Nutritional Status Of Premature Infants Research Articles

Nutritional status analysis in preterm infants on different types of feeding

Breathing newborns born prematurely is a challenging task of modern perinatology. One of the main factors determining the normal growth and development of newborns (especially premature babies) is adequate nutrition. Assessment of nutritional adequacy includes anthropometry data in the dynamics, analysis of nutritional tolerance and, when indicated, a set of laboratory tests, of which the most important are clinical laboratory results (hemoglobin and traditional parameters of erythrocyte evaluation) and biochemical parameters characterizing protein metabolism (including indirect method of assessment of visceral protein reserves by urea level), iron supply, vitamin status, etc. Data on the nutritional status of premature infants in the period of newborn feeding are very scarce and controversial in the modern scientific literature, which determines the need for further studies on this problem.
 Aim. To study the parameters of nutritional status (hemoglobin, total protein, albumin, creatinine, urea, plasma glucose) at birth, in dynamics on 10, 20, 30 days of life in the preterm infants with very low (VLBW) and low body weight (LBW) at birth on different types of feeding (breast milk GM, GM in combination with fortificator and artificial nutrition AI) to assess measures of feeding success and quality of nursing.
 Materials and methods. The study of 118 infants aged from birth to 1 month of life in the Department of Pathology of Newborn and Premature Babies, Krasnoyarsk Regional Perinatal Center of Maternal and Child Health Protection. Group 1 consisted of 50 infants with OMT at birth, of whom 3 subgroups were formed depending on the type of feeding: breastfed (HB) 17 infants, "enriched" GM (HB + fortificator) 17 children, IV feeding - 16 children; Group 2 consisted of 68 children with OMT at birth, of whom 36 were on HB, 12 were on HB + fortificator, 20 were on IV.
 Results. Assessment of the nutritional status of neonates with NFMT during IM revealed specific features in the development of early anemia of prematurity (10% of cases), high values of total protein in children by the end of the observation period in combination with increasing urea at all stages of observation and a higher creatinine level on day 20 of life. The incidence of early anemia of prematurity was comparable between the subgroups on different types of feeding and lower levels of total protein, albumin, and urea in the subgroup of children receiving HF + fortificator were obtained in the group of neonates with NMT.

Exclusive Breastfeeding, Complementary Food and Characteristics of the Nutritional Status of Premature Infants in Indonesia in 2018

Exclusive Breastfeeding, Complementary Food and Characteristics of the Nutritional Status of Premature Infants in Indonesia in 2018

Nutritional Status, Physical and Psychomotor Development of Premature Infants: A Prospective Observational Comparative Study

Background. The development of premature infants is slower than that of term ones, often due to nutritional status disorders in preterm infants. Objective. Our aim was to study the nutritional status, physical, and psychomotor development of infants. Methods. Nutritional status — the composition (the ratio of fat and fat-free tissues) and the value of lean body mass (LBM) — was assessed by plethysmography and densitometry; physical development — by measuring the mass and length of the body, the circumference of the head and chest, calculating the body mass index (BMI); psychomotor development — assessing compliance with the schedule of neuropsychological development of infants (GNOM). The examination was carried out at 12–14 and 16–18 weeks of the corrected age for preterm and actual age for full-term infants. Initially, the diet of infants was assessed by determining the amount, content of macronutrients and energy in the breast milk and/or milk formula and complementary food consumed. The diet was considered to be balanced if the diet parameters diverged not more than 10% of the norm. Results. The study included 23 preterm infants with extremely low (ELBW), 20 — with very low (VLBW), 34 — with low body weight (LBW), and 33 full-term infants. At 12–14 weeks of the corrected age, the magnitude of LBM in infants with ELBW — 3,397 (3,096; 3,608) and with VLBW — 3,824 (3,797; 3,899) was lower than in infants with LBW — 4,497 (4,034; 4,651) and full-term infants — 4,511 (3,887; 4,647) (Kruskal–Wallis test, p = 0.048). Protein balanced diet was in 2 (9%) infants with ELBW, energy balanced diet — in 1 (4%) infant. Among infants with ELBW, 17/23 (74%) referred to the risk group, 6/23 (26%) — to the developmental disorder group. Compared with infants with ELBW and VLBW, infants with LBW and full-term infants had a higher LBM and, correspondingly, higher body weight and BMI. Improvement of the nutritional status after 4–6 weeks due to correction of protein and energy consumption in infants with ELBW was accompanied by some increase in lean body mass, while its proportion was much higher and the proportion of fat mass was lower, which was accompanied by an improvement in the psychomotor development in individual infants: 5/23 (22%) became age-appropriate, and in the risk group of developmental disorders, the proportion of infants decreased from 17 (74%) to 13/23 (57%). The obtained results testify to the influence of nutritional status on the physical and psychomotor development of infants. Conclusion . The importance of dynamic assessment of the nutritional status of premature infants with individualized correction of their diet for improving the physical and psychomotor development of the child during the first year of life is shown.

Investigation of enteral iron and energy intake of premature infants in neonatal intensive care unit

Objective To assess the enteral iron and energy intake of premature neonates during hospitalization in neonatal intensive care unit(NICU). Methods This retrospective study enrolled 208 premature neonates admi-tted in the NICU of Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine within 48 hours after birth from January 2012 to December 2013.The following data were recorded for all infants: clinical basic information, the amount of formula iron intake in milk, enteral and parenteral nutrition intake as well as oral iron supplementation. Results The amount of enteral iron intake in the 1st, 2nd, 3rd, 4th week after birth and at discharge was (0.2±0.3) mg/(kg·d), (0.9±0.7) mg/(kg·d), (1.2±1.0) mg/(kg·d), (1.5±1.1) mg/(kg·d), and (2.2±1.1) mg/(kg·d), respectively, which accounted for 10%, 45%, 60%, 75% and 110% of the recommended iron intake.The energy intake in the 1st, 2nd, 3rd, 4th week after birth and at discharge was (13.2±14.8) kcal/(kg·d)(1 kcal=4.184 kJ), (46.0±32.6) kcal/(kg·d), (62.2±38.1) kcal/(kg·d), (71.3±38.2) kcal/(kg·d) and (105.3±32.1) kcal/(kg·d), which accounted for 11.0%, 38.3%, 51.8%, 59.4% and 87.8% of the recommended intake, respectively.Lower enteral iron and energy intake after birth occurred in the premature infants with lower birth weight, especially those with anemia who had significantly lower enteral iron intake than the normal neonates in the first 2 weeks after birth. Conclusions Enteral iron and energy intake among premature neonates were insufficient, especially during the first 2 weeks after birth.It is necessary to develop and implement more effective nutritional support to improve the nutritional status of premature infants. Key words: Iron element; Enteral nutrition; Infant, premature

Comparative study on the nutritional status effect of two different parenteral nutrition solutions in early preterm infants

Objective To compare the effects of two different parenteral nutrition solutions on nutritional status of premature infants,such as the early physical,serum prealbumin,retinol binding protein and albumin.Methods We collected 61 cases of premature infants in neonatal intensive care unit of the Third Military Medical University Xinqiao Hospital,which were divided into 2 groups of traditional parenteral nutrition (TTPN) and early parenteral nutrition (ETPN).Group TTPN geted 6％ paediatric compound amino acid 0.5 g/(kg·d) at24 hours after birth,daily increasing 0.25 ～0.5 g/(kg·d),up to 3.0 g/(kg·d).The 20％ long-chain fat emulsion 0.5 g/(kg ·d) was applied at 3 days after birth,daily increasing 0.25 ～ 0.5 g/(kg·d),up to 3.0 g/(kg·d).Group ETPN get 6％ paediatric compound amino acid 1 g/(kg·d) at 12 ～24 hours after birth,daily increasing 0.5 g/(kg·d),up to 3.0 ～ 0.5 g/(kg· d).The 20％ long-chain fat emulsion 0.5 ～ 1.0 g/(kg·d) was applied after 24 hours after birth,daily increasing 0.5 g/(kg· d),up to 3.0 g/(kg· d).We calculate calorie and amino acid intake of the two groups,and compared the weight,length,head circumference growth,serum prealbumin,retinol-binding protein and albumin levels of the two groups.Results The amino acid and total caloric intake of Group ETPN were significantly higher than those of Group TTPN (P ＜ 0.05).No statistical differences in the albumin,prealbumin,and retinol binding protein level of the two groups at birth (P ＞ 0.05).However,the prealbumin and retinol-binding protein level of group ETPN significantly higher than those of Group TTPN (P ＜ 0.05) at 7 days after birth.Conclusion Early parenteral nutrition in early life can effectively improve physical growth and nutrient metabolism status of premature infants.Prealbumin and retinol-binding protein are sensitive to evaluate the protein nutritional status in premature infants. Key words: Premature infants; Parenteral nutrition; Prealbumin; Retinol binding protein

Effect of liquid milk on the nutritional status in premature infants

Objective To investigate the effect of liquid milk on the nutritional status in premature infants with a gestational age of less than 36 weeks and give some suggestions on feeding in premature infants. Methods Ninety-five premature infants were divided into full -term in fant formula feeding group and liquid milk in premature feeding group. The rates of weight gain, length increment, head circumference increment and the incidence of extrauterine growth restriction (EUGR) were observed and compared between two groups before and after the time of full enteral feeding. Results The average daily weight gain[( 12. 1 ±2. 3 )g/( kg · d)v. s( 10. 5±2. 1)g/(kg· d),P＜ 0.01 ),head circumference increment[(0. 85 +0.29)v. s (0.71 +0.31)cm/W,P ＜0. 05 ) and length increment[(0. 76 + 0. 24) v. s ( 0. 65 + 0. 27 ) cm/W, P ＜ 0. 05 ) were significantly better in the infants fed with liquid milk in premature compared with the infants fed with full - term children formula. There was obvious difference in the incidence of EUGR between two groups ( P ＜ 0. 05 ) . Conclusion The growth and development of premature infants fed with liquid milk in premature were better than those of full - term in fant formula. Key words: Premature; Liquid milk; Nutrition; Growth and development;

Relation Between Serum Insulinlike Growth Factor‐1, Insulinlike Growth Factor Binding Protein‐2, and Insulinlike Growth Factor Binding Protein‐3 and Nutritional Intake in Premature Infants With Bronchopulmonary Dysplasia

ABSTRACTBackgroundThe usefulness of serum insulinlike growth factor (IGF)‐system–peptide measurement to assess the adequacy of nutritional intake in premature infants with chronic lung disease bronchopulmonary dysplasia (BPD) was assessed.MethodsTwenty‐nine premature infants had serial measurements taken of their serum IGF‐1, insulinlike growth factor binding protein (IGFBP)‐2, and IGFBP‐3 concentrations between 2 and 6 weeks of age. Regression analyses were used to examine the relation between nutritional parameters and IGF‐1, IGFBP‐2, and IGFBP‐3 concentrations in premature infants with and without BPD.ResultsThe group of infants with BPD (n = 12) did not differ from infants without BPD (n = 17) in gestational age or weight at entry, but gained less weight during the study period. In infants without BPD, IGF‐1 correlated positively with protein intake (r = 0.50) and caloric intake (r = 0.41) over the 3 days before sample collection and with weight change over the previous week (r = 0.46). In contrast, infants with BPD showed a significant correlation between IGF‐1 and weight change (r = 0.54) only. There was a significant negative correlation between IGFBP‐2 and protein intake in infants without BPD (r = −0.50) and in infants with BPD (r = −0.41). Negative correlations between IGFBP‐2 and both weight change (r = −0.64) and caloric intake (r = −0.43) over the previous week were found only in the group of infants without BPD. IGFBP‐3 correlated positively with weight changes and protein intake in both groups but correlated with caloric intake only in the group without BPD. Multiple regression analyses were used to determine significant independent variables associated with IGF‐1, IGFBP‐2, and IGFBP‐3. In infants without BPD, significant independent predictors of IGFBP‐2 were 7‐day weight change and 2‐day protein intake; 3‐day caloric intake was the only significant independent predictor for IGFBP‐3. For infants with BPD, 3‐day weight gain was the only independent variable associated with serum IGF‐1. Protein intake in the week before sample collection was an independent predictor of IGFBP‐2 and 3‐day weight change and 2‐day protein intake were independent predictors of IGFBP‐3.ConclusionsThese results confirm that changes in serum IGF‐1, IGFBP‐2, and IGFBP‐3 reflect the nutritional status of premature infants and demonstrate that the relation between these proteins and nutritional intake differs in premature infants with and without BPD. Refinement of these observations by future studies may permit a more accurate determination of the protein and caloric intake sufficient for growth and repair after injury in premature infants with lung disease.

Relation Between Serum Insulinlike Growth Factor-1, Insulinlike Growth Factor Binding Protein-2, and Insulinlike Growth Factor Binding Protein-3 and Nutritional Intake in Premature Infants With Bronchopulmonary Dysplasia

The usefulness of serum insulinlike growth factor (IGF)-system-peptide measurement to assess the adequacy of nutritional intake in premature infants with chronic lung disease bronchopulmonary dysplasia (BPD) was assessed. Twenty-nine premature infants had serial measurements taken of their serum IGF-1, insulinlike growth factor binding protein (IGFBP)-2, and IGFBP-3 concentrations between 2 and 6 weeks of age. Regression analyses were used to examine the relation between nutritional parameters and IGF-1, IGFBP-2, and IGFBP-3 concentrations in premature infants with and without BPD. The group of infants with BPD (n = 12) did not differ from infants without BPD (n = 17) in gestational age or weight at entry, but gained less weight during the study period. In infants without BPD, IGF-1 correlated positively with protein intake (r = 0.50) and caloric intake (r = 0.41) over the 3 days before sample collection and with weight change over the previous week (r = 0.46). In contrast, infants with BPD showed a significant correlation between IGF-1 and weight change (r = 0.54) only. There was a significant negative correlation between IGFBP-2 and protein intake in infants without BPD (r = -0.50) and in infants with BPD (r = -0.41). Negative correlations between IGFBP-2 and both weight change (r = -0.64) and caloric intake (r = -0.43) over the previous week were found only in the group of infants without BPD. IGFBP-3 correlated positively with weight changes and protein intake in both groups but correlated with caloric intake only in the group without BPD. Multiple regression analyses were used to determine significant independent variables associated with IGF-1, IGFBP-2, and IGFBP-3. In infants without BPD, significant independent predictors of IGFBP-2 were 7-day weight change and 2-day protein intake; 3-day caloric intake was the only significant independent predictor for IGFBP-3. For infants with BPD, 3-day weight gain was the only independent variable associated with serum IGF-1. Protein intake in the week before sample collection was an independent predictor of IGFBP-2 and 3-day weight change and 2-day protein intake were independent predictors of IGFBP-3. These results confirm that changes in serum IGF-1, IGFBP-2, and IGFBP-3 reflect the nutritional status of premature infants and demonstrate that the relation between these proteins and nutritional intake differs in premature infants with and without BPD. Refinement of these observations by future studies may permit a more accurate determination of the protein and caloric intake sufficient for growth and repair after injury in premature infants with lung disease.

Computerized TPN Ordering Saves Time and Optimizes Nutritional Therapy

Daily electrolyte and macronutrient changes to the parenteral nutrition (PN) order are required by the dietitian, neonatologists and pharmacists to optimize the nutritional status in premature infants. Our purpose was to determine if automation could accelerate the PN ordering and delivery process with concurrent improvements in the quality of nutritional therapy. A PN software program was designed for our neonatal intensive care unit (NICU) and a printer line linked the N1CU computers to the printer in pharmacy. Nutritional parameters and time variables were collected prospectively for two weeks on all NICU admissions receiving PN during both the manual phase (before automation) and computer phase of the study. These results are listed in the following table.

Effects of lactose intake on nutritional status in premature infants

Effects of lactose intake on nutritional status in premature infants

Effect of Total Parenteral Nutrition with Intravenous Fat on Lipids and High Density Lipoprotein Heterogeneity in Neonates

Plasma lipid concentrations and high density lipoprotein (HDL) subclass distributions were evaluated in 22 newborn infants nourished with intravenous (iv)-fat. The majority of infants were premature with respiratory distress syndrome. Based on baseline (prior to iv-fat) HDL subclass profiles determined by gradient gel electrophoresis (GGE), infants fell into two classes, one with two or more pronounced peaks within the normal HDL spectrum (group I, 17 subjects) and the other with highly unusual HDL distribution (group II, five subjects). Total plasma cholesterol increased in both groups during low and high fat intravenous feeding. HDL-cholesterol, however, did not change with iv-fat where mean values for groups I and II at baseline, iv-low fat and -high fat were: group I, 31.2 +/- 7.1, 30.0 +/- 8.8, and 36.6 +/- 16.7 mg/dl, respectively; and group II, 20.0 +/- 7.8, 20.2 +/- 7.4, and 19.8 +/- 8.8 mg/dl, respectively. Unlike HDL-cholesterol levels that remained constant with iv-fat, apolipoprotein (apo) AI concentrations increased significantly: group I, 73.0 +/- 11.0, 88.3 +/- 15.9, and 93.1 +/- 21.9 mg/dl, respectively; and group II, 31.8 +/- 10.5, 41.0 +/- 12.8, and 59.3 +/- 18.5 mg/dl, respectively. In group I infants, iv-fat is associated with an increase in larger-sized particles, particularly in the (HDL2b)gge range; in group II there is an increase in (HDL3b)gge and (HDL3c)gge components and a disappearance of particles that fall outside of the size range of normal HDL. In both groups, enteral feeding is associated with a further normalization of HDL subclass distribution. The aberrant GGE profiles and very low apoAI levels of group II infants at baseline were associated with unusual HDL morphology determined by electron microscopy where discoidal structures were prominent. With iv-fat, discoidal particles decline in number while normal spherical structures increase. Prevalence of discoidal HDL at baseline was associated with low concentrations of lecithin:cholesterol acyltransferase (LCAT) (1.12 +/- 0.5 micrograms/ml); with iv-fat this enzyme rose to 1.61 +/- 0.18 micrograms/ml. Increased LCAT is associated with the normalization of HDL morphology. It is likely that iv-fat improves the nutritional status of premature infants, thereby stimulating increased liver synthesis of important proteins, including apoAI and LCAT, associated with HDL metabolism.

Biochemical markers in the assessment of protein-calorie malnutrition in premature neonates.

We studied 135 premature newborns of 26 to 36 weeks gestation, divided into three groups: the control group, 66 premature infants with uncomplicated course; 51 premature neonates with appropriate birth weight for gestational age (AGA), who suffered from clinical problems that delayed oral feeding; and 18 premature infants with small birth weight for gestational age (SGA). When neonates of the same postnatal age were compared, prealbumin concentrations were the lowest in the SGA group at the third and fourth postnatal week. Although the AGA group had the most infants with serious illnesses and the lowest protein-calorie intakes, their prealbumin concentrations did not differ significantly from those of the control group. But when the infants of each group were subdivided on the basis of intakes and weight gain regardless of postnatal age, those with greater intakes showed significantly higher prealbumin values; however, in all groups, the infants with higher intakes were also significantly older. Total proteins and albumin showed similar changes in all groups. Prealbumin concentrations showed great interindividual variability in infants of the same postnatal age. We conclude that prealbumin, albumin, and serum total proteins are not sufficiently sensitive biochemical markers to assess alterations of the nutritional status of premature infants.

Plasma vitamin C levels are low in premature infants fed human milk

To evaluate the vitamin C nutritional status of premature infants, plasma vitamin C concentrations were measured in 7 neonates born before 32 wk of gestation and in 13 premature infants born at or after 32 wk of gestation. Samples of umbilical venous plasma from 14 full-term infants were analyzed to provide reference values. Oral feedings with pooled, pasteurized milk from human donors were initiated 1–3 days after birth and intake was gradually increased to 200 ml · kg · day during the second week. After 2 wk, the 13 larger infants received approximately half of their daily milk intake from their own mothers. Results showed that plasma concentrations of vitamin C decline rapidly after birth and approach very low levels in preterm infants fed pasteurized, pooled human milk.