psychomotor result. Conclusion: A fall in the weight z-score from birth to 36 weeks is a more rational definition of postnatal growth restriction, and it could predict neurodevelopment.

Nutritional practices in very low birth weight infants: a national survey

BACKGROUNDnSignificant efforts have been made to improve the nutritional support of very preterm infants. Large surveys may help to know the nutritional practices for preterm infants in neonatal units and identify if they are in line with the current guidelines.nnnMETHODSnA multicentre nationwide web-based survey on clinical feeding practices in very low birth weight (VLBW) infants was conducted in tertiary neonatal hospitals that admit infants with a birth weight < 1,500 g and/or a gestational age of < 32 weeks.nnnRESULTSnThe questionnaire was completed by 53 units (response rate, 59%). Over 90% of the units surveyed start amino-acid administration immediately after birth and more than half use novel intravenous fish oil-based lipid emulsions. Enteral nutrition is started within 24 hours of birth in 65% of units and 86% of these are medium-sized or large. Feeding volumes are increased at a rate of 10-30 ml/kg/day in > 90% of units. Monitoring of serum phosphorus was measured more frequently than albumin (p = 0.009) or triglycerides (p = 0.037), but only 28% of centres regularly measure pre-albumin as a nutritional biomarker. Human milk fortification and iron supplementation, starting at four weeks of age, are almost universal. However, only 30% of units administer 800 IU/day of vitamin D. Nearly 50% of the units discharge infants on preterm formula.nnnCONCLUSIONnMost Spanish neonatology units use early amino-acid supplementation and over half use novel fish oil-based lipid emulsions. Post-discharge nutrition practices and vitamin administration vary greatly.

Does early minimal enteral nutrition influence gut maturation? |[dagger]| 1570

Objective: We studied the influence of early minimal enteral nutrition with breast milk (BM) or formula (FF) from day 1 on splanchnic protein turnover as indicator of gut maturation. Subjects: 21 VLBW infants (birthweight (BW) 875-1635 gr.) were randomized to receive total parenteral nutrition (PN) only (n=8), BM 1 ml.kg-1.h-1 (n=6) or FF 1 ml.kg-1.h-1 (n=7) in connection to PN.Methodology: Gut maturation was studied on day 7 by double stable isotope tracers. 1-13C leucine was given as a primed constant infusion intragastric (ig) and 5,5,5-D3 leucine intravenously (iv). Turnover (Q)(μmol.kg-1.h-1) was calculated from theα-keto-isocaproic acid (α-KICA) enrichment in plasma. Qig is the flux calculated from the ig tracer, Q iv from the iv tracer. Splanchnic uptake(SU) of leucine was calculated by the following formula: SU=100*(Qig-Qiv)/Qig. Data is presented as mean±SD.