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Abstract Body

Background

Neonatal homecare for preterm infants is a method of supporting families in the home while monitoring infant growth and tube weaning parallel to establishment of breastfeeding. Telehealth can be used to deliver specialist care remotely, using online communications methods. This study explored parental experiences and infant growth and breastfeeding rates after neonatal tele-homecare (NTH).

Methods

A telehealth service was developed in collaboration with parents of preterm infants and clinicians from the neonatal intensive care unit (NICU). An observational study to test the telehealth service in a clinical setting of neonatal homecare was conducted including 96 preterm infants. Interviews were carried out with 49 of their parents. Historical controls of preterm infants were used for comparison of infant growth and breastfeeding rates.

Results

A total of 381 planned videoconferences between the NICU and parents were carried out in the study period complemented with 245 planned visits in the NICU. Parents felt that NTH promoted their role as primary care givers and independent decision-making gave the experience of a strong parent-infant relation. Having access to telehealth was a personalized method for linking to specialists in the NICU for support. The was no significant difference in weight-for-age z-score and breastfeeding rates at discharge compared to historical controls and readmission rates were low.

Conclusion

The use of telehealth in neonatal homecare may be an appropriate model of care for the management of clinically stable preterm infants outside the hospital environment.

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Background and aims: The effects of iron deficiency on the developing brain are permanent and life-altering. Iron supplementation is recommended for preterm infants, but there are few data on the prevalence of iron deficiency for newborns with mild-to-moderate prematurity and small for gestational age (SGA). The aim of the study is to investigate the efficacy of prophylaxis with Sucrosomial^® Iron (SI) in mild-to-moderate preterm and in SGA infants.

Method: Interventional, placebo-controlled, randomized, double-blind, multicenter study. Infants born from 32⁺⁰ to 36⁺⁶ weeks of gestational age (both adequate weight and SGA) and SGA infants born at term were included. Recruited newborns were divided into 3 groups: Group A: placebo, Group B: 1.4 mg/kg/day of elemental iron from SI, Group C: 2.8 mg/kg/day of elemental iron from SI, from the 1^st to the 6^th month of life. Mild preterm infants <34⁺⁰ and SGA <36⁺⁶ weeks were excluded from the placebo arm.

Results: data from 116 infants are reported. Blood parameters at 6 months are showed in table 1 for all infants and for the subgroup of breastfed ones.

In conclusion data of this ad interim analysis show that both treatments with SI ameliorate blood parameters in SGA and mild-to moderate preterm infants compared to placebo. The benefit of SI is better for those breastfed infants, who didn’t receive other iron supplements from milk formula. More data and deeper analysis are needed to establish the best dose of Sucrosomial^® Iron for each population.

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Background: In nutritional studies, growth is assessed by using weight, weight gain, growth rate, percentiles, or z-scores, which may not accurately reflect individual growth potential. Individualized growth trajectories (GTC) are a novel growth curve concept for preterm infants obtained on the basis of normal physiology (www.growthcalculator.org).

Objective: To compare methods of growth assessment in relation to macronutrient intake and metabolic markers using data from our recent RCT of target fortification (TFO) of breast milk (BM).

Methods: Single-center RCT of preterm infants (GA<30 weeks) receiving either standard fortification (SF) or SF+TFO. Delta W (the deviation between the GTC weight and the actual weight), weight, percentiles and z-scores at outcome time points. These parameters were correlated with intake of fat, protein, carbohydrate, and energy, blood urea, triglycerides. Regression analyses were performed at study day 14 and 21, at 36 weeks PMA and at discharge using R statistics.

Results: The RCT included n=103 with a BW: 980±240g, GA: 27.2±1.5 weeks and mean start of intervention at day of life 24±7. Mean intake of protein, carbohydrate, fat, and energy was 4.1±0.5, 12.2±1.6, 7.3±0.9 g/kg/d, 131±14 kcal/kg/d. Regression between macronutrient intake and outcome measurements at study day 14 and 21 showed significantly higher R for delta W (Figure 1 and 2).

Conclusion: GTC considers the physiological growth potential, provides a stronger determination (R²) between nutrition and other outcome variables and may allow earlier identification from the deviation of the individual growth curve.

Figure1:

Figure 2:

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Introduction:

Achieving ideal growth and body composition in preterm-born infants is desirable, as early development is related to long-term health outcomes. To create optimal growth in preterm infants, parameters impacting postnatal growth in healthy term-born infants have to be studied as a reference model. Furthermore, the entirety of the interplay between nutrition, hormonal and metabolic responses and resulting growth has to be established. Therefore, the aim of this study is to analyze this bioenergetic homeostasis in late-preterm and term-born infants to create a model for normal growth.

Methods:

This observational study collected data from healthy infants born at 34-42 weeks of gestation at three time points: t₁ = 0-5 days of life (DOL), t₂ = 55-65 DOL, t₃ = 115-125 DOL. Anthropometry (weight, length, BMI, head-circumference, skinfold-thickness), body composition (fat-mass, lean-mass, FMI, FFMI, % body-fat), hormonal levels (IGF-1, IGF-2, IGFBP-2, IGFBP-3, insulin, leptin), biomarkers of metabolism (protein, albumin, triglyceride, cholesterol) and the energy expenditure were measured.

Results:

In 94 infants (gestational age: 39.6±1.3weeks, birth weight 3330±570g) and 18 preterm infants (35.0±1.0 weeks, 2520±660g) positive associations between body composition and growth promoting hormones were established. Body compositional data was lower in the preterm-born group. Additionally, a relationship between lean mass and energy expenditure was found. Formula-fed infants had higher IGF levels compared with breast milk.

Conclusion:

The established interactions of multiple parameters may allow for a possibility to fine-tune growth. At this point, the observed interactions need further studies, especially including preterm-born infants at different postmenstrual ages and levels of maturity.