Infant Growth Rates Research Articles

The efficacy and safety of peripheral intravenous parenteral nutrition vs 10% glucose in preterm infants born 30 to 33\u2009weeks\u2019 gestation: a randomised controlled trial

BackgroundPreterm infants born 30 to 33 weeks’ gestation often require early support with intravenous fluids because of respiratory distress, hypoglycemia or feed intolerance. When full feeds are anticipated to be reached within the first week, risks associated with intravenous delivery mode and type must be carefully considered. Recommendations are for parenteral nutrition to be infused via central venous lines (because of the high osmolarity), however, given the risks associated with central lines, clinicians may opt for 10% glucose via peripheral venous catheter when the need is short-term. We therefore compare a low osmolarity peripheral intravenous parenteral nutrition (P-PN) solution with peripheral intravenous 10% glucose on growth rate in preterm infants born 30 to 33 weeks’ gestation.MethodsIn this parallel group, single centre, superiority, non-blinded, randomised controlled trial, 92 (P-PN 42, control 50) infants born 30+ 0 to 33+ 6 weeks’ gestation, were randomised within 24 h of age, to receive either P-PN (8% glucose, 30 g/L amino acids, 500 IU/L heparin and SMOFlipid®) or a control of peripheral intravenous 10% glucose. Both groups received enteral feeds according to hospital protocol. The primary outcome was rate of weight gain from birth to 21 days of age.ResultsThe rate of weight gain was significantly increased in P-PN infants compared with control (P-PN, n = 42, 18.7, SD 6.6 g/d vs control, n = 50, 14.8, SD 6.0 g/d; adjusted mean difference 3.9 g/d, 95% CI 1.3 to 6.6; P = 0.004), with the effect maintained to discharge home. Days to regain birthweight were significantly reduced and length gain significantly increased in P-PN infants. One infant in the P-PN group had a stage 3 extravasation which rapidly resolved. Blood urea nitrogen and triglyceride levels were significantly higher in the P-PN group in the first week of life, but there were no instances of abnormally high levels. There were no significant differences in any other clinical or biochemical outcomes.ConclusionP-PN improves the rate of weight gain to discharge home in preterm infants born 30 to 33 weeks gestation compared with peripheral intravenous 10% glucose.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12616000925448. Registered 12 July 2016.

The development of children nutrition science in Russia

The article presents the main directions of children nutrition science in Russia, that starts at the Institute of Nutrition (nowadays Federal Research Centre of Nutrition, Biotechnology and Food Safety). Almost all areas of children nutrition - from early age to adulthood, from the organization of public nutrition to personalized approaches - were developed on the base of the Department of Children Nutrition, founded in 1932. Years of beneficial work of famous Russian specialists in the field of pediatric dietetics and nutrition science are associated with this Department, for instance professors E.M. Fateeva, K.S. Ladodo, I.Ya. Kon and their followers. The priority role of the Department of Children Nutrition in different areas of nutrition science is also shown in the article, for example in the development and improvement of physiological needs in nutrients and energy for children, pregnant and nursing women; development of new specialized infant foods, including first Russian formulas. Perinatal nutrition science, fundamental research on the composition of breast milk, creation of the system supporting breastfeeding, and design of dietary approaches to the correction of alimentary-dependent diseases were developed. The research on the effects of the hormonal composition of breast milk on the growth rate of infants who are breastfed has attracted the interest of the world scientific community. In recent years, fundamentally new scientific directions have been formed, based on the theory of "food programming", and nutrigenetic research has been developed. An important impetus in the development of modern pediatric nutritional science is the introduction of new approaches based on the achievements of nutritional metabolomics, nutrigenomics and nutrigenetics, digital technologies, and innovations in the field of food production. Nowadays children's nutrition in our country has confidently developed into an independent scientific direction, its main sections have been clearly identified: prenatal nutrition; infant and toddler nutrition; nutrition of preschool and school-age children; epidemiology of child nutrition; technologies for the production of infant and baby food and its safety.

Multi-nutrient fortification of human milk for preterm infants.

Human breast milk-fed preterm infants can accumulate nutrient deficits leading to extrauterine growth restriction. Feeding preterm infants with multi-nutrient fortified human milk could increase nutrient accretion and growth rates and improve neurodevelopmental outcomes. Concern exists, however, that multi-nutrient fortifiers are associated with adverse events such as feed intolerance and necrotising enterocolitis. To determine whether multi-nutrient fortified human milk, compared with unfortified human milk, affects important outcomes (including growth rate and neurodevelopment) of preterm infants without increasing the risk of adverse effects (such as feed intolerance and necrotising enterocolitis). We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 9), MEDLINE via PubMed (1966 to 26 September 2019), Embase (1980 to 26 September 2019), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 26 September 2019). We searched clinical trials databases, conference proceedings, and reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. Randomised and quasi-randomised controlled trials that compared feeding preterm infants with multi-nutrient (protein and energy plus minerals, vitamins, or other nutrients) fortified human breast milk versus unfortified (no added protein or energy) breast milk. We used the standard methods of Cochrane Neonatal. Two review authors separately evaluated trial quality, extracted data, and synthesised effect estimates using risk ratios (RRs), risk differences, and mean differences (MDs). We assessed the certainty of the body of evidence at the outcome level using "Grading of Recommendations Assessment, Development and Evaluation" (GRADE) methods. We identified 18 trials in which a total of 1456 preterm infants participated. These trials were generally small and methodologically weak. Meta-analyses provided low- to moderate-certainty evidence showing that multi-nutrient fortification of human milk increases in-hospital rate of weight gain (MD 1.76 g/kg/d, 95% confidence interval (CI) 1.30 to 2.22), body length (MD 0.11 cm/week, 95% CI 0.08 to 0.15), or head circumference (MD 0.06 cm/week, 95% CI 0.03 to 0.08) among preterm infants. Few data on growth and developmental outcomes assessed beyond infancy are available, and these do not show effects of multi-nutrient fortification. The data do not suggest other benefits or harms and provide low-certainty evidence suggesting effects of multi-nutrient fortification on the risk of necrotising enterocolitis in preterm infants (typical RR 1.37, 95% CI 0.72 to 2.63; 13 studies, 1110 infants). Feeding preterm infants with multi-nutrient fortified human breast milk compared with unfortified human breast milk is associated with modest increases in in-hospital growth rates. Evidence is insufficient to show whether multi-nutrient fortification has any effect on long-term growth or neurodevelopment.

Antenatal exposure to second hand smoke of non-smoking mothers and growth rate of their infants.

ObjectivesThere is limited evidence on the effect of exposure to second hand smoke (SHS) in non-smoking pregnant mothers and infant health. We assessed the effects of maternal antenatal exposure to SHS on infant growth rate, and secondarily, on birth weight, birth length and head circumference at birth.MethodsIn this prospective cohort, 305 mother-infant pairs were studied. Mothers filled out questionnaires about exposure to SHS in pregnancy at the 3rd trimester of pregnancy. Infant anthropometry was performed at birth, day 7, and months 1, 2, 4, and 6, postnatally. Linear mixed modeling and linear regression were used to calculate growth rates over the first 6 months. The association between SHS-exposure with growth rate and birth sizes was assessed using multivariate linear regression adjusted for confounders, with SHS as both number of cigarettes and as groups (no exposure, SHS < 23 cigarettes, SHS ≥ 23 cigarettes).ResultsSeventy-three mothers were not exposed and 232 were exposed. SHS exposure (per cigarette) was not related to gain in weight, length, head circumference, and weight for length. However, infants born to mothers exposed to ≥ 23 cigarettes/d had lower head circumference gain (-0.32 mm/m, 95% CI -0.60, -0.03) than those born to non-exposed mothers. SHS exposure (per cigarette) was not related to birth weight, length, and head circumference, but exposure to ≥ 23 cigarettes was related to lower head circumference at birth (-11.09 mm, -20.03, -2.16).ConclusionsHeavy antenatal exposure to SHS in non-smoking mothers results in reduced neonatal head circumference at birth and head circumference gain over the first 6 months of life. Our findings show no clear relations between exposure to SHS during pregnancy and other markers of neonatal growth and birth size.

Clinical presentations, Laboratory analysis and Linear Growth in 50 Neonates and Young Infants with Acute Meningitis: One Year Experience of a Single Center in Qatar.

BackgroundMeningitis frequently occurs in neonates and can lead to a number of acute, severe complications and long-term disabilities. Although, long term growth delay and abnormal weight gain appear to be risk factors following an acute attack of both bacterial and aseptic meningitis in children, especially during the fast phase of infantile growth, the long-term effects of acute meningitis occurring during the neonatal and early infantile periods on linear growth (length, weight and head growth) have not fully reported.Aim of the studyThe objective of this study is to describe the clinical presentation of neonates and young infants with acute meningitis with different etiologies and to determine the clinical impact of the effect of acute meningitis on growth parameters.Material and methodsWe analyzed the clinical data and the growth parameters of 50 newborns and young infants (age: 1.6 ± 0.9 months) admitted to our hospital (Al Wakhra Hospital, Department of Pediatrics, Doha, Qatar), between 1-1-2016 to 1-1-2017, with acute meningitis. Anthropometric measurements included weight, length, and head circumference. Length SDS (L-SDS) and body-mass-index (BMI) were calculated and recorded at every clinic visit, every 3 months for 8 ± 2 months.ResultsIn this age group of neonates and young infants with acute meningitis fever (84%) and hypoactivity (64%) were the major presenting manifestations. Acute bacterial meningitis (n: 10) was associated with higher morbidity [shock (n: 1), subdural empyema (n: 1) and hydrocephalus (n: 1)]. Cerebrospinal fluid (CSF) examinations showed that infants with bacterial meningitis had significantly higher pleiocytosis of mainly polymorphic leukocytes and protein levels, compared to those with aseptic meningitis.All infants showed normal linear growth and weight gain during the follow-up period (8 ± 2 months). The annualized growth rate of infants was 25.3 ± 3.5 cm per year. All had normal length standard deviation scores (LSDS) (−0.2 ± 0.9) and none of them had LSDS < −2. All infants had a normal BMI (16.7 ± 1.8 kg/m2). Head circumference growth was normal in 49/50 infants (43.8 ± 1.8 cm) at 8 ± 2 months. One infant developed hydrocephalus after group B streptococcus (GBS) meningitis. There was no statistical difference in linear growth between infants with aseptic and bacterial meningitis.ConclusionAcute bacterial meningitis in newborns and young infants is still associated with considerably high morbidity and complications. Infantile linear growth appears to be normal in all newborns and young infants with both bacterial and aseptic meningitis.

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.

Nutrition Practices and Predictors of Postnatal Growth in Preterm Infants During Hospitalization

The aim of the study was to evaluate the relation between nutrition practices and growth rate in preterm infants from birth to 36 weeks postmenstrual age (PMA). Longitudinal data were collected retrospectively in 103 infants born <33 weeks gestation admitted to Dunedin Neonatal Intensive Care Unit, New Zealand. Weight, length, and head circumference at birth and 36 weeks PMA z scores were calculated using the INTERGROWTH Preterm Growth Standard. Growth velocity (g · kg · day) was determined via exponential model. Time to regain birth weight and nutritional practices including enteral nutrition, withholding feeds, nutrient intake, and feeding at discharge were described. Regression was used to explore associations between growth and nutritional variables. Growth faltering (weight-for-age z score <-1.28/10th centile) increased from 9% at birth to 19% at 36 weeks PMA. Mean (standard deviation) growth velocity in-hospital (14.2 [3.3] g · kg · day) was well below the desirable rate of 18 g · kg · day. Forty-one percent of infants had feeds withheld, which was significantly associated with a longer time period to achieve full enteral feedings (P < 0.001) and poorer weight and length z score at 36 weeks PMA (both P < 0.05). The day of life to establish full enteral feedings was longer than recommended yet positively associated with weight at 36 weeks PMA (P = 0.019), whereas controlling for withholding feeds and other known confounders. Extrauterine growth restriction was highly prevalent in this population. The negative association of withholding of feeds on growth reinforces the need to evaluate early life feeding protocols and further assess the longer-term influence of this practice on postdischarge growth outcomes.

Arrhythmia risk and β-blocker therapy in pregnant women with long QT syndrome

BackgroundPregnancy is one of the biggest concerns for women with long QT syndrome (LQTS).ObjectivesThis study investigated pregnancy-related arrhythmic risk and the efficacy and safety of β-blocker therapy for lethal ventricular...

Higher Pre-pregnancy BMI and Excessive Gestational Weight Gain are Risk Factors for Rapid Weight Gain in Infants

Objective To describe the effects of maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) on infant anthropometrics at birth and 3months and infant growth rates between birth and 3months. Methods Body weight prior to and during pregnancy and infant weight and length at birth and 3months were collected from 600 mother-infant pairs. Adherence to GWG was based on IOM recommendations. Age and sex specific z-scores were calculated for infant weight and length at birth and 3months. Rapid postnatal growth was defined as a difference of >0.67 in weight-for-age z-score between birth and 3months. Relationships between maternal and infant characteristics were analysed using multilinear regression. Results Most women (65%) had a normal pre-pregnancy BMI and 57% gained above GWG recommendations. Infants were 39.3 ± 1.2weeks and 3431 ± 447.9g at birth. At 3months postpartum 60% were exclusively breast fed while 38% received breast milk and formula. Having a pre-pregnancy BMI >25kg/m2 was associated with higher z-scores for birth weight and weight-for-age at 3months. Gaining above recommendations was associated with higher z-scores for birth weight, weight-for-age and BMI. Infants who experienced rapid postnatal growth had higher odds of being born to women who gained above recommendations. Conclusion for Practice Excessive GWG is associated with higher birth weight and rapid weight gain in infants. Interventions that optimize GWG should explore effects on total and rates of early infant growth.

Nutritional status and nutrient intake from complementary foods among breastfed children in Purworejo District, Central Java, Indonesia

Background The growth rate of Indonesian infants beyond sixmonths of age declines compared with that of the internationalreference population.Objective This study aimed to describe the pattern of nutritionalstatus among breastfed children and their intake of energy, pro-tein, and zinc from complementary foods in Purworejo District, Cen-tral Java, Indonesia.Methods The study was a cross sectional survey drawing breastfedchildren under 24 months old from a well-defined population. Chil-dren with a history of prematurity or low birth weight were excluded.Anthropometrical measurements were collected. Intake of comple-mentary food was assessed using 24-hour recall. Analysis of nu-tritional intake was only performed in 11-23 month-old children.Results Of 577 children enrolled, the prevalence of underweight,stunting, and wasting were 8.1%, 8.8%, and 4.6%, respectively.The prevalence of undernutrition increased with age. There wasno association between frequency of breastfeeding during 24 hoursin the second year of life and the nutritional status. The averageintake of energy, protein, and zinc from complementary foods wasvery low i.e., 30%, 45%, and 5% of the Indonesian recommendeddietary allowance (RDA), respectively.Conclusion The prevalence of undernutrition in breastfed chil-dren increases with age. The breastfed children beyond 11 monthsof age in Purworejo District need sufficient density of nutrients fromcomplementary foods.

Expressed Breast Milk Volume May Need to Be Considered in Studies of Lactational Programming of Obesity

There is increased interest in “lactational programming” as a potential mechanism by which maternal and offspring obesity are linked; that is, there are bioactive hormonal and other factors in milk that vary by maternal nutritional status and can alter infant growth rate. However, existing studies often do not consider whether breast milk sample volume could play a role in these associations.ObjectivesWe tested whether the volume of milk collected from mothers for hormone assays was associated with maternal pre‐pregnancy body mass index (BMI) and gestational weight gain. Secondary analyses examined the associations of breast milk volume with infant weight status.MethodsParticipants were 54 exclusively breastfeeding mother‐infant dyads (average maternal age 30.9 ± 3.8 years, 91% White), enrolled in the ongoing Mothers and Infants LinKed for Healthy Growth (MILK) study. Maternal and infant anthropometrics and breast milk volume were assessed at one and three months postpartum. Pre‐pregnancy BMI and gestational weight gain were calculated using first prenatal visit weight, measured height, and delivery weight. Infant weight and length were measured and converted to WHO Z‐scores. Milk volume was assessed by having mothers provide a single complete breast expression using an electric breast pump (Medela, Inc.) exactly two hours after feeding their infant until volitionally satisfied. Linear regression models examined associations of maternal pre‐pregnancy BMI and gestational weight gain with milk volume, after controlling for age, parity, education, and race. Milk volume was also examined as a predictor of infant weight and length status.ResultsAverage pre‐pregnancy BMI was 25.6 ± 4.7 kg/m2 (53.7% normal weight, 25.9% overweight, 20.4% obese), and mean gestational weight gain was 14.1 ± 5.2 kg. Breast milk volume increased from 68.4 ± 32.0 ml at one month postpartum to 70.3 ± 35.1 ml at three months. An inverse association was observed between pre‐pregnancy BMI and milk volume at three months only (β=−3.13, p=0.006). Gestational weight gain was not associated with milk volume at one or three months. We also found that milk volume at one month was positively associated with weight for‐age Z‐scores at one (β= 0.01, p=0.015) and three months (β= 0.01, p=0.023). Milk volume was not associated with length‐for‐age or weight‐for‐length Z‐scores.ConclusionsPreliminary analyses from the MILK study showed that greater pre‐pregnancy BMI was associated with a reduction in milk volume from a standardized milk expression at three months postpartum. Milk volumes were also positively associated with weight‐for‐age Z‐scores at one and three months postpartum. If milk hormone concentrations are found to vary with milk volume produced, our results indicate the need to control for this factor when examining the role of breast milk hormones in the transmission of obesity risk from mother to offspring.Support or Funding InformationR01 HD080444 (National Institute for Child Health and Development)

Bioactive factors in milk across lactation: Maternal effects and influence on infant growth in rhesus macaques (Macaca mulatta).

Among mammals, numerous bioactive factors in milk vary across mothers and influence offspring outcomes. This emerging area of research has primarily investigated such dynamics within rodent biomedical models, domesticated dairy breeds, and among humans in clinical contexts. Less understood are signaling factors in the milk of non-human primates. Here, we report on multiple bioactive components in rhesus macaque (Macaca mulatta) milk and their associations with maternal and infant characteristics. Milk samples were collected from 59 macaques at multiple time points across lactation in conjunction with maternal and infant morphometrics and life-history animal records. Milk was assayed for adiponectin (APN), epidermal growth factor (EGF) and its receptor (EGF-R), and transforming growth factor beta 2 (TGF-β2 ). Regression models were constructed to assess the contributions of maternal factors on variation in milk bioactives, and on the relationship of this variation to infant body mass and growth. Maternal body mass, parity, social rank, and infant sex were all predictive of concentrations of milk bioactives. Primiparous mothers produced milk with higher adiponectin, but lower EGF, than multiparous mothers. Heavier mothers produced milk with lower EGF and EGF-R, but higher TGF-β2 . Mothers of daughters produced milk with higher TGF-β2 . Mid-ranking mothers produced milk with higher mean EGF and adiponectin concentrations than low-ranking mothers. Milk EGF and EGF-R were positively associated with infant body mass and growth rate. Importantly, these signaling bioactives (APN, EGF, EGF-R, and TGF-β2 ) were significantly correlated with nutritional values of milk. The effects of milk signals remained after controlling for the available energy in milk revealing the added physiological role of non-nutritive milk bioactives in the developing infant. Integrating analyses of energetic and other bioactive components of milk yields an important perspective for interpreting the magnitude, sources, and consequences of inter-individual variation in milk synthesis. Am. J. Primatol. 78:838-850, 2016. © 2016 Wiley Periodicals, Inc.

Extrauterine growth restriction: Universal problem among premature infants

ABSTRACT Objective: To analyze the growth rate of premature infants in the first weeks of life and factors associated with extrauterine growth restriction. Methods: This is a cross-sectional study of 254 premature infants in a neonatal intensive care unit conducted from January 1, 2008 to December 31, 2010. Infants who died or had malformations incompatible with life were excluded. Median weight curves according to gestational age were constructed for the first four weeks of life. The Fenton growth chart calculations provided the weight Z-scores. Extrauterine growth restriction was defined as corrected weight-for-age Z-score ≤-2. Perinatal, morbidity, and health care variables were analyzed. The Poisson regression model yielded the prevalenceratios . Associations between extrauterine growth restriction and the perinatal, morbidity, and care variables were investigated. Poisson regression controlled possible confounding factors. Results: The frequency of extrauterine growth restriction was 24.0%. Most (85.0%) small-for-gestational-age infants developed extrauterine growth restriction; 55.3% of extrauterine growth restriction cases involved small-for-gestational-age infants. Premature infants with gestational age &gt;32 weeks did not recover the median birth weight until the third week of life and had a higher frequency of small-for-gestational-age. The Z-scores of non-small-for-gestational-age infants decreased more after birth than those of small-for-gestational-age infants. extrauterine growth restriction was associated with small-for-gestational-age (PR=6.14; 95%CI=3.33-11.33;p &lt;0.001) and time without enteral diet (PR=1.08; 95%CI=1.04-1.13; p =0.010). Conclusion: Extrauterine growth restriction occurs in premature infants of all gestational age. The participation of small-for-gestational-age and nutritional practices in its genesis is noteworthy. We suggest prospective studies of all premature infants. The implementation of best care practices, individualized for small-for-gestational-age infants, to improve nutrient supply can minimize the problem.

Effects of environmental enrichment and stereotypic behavior on maternal behavior and infant viability in a model carnivore, the American mink (Neovison vison).

In several species, stress compromises maternal behaviors that are important for infant viability (e.g. licking and grooming). Understanding how stress in captivity affects maternal behavior could therefore be beneficial, especially for carnivores in zoos and breeding centers where infant mortality is often high. We used a model carnivore--American mink--to test two hypotheses, namely that maternal investment and/or behavior is i. improved by environmental enrichment; and ii. compromised by stereotypic behavior. We observed 22 females raised in an indoor facility, 9 enriched, 13 non-enriched. At birth, and at post-natal day 20 when altricial infants were still fully dependent on their mothers, the following offspring variables were recorded: litter size, infant mortality, litter sex ratio (post-natal day 1), and weight. Maternal behavior was assessed by recording nest shape (post-natal day 1), and the frequency of licking and grooming (post-natal days 1-7). Non-enriched females stereotyped more, had female-skewed litters at birth, and tended to make poorer, flatter nests. Maternal licking and grooming showed large, stable individual differences, but appeared unaffected by enrichment. High levels of maternal stereotypic behavior predicted slower offspring growth, replicating previous findings for farmed mink. Nevertheless, enrichment did not significantly increase infant growth rates nor decrease infant mortality. Due to small sample sizes, our study now needs replicating, particularly to explore the potential benefits of enrichment on nest building, sex ratio effects, and the implications of maternal licking and grooming for offspring stress reactivity. Findings could then apply to endangered mustelids like the European mink.

Differential relationships between chronic hormone profiles in pregnancy and maternal investment in rhesus monkey mothers with hair loss in the neonatal period.

Hair loss is commonly used as an indicator of well being in primate facilities, yet it has been shown to also occur in otherwise healthy pregnant and postpartum females. There is significant variability in the incidence of hair loss during these important developmental periods, reasons for which remain unclear. We studied female rhesus monkeys (Macaca mulatta, n = 47) with and without hair loss in pregnancy/postpartum. We hypothesized that, similar to previously published reports, pregnancy would result in an increased likelihood of hair loss, and that hair loss would be correlated with higher hair cortisol concentrations (HCCs). We further hypothesized that hair loss among pregnant females is related to differential maternal investment. We studied a subset of monkeys (n = 26) from mid-to-late pregnancy through peak lactation, some of which exhibited hair loss in the perinatal period (n = 15), and some of which did not (n = 11). We examined fetal measurements, infant birth weight, infant growth rate, and milk yield volume (MYV) in the first 30 days as indices of investment. We found that pregnant monkeys showed a greater incidence of hair loss across the study year (χ2(2) = 6.55, P = 0.038), and that mothers with hair loss had significantly higher HCCs in pregnancy than those without (F(2,28) = 3.8, P = 0.017, ηp2 = 0.21). HCCs in pregnancy were correlated with severity of hair loss in the neonatal period (r(37) = 0.42, P = 0.008). Moreover, HCCs in pregnancy were positively correlated with infant birth weight (r(12) = 0.56, P = 0.038), infant growth rate (r(12) = 0.64, P = 0.014), and MYV (r(11) = 0.85, P < 0.001) for alopecic but not non-alopecic mothers. These mothers did not differ in fetal measurements, infant birth weight/growth rate, or MYV. Our results suggest that hair loss in some monkeys, especially during the birthing season, may be a signal of greater physiological stress during pregnancy and differential investment by mothers to their offspring. Am. J. Primatol. 79:e22489, 2017. © 2015 Wiley Periodicals, Inc.

Low-level prenatal mercury exposure in north China: an exploratory study of anthropometric effects.

In order to investigate anthropometric effects of mercury (Hg) exposure, we examined the status of human prenatal exposure to Hg species, including total mercury (THg), methylmercury (MeHg) and inorganic mercury (IHg), in North China, as well as their potential effects on fetal and infant growth. Hg concentrations in various bioindicators were measured from 50 Chinese women and newborns in 2011. The participants were followed for 12 months to collect anthropometric information. Linear and two-level regression analyses were performed to determine the associations between Hg levels and body growth. The geometric mean levels of THg in the placenta, cord blood, fetal hair, and maternal blood, hair, and urine were 25.88 μg/kg dry wt, 2.73 μg/L, 572.98 μg/kg, 2.29 μg/L, 576.54 μg/kg, and 0.58 μg/g creatinine, respectively. Nearly 100% of Hg presented as IHg in urine, and the percentage of IHg in other bioindicators was 14.86-48.73%. We observed significantly negative associations between Hg levels in some matrixes and anthropometry of neonates (weight and height) and infants (height) (p < 0.05). THg levels in maternal hair were also negatively associated with infant growth rate of weight during 12 months after delivery (p = 0.017). This study suggests that low-level prenatal Hg exposure could play a role in attenuating fetal and infant growth, and the effects of MeHg and IHg are different.

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Effect of nutrition on growth and neurodevelopment in the preterm infant: a systematic review

The energy needs of preterm infants are high and more so when the body weight is lower; for this reason, and to safeguard the infant's future development, it is important to ensure an optimal caloric intake is obtained. To analyse leading research papers related to nutrition in the preterm newborn and its effects on growth and development. Systematic review of relevant studies, based on the application of a search strategy, from March to September 2014. The literature search was conducted using document analysis and information synthesis to classify and compile the information extracted, followed by a comparative evaluation. The validity of the articles obtained was corroborated by the weight of findings obtained, by the citations received by the articles and by their applicability to our healthcare environment. The search process produced 61 studies that met the selection criteria. The research question addressed has been widely examined and many studies have reported findings related to the nutrition of preterm infants. The direct relationship between nutritional intake and the growth rate of preterm infants is well documented. Proper nutrition in the preterm infant has positive effects on its growth and neurodevelopment. It has been reported that a greater intake of proteins and lipids favours the growth of preterm infants, but not weight gain. Studies have demonstrated the beneficial effect of breast milk on the brain, the retina and the blood vessels; however, there is a negative correlation between adiposity and brain volume.

Randomized Trial of Human Milk Cream as a Supplement to Standard Fortification of an Exclusive Human Milk-Based Diet in Infants 750-1250 g Birth Weight

To evaluate whether premature infants who received an exclusive human milk (HM)-based diet and a HM-derived cream supplement (cream) would have weight gain (g/kg/d) at least as good as infants receiving a standard feeding regimen (control). In a prospective noninferiority, randomized, unmasked study, infants with a birth weight 750-1250 g were randomly assigned to the control or cream group. The control group received mother's own milk or donor HM with donor HM-derived fortifier. The cream group received a HM-derived cream supplement if the energy density of the HM tested <20 kcal/oz using a near infrared HM analyzer. Infants were continued on the protocol until 36 weeks postmenstrual age. Primary outcomes included growth velocities and amount of donor HM-derived fortifier used. The hypothesis of noninferiority was established if the lower bound of the one-sided 95% CI for the difference in weight velocities exceeded -3 g/kg/day. There were no differences between groups in baseline demographics for the 78 infants studied except racial distribution (P = .02). The cream group (n = 39) had superior weight (14.0 ± 2.5 vs 12.4 ± 3.0 g/kg/d, P = .03) and length (1.03 ± 0.33 vs 0.83 ± 0.41 cm/wk, P = .02) velocity compared with the control group (n = 39). There were no significant differences in amount of fortifier used between study groups. The 1-sided 95% lower bound of the CI for the difference in mean velocity (cream-control) was 0.38 g/kg/d. Premature infants who received HM-derived cream to fortified HM had improved weight and length velocity compared with the control group. HM-derived cream should be considered an adjunctive supplement to an exclusive HM-based diet to improve growth rates in premature infants.