Background and Aims

Although Human milk (HM) is considered the ideal source of nutrition for all infants, it fails to provide sufficient protein/non-protein calories in term infants with surgical conditions. Current practice is formula fortification, which carries risk for deleterious outcomes like necrotizing enterocolitis (NEC).

Methods

Two multicenter trials were conducted in infants with single ventricle physiology (SVP) (n=107) or congenital gastrointestinal disorders (CGD) (n=151). Experimental groups were fed exclusive human milk (EHM) diets of mother’s own milk (MOM), pasteurized donor human milk (PDHM) fortified with novel human milk-based fortifier (HMBF) (PBCLN-002) formulated for term infants. Control diet consisted of MOM, cow’s milk fortifier and/or formula.

Results

Necrotizing enterocolitis (NEC) rates were reduced to 1.8% and 2.0% for the EHM group as compared to 3.6% and 7.3% in control groups for SVP and CGD respectively.

Conclusions

In neonates with high-risk surgical conditions of SVP or CGD, PBCLN-002 demonstrated increased growth velocity and a substantial decrease in the incidence of NEC. The effect on weight gain and intestinal disease may translate into beneficial long-term neurodevelopment.

Background and Aims

Air-displacement plethysmography(ADP) is common method to measure body composition(BC) in neonates. Bioelectric lmpedance (BIA) is also available for neonates. Aim1)to analyze the workload for weekly measurement of BCT, 2)to assess the applicability of ADP in infants in different age groups, 3)to compare BC with current reference curves, 4)to compare BC measured with BIA and ADP.

Methods

This QI project was conducted (Jan to Sept 2021) with weekly ADP(PeaPod®) of clinically stable infants without respiratory support. In a subgroup, BIA(BioScan touch i8-nano) from the first week of life were analyzed daily and weekly thereafter. Individual trajectories for fat mass(FM%), fat mass(FM), and fat-free mass(FFM)

Results

386 tests available from 168 infants. ADP testing was at significantly later weeks of life in infants<28weeks compared with infants>32weeks(Fig.1).

Time required for ADP was 7min, 11(7-15) ADP measurements resulted in a workload of 77(49-105)min for each of two operators. BIA took 3min with one study nurse. Individual FM and FFM trajectories measured with the ADP were parallel to reference curves. The simultaneous BIA and ADP measurements showed differences (FM:14±70g, FM%:5±3%, FFM:11±70g)(Fig. 2). BIA had smaller 95%CI of FM%(10-11%) compared to ADP(11.5-13.5%).

Conclusions

ADP and BIA have been successfully integrated into routine clinical practice with reasonable workload. The later availability of ADP during NICU stay limits narrows window for nutritional interventions. Parallel BC trajectories to reference percentiles indicate that our cohort studied had a similar growth to the reference cohort. The BIA asked potential BC measurements over the entire hospital stay. The validity of BC measurements needs further validation.

Background and Aims

Preterm infants are at risk of malnutrition and growth failure, among other neonatal morbidities. This study aimed to evaluate whether implementation of a nutrition care bundle is associated with growth and morbidity in very preterm infants.

Methods

This before-and-after study compared 87 very preterm infants (<32 gestational weeks) born 2018 (BG) with 75 infants born 2020 (AG), all treated at the same neonatal intensive care unit in the Czech Republic. A nutrition care bundle was implemented during 2019, comprising daily calculation of fluids using an online software, targeted fortification of breastmilk, and use of a standard concentrated parenteral solution. Anthropometric data was registered once weekly and perinatal data was prospectively registered for both groups.

Results

There were no differences in baseline characteristics between the groups. During postnatal days 1-14, parenteral fluid intake was significantly lower in the AG compared to the BG and conversely, enteral fluid intake was significantly higher in the AG. Weight z-scores decreased significantly less from birth to postmenstrual age 36 weeks in the AG (–0.8 [IQR –1.3 to –0.5]) compared to the BG (–1.5 [IQR –2.0 to –1.2]) and head circumference z-scores decreased significantly less in the AG (–0.8±0.9) compared to the BG (–1.6±1.1). A decrease in the rate of treated patent ductus arteriosus was noted in the AG (P<0.001).

Conclusions

Implementation of nutritional care bundle was associated with improved postnatal growth and may reduce treatment-requiring patent ductus arteriosus in very preterm infants.

Background and Aims

Historical reports suggest that infants born small for gestational age (SGA) are at increased risk for adiposity at older ages. The objective was to assess the association between SGA births and later adiposity among preterm births.

Methods

Data Sources searched to October 2022: MEDLINE, EMBASE and CINAHL (PROSPERO CRD42020162353). Studies were included if they reported body mass index or body fat for participants born preterm with SGA or non-SGA births. All screening and extraction steps were conducted in duplicate by two reviewers. Risk of bias was assessed using the Risk of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. Data were pooled in meta-analysis using random-effects models. We explored potential sources of heterogeneity.

Results

We found no meaningful difference in later measures of adiposity between preterm infants with and without SGA status at birth. Meta-analysis of 39 studies showed that preterm SGA birth, compared to preterm non-SGA birth, was not associated with higher BMI later in life with mean differences: -0.21 (95% CI: -0.29, 0.14, n=21,508, 31 studies, I² = 23%), percent body fat (fat -0.02 [-0.16, -0.13], n= 797, 10 studies, I² = 0%) or truncal fat percent -0.09 (95% CI: -0.40, 0.23, n=176, 3 studies, I² = 0%).

Conclusions

Evidence indicates that preterm infants born SGA are not at increased risk of developing higher adiposity or truncal fat as compared to those born non-SGA preterm infants.

Background and Aims

Human milk (HM) is recommended for extreme preterm infants. As breastmilk is highly variable in nutrient content, fortification of (HM) is recommended to prevent extra-uterine growth retardation. Our study evaluates the impact of targeted fortification on preterm weight gain by tailoring single macronutrients.

Methods

This randomized controlled trial recruited preterm infants (≤ 32 weeks of gestation) within the first 7 days of life. After reaching 80 ml/kg/day of enteral feeding, patients were randomised to receive standard fortification-SF or targeted fortification- TF (standard fortification plus protein, carbohydrates, or lipids). The intervention continued until 37 weeks of post-conception age, or hospital discharge. The primary outcome measure was velocity of weight, length and head growth until 36 weeks postconceptional age or discharge. Secondary outcomes were incidence of necrotizing enterocolitis, sepsis, retinopathy of prematurity, and bronchopulmonary dysplasia.

Results

Baseline characteristics, morbidities and total enteral nutrition did not differ (SF=21, TF=18). Eight infants required supplementation in the TF group. Macronutrient milk composition did not differ between the groups, apart from glucose, which was lower in TF. The SF had a lower macronutrient intake, but a higher weight gain (16.84 vs. 15.76, mean difference -1.08 g/kg/d 95% CI -6.39;4.24) and body weight, but this was not statistically significant. The drop-out rate was 5 vs. 7 for the TF and SF respectively.

Conclusions

Growth was not improved by single nutrient targeted fortification. Additionally, TF turned out to be laborious, required frequent milk sampling and was inconvenient for mothers, which maybe the reason why this practice is limited to research settings.

Background and Aims

Background: Focus on preterm nutrition strategies are imperative. Extrauterine growth restriction (EUGR) is a clinically relevant, but seemingly elusive consequence that is often used to benchmark and compare outcomes. Low-middle-income countries make fastidious attempts to optimise nutrition of possibly already nutritionally-compromised fetuses

Aims:To study effect of a multipronged “Rational Nutrition care bundle”(RNCB) in very preterm infants on EUGR; in a tertiary-care unit of South-India.

Methods

This before-after observational analytical study was designed to compare 2 groups of those <32 weeks’ gestation who completed care in the unit: Before RNCB(retrospective: BRNCB); and After RNCB(prospective:ARNCB). RNCB constituted of 3 key interventions: (a) Aggressive parenteral nutrition (PN) with high dose amino acids and lipids from day 1, (b) “rapid escalation” enteral feed regimens including earlier introduction of human milk fortifier than conventional practice (at 40 ml/kg/day feeds itself), (c) structured oromotor stimulation to promote oral feeding and colostrum mouth painting. EUGR was defined as more than -1z score difference in weight for postmenstrual age(PMA) at discharge and at birth.

Results

Data of 81 babies was retrieved for BRNCB group; 80 were included in prospective ARNCB group. EUGR proportions were not statistically significant between groups [BRNCB 62%, ARNCB 56.2%; OR 1.32 (0.67-2.6), p=0.42]. Full oral feeds were achieved at earlier PMA after RNCB.

Conclusions

EUGR rates were not reduced significantly after implementation of RNCB. Full oral-feeds were achieved earlier after RNCB implementation. RNCB including aggressive PN and early HMF is safe. Scientists may need to introspect on timing of EUGR diagnosis; other strategies to optimise body compositions.

Background and Aims

Plasma amino acid (AA) profiles in parenteral nutrition (PN) dependent preterm infants (PI) consistently show overprovision of essential AA (EAA) and arginine deficiency. This may have implications for immune/inflammatory responses. PN arginine supplementation is recommended in international guidelines. Aim: To compare plasma AA profiles on d10 in PI receiving standard PN (6.3g/100gAA arginine) and a range of arginine supplemented PN (12-15;18g/100gAA).

Methods

PI were allocated (according to intervention PN availability) in a series of 3 separate physiological (transcriptomic) studies to receive standard PN or arginine supplemented PN using identical clinical protocols. Clinical, nutritional and biochemical data were collected. Point of care testing was used to measure ammonia levels. Plasma AA levels were measured on d10 using ion exchange chromatography.

Results

The table shows the mean (sd) data for 3 groups after combining the 3 studies. There were statistically significantly higher mean plasma arginine and lower plasma EAA levels comparing control and arginine 18g/100gAA groups. Arginine 12-15g/100gAA group data support a dose dependent relationship between arginine supplementation and plasma arginine/EAA.

*controls versus 18g/100gAA arginine

Conclusions

PN arginine supplementation of 18g/100gAA corrects arginine deficiency and reduces overprovision of EAA in the PI plasma AA profile.

Background and Aims

Practices differ between Neonatal Intensive Care Units (NICUs) in regard to the use of fortification. It is unclear if enteral energy intakes above 140 kcal/kg/day result in a higher weight gain in extremely preterm infants (EPT).

Methods

Daily nutritional and anthropometric data were obtained from clinical records for non-small-for-gestational-age Swedish EPT infants born week 26+0 to 27+6. Included infants were treated at NICU A (n=25) or NICU B (n=39). The main outcome was change in standard deviation scores (ΔSDS) between gestational weeks 29+0 and 34+0.

Results

The mean gestational age was 26.9 (±0.438 SD) postmenstrual weeks at birth, and mean birthweight 966 (±109 SD) grams. Preliminary results showed no significant baseline differences in gestational age or birthweight. Between post menstrual weeks 29+0 and 33+6, the energy intake was significantly higher at NICU B: mean (SD) 149 (±14.9) vs 129 (±12.0) kcal/kg/day, p=<0.001. This was driven by a higher fat intake at NICU B: mean (SD) 7.97 (±1.05) vs 6.03 (±0.94) grams/kg/day, p=<0.001.

There were no significant differences in ΔSDS for weight (p=0.809), length (p=0.530) or head circumference (p=0.268) between the two NICUs. Also, no significant differences in weight at postmenstrual week 34+0 was observed: 2037 grams (SD 341) at NICU A and 2022 grams (SD 214) at NICU B.

Conclusions

Nutritional practices differ between Swedish NICUs which may be explained by differences in fortification practices and clinical traditions. Despite the considerable differences in energy and fat intake no difference in weight, length or head circumference was seen between gestational weeks 29+0 and 34+0.