Nadia Liotto

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.

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.

Invasive Aspergillus nidulans infection in a patient with chronic granulomatous disease

The patient was a 21-year-old boy affected by X-linked chronic granulomatous disease (CGD-OMIM number 3064000), with a mutation in the gene encoding gp91 phox (deletion of a single G in position 767, with loss of gp91 phox and no residual NADPH oxidase activity), diagnosed at the age of 2, because of a positive family history for CGD. He had recurrent skin abscesses, lymphadenitis, bacterial pneumonia, and lung aspergillosis with probable brain dissemination. His parents compliance was poor and they had discontinued all therapies for a number of years without notice. The patient was referred to our hospital for the first time at the age of 10 because of a multifocal pneumonia with isolation of Aspergillus fumigatus in multiple sputum cultures. He was successfully treated with intravenous conventional amphotericin B and then a prophylactic regimen with trimethoprim–sulfamethoxazole, itraconazole and interferon gamma was prescribed. At the age of 13, the patient presented another brain focus, which resolved under a treatment with liposomal amphotericin B followed by oral itraconazole. His parents admitted once again their poor compliance with prophylactic treatment. When he was 21, the patient was hospitalised because of a large popliteal abscess in the right leg (Fig. 1) and a large area of parenchymal consolidation in the right lung. Right leg magnetic resonance imaging (MRI) excluded bone damage on multiple scans and a brain MRI did not reveal any new damage, but only traces of the old parenchymal lesions. Aspergillus spp. was isolated from a sputum sample and Aspergillus nidulans was isolated in repeated popliteal abscess cultures. An in vitro antifungal susceptibility test of the A. nidulans isolate was performed with Etest (AB-Biodisk, Solna, Sweden). The minimum inhibitory concentrations resulted in the following: itraconazole 0.12 lg ml, voriconazole 0.094 lg ml, amphotericin B 0.19 lg ml. Histological examination showed granulation tissue with abscesses, a granuloma of giant plurinucleated cells and the presence of septate hyphae compatible with the morphology of the isolated A. nidulans. The presence of precipitating antibodies against somatic and metabolic A. fumigatus antigens (Microgen Bioproducts, Camberley, UK; Bio-Rad, Marnes-la Coquette, France) agreed with the isolation of Aspergillus in culture. On the contrary, no galactomannan antigen was detected using Platelia Aspergillus (Bio-Rad) in repeated serum samples. The level of total serum IgE was 8910 kIU l and anti A. fumigatus IgE Correspondence: Prof. Maria Cristina Pietrogrande, Department of Pediatrics, University of Milan, Fondazione IRCCS Ospedale Maggiore Policlinico, Via Commenda 9, Milan 20122, Italy. Tel.: +39 2 5503 2496. Fax: +39 2 5032 0210. E-mail: mariacristina.pietrogrande@unimi.it

Relationship between in utero sonographic evaluation and subcutaneous plicometry after birth in infants with intrauterine growth restriction: an exploratory study

BackgroundIntrauterine growth restriction (IUGR) is associated with several medical complications before and after delivery. The aim of this study was to evaluate the concordance between the fetal ultrasonographic measurement of subcutaneous tissue thicknesses and the skinfold thicknesses assessment in intrauterine growth restricted newborns.MethodsWe designed an exploratory study. Fetal ultrasonographic measurement of subcutaneous tissue thicknesses, according to Bernsteins and Galans method, and neonatal skinfold thicknesses were evaluated in 13 intrauterine growth restricted newborns within 4 hours before delivery and on the first day of life, respectively. Concordance between fetal and neonatal measurements was assessed using the Lins correlation coefficient and the Bland-Altman method.ResultsThe data obtained by the measurements of neonatal skinfold thicknesses was significantly correlated with the prenatal measurements (Lins coefficients, arm: 0.60; subscapular: 0.72; abdomen: 0.51). Bland-Altman analysis showed moderate agreement between the fetal ultrasonographic measurement of subcutaneous tissue thicknesses and the neonatal skinfold thicknesses assessment.ConclusionsThe present study provides preliminary evidence that fetal sonographic measurements may represent additional indices of intrauterine growth restriction.

The Effect of Human Milk on Modulating the Quality of Growth in Preterm Infants

Introduction: Human milk is the optimal nutrition for preterm infants. When the mothers own milk is unavailable, donor human milk is recommended as an alternative for preterm infants. The association among early nutrition, body composition and the future risk of disease has recently attracted much interest. The aim of this study was to investigate the effect of human milk on the body composition of preterm infants. Materials and Methods: Very low birth weight infants (VLBW: birth weight <1,500 g) with a gestational age (GA) between 26 and 34 weeks were included. Clinical data, anthropometric measurements and nutritional intake in terms of the volume of human milk were extracted from computerized medical charts. The human milk intake was expressed as a percentage of target fortified donor human milk and/or target fortified fresh mothers milk, compared with the total volume of milk intake during the hospital stay. All included infants underwent anthropometric measurements and body composition analysis (expressed as fat-free mass percentage) at term corrected age (CA) by air-displacement plethysmography. A comparison between infants fed human milk at <50% (group 1) and infants fed human milk at ≥50% of the total volume of milk intake (group 2) was conducted. Multiple linear regression analyses were conducted to explore the modulating effect of fortified human milk on fat-free mass at term CA. Results: Seventy-three VLBW infants were included in the study. The mean weight and GA at birth were 1,248 ± 198 g and 30.2 ± 2.0 weeks, respectively. No differences were found regarding anthropometric measurements at birth, at discharge and at term CA between the two groups. The mean fortified human milk intake was 34.9 ± 12.5 and 80.9 ± 15.5% in groups 1 and 2, respectively (p < 0.001). A multiple regression analysis corrected for sex and birth weight demonstrated that intake of ≥50% fortified human milk was associated with a higher fat-free mass percentage at term CA than intake of <50% fortified human milk. Conclusion: The use of target fortified human milk modulated growth and improved growth quality in vulnerable preterm infants. Thus, the use of donor human milk should be encouraged when fresh mothers milk is insufficient or not available.

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.

Is Fat Mass Accretion of Late Preterm Infants Associated with Insulin Resistance

Background: Late preterm infants show a major fat mass accretion from birth to term. The contribution of preterm birth to the development of the metabolic syndrome is still under investigation. Objectives: To evaluate body composition changes in late preterm infants during the first 3 months and to investigate their insulin sensitivity and resistance. Methods: We conducted an observational, longitudinal study. A total of 216 late preterm infants underwent body composition assessment using an air displacement plethysmograph at term and at 3 months of corrected age. In a subgroup of infants (n = 48) the blood glucose and insulin concentration were determined at term and insulin resistance (homeostasis model assessment for insulin resistance; HOMA-IR) and sensitivity (quantitative insulin sensitivity check index; QUICKI) were then calculated. The reference group comprised 71 healthy term infants. Results: The mean birth weight and gestational age were 2,390 ± 391 g and 35.2 ± 0.8 weeks, respectively. At term the fat mass index (kg/m2) of late preterm infants, born adequate for their gestational age and small for their gestational age, was higher than that of term infants (2.08 ± 0.82 vs. 1.62 ± 0.64 vs. 1.03 ± 0.36, p < 0.005, respectively), whereas at 3 months of corrected age no difference was found among the groups. The mean values of glucose, insulin, HOMA-IR, and QUICKI were within the 5th and 95th percentiles. Conclusions: On the basis of these preliminary findings, fat mass accretion of late preterm infants appears not to be associated with perturbation of the glucose homeostasis.