Myla Ebeling

Intestinal Permeability in Preterm Infants by Feeding Type: Mother's Milk Versus Formula

BACKGROUND AND OBJECTIVE Intestinal permeability in preterm infants represents a critical balance between absorption of nutritional agents and protection from dangerous pathogens. This study identified the relationship between feeding type (human milk and formula) and intestinal permeability as measured by lactulose to mannitol ratio in preterm infants in the first postnatal month. STUDY DESIGN Sixty-two preterm (<or=32 weeks of gestation) infants had assessment of feeding type and evaluation with enteral lactulose and mannitol administration and urinary measurement at three time points in the first postnatal month. RESULTS Infants who received the majority of feeding as human milk (>75%) demonstrated significantly lower intestinal permeability when compared to infants receiving minimal or no human milk (<25% or none) at postnatal days 7, 14, and 30 (p = 0.02, 0.02, and 0.047, respectively). When infants receiving any human milk were compared to infants receiving formula only, a significant difference existed at day 7 and day 14 but not for day 30 (p = 0.04, 0.02, and 0.15, respectively). With evaluation over the complete study period, exclusively formula-fed infants demonstrated a 2.8-fold higher composite median lactulose/mannitol ratio when compared with those who received any human milk. Infants who received >75% of enteral feeding as mothers milk demonstrated a 3.8-fold lower composite median ratio when compared to infants receiving <25% or no mothers milk. CONCLUSION Preterm infant intestinal permeability was significantly decreased for those receiving human milk versus formula in a dose-related manner in the first postnatal month.

Time Required for Blood Lead Levels to Decline in Nonchelated Children

Objective: To determine the time for a decline in blood lead to less than 10 μg/ dL in nonchelated children who are enrolled in case management. Study Design: Retrospective analysis of venous blood lead data of lead-poisoned children followed in a case management program designed to decrease lead exposure. Children were excluded if their blood lead had not yet declined to less than 10 μg/dL, if they received chelation therapy, or if they had not received follow-up for more than 15 months. We calculated the time between peak elevation of lead and decline to less than 10 μg/dL. Data were categorized based on the childs peak blood lead and season in which their peak blood lead occurred. Data were analyzed using ANOVA and linear regression. Kaplan-Meier survival analysis was used to describe data in population form. Results: 579 patients were included in the analysis. Blood leads of 25–29, 20–24, 15–19, and 10–14 μg/dL required 24.0, 20.9, 14.3, and 9.2 months, respectively, to decline to less than 10 μg/dL. For continuous data, a linear relationship was described by the following equation: Time (# of months required to achieve a blood lead less than 10 μg/dL) = 0.845 × peak lead; p < 0.0001. Kaplan-Meier curves complement the findings in a population-based fashion. Conclusions: The mean time for blood lead to decline was linearly related to the peak in blood lead. The time for 50% of the blood lead to decline to less than 10 μg/dL was not linear and varied with peak lead.

An Exploratory Study of Postpartum Depression and Vitamin D

BACKGROUND: Low levels of serum 25-hydroxyvitamin D (25[OH]D), a reliable measurement of vitamin D, have been implicated in several mood disorders. To date, studies exploring the relationship between vitamin D and postpartum depression are absent from the literature. OBJECTIVES: To determine whether a relationship exists between symptoms associated with postpartum depression and vitamin D levels and to determine if serum 25(OH) D levels can predict the incidence of symptoms associated with postpartum depression. STUDY DESIGN: An exploratory, descriptive study using a convenience sample of 97 postpartum women attending seven monthly visits. Women provided serum 25(OH)D samples and completed the Edinburgh Postpartum Depression Scale (EPDS) at each visit. RESULTS: A significant relationship over time was found between low 25(OH)D levels and high EPDS scores, indicative of postpartum depression. CONCLUSIONS: Future rigorous studies investigating vitamin D and postpartum depression are warranted with larger sample sizes using confirmatory methods to diagnose postpartum depression.

The Role of Personality and Other Factors in a Mother’s Decision to Initiate Breastfeeding:

The objective of the study was to measure the impact of personality and other factors on the decision to initiate breastfeeding. Mothers were enrolled (24-96 hours postpartum) and were classified as fully breastfeeding, formula-feeding, or combination-feeding. A semi-structured interview about maternal sociodemographics and attitudes and a standardized personality inventory (NEO-PI-R) were conducted. Eighty-seven mothers completed the study: 50 breastfeeders, 6 combination feeders, and 31 formula feeders. Because of small numbers, combination-feeder mothers (n = 6) were excluded from analyses. Maternal age, marriage, ethnicity, and socioeconomic status were significantly associated with breastfeeding. Breastfeeding and formula-feeding groups differed on 3 personality domains: extraversion (53.3 breastfeeding vs 46.9 formula-feeding, P = .002), openness (51.6 vs 46.2, P = .008), and agreeableness (48.5 vs 41.5, P = .01). In a multiple variable logistic regression model, extraversion (P = .03) and openness (P = .003) remained significant. Sociodemographics, experiential factors, and specific personality characteristics of mother were independently associated with maternal feeding decision.

Effect of metabolic syndrome and its components on recurrence and survival in colon cancer patients

Although epidemiologic studies suggest that metabolic syndrome (MetS) increases the risk of colorectal cancer, its effect on cancer mortality remains controversial.

The Effect of Anemia on Retinopathy of Prematurity in Extremely Low Birth Weight Infants

OBJECTIVE: Numerous risk factors for development of retinopathy of prematurity (ROP) in very low birth weight infants have been identified in the literature. However, the role of anemia in the development of ROP has not been adequately addressed.STUDY DESIGN: We retrospectively examined the medical records of all infants weighing ≤800 g who were admitted to a university hospital between July 1, 1992 and December 30, 1997. Highest and lowest hemoglobin and hematocrit values and the number of blood transfusions were recorded at each week of life during hospitalization. Gestational age at birth, birth weight, race, sex, oxygen status, history of bronchopulmonary dysplasia, length of hospital stay, and sepsis were also identified as potential risk factors. Data were analyzed using logistic regression to adjust for these confounding variables.RESULTS: Infants were grouped according to ROP status in the following manner: stage 0 to 1 ROP, stage 2 ROP, and stage 3 to threshold ROP. Sex, gestational age at birth, bronchopulmonary dysplasia, ventilator days, length of hospital stay, and number of blood transfusions were significantly associated with severity of ROP by univariate analysis. Using a logistic regression model, only gestational age (p=0.007) and number of blood transfusions (p=0.04) remained statistically significant.CONCLUSIONS: Anemia did not affect severity of ROP as an independent risk factor. However, the number of blood transfusions did affect the highest stage of ROP in this group of premature infants. Infants who remained severely anemic (Hgb≤8 g/dl or Hct≤25%) for longer periods of time developed milder ROP than less anemic infants.

Early-onset severe preeclampsia: induction of labor vs elective cesarean delivery and neonatal outcomes

OBJECTIVE The purpose of this study was to describe the success rate of and analyze differences in neonatal outcomes with labor induction, compared with elective cesarean delivery in women with early-onset severe preeclampsia. STUDY DESIGN We conducted a cross-sectional study of women with severe preeclampsia who required delivery between 24 and 34 weeks of gestation. Bivariate and multivariable regression analyses were used to determine factors that were associated with assignment to, success of, and odds of neonatal outcomes after induction of labor. RESULTS Fifty-seven and four-tenths percent of 491 women underwent induction of labor. Vaginal delivery occurred in 6.7%, 47.5%, and 68.8% of women who underwent labor induction between 24 and 28, 28 and 32, and 32 and 34 weeks of gestation, respectively. Induction of labor was not associated with an increase in neonatal morbidity or mortality rate after we controlled for gestational age and other confounders. CONCLUSION Neonatal outcomes are not worsened by induction of labor in women with early-onset severe preeclampsia, although it is rarely successful at <28 weeks of gestation.

Circulating 25-hydroxyvitamin d levels in fully breastfed infants on oral vitamin d supplementation.

Objective. To examine the effectiveness of oral vitamin D3 (400 IU) supplementation on the nutritional vitamin D status of breastfeeding infants. Design. As part of a larger ongoing vitamin D RCT trial of lactating women, infants of mothers assigned to control received 1 drop of 400 IU vitamin D3/day starting at one month of age. Infant 25(OH)D levels (mean ± S.D.) were measured by RIA at visits 1, 4, and 7. Results. The infant mean ± S.D. 25(OH)D at baseline was 16.0 ±9.3 ng/mL (range 1.0–40.8; n = 33); 24 (72.7%) had baseline levels <20 ng/mL (consistent with deficiency). The mean levels increased to 43.6 ±14.1 (range 18.2–69.7) at 4 months and remained relatively unchanged at month 7: 42.5 ±12.1 ng/mL (range 18.9–67.2). The change in values between 1 and 4 months and 1 and 7 months was statistically significant (P ≤ .0001), and despite a decrease in dose per kilogram, values were not significantly different between months 4 and 7 (P = .66). Conclusions. Oral vitamin D3 supplementation as an oil emulsion was associated with significant and sustained increases in 25(OH)D from baseline in fully breastfeeding infants through 7 months.

Maternal 25(OH)D concentrations ≥40 ng/mL associated with 60% lower preterm birth risk among general obstetrical patients at an urban medical center

Background Given the high rate of preterm birth (PTB) nationwide and data from RCTs demonstrating risk reduction with vitamin D supplementation, the Medical University of South Carolina (MUSC) implemented a new standard of care for pregnant women to receive vitamin D testing and supplementation. Objectives To determine if the reported inverse relationship between maternal 25(OH)D and PTB risk could be replicated at MUSC, an urban medical center treating a large, diverse population. Methods Medical record data were obtained for pregnant patients aged 18–45 years between September 2015 and December 2016. During this time, a protocol that included 25(OH)D testing at first prenatal visit with recommended follow-up testing was initiated. Free vitamin D supplements were offered and the treatment goal was ≥40 ng/mL. PTB rates (<37 weeks) were calculated, and logistic regression and locally weighted regression (LOESS) were used to explore the association between 25(OH)D and PTB. Subgroup analyses were also conducted. Results Among women with a live, singleton birth and at least one 25(OH)D test during pregnancy (N = 1,064), the overall PTB rate was 13%. The LOESS curve showed gestational age rising with increasing 25(OH)D. Women with 25(OH)D ≥40 ng/mL had a 62% lower risk of PTB compared to those <20 ng/mL (p<0.0001). After adjusting for socioeconomic variables, this lower risk remained (OR = 0.41, p = 0.002). Similar decreases in PTB risk were observed for PTB subtypes (spontaneous: 58%, p = 0.02; indicated: 61%, p = 0.006), by race/ethnicity (white: 65%, p = 0.03; non-white: 68%, p = 0.008), and among women with a prior PTB (80%, p = 0.02). Among women with initial 25(OH)D <40 ng/mL, PTB rates were 60% lower for those with ≥40 vs. <40 ng/mL on a follow-up test (p = 0.006); 38% for whites (p = 0.33) and 78% for non-whites (p = 0.01). Conclusions Maternal 25(OH)D concentrations ≥40 ng/mL were associated with substantial reduction in PTB risk in a large, diverse population of women.

Refeeding syndrome in very-low-birth-weight intrauterine growth-restricted neonates.

Objective:Determine the incidence of refeeding syndrome, defined by the presence of hypophosphatemia in very-low-birth-weight (VLBW) infants with intrauterine growth restriction (IUGR) compared with those without IUGR.Study design:In this retrospective cohort study, VLBW infants admitted over a 10-year period (271 IUGR and 1982 non-IUGR) were evaluated for specific electrolyte abnormalities in the first postnatal week.Result:IUGR infants were significantly more likely to have hypophosphatemia (41% vs 8.9%, relative risk (95% confidence interval: 7.25 (5.45, 9.65)) and severe hypophosphatemia (11.4% vs 1%, 12.06 (6.82, 21.33)) in the first postnatal week. The incidence of hypophosphatemia was significantly associated with the presence of maternal preeclampsia in all VLBW infants (odds ratio (OR): 2.58 (1.96, 3.40)) when controlling for birth weight and gestational age.Conclusion:Refeeding syndrome occurs in VLBW infants with IUGR and born to mothers with preeclampsia. Close monitoring of electrolytes, especially phosphorus, is warranted in this population.