scholarly journals Macronutrient Intake from Human Milk, Infant Growth, and Body Composition at Term Equivalent Age: A Longitudinal Study of Hospitalized Very Preterm Infants

Nutrients ◽  
2020 ◽  
Vol 12 (8) ◽  
pp. 2249 ◽  
Author(s):  
Mandy Belfort ◽  
Sara Cherkerzian ◽  
Katherine Bell ◽  
Betina Soldateli ◽  
Erika Cordova Ramos ◽  
...  
Keyword(s):  
Longitudinal Study ◽  
Human Milk ◽  
Preterm Infants ◽  
Fat Mass ◽  
Fat Free Mass ◽  
Macronutrient Intake ◽  
Very Preterm Infants ◽  
Equivalent Age ◽  
Growth Outcomes ◽  
Z Scores

The variable macronutrient content of human milk may contribute to growth deficits among preterm infants in the neonatal intensive care unit (NICU). In a longitudinal study of 37 infants < 32 weeks gestation, we aimed to (1) determine the between-infant variation in macronutrient intake from human milk and (2) examine associations of macronutrient intake with growth outcomes. We analyzed 1626 human milk samples (median, 43 samples/infant) with mid infrared spectroscopy. Outcomes at term equivalent age were weight, length, head circumference, fat mass, and fat-free mass. Median (range) intakes from human milk were: protein 1.37 (0.88, 2.43) g/kg/day; fat 4.20 (3.19, 5.82) g/kg/day; carbohydrate 8.94 (7.72, 9.85) g/kg/day; and energy 82.5 (68.7, 99.3) kcal/kg/day. In median regression models adjusted for birth size and gestational age, and other covariates, greater intakes of fat and energy were associated with higher weight (0.61 z-scores per g/kg/day fat, 95% CI 0.21, 1.01; 0.69 z-scores per 10 kcal/kg/day, 95% CI 0.28, 1.10), whereas greater protein intake was associated with greater body length (0.84 z-scores per g/kg/day protein, 95% CI 0.09, 1.58). Higher fat intake was also associated with higher fat mass and fat-free mass. Macronutrient intakes from human milk were highly variable and associated with growth outcomes despite routine fortification.

scholarly journals Customized Human Milk Fortification Based on Measured Human Milk Composition to Improve the Quality of Growth in Very Preterm Infants: A Mixed-Cohort Study Protocol

2021 ◽  
Vol 18 (2) ◽  
pp. 823
Author(s):  
Manuela Cardoso ◽  
Daniel Virella ◽  
Israel Macedo ◽  
Diana Silva ◽  
Luís Pereira-da-Silva
Keyword(s):  
Human Milk ◽  
Preterm Infants ◽  
Fat Mass ◽  
Study Protocol ◽  
Milk Composition ◽  
Fixed Dose ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Pea Pod

Adequate nutrition of very preterm infants comprises fortification of human milk (HM), which helps to improve their nutrition and health. Standard HM fortification involves a fixed dose of a multi-nutrient HM fortifier, regardless of the composition of HM. This fortification method requires regular measurements of HM composition and has been suggested to be a more accurate fortification method. This observational study protocol is designed to assess whether the target HM fortification method (contemporary cohort) improves the energy and macronutrient intakes and the quality of growth of very preterm infants, compared with the previously used standard HM fortification (historical cohorts). In the contemporary cohort, a HM multi-nutrient fortifier and modular supplements of protein and fat are used for HM fortification, and the enteral nutrition recommendations of the European Society for Paediatric Gastroenterology Hepatology and Nutrition for preterm infants will be considered. For both cohorts, the composition of HM is assessed using the Miris Human Milk analyzer (Uppsala, Sweden). The quality of growth will be assessed by in-hospital weight, length, and head circumference growth velocities and a single measurement of adiposity (fat mass percentage and fat mass index) performed just after discharge, using the air displacement plethysmography method (Pea Pod, Cosmed, Italy). ClinicalTrials.gov registration number: NCT04400396.

scholarly journals Extremely Preterm Infants Have a Higher Fat Mass Percentage in Comparison to Very Preterm Infants at Term-Equivalent Age

2020 ◽  
Vol 8 ◽  
Author(s):  
Marlies Bruckner ◽  
Zahra Khan ◽  
Christoph Binder ◽  
Nicholas Morris ◽  
Bernadette Windisch ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Fat Mass ◽  
Mass Percentage ◽  
Very Preterm Infants ◽  
Equivalent Age ◽  
Very Preterm ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

scholarly journals Growth of Very Preterm Infants in a Low-Resourced Rural Setting after Affiliation with a Human Milk Bank

Children ◽  
2022 ◽  
Vol 9 (1) ◽  
pp. 80
Author(s):  
Chia-Huei Chen ◽  
Hui-Ya Chiu ◽  
Szu-Chia Lee ◽  
Hung-Yang Chang ◽  
Jui-Hsing Chang ◽  
...  
Keyword(s):  
Human Milk ◽  
Preterm Infants ◽  
Rural Areas ◽  
Z Score ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Growth Outcomes ◽  
Milk Bank ◽  
Human Milk Bank ◽  
Milk Banks

The extrauterine growth restriction (EUGR) of very preterm infants has been associated with long-term complications and neurodevelopmental problems. EUGR has been reported at higher rates in low resource settings. There is limited research investigating how metropolitan human milk banks contribute to the growth outcomes of very preterm infants cared in rural areas. The setting of this study is located at a rural county in Taiwan and affiliated with the Taiwan Southern Human Milk Bank. Donor human milk was provided through a novel supplemental system. A renewal nutritional protocol was initiated as a quality improvement project after the affiliated program. This study aimed to compare the clinical morbidities and growth outcome at term equivalent age (TEA) of preterm infants less than 33 weeks of gestational age before (Epoch-I, July 2015–June 2018, n = 40) and after the new implementation (Epoch-II, July 2018–December 2020, n = 42). The Epoch-II group significantly increased in bodyweight z-score at TEA ((−0.02 ± 1.00) versus Epoch-I group (−0.84 ± 1.08), p = 0.002). In multivariate regression models, the statistical difference between two epochs in bodyweight z-score changes from birth to TEA was still noted. Modern human milk banks may facilitate the nutritional protocol renewal in rural areas and improve the growth outcomes of very preterm infants cared for. Establishing more distribution sites of milk banks should be encouraged.

scholarly journals Metabolic Hormone Profiles in Breast Milk From Mothers of Moderate-Late Preterm Infants Are Associated With Growth From Birth to 4 Months in a Sex-Specific Manner

2021 ◽  
Vol 8 ◽  
Author(s):  
Laura Galante ◽  
Clare M. Reynolds ◽  
Amber M. Milan ◽  
Tanith Alexander ◽  
Frank H. Bloomfield ◽  
...  
Keyword(s):  
Body Composition ◽  
Preterm Infants ◽  
Fat Mass ◽  
Fat Free Mass ◽  
Late Preterm ◽  
Linear Regression Models ◽  
Late Preterm Infants ◽  
Specific Effects ◽  
Z Scores ◽  
Discharge From Hospital

Background: Differing environmental conditions experienced by mother-infant dyads may influence composition of the milk received by the infant. As a consequence, diverse milk compositional profiles may contribute to different postnatal outcomes, especially in infants facing adverse perinatal environments. We investigated whether variability in milk concentrations of key metabolic hormones is associated with different growth outcomes in infants born preterm, a perinatal complication known to impact on infant growth.Methods: Human milk samples were collected from 169 mothers of 191 infants enrolled in the DIAMOND trial, a randomized trial of nutrition for moderate-late preterm infants, at 5 and 10 days postpartum and again at 4 months' corrected age and analyzed for leptin, adiponectin and insulin-like growth factor (IGF)-1. Infant weight and body composition were measured at birth, discharge and 4 months' corrected age. Multiple linear regression models were used to examine correlations between milk hormone concentrations, weight z-scores and body composition at discharge and 4 months' corrected age, and weight gain from birth to 4 months' corrected age. Sex-specific interactions were examined.Results: Higher milk IGF-1 concentrations on day 5 after birth were associated with greater infant fat-free mass at 4 months' corrected age. Milk IGF-1 concentrations at 4 months were positively associated with fat mass and fat-free mass at 4 months in boys but not girls. Milk leptin concentrations on day 5 after birth were positively associated with fat mass at discharge from hospital, but negatively associated with fat mass at 4 months' corrected age. No significant association was found for milk adiponectin concentrations.Conclusion: Milk IGF-1 and leptin concentrations in mothers of moderate-late preterm babies are associated with different growth and body composition through to 4 months' corrected age and these associations are often different in boys and girls. The sex-specific effects of nutrient and hormone exposure during early life in preterm infants warrants further investigation to optimize the nutritional care these infants receive, particularly in hospital, where the same nutrition is provided to boys and girls.

Early Electroencephalography Suppression and Postnatal Morbidities Correlate with Cerebral Volume at Term-Equivalent Age in Very Preterm Infants

Neonatology ◽  
2017 ◽  
Vol 113 (1) ◽  
pp. 15-20
Author(s):  
Sverre Wikström ◽  
Holger Hövel ◽  
Ingrid Hansen Pupp ◽  
Vineta Fellman ◽  
Petra S. Hüppi ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Very Preterm Infants ◽  
Equivalent Age ◽  
Very Preterm

scholarly journals Cytotoxic Lactalbumin-Oleic Acid Complexes in the Human Milk Diet of Preterm Infants

Nutrients ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 4336
Author(s):  
Katherine E. Chetta ◽  
Joseph L. Alcorn ◽  
John E. Baatz ◽  
Carol L. Wagner
Keyword(s):  
Oleic Acid ◽  
Human Milk ◽  
Preterm Infants ◽  
Frozen Storage ◽  
Lipid Complex ◽  
Acid Complex ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Milk Casein ◽  
Alpha Lactalbumin

Frozen storage is necessary to preserve expressed human milk for critically ill and very preterm infants. Milk pasteurization is essential for donor milk given to this special population. Due to these storage and processing conditions, subtle changes occur in milk nutrients. These changes may have clinical implications. Potentially, bioactive complexes of unknown significance could be found in human milk given to preterm infants. One such complex, a cytotoxic α-lactalbumin-oleic acid complex named “HAMLET,” (Human Alpha-Lactalbumin Made Lethal to Tumor cells) is a folding variant of alpha-lactalbumin that is bound to oleic acid. This complex, isolated from human milk casein, has specific toxicity to both carcinogenic cell lines and immature non-transformed cells. Both HAMLET and free oleic acid trigger similar apoptotic mechanisms in tissue and stimulate inflammation via the NF-κB and MAPK p38 signaling pathways. This protein-lipid complex could potentially trigger various inflammatory pathways with unknown consequences, especially in immature intestinal tissues. The very preterm population is dependent on human milk as a medicinal and broadly bioactive nutriment. Therefore, HAMLET’s possible presence and bioactive role in milk should be addressed in neonatal research. Through a pediatric lens, HAMLET’s discovery, formation and bioactive benefits will be reviewed.

scholarly journals Tolerance of preterm formula versus pasteurized donor human milk in very preterm infants: a randomized non-inferiority trial

2018 ◽  
Vol 44 (1) ◽  
Author(s):  
Simonetta Costa ◽  
Luca Maggio ◽  
Giovanni Alighieri ◽  
Giovanni Barone ◽  
Francesco Cota ◽  
...  
Keyword(s):  
Human Milk ◽  
Preterm Infants ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Donor Human Milk ◽  
Preterm Formula
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