Supplementation In Preterm Infants Research Articles

Thyroxine supplementation in preterm infants: critical analysis.

Thyroxine supplementation in preterm infants: critical analysis.

Calcium and phosphorus supplementation of human milk for preterm infants.

Preterm infants are born with low skeletal stores of calcium and phosphorus. Preterm human milk provides insufficient calcium and phosphorus to meet their estimated needs. To determine if addition of calcium and phosphorus supplements to human milk leads to improved growth and bone metabolism without significant adverse effects in preterm infants. The standard search strategy of the Cochrane Neonatal Review Group (NRG) was used. This includes searches of the Oxford Database of Perinatal Trials, MEDLINE, previous reviews including cross references, abstracts, conferences and symposia proceedings, expert informants, journal handsearching mainly in the English language. All trials utilizing random or quasi-random allocation to supplementation of human milk with calcium and/or phosphorus or no supplementation in preterm infants within a hospital were eligible. Data were extracted using the standard methods of the Cochrane NRG, with separate evaluation of trial quality and data extraction by each author and synthesis of data using relative risk and weighted mean difference. No studies which met selection criteria were identified. Excluded studies that were identified included minerals as one component of a multicomponent fortifier or reported only non-clinical outcomes (for example, urinary excretion of calcium). Two studies were excluded because of methodological concerns. There are no randomized controlled data evaluating clinical outcomes of calcium and phosphorus supplementation of human milk for preterm infants on which to base practice recommendations. Further trials should assess the clinical benefits and potential adverse effects of supplementation of human milk with minerals. This may best be done in the context of manipulation of the composition of human milk fortifiers containing multiple nutrients (carbohydrate, protein, and minerals).

Folate and Vitamin B12 Supplementation in Very Low Birth Weight Infants Treated With Erythropoietin: A Cautionary Note

To the Editor. Although iron supplementation is reported in detail in all studies of erythropoietin in very low birth weight infants, the dosages for folate and vitamin B12 are often not clearly mentioned, despite their considerable role in the prevention of anemia of prematurity.1 Vitamin B12 appears to be even more important than folate in this context.1 Vitamin B12 deficiency reduces the endogenous erythropoietin response to anemia,2 and thus could create a bias in favor of the treatment group in studies comparing erythropoietin to placebo. A wide range of dosages has been used for folate supplementation in preterm infants, most authors recommending 50–100 μg/day.1,3–5 Excessive plasma folate levels were found in preterm infants immediately after introduction of an oral daily dose of 1 mg.5 In their study on erythropoietin in very low birth weight infants, Donato et al6 did not report on vitamin B12 supplementation, and administered folate at an oral dose of 2 mg/day, exceeding the range of previously recommended dosages by …

Randomised controlled trial of oral vitamin A supplementation in preterm infants to prevent chronic lung disease

BACKGROUNDIntramuscular supplementation with vitamin A in large doses may reduce the incidence of chronic lung disease.AIMTo investigate whether oral supplementation with vitamin A would reduce the incidence of chronic lung...

Iron Supplementation in Preterm Infants: A Study Comparing the Effect and Tolerance of a Fe2+ and a Nonionic FeIII Compound

The more widely used divalent forms of iron (Fe2+) supplementation often lead to gastrointestinal symptoms in preterm infants although little is known about the use of nonionic trivalent iron preparations (FeIII) in these patients. It is especially under this nonionic form that dietary iron is available. For this reason, a randomized controlled study was undertaken to compare the efficacy and the extent of possible side effects in two groups of preterm infants. In one group, the elemental iron was given in the Fe2+ form, while the other group received a nonionic trivalent iron (FeIII) complexed with polysaccharides of low molecular weight. Both groups received 7.5 mg elemental iron daily. Measured parameters in the two study groups did not differ significantly throughout the study period of 14 weeks. Both forms of iron supplementation were well tolerated. However, vomiting, diarrhea, or constipation occurred slightly more often in the group receiving iron supplementation in the Fe2+ form without reaching statistical difference. The authors found a nonionic trivalent polysaccharide-iron complex given as iron supplementation as effective as the generally more favored ferrous sulphate. Since iron therapy is mandatory in the preterm infant, the use of trivalent iron complexes can be considered as a good alternative.

Fat supplementation of human milk for promoting growth in preterm infants

For term infants, human milk provides adequate nutrition to facilitate growth, as well as potential beneficial effects on immunity and the maternal-infant emotional state. However, the role of human milk in premature infants is less well defined as it contains insufficient quantities of some nutrients to meet the estimated needs of the infant. There are potential short term and long term benefits from human milk, although observational studies have suggested that infants fed formula have a higher rate of growth than infants who are breast fed. The main objective is to determine if addition of supplemental fat to human milk leads to improved growth and neurodevelopmental outcomes without significant adverse effects in preterm infants. The standard search strategy of the Cochrane Neonatal Collaborative Review Group was used. This includes searches of the Oxford Database of Perinatal Trials, MEDLINE, previous reviews including cross references, abstracts, conferences and symposia proceedings, expert informants, journal handsearching mainly in the English language. All trials utilizing random or quasi-random allocation to supplementation of human milk with fat or no supplementation in preterm infants within a hospital were eligible. Data were extracted using the standard methods of the Cochrane Neonatal Collaborative Review Group, with separate evaluation of trial quality and data extraction by each author and synthesis of data using relative risk and weighted mean difference. Results are available for only one small study evaluating the effects of fat supplementation. There are insufficient data to evaluate short term or long term growth outcomes and neurodevelopmental outcomes. There are insufficient data to comment on potential adverse effects. There is insufficient evidence to make recommendations for practice. Further research should evaluate the practice of supplementation of human milk with fat. This may best be done in the context of the development of multicomponent fortifiers. Both short term growth outcomes and long term growth and neurodevelopmental outcomes should be evaluated. Adverse effects should be evaluated.

Long-chain polyunsaturated fatty acid supplementation in preterm infants.

This section is under preparation and will be included in the next issue. The n-3 and n-6 essential fatty acids alpha linolenic acid and linoleic acid are the precursors of the n-3 and n-6 longchain polyunsaturated fatty acids (LCPUFA). Controversy exists over whether LCPUFA are essential nutrients for preterm infants who may not be able to synthesise sufficient amounts of LCPUFA to satisfy the needs of the developing brain and retina. The aim of this review is to assess whether supplementation of infant formula with LCPUFA is safe and of benefit to preterm infants. Trials were identified by MEDLINE and by checking reference lists of relevant articles and conference proceedings. All randomised trials of formula supplemented with LCPUFA and with clinical endpoints were reviewed. Eight randomised trials were identified. Five were assessed as being of high quality and one is awaiting assessment. Problems with the remaining two included a change in assessment methodology mid-study (Memphis 1996) and assessment methodology that deviated from generally accepted international standards (Bologna 1996). Studies from Dallas (Uauy et al 1990, Birch et al 1992, Hoffman & Uauy 1992, Uauy et al 1994) and Memphis (Carlson et al 1991, Carlson et al 1992, Carlson et al 1993, Werkman & Carlson 1996) suggest that early visual development is better in formula-fed infants who receive a LCPUFA supplement compared with those fed standard formula. However, the effects were not long-term, with no differences detected between groups after 4 months of age. The Bologna group (Fadelli et al 1996) reported some differences in the visual evoked potential at 3 months post-term but their methodology was questionable making interpretation of the data difficult. In the largest study (the Mead Johnson study, Hansen et al 1997), no difference in visual acuity was demonstrated between LCPUFA supplemented and control infants at 2 and 4 months post-term. The Memphis studies used the Fagan Infantest (Fagan 1970) to measure infant development and demonstrated lower novelty preferences (possibly predictive of lower intelligence) in preterm infants supplemented with LCPUFA. However, the supplemented infants had more looks at the novel stimulus and each look was of shorter duration which may represent more rapid visual information processing. Normalised weight (expressed as SD from the mean for age) was lower in preterm infants who were fed supplemented formula in the Memphis studies. No difference in growth between supplemented and control infants was documented in the Dallas, Bologna, Alberta (Clandinin et al 1997) and Wyeth (Vanderhoof et al 1997) studies while the Mead Johnson study documented higher weights in supplemented infants compared with controls at two months post-term. The Dallas study documented little effect of LCPUFA supplements on bleeding time and membrane fragility. No long-term benefit has been demonstrated for preterm infants receiving formula supplemented with LCPUFA. There is some evidence that n-3 LCPUFA supplementation of formula increases the early rate of visual maturation in preterm infants. Supplementation of formula with n-3 and n-6 LCPUFA does not impair the growth of preterm infants.

Enteral yeast–selenium supplementation in preterm infants

AIMTo study the bioavailability of selenium enriched yeast in preterm infants living in a low selenium area (Hungary).METHODSThirty six preterm infants were randomly assigned to two groups at birth with...

PSYCHOMOTOR DEVELOPMENT OF TERM INFANTS RECEIVING LC-PUFA-ENRICHED FORMULA IN A PROSPECTIVE, RANDOMIZED, DOUBLE BLIND STUDY

Aims: Recent clinical studies have shown the importance of dietary LC-PUFA supplementation in preterm infants. Our current study evaluates whether n-3 and n-6 LC-PUFA are required in formula-fed term infants for psychomotor development in the first 18 months of life. We report the first results of 2, 4 and 9 months of age. Methods: A total of 85 healthy term infants were included in the study. They received human milk (HM) or were randomized to a conventional formula (FM-) or LC-PUFA enriched formula (FM+) (docosahexaenoic acid, DHA: 0.5%; arachidonic acid, AA: 0.11% of total lipids). For psychomotor development the Griffiths developmental test was used. Fatty acids of red blood cells (RBC) and plasma phospholipids (PL), plasma triglycerides and sterol esters were seperated by high-resolution gas-liquid chromatography. Results: Psychomotor development, body weight, heigth, head circumferences and skin fold measurements were not significantly different among the dietary groups at 2, 4 and 9 months. The levels (%(wt/wt), medians, interquartile ranges) of selected fatty acids found in umbilical cord blood (UCB) and at 2 and 4 mon of age are shown in the table. Conclusions: Supplementation of formula with 0.5% DHA and 0.11% AA of total lipids caused significantly higher levels of DHA in RBC-PL in term infants in comparison to breast-fed infants and conventional formula fed infants. In plasma lipids AA content was significantly lower. Psychomotor development was not affected by LC-PUFA supplementation.

A comparison of oral and intravenous iron supplementation in preterm infants receiving recombinant erythropoietin

OBJECTIVE: To determine whether intravenously administered iron supplements would improve the hematologic response to recombinant erythropoietin in stable preterm infants. METHODS: Forty-two preterm infants (<33 weeks' gestation, birth weight <1500 gm, hematocrit <38%) were treated with recombinant human erythropoietin (Eprex), 600 U/kg per week, and randomly assigned to receive either an oral preparation of ferrous lactate (elemental iron, 12 mg/kg per day) or an intravenous preparation of iron sucrose (6 mg/kg per week). RESULTS: Hematocrits, reticulocyte counts, and transfusions were similar in the oral group (OG) and the intravenous group (IVG). However, markedly higher serum ferritin concentrations were noted in the IVG ( p <0.001), and by completion of the study the arithmetic mean values were 265 ± 127 μg/L versus 137 ± 65 μg/L in the IVG and the OG, respectively. The numbers of hypochromic erythrocytes increased in both groups during the study but were significantly higher in the OG ( p = 0.04). Mean daily weight gain in the IVG (27 ± 6.4 gm/day) was greater than in the OG (22.9 ± 4.78 gm/day; p = 0.04). CONCLUSIONS: High doses of both orally administered iron and intravenously administered iron sucrose appear to supply sufficient iron for erythropoiesis in stable infants. Storage iron may become depleted after oral supplementation. The intravenous preparation appears to be safe and maintains serum ferritin concentrations, and it may be indicated for patients with low ferritin levels and for those not established on enteral feedings. (J P EDIATR 1996;129:258-63)

A randomized clinical trial of parenteral selenium supplementation in preterm infants

A randomized clinical trial of parenteral selenium supplementation in preterm infants

Immediate commencement of amino acid supplementation in preterm infants: Effect on serum amino acid concentrations and protein kinetics on the first day of life

To determine whether the general reluctance to begin amino acid administration to preterm infants from birth onward might lead to loss of lean body mass and impairment of growth, we measured amino acid levels and protein kinetics in 18 preterm infants. Nine infants received amino acids (1.15 ± 0.06 gm · kg -1 · day -1) and glucose (6.05 ± 1.58 gm · kg -1 · day -1), whereas the other nine infants received only glucose (6.48 ± 1.30 gm · kg -1 · day -1) from birth onward. Protein kinetics on the first postnatal day were measured with a stable isotope dilution technique with [1- 13C]leucine as a tracer. No statistically significant differences were noted in blood pH, base excess, urea concentration, or glucose levels. Both total amino acid concentration and total essential amino acid concentration were significantly lower and were below the reference range in the nonsupplemented group. Plasma amino acid levels of five essential amino acids (methio-nine, cystine, isoleucine, leucine, arginine) were below the reference range in the nonsupplemented group, whereas only cystine was below the reference range in the supplemented group. Nitrogen retention was improved significantly by the administration of amino acids (-110 ± 44 mg nitrogen per kilogram per day in the glucose-only group vs +10 ± 127 mg nitrogen per kilogram per day in the group given glucose and amino acids; p = 0.001); leucine oxidation was not significantly increased in the supplemented group (41 ± 13 μmol · kg -1 · hr -1 vs 46 ± 16 μmol · kg -1 · hr -1). Leucine balance also improved significantly (-41 ± 13 μmol ·kg -1 · hr -1 vs -8 ± 16 μmol · kg -1 · hr -1; p = 0.01) because of a combination of an increased amount of leucine being used for protein synthesis and a lower amount of leucine coming from protein breakdown. Plasma cystine concentration, the only amino acid below the reference range in the supplemented group, was highly predictive for protein synthesis in that group. We conclude that the administration of amino acids to preterm infants from birth onward seems safe and prevents the loss of protein mass. (J P EDIATR 1995;127:458-65)

250 RANDOMIZED PLACEBO-CONTROLLED TRIAL OF THYROXINE ADMINISTRATION TO INFANTS OF LESS THAN 30 WEEKS GESTATIONAL AGE IN RELATION TO MORTALITY AND MORBIDITY

BACKGROUND: Transient hypothyroxinemia is a very frequent occurring phenomenon in very preterm infants. Low T4 levels are related to poor developmental outcome. However, T4 treatment in very preterm infants is still controversial.AIM: To improve developmental outcome at 24 months. Preliminary analysis of clinical outcome is now presented.METHODS: 193 infants <30 wks GA were randomly assigned to T4(T)- or placebo(P) treatment, which was started 12-24 hrs after birth in a dosage of 8 μg/kg birthweight/day during the first 6 weeks after birth.RESULTS: The T-and P-groups did not differ regarding the following items: Mean GA, mean birthweight, number of SGA-infants, sex ratio, mean APGAR-score at 5′, and uBe of antenatal steroids.CONCLUSIONS: This is the first large trial of T4 supplementation in preterm infants, studying the short- and longterm effects of thyroxine treatment. Although we did not find a statistically significant improvement of mortality and morbidity, T4 treated infants tended to have better survival and less clinical problems. A multi-centre trial is needed to investigate the importance of our clinical outcome data.

Comparison of enteral and intramuscular vitamin A supplementation in preterm infants

Vitamin A deficiency associated with preterm delivery is not readily reversible using the recommended supplement of 1500 IU per day. It has been reported that 2000 IU of intramuscular vitamin A administered on alternate days for 28 days will correct the deficiency. The objective of this study was to compare this regime with the practice in our nursery of giving 5000 IU of vitamin A per day with the early introduction of feeds. The vitamin A status of ten preterm infants (mean gestation 30.5 weeks) who received intramuscular vitamin supplementation was compared with that of nine infants (mean gestation 30.7 weeks) given enteral vitamin A. Vitamin A status was evaluated on the 32nd day of life using plasma retinol and retinol-binding protein (RBP) concentrations and a modified relative dose response (RDR) test. Plasma retinol and RBP concentrations were similar in the two groups shortly after birth revealing vitamin A deficiency. By the 32nd day of life, plasma retinol and RBP concentrations had risen significantly in both groups and in 70% the modified RDR was normal. Differences between the groups were not observed irrespective of the method of vitamin A administration. None of the infants developed clinical or biochemical vitamin A toxicity. In most preterm infants who tolerate feeds, vitamin A deficiency can be corrected safely by supplementing the feeds with 5000 IU of vitamin A per day.

Taurine and BAER Maturation

A blinded randomized trial of taurine supplementation of preterm infants was conducted at the Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, and Ross Laboratories, Columbus, Ohio.