Infant Growth Parameters Research Articles

Effects of iodine supplementation during pregnancy on pregnant women and their offspring: a systematic review and meta-analysis of trials over the past 3 decades.

The current systematic review aimed to provide comprehensive data on the effects of iodine supplementation in pregnancy and investigate its potential benefits on infant growth parameters and neurocognitive development using meta-analysis. A systematic review was conducted on trials published from January 1989 to December 2019 by searching MEDLINE, Web of Science, the Cochrane Library, Scopus, and Google Scholar. For most maternal and neonatal outcomes, a narrative synthesis of the data was performed. For birth anthropometric measurements and infant neurocognitive outcomes, the pooled standardized mean differences (SMDs) with 95% CIs were estimated using fixed/random effect models. Fourteen trials were eligible for inclusion in the systematic review, of which five trials were included in the meta-analysis. Although the findings of different thyroid parameters are inconclusive, more consistent evidence showed that iodine supplementation could prevent the increase in thyroglobulin concentration during pregnancy. In the meta-analysis, no differences were found in weight (-0.11 (95% CI: -0.23 to 0.01)), length (-0.06 (95% CI: -0.21 to 0.09)), and head circumference (0.26 (95% CI: -0.35 to 0.88)) at birth, or in cognitive (0.07 (95% CI: -0.07 to 0.20)), language (0.06 (95% CI: -0.22 to 0.35)), and motor (0.07 (95% CI: -0.06 to 0.21)) development during the first 2 years of life in infants between the iodine-supplemented and control groups. Iodine supplementation during pregnancy can improve the iodine status in pregnant women and their offspring; however, according to our meta-analysis, there was no evidence of improved growth or neurodevelopmental outcomes in infants of iodine-supplemented mothers.

Length of Neuromuscular Re-education Therapy and Growth Parameters in Premature Infants.

Neuromuscular re-education (NMRE) therapy including bracing, containment, facilitation techniques, joint compression, weight (WT) bearing, and myofascial release has been shown to improve neurodevelopmental maturation in premature infants. This study aimed to examine the association of NMRE with growth parameters including WT and length (L) at 36 weeks postmenstrual age (PMA) and at discharge. We analyzed data of infants <34 weeks gestational age (GA) or <1,800 g birth weight (BW) to examine the association of NMRE with growth parameters using correlation coefficient analysis. The effect of potential confounders was examined using multilinear regression models. Study includes 253 premature infants. Average GA was 300/7 weeks (±23/7) and BW was 1,315 g (±416), 49.8% were females and 65% were African Americans. NMRE has inverse correlation with WT at birth and at 36 weeks PMA, -0.66 (<0.001) and -0.21 (<0.001), respectively, but not at the time of discharge. NMRE has direct correlation with change in WT from birth to 36 weeks PMA and time of discharge, 0.50 (<0.001) and 0.62 (<0.001), respectively, and from the time of starting therapy to 36 weeks PMA or discharge, 0.25 (<0.001) and 0.51 (<0.001), respectively. There was no negative correlation between NMRE with daily WT gain from birth to 36 weeks PMA or to discharge, -0.05 (0.43) and -0.07 (0.23), respectively, or from the time of starting therapy to 36 weeks PMA, -0.09 (0.14). There was an inverse correlation between NMRE with average WT gain per day from the time of starting therapy to discharge, -0.26 (<0.001), Similar findings were found examining the correlation between NMRE and changes in L. Multilinear regression analysis examining the relationship while controlling for GA, BW, sex, and race; socioeconomic variables; and concurrent massage therapy and sensory integration revealed similar results. NMRE, aimed to enhance neurodevelopmental outcomes of premature infants, may not have a negative impact on their physical growth. · NMRE has been introduced in the care of premature infants to improve neurodevelopmental outcomes.. · It was hypothesized that NMRE may cause stress and lead to failure to thrive or suboptimal growth.. · The association of the duration of NMRE with length and weight gain in very low birth weight infants was examined, and there was no negative correlation..

Human milk composition differs by maternal BMI in the first 9 months postpartum

Studies indicate that maternal weight status modulates human milk composition; however, results are conflicting. Our objective was to examine the relation between maternal body composition and human milk macronutrients and bioactive components and also their association with infant daily intakes and body composition. Human milk samples were obtained from a longitudinal study (NCT01131117) in normal weight (NW: 18.5-24.9 kg/m2, n=88) and overweight/obese (OW: 25-35 kg/m2, n=86) women between 0.5 and 9 mo postpartum. Macronutrient content was estimated using mid-infrared spectroscopy. Leptin, insulin, and C-reactive protein (CRP) were measured using electrochemiluminescence immunoassays. Infant body composition was obtained using quantitative MRI. Linear mixed models were adjusted for postpartum age and infant sex. Human milk in OW mothers was higher in fat and protein and lower in carbohydrate content at some time points compared with that in NW mothers. Human milk leptin, insulin, and CRP concentrations were higher in OW mothers compared with NW mothers, with infants of OW mothers exposed to 1.5-2.5 times higher concentrations of leptin and insulin compared with infants of NW mothers. Similar results were observed when concentrations were normalized to infant daily intake and body weight. The effect sizes of infant daily intakes associated with infant growth parameters were small for macronutrients [0.005-0.05 z-score units and 0.02-0.45 fat mass index (FMI) or fat-free mass index units per unit of change in composition, P<0.05]. Larger effect sizes were seen with human milk insulin and leptin (0.24 z-score units and 0.37-1.15 FMI units per unit of change in composition, P<0.05). These findings demonstrate that infants of OW mothers are exposed to higher concentrations of insulin, leptin, and, to a lesser extent, CRP. The bioavailability of these 3 human milk bioactives and their mechanisms of action in the infant are unclear.This trial was registered at clinicaltrials.gov as NCT01131117.

World Health Organization growth standards: How do Canadian children measure up?

World Health Organization (WHO) growth standards for children aged 0 to 5 years describe growth under optimal conditions and were adopted for use in Canada in 2012. We are seeking to validate these charts in a well-characterized, longitudinal cohort of healthy, Canadian youngsters, assess tracking over time, and evaluate the prognostic implications of early growth. Data from 2,795 mother-infant dyads from the CHILD birth cohort were classified by feeding modality at 6 months as exclusively breastfed, partially breastfed, or formula-fed. WHO z-scores (z) were calculated at birth, 3 months, 1 year, and 3 years. Receiver operator characteristics (ROC) assessed the predictive performance of early weight (WT), weight-for-length (WfL), or body mass index (BMI) z-scores for overweight/obesity at 3 years. Compared to WHO standards, Canadian children at birth had lower median WfLz (-0.73) and BMIz (-0.29), with more positive scores by 3 years (WfLz=BMIz=0.58). At both 1 and 3 years, formula feeding was associated with higher scores than breastfeeding, even after regression adjustment for covariates. Head circumference z-score was typically positive at all times and regardless of feeding modality. At 1 year, ROC area under the curve was 0.79 for WTz, WfLz, and BMIz, and BMIz>0.88 identified children with increased risk of overweight/obesity (BMIz >2) at age 3 years (20.3% versus 3.0%, P<0.001). Compared to WHO growth charts, Canadian children at 3 years show an upward shift in BMIz and WfLz, particularly when formula-fed. Infant growth parameters may identify infants with increased risk of overweight/obesity at age 3 years; early recognition may allow targeting infants at higher risk.

Effect of tactile/kinesthetic massage therapy on growth and body composition of preterm infants.

Massage therapy (MT) improves growth parameters in preterm infants. The growth of lean mass rather than fat mass has been associated with better long-term outcomes. We aimed to study the effect of tactile/kinesthetic MT on growth and body composition parameters in preterm infants. Preterm (< 32weeks gestation) infants were randomly assigned at corrected gestational age of 35weeks to receive 3 consecutive, 15-min, sessions of MT over 5days or routine care. Primary outcome was mean daily weight gain. Secondary outcomes included anthropometric measurements and body composition parameters assessed by dual X-ray absorptiometry (DXA) scan. Out of 218 infants screened, 86 were eligible and 60 infants (30 in each group) were recruited after parental consent. MT was associated with significant increase in daily weight gain [19.3 (10-34.3) versus 6.2 (2.5-18.4)g/day, p = 0.01] and growth velocity [12.5 (6-21) versus 3.6 (1.6-12.6)g/kg/d, p = 0.01] compared with routine care. Infants on MT showed significant increase in total body mass, fat mass (total/legs), lean mass (total/arms/legs/trunk), and bone mineral density (arms/legs/trunk) values compared with routine care group. In conclusions, MT improves growth quality as evident by increased total and regional lean masses, increased bone mineral density, and peripheral rather than central fat distribution. What is known on this subject? • Massage therapy (MT) for preterm infants leads to achievement of faster independent oral feeding, increased weight gain, less stress, less response to pain, less occurrence of sepsis, and shorter hospital stay. • Growth of lean mass rather than fat mass has been associated with better long-term outcomes. What this study adds? • Tactile/kinesthetic massage therapy in preterm infant is associated with improved growth parameters and anthropometric measures. • Tactile/kinesthetic massage therapy increased total body mass, fat mass (total/legs), lean mass (total/arms/legs/trunk), and bone mineral density (arms/legs/trunk) values.

Human Milk Composition Differs by Maternal BMI in the First 9 Months Postpartum

Abstract Objectives Recent studies indicate that human milk composition is modulated by maternal weight status; however, results are conflicting. The objective of this study was to examine the relationship between maternal body composition and human milk macronutrients and bioactive components, as well as the association between infant daily intakes and infant body composition. Methods Human milk samples (N = 990) were obtained from a longitudinal study (NCT#0,113,1117) in normal weight (NW: 18.5–24.9 kg/m,2 N = 88) and overweight/obese (OW: 25–35 kg/m,2 N = 86) women between 0.5 and 9 months postpartum. Macronutrient content was estimated using mid-infrared spectroscopy (MIRIS AB). Leptin, insulin, C-reactive protein (CRP), IL-6, IL-8 and TNF-α were measured using electrochemiluminescence immunoassays (Meso Scale Diagnostics). Infant body composition was obtained using quantitative magnetic resonance (Echo-MRI-AH). Linear mixed models adjusted for postpartum age and infant sex. Results Human milk was higher in fat and protein, and lower in carbohydrate content at only a few time points in OW compared to NW mothers. Human milk leptin and insulin concentrations were higher in OW mothers throughout lactation and CRP content differed at most time points compared to NW mothers. Similar results were observed when concentrations were normalized to infant daily intake and body weight. The effect sizes of infant daily intakes associated with infant growth parameters were small for macronutrients (0.005 to 0.05 Z-score units and 0.02 to 0.45 fat mass index (FMI)/fat free mass index (FFMI) units per unit of change in composition). Larger effect sizes were seen with human milk insulin and leptin, with infants of OW mothers exposed to 1.5 to 2.5 times higher concentrations compared to infants of NW mothers. Conclusions This study allows for a more comprehensive understanding of maternal BMI effects on human milk composition and its association with infant growth. Of note, the concentrations of leptin and insulin in human milk from OW mothers were higher than those in milk from NW mothers, resulting in higher daily intakes by their infants and modulation of FMI from 0.5 to 9 months postpartum. This study demonstrates the value of considering both human milk composition and infant daily intake when assessing infant growth. Funding Sources USDA/ARS Project # 6026–51,000-012–06S, NIH R01 DK107516.

Early versus late fortification of breast milk in preterm infants: a systematic review and meta-analysis.

This systematic review and meta-analysis assessed the effects of early fortification (EF) versus late fortification (LF) of breast milk (BM) on growth of preterm infants. Randomized and quasi-randomized controlled trials (RCTs) dealing with the effects of EF versus LF on growth parameters, incidence of adverse events, and duration of hospital stay in preterm infants were included. Data were pooled using the RevMan 5.3 software. Quality of evidence for predefined outcomes was analyzed by GRADE. Available evidence (3 RCTs, 309 preterm infants) showed no statistically significant difference between EF and LF of BM for any of the growth parameters-weight (standardized mean difference (SMD) 0.13; 95% confidence interval (CI) - 0.09, 0.36); length (SMD 0.02; 95% CI - 0.20, 0.25); and head circumference (SMD - 0.10; 95% CI - 0.33, 0.12). Total parenteral nutrition days were similar. Duration of hospital stay was significantly higher with EF (MD 4.29; 95% CI 0.84, 7.75) with a trend of non-significant increase in feed intolerance and necrotizing enterocolitis (NEC).Conclusion: Very low quality evidence did not find any significant difference in growth parameters of preterm infants in association with EF or LF of BM. A significant increase in hospital stay and non-significant increase in feed intolerance and NEC were associated with EF.PROSPERO registration number: CRD42019139235What is Known:• Fortification of breast milk with essential macro- and micronutrients is necessary for optimization of nutrition in preterm infants.• There is no consensus regarding the breast milk feeding volume at which fortification should be initiated.What is New:• Very low quality evidence showed no significant difference between early and late fortification of breast milk on growth parameters of preterm infants.• Early fortification was associated with non-significant increase in feed intolerance and necrotizing enterocolitis and a significant increase in hospital stay.

The Short-Term Effects of Intravitreal Injection of Bevacizumab on the Plasma Levels of Vascular Endothelial Growth Factor, Insulin-Like Growth Factor-1, and Growth Parameters in Infants with Retinopathy of Prematurity.

Purpose:To determine the changes in serum levels of free vascular endothelial growth factor (VEGF), insulin-like growth factor-1 (IGF-1), and growth parameters in infants with retinopathy of prematurity (ROP) who received intravitreal injection of the bevacizumab (IVB).Methods:A prospective interventional case series study, including 10 infants with Type 1 ROP was conducted. Using the enzyme-linked immunosorbent assay, serum levels of VEGF and IGF-1 were measured before, 1 month and 2 months after treatment with IVB in both eyes. Growth parameters, including weight, length, and head circumference and their Fenton’s z-score, were also measured.Results:Serum VEGF levels were suppressed 1 month after IVB (P = 0.007) and then increased between 1 and 2 months (P = 0.064). Z-scores of all growth parameters except weight z-score decreased in the 1st and 2nd months.Conclusion:Serum VEGF levels showed a transient reduction after IVB which lasted at least 2 months. Growth velocity of premature infants may be affected by anti-VEGF therapy and should be followed with particular attention.

Calcium l-methylfolate as a source of folate added for nutritional purposes to infant and follow-on formula, baby food and processed cereal-based food.

Following a request from the European Commission, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was asked to deliver a scientific opinion on the extension of use of calcium l‐methylfolate to be used as a source of folate added for nutritional purposes to infant and follow‐on formula, baby food and processed cereal‐based food pursuant to Regulation (EU) 609/2013. In 2004, EFSA assessed the use of calcium l‐methylfolate as a source of folate in foods for particular nutritional uses, food supplements and foods intended for the general population. The new alternative synthetic step proposed to produce the nutrient source, using platinum as a catalyst, did not raise any safety concern and the production process was found to consistently yield a product in line with the proposed specifications. Based on the studies assessed in the previous evaluation, it was concluded that calcium l‐methylfolate is non‐genotoxic and that subchronic and embryotoxicity/teratogenicity studies in rats did not reveal any adverse effects up to the highest doses tested. The Panel considered that no additional toxicological studies are required on the nutrient source. The intervention study in healthy infants provided by the applicant did not indicate differences in growth and tolerance parameters in infants who consumed either an infant formula supplemented with calcium l‐methylfolate or with folic acid, and did not raise concerns regarding safety or tolerability of the infant formula with the proposed nutrient source. The study also provided further supporting evidence for the bioavailability of calcium l‐methylfolate. The Panel considers that calcium l‐methylfolate is a source from which folate is bioavailable and concludes that calcium l‐methylfolate is safe under the proposed uses and use levels for infants and young children.

Postpartum hormonal contraception in breastfeeding women.

To provide an overview of recent research and guidelines regarding contraception and breastfeeding. Recent studies assessed lactogenesis, breastfeeding rates, and milk supply concerns in patients starting postpartum hormonal contraception. One study showed a small but statistically significant increase in milk supply concerns between users and nonusers of postpartum hormonal contraception. Mean time to lactogenesis and breastfeeding rates were similar between patients with immediate and delayed insertion of the levonorgestrel (LNG) implant in one study and the LNG intrauterine device (IUD) in another study. Two studies assessed nursing knowledge and attitudes toward postpartum contraception in breastfeeding women, showing that postpartum nurses had incorrect knowledge of contraceptive safety in this patient population. Both studies demonstrated persistent erroneous beliefs that depot medroxyprogesterone acetate (DMPA) adversely affects breastfeeding. In postpartum patients intending to breastfeed, more than half intended to initiate contraception within 6 weeks postpartum and few indicated effect on breastfeeding as a factor in their decision. There are no significant differences in lactogenesis, breastfeeding, and infant growth parameters between immediate postpartum (IPP) and delayed insertion of LNG implants and IUDs. Labor and delivery and postpartum nurses have persistent erroneous beliefs that DMPA negatively affects breastfeeding. Patients desire to use contraception postpartum but prenatal counseling rates and practices are of variable content and quality.

Preterm Bebeklere Uygulanan Masajın Kilo Alımı Üzerine Etkisi: Sistematik Derleme

Objective: Along with the present systematic review, it was aimed to examine and discuss the effects of therapeutic massage implementations on weight gain of very low birthweight preterm infants in intensive care unit. Material and Methods: The relevant documents of the study were retrieved using keywords namely, preterm, massage and weight gain from PubMed, Google Scholar and ScienceDirect databases. Accordingly, a total of 5,453 documents were recorded. After inclusion criteria (experimental, semi-experimental and randomized controlled trials, full texts published) and exclusion of the duplicated articles, errata and undefined documents, we identified 18 relevant and available peer-reviewed publications from 2002 to 2017. PRISMA checklist was used for systematic review. Results: A total of 18 research articles examined the effects of therapeutic massage applications (Tactile kinesthetic practices, coconut, mineral oil and standardized massage) on weight gain. Of those studies, 15 research articles reported the positive effect of the massage on the weight gain but there were no remarkable effects of massage in the remained studies. Physiologically, any increment in weight gain resulting from massage has been attributed to improved conversion of food into growth coupled with the improved metabolic efficiency and attenuated stress. Conclusion: In general, we can deduce and conclude that therapeutic massage implementations on weight gain, which is of the growth and development parameters of preterm infants who are no matter from different physiological, sociological and cultural characteristics are effective. In this context, the present review study is considered to contribute to the research areas with respect to the massage implementations topics for preterm infants.

Growth of HIV-Exposed Infants in Southwest China: A Comparative Study.

Objectives. Prevention of mother-to-child HIV transmission has been globally successful leading to a decline in HIV-infected infants. Thus, the number of HIV-exposed, but uninfected, infants is increasing. As growth is an important indicator of child health, this study aimed to evaluate growth parameters of HIV-exposed Chinese infants. Methods. A prospective study was conducted among HIV-exposed (HIV-infected and uninfected) infants born during 2007 to 2015 in Liuzhou, China. Their weight and length were assessed longitudinally from birth to 18 months of age and compared with HIV-unexposed, uninfected (HUU) infants from the same region. Results. There were 467 HIV-exposed infants. Four percent of infants were HIV-infected. The mean weight-for-age (WAZ) and length-for-age (LAZ) z scores of HIV-infected infants were significantly lower than those of HIV-exposed but uninfected (HEU) infants during 9 to 18 months and 12 to 18 months of age, respectively. Additionally, the mean WAZ and LAZ scores of HIV-infected infants were significantly lower than HUU infants during the first 12 months and 18 months of life, respectively. The mean WAZ and LAZ scores of HEU infants were significantly lower than HUU infants during the first 12 months and 6 months of life, respectively. HEU infants also had a lower mean weight-for-length z score than HUU infants during the first 6 months. Conclusion. We demonstrated poor growth among HIV-exposed Chinese infants, including HIV-uninfected, compared with HUU infants. The results emphasize the need for nutritional monitoring and interventions for HIV-exposed infants regardless of HIV infection status. Research is needed on long-term growth trajectories and factors affecting growth of HIV-exposed infants in China.

What should be the protein target for adjustable Human Milk fortification in premature infants?

Objective:To assess the short- and long-term effects of the adjustable fortification (ADJ) regimen on growth parameters in premature infants and to evaluate the amount of protein supplements given to reach the targeted blood urea nitrogen (BUN) levels.Methods:In this retrospective study, preterm babies who were born at ≤32 weeks gestational age and fed with human milk, were evaluated in two groups. Infants in Group-I were fed only standard fortification (STD). Infants in Group-II were fed the ADJ regimen. The study was conducted between 2011 and 2016.Results:There were 123 infants in the STD group and 119 in the ADJ group. The mean gestational age of the patients in Group-I was 29.7±1.8 weeks, and mean birth weight was 1266.1±347.1 g. The mean gestational age of the patients in Group-II was 29.5±1.9 weeks, and the mean birth weight was 1217.5±345.5 g. The daily increase in weight and weekly increase in HC were significantly higher in the ADJ group infants. Weight and HC of infants in the ADJ group were significantly higher at 40 weeks. At one year corrected age, weight, length, and HC measurements of both groups were similar. In Group-II, 63% of patients required additional protein supplementation up to 1.6 g/day to achieve the target BUN levels.Conclusion:A higher protein intake through the ADJ regimen improves the physical growth rate of premature infants in the NICU and after discharge. However, sometimes, the targeted growth and BUN values cannot be achieved despite the administration of protein at the recommended increased doses. Increasing protein supplementation up to 1.6 g/day is safe, feasible, and beneficial for these infants.

Lactating Mothers and Infants Residing in an Area with an Effective Salt Iodization Program Have No Need for Iodine Supplements: Results from a Double-Blind, Placebo-Controlled, Randomized Controlled Trial

The necessity of iodine supplementation in lactating mothers residing in countries with sustained salt iodization programs for iodine sufficiency of breast-fed infants remains unclear. The aims of this study were to investigate the effect of iodine supplementation on iodine status and growth parameters of lactating mothers and breast-fed infants and to compare these data with that of formula-feeding mothers and their infants during the first year of infancy. In this multicenter, double-blinded, randomized clinical trial conducted in four healthcare centers in Tehran (Iran), healthy lactating mothers and their term newborns aged 3-5 days were randomly assigned to treatment groups: placebo, 150 μg/day iodine, or 300 μg/day iodine. They were followed up for 12 months. Formula-fed infants aged 30-45 days and their mothers were randomly selected from the same centers. The primary outcomes were maternal and infant urinary iodine concentrations (UICs), breast-milk iodine concentrations (BMICs), and infant growth parameters, measured at 1, 2, 4, 6, 9, and 12 months during routine health visits. The formula-fed group was assessed at 2, 4, 6, 9, and 12 months of age. Analysis was by per protocol principle using mixed-effects models. Mother-newborn pairs (n = 180) in treatment groups and partially/exclusively formula-feeding mother-infant pairs (n = 60) participated between October 2014 and January 2016. Median baseline UICs in the treatment groups were 84 μg/L (interquartile range [IQR] 41-143 μg/L) in mothers and 208 μg/L (IQR 91-310 μg/L) in their infants. The values in the formula-fed group were 76 μg/L (IQR 40-144 μg/L) in mothers and 121 μg/L (IQR 66-243 μg/L) in infants. The 300 μg/day iodine group showed significantly higher UICs and BMICs than did the other treatment groups; infant UICs in the 150 μg/day iodine, placebo, and formula-fed groups were similar. Infants in all groups showed iodine sufficiency (median UIC ≥100 μg/L) throughout the study period. Anthropometric measurements were similar between the treatment and formula-fed groups over the study period, except at the last follow-up visit at 12 months. Supplementation of breast-feeding mothers with either 300 or 150 μg/day iodine improved their iodine status. However, the iodine status of infants in all groups studied indicated iodine sufficiency during the first year of infancy, demonstrating that in countries with effective salt iodization program, iodine supplementation for lactating mothers is unnecessary.

Effect of maternal supplement beverage with and without probiotics during pregnancy and lactation on maternal and infant health: a randomized controlled trial in the Philippines

BackgroundAdequate nutrition is essential during pregnancy and lactation to provide sufficient energy and nutrients to meet the nutritional requirements of the mother, fetus and infant. The primary objective of this study was to assess the effect of a maternal nutritional supplement enriched with probiotics during pregnancy and early lactation on the incidence of infant diarrhea.MethodsHealthy, pregnant (24–28 weeks gestation) women were randomized 1:1:1 to receive either no supplement or two servings per day of an oral supplement (140 kcal/serving) providing 7.9 g protein, multivitamin/minerals, and enriched or not with the probiotics Lactobacillus rhamnosus and Bifidobacterium lactis, from the third trimester of pregnancy until at least 2 months post-delivery. Incidence of infant diarrhea until 12 months post-delivery was analyzed by Poisson regression. The effect on maternal health, fetal growth, and infant growth and morbidity were also evaluated and analyzed by ANOVA.ResultsA total of 208 mother/infant pairs were included in the analysis. No significant difference in the incidence of infant diarrhea was observed between the three study groups. The mean maternal weight gains at delivery were similar among groups, despite an increase in caloric intake in the supplemented groups. No statistically significant differences between groups were observed in incidence of pregnancy-related or fetal adverse outcomes. Mean weight-, length-, BMI- and head circumference-for-age z-scores were below the WHO median value for all groups. Post-hoc analysis to compare the effect of the combined supplement groups versus the no supplement group on infant growth parameters showed, at 12 months, that the combined supplemented group had gained statistically significant more weight (8.97 vs. 8.61 kg, p = 0.001) and height (74.2 vs. 73.4 cm, p = 0.031), and had a higher weight-for-age z-score (− 0.62 vs. -0.88, p = 0.045) than the no supplement group.ConclusionsMaternal nutritional supplement with or without probiotics given during late pregnancy and early lactation was well tolerated and safe. Even though no difference in incidence of infant diarrhea was observed between the three groups, the analysis of the combined supplemented groups showed beneficial effects of maternal supplementation on infant weight and length gains at 12 months.Trial registrationClinicalTrial.gov: NCT01073033. Registered 17.02.2010.

Vitamin E status and associations in maternal-infant Dyads in the Midwestern United States

Oxidative stress has been associated with adverse neonatal outcomes, and vitamin E has powerful anti-oxidant properties. Vitamin E occurs in several different isoforms which differ in their ability to modulate inflammation and oxidative stress. Therefore, the purpose of this study was to evaluate the status of α-, γ- and δ-tocopherol in maternal-infant pairs, and the impact on maternal-newborn outcomes. Vitamin E status was evaluated in 189 mother-infant pairs. Concentrations of α-, γ- and δ-tocopherol were measured using HPLC. Descriptive statistics were calculated and Spearman coefficients were used to assess correlations between maternal and cord measurements. Linear and logistic regression models were used to adjust for relevant confounders. A p<0.05 was considered statistically significant. Maternal and cord serum tocopherol concentrations were positively correlated for γ-tocopherol (r=0.32, p˂0.001) and δ-tocopherol (r=0.46, p˂0.001) but not for α-tocopherol. After adjustment for confounders, maternal concentrations of tocopherols were positively associated with Apgar scores (p=0.02) and infant growth parameters at birth. Conversely, cord tocopherol levels were inversely associated with Apgar scores (p=0.02) and infant growth. Cord concentrations of α-tocopherol were higher in infants born to mothers with a diagnosis of pre-eclampsia (p=0.04). Maternal-fetal transfer of γ- and δ-tocopherols is higher than α-tocopherol and may be mediated by either different or more efficient methods, conversely tissue uptake of α-tocopherol by the developing fetus may be higher. As serum levels of maternal tocopherols are positively associated with outcomes while higher cord levels show a negative impact, uptake and tissue deposition of vitamin E by the fetus may be crucial in growth and development. More research into the role of maternal diet, placental regulation, and fetal uptake of vitamin E tocopherols in relation to clinical outcomes is warranted.

Got Eggs?

Research Article| October 01 2017 Got Eggs? AAP Grand Rounds (2017) 38 (4): 42. https://doi.org/10.1542/gr.38-4-42 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Got Eggs?. AAP Grand Rounds October 2017; 38 (4): 42. https://doi.org/10.1542/gr.38-4-42 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: eggs Source: Iannotti LL, Lutter CK, Stewart CP, et al. Eggs in early complementary feeding and child growth: a randomized controlled trial. Pediatrics. 2017; 140(1): e20163459; doi: https://doi.org/10.1542/peds.2016-3459Google Scholar Investigators from multiple institutions in the United States and Ecuador conducted a randomized controlled trial to assess the effect of early introduction of eggs on growth parameters in infants and toddlers. Healthy infants 6–9 months old who resided in Co-topaxi Providence, Ecuador, were enrolled in the study. During the 6-month study period, 1 medium-sized egg per day was provided on a weekly basis to infants randomized to the intervention group. Anthropometric measurement was performed in all study infants at baseline and at the end of the study period; daily egg consumption was also assessed. For the analysis, anthropometric measures were converted into z scores, including length-for-age (LAZ), weight-forage (WAZ), weight-for-length (WLZ), and body mass index (BMIz). Stunting was defined as an LAZ less than −2, and being underweight was defined as WAZ less than −2. Primary study outcomes were measures at the end of the 6-month study period. Regression analyses were used to compare outcomes in study infants who received eggs daily and those in the control group. Baseline anthropometric measures and other confounding variables (age at enrollment and sex) were included in the analyses. A total of 163 infants were enrolled in the study; outcome data were analyzed in 148 (91% of those enrolled), including 75 randomized to the intervention group and 73 in the control group. Overall, 84% of enrolled infants came from households engaged in food production, and 84% lived in households in which animals were raised for food and income. The mean education level of the mothers of enrolled infants was 9.0 years. At baseline, the mean LAZ of study infants was −1.9. The prevalence of stunting at baseline was 38%, including 47% of those in the intervention group and 32% of infants in the control group. Over the 6-month study period, egg consumption increased in both groups; however, at the end of the study period, egg intake was significantly higher among those in the intervention group. After adjusting for baseline measurements, LAZ, WAZ, WLZ, and BMIz were all significantly better among those who received eggs daily than those in the control group. At the end of the study period, the prevalence of stunting was 28% in the intervention group and 40% among control infants (P = .001), and the prevalence of underweight infants was 5% and 7%, respectively (P = .008 after controlling for baseline underweight status). The authors conclude that, in this population of young infants, early introduction of eggs significantly improved growth. Dr Dubik has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Stunting reflects the cumulative effects of poor maternal and early childhood nutrition and repeated childhood infections. Its long-term consequences include impaired neurodevelopment and... You do not currently have access to this content.

Prenatal ambient air pollution exposure, infant growth and placental mitochondrial DNA content in the INMA birth cohort

BackgroundThe association between prenatal air pollution exposure and postnatal growth has hardly been explored. Mitochondrial DNA (mtDNA), as a marker of oxidative stress, and growth at birth can play an intermediate role in this association. ObjectiveIn a subset of the Spanish birth cohort INMA we assessed first whether prenatal nitrogen dioxide (NO2) exposure is associated with infant growth. Secondly, we evaluated whether growth at birth (length and weight) could play a mediating role in this association. Finally, the mediation role of placental mitochondrial DNA content in this association was assessed. MethodsIn 336 INMA children, relative placental mtDNA content was measured. Land-use regression models were used to estimate prenatal NO2 exposure. Infant growth (height and weight) was assessed at birth, at 6 months of age, and at 1 year of age. We used multiple linear regression models and performed mediation analyses. The proportion of mediation was calculated as the ratio of indirect effect to total effect. ResultsPrenatal NO2 exposure was inversely associated with all infant growth parameters. A 10µg/m³ increment in prenatal NO2 exposure during trimester 1 of pregnancy was significantly inversely associated with height at 6 months of age (−6.6%; 95%CI: −11.4, −1.9) and weight at 1 year of age (−4.2%; 95%CI: −8.3, −0.1). These associations were mediated by birth length (31.7%; 95%CI: 34.5, 14.3) and weight (53.7%; 95%CI: 65.3, −0.3), respectively. Furthermore, 5.5% (95%CI: 10.0, −0.2) of the association between trimester 1 NO2 exposure and length at 6 months of age could be mediated by placental mtDNA content. ConclusionsOur results suggest that impaired fetal growth caused by prenatal air pollution exposure can lead to impaired infant growth during the first year of life. Furthermore, molecular adaptations in placental mtDNA are associated with postnatal consequences of air pollution induced alterations in growth.

Longitudinal change of selected human milk oligosaccharides and association to infants' growth, an observatory, single center, longitudinal cohort study.

BackgroundHuman milk is the recommended and sole nutrient source for newborns. One of the largest components of human milk is oligosaccharides (HMOs) with major constituents determined by the mother genotype for the fucosyltransferase 2 (FUT2, secretor) gene. HMO variation has been related with infant microbiota establishment, diarrhea incidence, morbidity and mortality, IgE associated eczema and body composition.ObjectivesWe investigated the (i) dependence of several major representative HMOs on the FUT2 status assessed through breast milk 2’Fucosyllactose (2’FL) and (ii) the relation of the 2’FL status with infant growth up to 4 months of life.DesignFrom an open observatory, single center, longitudinal cohort study with quantitative human milk collection at 30, 60, and 120 days postpartum from 50 mothers, who gave birth to 25 female and 25 male singleton infants, we collected a representative sample of human milk. We quantified the following 5 representative HMOs: 2’FL, Lacto-N-tetraose (LNT), Lacto-N-neotetraose (LNnT), 3’Sialyllactose (3’SL) and 6’Sialyllactose (6’SL). We grouped the milk samples and corresponding infants according to the measured milk 2’FL concentrations at 30 days of lactation, which clustered around low concentrations (95% CI of mean 12–42 mg/L) and high concentrations (95% CI of mean 1880–2460 mg/L) with the former likely representing Secretor negative mothers. Infant anthropometric measures were recorded at birth, 1, 2 and 4 months of age. Relations among the quantified HMOs and the relation of the high and low 2’FL HMOs groups with infant growth parameters were investigated via linear mixed models.ResultsThe milk samples with low 2’FL concentration had higher LNT and lower LNnT concentrations compared to the samples with high 2’FL. The milk 3’- and 6’SL concentrations were independent of 2’FL. Over lactation time we observed a drop in the concentration of 2’FL, LNT, LNnT and 6’SL, especially from 1 to 2 months, while 3’SL remained at relatively constant concentration from 1 month onwards. Up to 4 months of age, we did not observe significant differences in body weight, body length, body mass index and head circumference of the infants who consumed breast milk with low or high FUT2 associated HMO concentrations and composition.ConclusionsOur findings on HMO concentrations over time of lactation and clusters based on 2’FL concentrations confirm previous observations and suggest that LNnT and LNT are ‘co-regulated’ with the FUT2 dependent 2’FL concentration, with LNnT showing a positive and LNT a negative relation. Further, our findings also suggest that the relatively substantial variation in HMOs between the high and low 2’FL clusters do not impact infant growth of either sex up to 4 months of age. The study was registered in www.ClinicalTrial.gov (NCT01805011).

Effects of zinc supplementation on catch-up growth in children with failure to thrive.

BACKGROUND/OBJECTIVESAlthough globally the numbers of children diagnosed with failure to thrive (FTT) have decreased, FTT is still a serious pediatric problem. We aimed to investigate the effects of zinc supplementation for 6 months on growth parameters of infants and children with FTT.SUBJECTS/METHODSIn this retrospective study, of the 114 participants aged between 4 months and 6 years, 89 were included in the zinc supplementation group and were provided with nutrition counseling plus an oral zinc supplement for 6 months. The caregivers of the 25 participants in the control group received nutrition counseling alone. Medical data of these children, including sex, age, height, weight, serum zinc level, and serum insulin-like growth factor 1 (IGF1) level were analyzed.RESULTSZinc supplementation for 6 months increased weight-for-age Z-score and serum zinc levels (5.5%) in the zinc supplementation group of underweight category children. As for stunting category, height-for-age Z-score of the participants in the zinc supplementation group increased when compared with the baseline, and serum zinc levels increased in the normal or mild stunting group. Serum IGF1 levels did not change significantly in any group. Thus, zinc supplementation was more effective in children in the underweight category than those in the stunted category; this effect differed according to the degree of the FTT.CONCLUSIONThese findings suggest that zinc supplementation may have beneficial effects for growth of infants and children with FTT, and zinc supplementation would be required according to degree of FTT.