7 research outputs found
Nutrient Intake in the First Two Weeks of Life and Brain Growth in Preterm Neonates.
BACKGROUND: Optimizing early nutritional intake in preterm neonates may promote brain health and neurodevelopment through enhanced brain maturation. Our objectives were (1) to determine the association of energy and macronutrient intake in the first 2 weeks of life with regional and total brain growth and white matter (WM) maturation, assessed by 3 serial MRI scans in preterm neonates; (2) to examine how critical illness modifies this association; and (3) to investigate the relationship with neurodevelopmental outcomes.
METHODS: Forty-nine preterm neonates (21 boys, median [interquartile range] gestational age: 27.6 [2.3] weeks) were scanned serially at the following median postmenstrual weeks: 29.4, 31.7, and 41. The total brain, basal nuclei, and cerebellum were semiautomatically segmented. Fractional anisotropy was extracted from diffusion tensor imaging data. Nutritional intake from day of life 1 to 14 was monitored and clinical factors were collected.
RESULTS: Greater energy and lipid intake predicted increased total brain and basal nuclei volumes over the course of neonatal care to term-equivalent age. Similarly, energy and lipid intake were significantly associated with fractional anisotropy values in selected WM tracts. The association of ventilation duration with smaller brain volumes was attenuated by higher energy intake. Brain growth predicted psychomotor outcome at 18 months\u27 corrected age.
CONCLUSIONS: In preterm neonates, greater energy and enteral feeding during the first 2 weeks of life predicted more robust brain growth and accelerated WM maturation. The long-lasting effect of early nutrition on neurodevelopment may be mediated by enhanced brain growth. Optimizing nutrition in preterm neonates may represent a potential avenue to mitigate the adverse brain health consequences of critical illness
Impact of Early Nutritional Intake on Preterm Brain: a Magnetic RĂ©sonance Imaging Study
Investigateurs : Lydie Beauport, Juliane Schneider, Mohamed Faouzi, Patric Hagmann, Petra HĂŒppi, Jean-François Tolsa, Anita C Truttmann, CĂ©line J Fischer Fumeaux
Contexte : Plusieurs Ă©tudes ont montrĂ© un bĂ©nĂ©fice de lâoptimisation du soutien nutritionnel prĂ©coce sur le dĂ©veloppement neurologique et cognitif des enfants nĂ©s prĂ©maturĂ©ment. Cependant lâimpact de la nutrition sur la maturation et les lĂ©sions cĂ©rĂ©brales reste peu compris.
Objectifs: Cette Ă©tude a pour objectif dâĂ©valuer lâimpact des apports nutritionnels, lipidiques et Ă©nergĂ©tiques pendant les 14 premiers jours de vie sur le dĂ©veloppement cĂ©rĂ©bral Ă©valuĂ© par IRM cĂ©rĂ©brale Ă lâĂąge du terme chez des nouveau-nĂ©s grand prĂ©maturĂ©s.
MĂ©thode : Il sâagit dâune Ă©tude ancillaire dâune cohorte prospective (1) incluant des prĂ©maturĂ©s de <30 semaines dâĂąge gestationnel nĂ©s dans un niveau 3 sans malformation majeure. Les donnĂ©es cliniques et nutritionnelles Ă©taient collectĂ©es Ă partir des dossiers informatisĂ©s. Les apports cumulatifs entĂ©raux et parentĂ©raux en protĂ©ines, lipides et Ă©nergie Ă©taient calculĂ©s de J1 Ă 14. LâIRM cĂ©rĂ©brale (Trio3Tesla Siemens) Ă©tait effectuĂ©e Ă terme et comprenaient les sĂ©quences conventionnelles T1 et T2. Le degrĂ© de sĂ©vĂ©ritĂ© des lĂ©sions de la substance blanche et grise ainsi que le niveau de maturation Ă©taient Ă©valuĂ©s selon le score de Kidokoro (2), rĂ©sultant en un score global. Les patients Ă©taient alors divisĂ©s en un premier groupe avec un score normal ou lĂ©gĂšrement anormal (score < 75Ăšme percentile) et en un 2Ăšme groupe avec un score modĂ©rĂ©ment Ă sĂ©vĂšrement anormal (score > 75Ăšme percentile). Lâassociation entre les apports nutritionnels et le degrĂ© de sĂ©vĂ©ritĂ© du score IRM Ă©tait analysĂ©e par rĂ©gression uni-et multivariĂ©e.
RĂ©sultats : 42 patients avec un Ăąge gestationnel mĂ©dian [Q1, Q3] de 27.4 [26.4-28.4] semaines et un poids de naissance mĂ©dian de 890 g [763-1045] ont Ă©tĂ© inclus. La mĂ©diane du score IRM Ă©tait Ă 4 et le 75Ăšme percentile Ă 6, sĂ©parant le groupe 1 avec un score normal ou lĂ©gĂšrement anormal (score 0-5, n= 27), du groupe 2 prĂ©sentant un score modĂ©rĂ©ment Ă sĂ©vĂšrement anormal (score 6-12, n=15). En analyse univariĂ©e, le sepsis, le CRIB score et les apports nutritionnels faibles Ă©taient significativement associĂ©s Ă un risque plus Ă©levĂ© dâavoir un score IRM â„ 6 (OR [95%CI] Ă©nergie : 0.99 [0.99-0.99], lipides : 0.89 [0.83-0.97], hydrates de carbone : 0.95 [0.91-0.99]). Dans des modĂšles bivariĂ©s, aprĂšs ajustements pour le sepsis, le CRIB score, lâĂąge gestationnel, les stĂ©roĂŻdes postnataux et la dysplasie bronchopulmonaire, lâassociation avec les apports Ă©nergĂ©tiques et lipidiques totaux restait significative. Lâassociation Ă©tait plus forte pour la composante de la substance grise du score IRM.
Conclusions : Cette Ă©tude montre que des apports Ă©nergĂ©tiques et lipidiques plus Ă©levĂ©s durant les 2 premiĂšres semaines de vie sont associĂ©s Ă un risque plus faible de lĂ©sions et de troubles de maturation cĂ©rĂ©braux Ă terme corrigĂ© chez les nouveau-nĂ©s grands prĂ©maturĂ©s. Optimiser la nutrition durant cette pĂ©riode vulnĂ©rable pourrait mĂȘme rĂ©duire lâimpact nĂ©gatif de certains facteurs comme le sepsis. Lâimpact sur le devenir neuro-dĂ©veloppemental Ă long terme doit cependant encore ĂȘtre confirmĂ©
Pulsoximetrie Screening zur Erfassung von kritischen angeborenen Herzfehlern
Vor 14 Jahren wurde in der Schweiz das Pulsoximetrie Screening (POx Screening) fĂŒr Neugeborene ????Ă€chendeckend eingefĂŒhrt ; es gehört heute zu unserer tĂ€glichen Routine. Was haben wir in der Zwischenzeit weltweit hinzugelernt? Ist unsere Methode immer noch korrekt? Anhand der aktuellen Literatur möchten wir diese Fragen beantworten und gleichzeitig die korrekte Anwendung des POx Screenings in Erinnerung rufen
Longitudinal Analysis of Macronutrient Composition in Preterm and Term Human Milk: A Prospective Cohort Study
Background: Mother’s own milk is the optimal source of nutrients and provides numerous health advantages for mothers and infants. As they have supplementary nutritional needs, very preterm infants may require fortification of human milk (HM). Addressing HM composition and variations is essential to optimize HM fortification strategies for these vulnerable infants. Aims: To analyze and compare macronutrient composition in HM of mothers lactating very preterm (PT) (28 0/7 to 32 6/7 weeks of gestational age, GA) and term (T) infants (37 0/7 to 41 6/7 weeks of GA) over time, both at similar postnatal and postmenstrual ages, and to investigate other potential factors of variations. Methods: Milk samples from 27 mothers of the PT infants and 34 mothers of the T infants were collected longitudinally at 12 points in time during four months for the PT HM and eight points in time during two months for the T HM. Macronutrient composition (proteins, fat, and lactose) and energy were measured using a mid-infrared milk analyzer, corrected by bicinchoninic acid (BCA) assay for total protein content. Results: Analysis of 500 HM samples revealed large inter- and intra-subject variations in both groups. Proteins decreased from birth to four months in the PT and the T HM without significant differences at any postnatal time point, while it was lower around term equivalent age in PT HM. Lactose content remained stable and comparable over time. The PT HM contained significantly more fat and tended to be more caloric in the first two weeks of lactation, while the T HM revealed higher fat and higher energy content later during lactation (three to eight weeks). In both groups, male gender was associated with more fat and energy content. The gender association was stronger in the PT group, and it remained significant after adjustments. Conclusion: Longitudinal measurements of macronutrients compositions of the PT and the T HM showed only small differences at similar postnatal stages in our population. However, numerous differences exist at similar postmenstrual ages. Male gender seems to be associated with a higher content in fat, especially in the PT HM. This study provides original information on macronutrient composition and variations of HM, which is important to consider for the optimization of nutrition and growth of PT infants