Neonatal Nutrition Research Articles

Estudio de calidad de la pasteurización Holder de leche materna donada en una unidad de nutrición personalizada neonatal

ObjectiveHolder pasteurization is the technique used most frequently in milk banks to minimize the risk of transmission of infectious agents. Different pasteurization devices have been described that generally use hot water or air as heat sources. In our study, we analysed the quality of pasteurization achieved with a new automated water-free pasteurizer in a neonatal personalized nutrition unit in which donated milk from mothers of infants delivered at different gestational ages and of different postnatal ages is pasteurized. Material and methodsWe analysed the temperatures of different phases of pasteurization with 8 external probes distributed evenly throughout the pasteurizer. We applied the optimal range criteria established by the European Milk Bank Association (EMBA) to assess the quality of pasteurization. We also analysed the macronutrient composition of 8 samples of donor human milk of different volumes before and after automated pasteurization. ResultsWe did not find no significant differences in the following parameters under study: time from 58°C to 62.5°C, duration of plateau, highest temperature during plateau and length of exposure to temperatures over 58°C. The macronutrient analysis showed significant changes in fat content but not in protein or lactose content. ConclusionsHolder pasteurization of human milk with a water-free pasteurizer met the quality standards recommended by the European Milk Bank Association independently of the quantity of milk pasteurized in each bottle and with significant changes in the fat content but not in the protein or lactose content.

Optimizing Early Neonatal Nutrition and Dietary Pattern in Premature Infants.

Providing adequate amounts of all essential macro- and micronutrients to preterm infants during the period of extraordinarily rapid growth from 24 to 34 weeks’ postmenstrual age to achieve growth as in utero is challenging yet important, since early growth restriction and suboptimal neonatal nutrition have been identified as risk factors for adverse long-term development. Along with now well-established early parenteral nutrition, this review emphasizes enteral nutrition, which should be started early and rapidly increased. To minimize the side effects of parenteral nutrition and improve outcomes, early full enteral nutrition based on expressed mothers’ own milk is an important goal. Although neonatal nutrition has improved in recent decades, existing knowledge about, for example, the optimal composition and duration of parenteral nutrition, practical aspects of the transition to full enteral nutrition or the need for breast milk fortification is limited and intensively discussed. Therefore, further prospective studies on various aspects of preterm infant feeding are needed, especially with regard to the effects on long-term outcomes. This narrative review will summarize currently available and still missing evidence regarding optimal preterm infant nutrition, with emphasis on enteral nutrition and early postnatal growth, and deduce a practical approach.

Growth patterns of preterm infants in Korea.

With advancements in neonatal care and nutrition, the postnatal growth of preterm infants has improved; however, it remains an issue. Accurate assessments of growth using a standardized reference are needed to interpret the intrauterine and postnatal growth patterns of preterm infants. Growth in the earlier periods of life can contribute to later outcomes, and the refinement of postnatal growth failure is needed to optimize outcomes. Catchup growth occurs mainly before discharge and until 24 months of age, and very low birth weight infants in Korea achieve retarded growth later in life. Knowing an infant’s perinatal history, reducing morbidity rates during admission, and performing regular monitoring after discharge are required. Preterm infants with a lower birth weight or who were small for gestational age are at increased risk of poor neurodevelopmental outcomes. Furthermore, poor postnatal growth is predictive of adverse neurodevelopmental outcomes. Careful monitoring and early intervention will contribute to better development outcomes and national public health improvements.

Quality study of Holder pasteurization of donor human milk in a neonatal personalized nutrition unit

ObjectiveHolder pasteurization is the technique used most frequently in milk banks to minimize the risk of transmission of infectious agents. Different pasteurization devices have been described that generally use hot water or air as heat sources. In our study, we analysed the quality of pasteurization achieved with a new automated water-free pasteurizer in a neonatal personalized nutrition unit in which donated milk from mothers of infants delivered at different gestational ages and of different postnatal ages is pasteurized. Material and methodsWe analysed the temperatures of different phases of pasteurization with 8 external probes distributed evenly throughout the pasteurizer. We applied the optimal range criteria established by the European Milk Bank Association (EMBA) to assess the quality of pasteurization. We also analysed the macronutrient composition of 8 samples of donor human milk of different volumes before and after automated pasteurization. ResultsWe did not find significant differences in the following parameters under study: time from 58 °C to 62.5 °C, duration of plateau, highest temperature during plateau and length of exposure to temperatures over 58 °C. The macronutrient analysis showed significant changes in fat content but not in protein or lactose content. ConclusionsHolder pasteurization of human milk with a water-free pasteurizer met the quality standards recommended by the European Milk Bank Association independently of the quantity of milk pasteurized in each bottle and with significant changes in the fat content but not in the protein or lactose content.

Soft tissue assessment for fetal growth restriction.

Contemporary clinical practice heavily relies on interpretation of population-based birth weight standards to evaluate neonatal nutrition status. Obstetricians have adopted the use of estimated fetal weight in a similar manner to estimate fetal nutritional status. However, most fetal weight prediction models overemphasize skeletal parameters such as biparietal diameter, head circumference, and femur diaphysis length. Although most EFW calculations also include abdominal circumference, this 2D growth parameter is largely defined by liver size and a small rim of subcutaneous fat. Advances in 3D ultrasound imaging and the development of more robust image analysis tools have now made it possible to reliably add a soft tissue component for fetal nutritional assessment. This chapter explains why fetal soft tissue evaluation is clinically relevant, describes different techniques for evaluating these sonographic parameters, and outlines future directions for their practical utility in the care of malnourished fetuses.

Body composition of extremely preterm infants fed protein-enriched, fortified milk: a randomized trial.

BackgroundCritically ill extremely preterm infants fed human milk are often underrepresented in neonatal nutrition trials aimed to determine the effects of enteral protein supplementation on body composition outcomes.MethodsMasked randomized trial in which 56 extremely preterm infants 25–28 weeks of gestation were randomized to receive either fortified milk enriched with a fixed amount of extensively hydrolyzed protein (high protein group) or fortified milk without additional protein (standard protein group).ResultsBaseline characteristics were similar between groups. In a longitudinal analysis, the mean percent body fat (%BF) at 30–32 weeks of postmenstrual age (PMA), 36 weeks PMA, and 3 months of corrected age (CA) did not differ between groups (17 ± 3 vs. 15 ± 4; p = 0.09). The high protein group had higher weight (−0.1 ± 1.2 vs. −0.8 ± 1.3; p = 0.03) and length (−0.8 ± 1.3 vs. −1.5 ± 1.3; p = 0.02) z scores from birth to 3 months CA. The high protein group also had higher fat-free mass (FFM) z scores at 36 weeks PMA (−0.9 ± 1.1 vs. −1.5 ± 1.1; p = 0.04).ConclusionsIncreased enteral intake of protein increased FFM accretion, weight, and length in extremely preterm infants receiving protein-enriched, fortified human milk.Impact Extremely preterm infants are at high risk of developing postnatal growth failure, particularly when they have low fat-free mass gains.Protein supplementation increases fat-free mass accretion in infants, but several neonatal nutrition trials aimed to determine the effects of enteral protein supplementation on body composition outcomes have systematically excluded critically ill extremely preterm infants fed human milk exclusively.In extremely preterm infants fed fortified human milk, higher enteral protein intake increases fat-free mass accretion and promotes growth without causing excessive body fat accretion.

Nutrition Considerations in Neonatal Extracorporeal Life Support.

Extracorporeal life support (ECLS) is a life-saving therapy, but neonates who require ECLS have unique nutritional needs and require aggressive, early nutritional support. These critically ill neonates are at increased risk for long-term feeding difficulties, malnutrition, and growth failure with associated increased morbidity and mortality. Unfortunately, few studies specific to this population exist. Clinical guidelines published by the American Society for Parenteral and Enteral Nutrition are specific to this population and available to aid clinicians in appropriate nutrition regimens, but studies to date suggest that nutrition provision varies greatly from center to center and often is inadequate. Though enteral feedings are becoming more common, aggressive parenteral nutrition is still needed to ensure nutrition goals are met, including the goal of increased protein provision. Long-term complications, including the need for tube feedings and growth failure, are common in neonatal ECLS survivors, particularly those with congenital diaphragmatic hernia. Oral aversion with poor feeding and growth failure must be anticipated and recognized early if present. The nutritional implications associated with the development of acute kidney injury, fluid overload, or the use of continuous renal replacement therapy must be recognized. In this state-of-the-art review, we examine aspects of nutrition for neonates receiving ECLS including nutritional requirements, nutrition provision, current practices, long-term outcomes, and special population considerations.

β-Lactoglobulin and Glycodelin: Two Sides of the Same Coin?

The two lipocalins, β-lactoglobulin (βLg) and glycodelin (Gd), are possibly the most closely related members of the large and widely distributed lipocalin family, yet their functions appear to be substantially different. Indeed, the function of β-lactoglobulin, a major component of ruminant milk, is still unclear although neonatal nutrition is clearly important. On the other hand, glycodelin has several specific functions in reproduction conferred through distinct, tissue specific glycosylation of the polypeptide backbone. It is also associated with some cancer outcomes. The glycodelin gene, PAEP, reflecting one of its names, progestagen-associated endometrial protein, is expressed in many though not all primates, but the name has now also been adopted for the β-lactoglobulin gene (HGNC, www.genenames.org). After a general overview of the two proteins in the context of the lipocalin family, this review considers the properties of each in the light of their physiological functional significance, supplementing earlier reviews to include studies from the past decade. While the biological function of glycodelin is reasonably well defined, that of β-lactoglobulin remains elusive.

Ante-Natal and Post-Natal Influences on Neonatal Immunity, Growth and Puberty of Calves-A Review.

Simple SummaryThe objective of this review is to give the reader an overview of interactions between immunity, growth and puberty in calves and highlight how these influence future performances. The risk of morbidity and mortality is high during the first four weeks of age. Adaption to extra-uterine life starts early during embryonic development and is underpinned by optimal maternal nutrition. It is known that colostrum is paramount to neonate nutrition and passive immunity. Good colostrum management allows the calf to develop coping mechanisms to efficiently utilize feed resources for optimal growth. A deeper understanding of these interactions paves the way for developing strategies to improve immune responses to environmental pathogens, optimal growth and timely attainment of puberty in calves. The literature reviewed here shows that there are opportunities to enhance future performance of cattle paying attention to the interaction of nutrition and immunity at early developmental stages. This then guarantees efficient neonate nutrition and profitable cattle production.Calf immunity, growth and puberty are important factors affecting heifer productivity. The first four weeks of age are critical for reducing calf morbidity and mortality. It is well documented that colostrum is paramount to neonatal nutrition and passive immunity, however, adaptation to extra-uterine life starts early during embryonic development. Therefore, successful calf rearing strategies are underpinned by adequate maternal nutrition during gestation, and good colostrum management. A deeper understanding of these interactions paves the way for developing strategies to improve immune responses to environmental pathogens, optimal growth and timely attainment of puberty in calves. The literature reviewed here shows that there are opportunities to enhance the future performance of cattle paying attention to the interaction of nutrition and immunity at each developmental stage. Therefore, the objective of this review is to give the reader an overview of interactions between immunity, growth and puberty in dairy calves and highlight how these influence future performances.

A demonstration of using formal consensus methods within guideline development; a case study

BackgroundRecommendations within guidelines are developed by synthesising the best available evidence; when limited evidence is identified recommendations are generally based on informal consensus. However, there are potential biases in group decision making, and formal consensus methods may help reduce these.MethodsWe conducted a case study using formal consensus, to develop one set of recommendations within the Neonatal Parenteral Nutrition guideline being produced for the National Institute for Health and Care Excellence. Statements were generated through identification of published guidelines on several topics relating to neonatal parenteral nutrition. Ten high quality guidelines were included, and 28 statements were generated; these statements were rated by the committee via two rounds of voting. The statements which resulted in agreement were then used to develop the recommendations.ResultsThe approach was systematic and provided transparency. Additionally, a number of lessons were learnt; including the value of selecting the appropriate topic, giving adequate time to the process, and ensuring methodologies are understood by the committee for their value and relevance.ConclusionFormal consensus is a valuable option for use within guideline development when specific criteria are met. The approach provides transparent methodology, ensuring clarity on how recommendations are developed.

A study to Assess the Knowledge and Practice of Staff Nurses and Postnatal Mothers on Implementation of Baby Friendly Hospital Initiative in a Tertiary Care Hospital in Chennai

Aims: Breastfeeding is considered the ideal nutrition for neonates. It not only provides the essential micronutrients and macronutrients but also helps in building a bond between the baby and the mother apart from its long term effects. For the promotion of breastfeeding several steps have been initiated by the UNICEF and WHO of which BFHI is the most important initiative. This study is to assess Knowledge and Practice regarding breastfeeding of BFHI among Nurses and postnatal mothers.
 Study Design: A non experimental descriptive study.
 Place and Duration of Study: Department of Neonatology and Department of obstetrics, Saveetha Medical College and Hospital, Saveetha University, Chennai, India. Between September 2020 and December 2020.
 Methodology: A hospital based survey was done among 40 staff nurses and 40 postnatal mothers regarding their knowledge about BFHI and breastfeeding, demonstration of practice of breastfeeding and principles of BFHI and their perceptions on factors that hinder the implementation of BFHI. Data on knowledge of baby-friendly hospital initiative and breastfeeding was collected by using a self-administered structured questionnaire and practice of breastfeeding by observation checklist. Descriptive (frequency, percentage, mean, standard deviation) and inferential (Chi-square, normality test, and Spearman’s rank correlation) statistics were used for data analysis with SPSS version 20.
 Results: Both the staff nurses and mothers were assed for knowledge using7 questions compared to the postnatal mothers the knowledge about BFHI and Breastfeeding was higher among the staff nurses. Successful practice of breastfeeding and principles of BFHI was studied using demonstration of proper positioning, attachment, expression of breast milk and skin to skin contact which again was higher among the staff nurses compared to the mothers. The findings show that out of 40nurses surveyed, more than (77.1%) of the respondents had a good level of knowledge and more than three-fourth had a good level of practice of breastfeeding. Among the mothers there was significantly lesser knowledge with less than half (45%) had knowledge about BFHI .Regarding the practice of breastfeeding and BFHI (89%) of the staff nurses demonstrated successful breastfeeding and principles of BFHI in comparison (75.5%) of the mothers showed successful breastfeeding. Regarding the hindrances to breastfeeding both the mothers and staff nurses had similar views.
 Conclusion: There is still lack of complete awareness of some major recommended practices in the hospitals that will promote and sustain breastfeeding. The staff nurses and postnatal mothers need to be educated further on the importance of breastfeeding and principles of BFHI. This can be achieved by promoting antenatal and lactation counseling of the mothers and training of the staff nurses on the principles of BFHI. Policy changes in educating mothers and staff nurses on promoting breastfeeding should be implemented.

What are the new guidelines and position papers in pediatric nutrition: A 2015-2020 overview.

Nutrition related publications in pediatric population cover wide range of topics and therefore it is usually difficult for clinicians to get an overview of recent nutrition related guidelines or recommendations. The Special Interest Group (SIG) of Pediatrics of European Society for Clinical Nutrition and Metabolism (ESPEN) performed a literature search to capture publications in the last five years aiming to provide the latest information concerning nutritional issues in children in general and in specific diseases and to discuss progression in the field of pediatric nutrition evidence-based practice. Eight major topics were identified as the most frequently reported including allergy, critical illness, neonatal nutrition, parenteral and enteral nutrition, micronutrients, probiotics and malnutrition. Furthermore, it was noted that many reports were disease focused or included micronutrients and were, therefore, represented as tables. Overall, it has been shown that most reports on nutrition topics in pediatrics were systematic reviews or guidelines/position papers of relevant societies, but many of them basing the conclusion on a limited number of high-quality randomized controlled trials or large observational cohort studies.

Outcomes and survival of infants with congenital duodenal obstruction following Kimura procedure with post-anastomosis jejunostomy feeding tube

BackgroundSeveral modifications of the Kimura procedure for congenital duodenal obstruction (CDO) have been reported, however, their effects on the outcomes show conflicting results.MethodsWe compared the CDO outcomes following the Kimura procedure with and without post-anastomosis jejunostomy feeding tube (JFT).ResultsA total of 52 CDO neonates were involved (JFT: 13 males and 2 females vs. non-JFT: 14 males and 23 females, p = 0.0019). Time to full oral feeding was significantly earlier in the JFT than non-JFT group (14 [interquartile range (IQR), 12–15] vs. 17 [IQR, 14–22.5] days; p = 0.04). Duration of parenteral nutrition given to infants with CDO after surgery was significantly shorter in the JFT than non-JFT group (12 [IQR, 10–15] vs. 17 [IQR, 13–23] days; p = 0.031). Moreover, enteral feeding was significantly earlier in the JFT than non-JFT group (2 [IQR, 1–3.5] vs. 5 [IQR, 4–6] days; p = < 0.0001). However, the length of stay following surgery was not significantly different between groups (16 [IQR, 14–22] vs. 20 [IQR, 17–28] days; p = 0.22). Also, overall patient survival did not significantly differ between JFT (66.7%) and non-JFT patients (59.5%) (p = 0.61).ConclusionJejunostomy feeding tube shows a beneficial effect on the time to full oral feeding, duration of parenteral nutrition and early enteral feeding in neonates with congenital duodenal obstruction after Kimura procedure.

Association Between Enteral Nutrition and Necrotizing Enterocolitis in Neonates with Congenital Heart Disease

Association Between Enteral Nutrition and Necrotizing Enterocolitis in Neonates with Congenital Heart Disease

Effects of neonatal nutrition interventions on neonatal mortality and child health and development outcomes: A systematic review.

Effects of neonatal nutrition interventions on neonatal mortality and child health and development outcomes: A systematic review.

Addition of Dairy Lipids and Probiotic Lactobacillus fermentum in Infant Formulas Modulates Proteolysis and Lipolysis With Moderate Consequences on Gut Physiology and Metabolism in Yucatan Piglets.

Breast milk is the gold standard in neonatal nutrition, but most infants are fed infant formulas in which lipids are usually of plant origin. The addition of dairy lipids and/or milk fat globule membrane extracts in formulas improves their composition with beneficial consequences on protein and lipid digestion. The probiotic Lactobacillus fermentum (Lf) was reported to reduce transit time in rat pups, which may also improve digestion. This study aimed to investigate the effects of the addition of dairy lipids in formulas, with or without Lf, on protein and lipid digestion and on gut physiology and metabolism. Piglets were suckled from postnatal days 2 to 28, with formulas containing either plant lipids (PL), a half-half mixture of plant and dairy lipids (DL), or this mixture supplemented with Lf (DL+Lf). At day 28, piglets were euthanized 90 min after their last feeding. Microstructure of digesta did not differ among formulas. Gastric proteolysis was increased (P < 0.01) in DL and DL+Lf (21.9 ± 2.1 and 22.6 ± 1.3%, respectively) compared with PL (17.3 ± 0.6%) and the residual proportion of gastric intact caseins decreased (p < 0.01) in DL+Lf (5.4 ± 2.5%) compared with PL and DL (10.6 ± 3.1% and 21.8 ± 6.8%, respectively). Peptide diversity in ileum and colon digesta was lower in PL compared to DL and DL+Lf. DL and DL+Lf displayed an increased (p < 0.01) proportion of diacylglycerol/cholesterol in jejunum and ileum digesta compared to PL and tended (p = 0.07) to have lower triglyceride/total lipid ratio in ileum DL+Lf (0.019 ± 0.003) as compared to PL (0.045 ± 0.011). The percentage of endocrine tissue and the number of islets in the pancreas were decreased (p < 0.05) in DL+Lf compared with DL. DL+Lf displayed a beneficial effect on host defenses [increased goblet cell density in jejunum (p < 0.05)] and a trophic effect [increased duodenal (p = 0.09) and jejunal (p < 0.05) weights]. Altogether, our results demonstrate that the addition of dairy lipids and probiotic Lf in infant formula modulated protein and lipid digestion, with consequences on lipid profile and with beneficial, although moderate, physiological effects.

Оценка сосательного рефлекса и эффективности энтерального питания у новорожденных в течение первых месяцев жизни

Оценка сосательного рефлекса и эффективности энтерального питания у новорожденных в течение первых месяцев жизни

When a Neonate Is Born, So Is a Microbiota.

In recent years, the role of human microbiota as a short- and long-term health promoter and modulator has been affirmed and progressively strengthened. In the course of one’s life, each subject is colonized by a great number of bacteria, which constitute its specific and individual microbiota. Human bacterial colonization starts during fetal life, in opposition to the previous paradigm of the “sterile womb”. Placenta, amniotic fluid, cord blood and fetal tissues each have their own specific microbiota, influenced by maternal health and habits and having a decisive influence on pregnancy outcome and offspring outcome. The maternal microbiota, especially that colonizing the genital system, starts to influence the outcome of pregnancy already before conception, modulating fertility and the success rate of fertilization, even in the case of assisted reproduction techniques. During the perinatal period, neonatal microbiota seems influenced by delivery mode, drug administration and many other conditions. Special attention must be reserved for early neonatal nutrition, because breastfeeding allows the transmission of a specific and unique lactobiome able to modulate and positively affect the neonatal gut microbiota. Our narrative review aims to investigate the currently identified pre- and peri-natal factors influencing neonatal microbiota, before conception, during pregnancy, pre- and post-delivery, since the early microbiota influences the whole life of each subject.

Association of First-Week Nutrient Intake and Extrauterine Growth Restriction in Moderately Preterm Infants: A Regional Population-Based Study.

The purpose of this study was to determine the influence of first-week nutrition intake on neonatal growth in moderate preterm (MP) infants. Data on neonatal morbidity and nutrition intake on day of life 7 (DoL7) were prospectively collected from 735 MP infants (320/7–346/7 weeks gestational age (GA)). Multivariable regression was used to assess the factors associated with extrauterine growth restriction (EUGR) defined as a decrease of more than 1 standard deviation (SD) in the weight z-score during hospitalization. Mean (SD) gestational age and birth weight were 33.2 (0.8) weeks and 2005 (369) g. The mean change in the weight z-score during hospitalization was −0.64 SD. A total of 138 infants (18.8%) had EUGR. Compared to adequate growth infants, EUGR infants received 15% and 35% lower total energy and protein intake respectively (p < 0.001) at DoL7. At DoL7, each increase of 10 kcal/kg/d and 1 g/kg/d of protein was associated with reduced odds of EUGR with an odds ratio of 0.73 (95% CI, 0.66–0.82; p < 0.001) and 0.54 (0.44–0.67; p < 0.001), respectively. Insufficient energy and protein intakes on DoL7 negatively affected neonatal growth of MP infants. Nutritional support should be optimized from birth onwards to improve neonatal weight growth.

The Impact of 2 Weight-Based Standard Parenteral Nutrition Formulations Compared With One Standard Formulation on the Incidence of Hyperglycemia and Hypernatremia in Low Birth-Weight Preterm Infants.

Standardized parenteral nutrition (PN) formulations are used in at-risk neonates to provide nutrition immediately following birth. However, evidence for the optimal formulation(s) to maximize growth while reducing the risks of glucose and electrolyte abnormalities is limited. The purpose of this study was to compare the rates of hypernatremia and hyperglycemia with 2 weight-based standardized PN formulations versus one standard PN in low birth-weight preterm neonates. This was a single-center observational study of infants less than 1800 g birth weight and less than 37 weeks' gestation who received standardized PN in the first 48 hours of life. Patients in the weight-based PN group were compared with a historical group of patients receiving single standard PN. Rates of hypernatremia and hyperglycemia were compared by χ2 analysis. There was a nonsignificant (P = .147) reduction in hypernatremia in the weight-based PN group (9 of 87; 10.3%) compared with the single PN group (16 of 89; 18.0%). However, hyperglycemia was significantly more frequent in the weight-based group than in the single PN group (24.1% vs 12.4%, P = .035). The 2 weight-based PN standardized formulations studied did not significantly decrease the incidence of hypernatremia or hyperglycemia. Future studies to determine optimal standardized PN to provide early nutrition in high-risk neonates are warranted.