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

Infant exposure to Fluvoxamine through placenta and human milk: a case series - A contribution from the ConcePTION project [case report].

INTRODUCTION Fluvoxamine is widely used to treat depression during pregnancy and lactation. However, limited data are available on its transfer to the fetus or in human milk. This case series provides additional information on the infant exposure to fluvoxamine during pregnancy and lactation. CASE PRESENTATION Two women, aged 38 and 34 years, diagnosed with depression were treated with 50 mg fluvoxamine during pregnancy and lactation. At delivery a paired maternal and cord blood sample was collected for each woman. The first mother exclusively breastfed her child for 4 months and gave one foremilk and one hindmilk sample at 2 days and 4 weeks post-partum, whereas the second mother did not breastfeed. RESULTS The cord to plasma concentration ratios were 0.62 and 0.48, respectively. At 2 weeks post-partum, relative infant doses (RID) were 0.47 and 0.57% based on fluvoxamine concentrations in foremilk and hindmilk, respectively. At 4 weeks post-partum, the RIDs were 0.35 and 0.90%, respectively. The child from the first mother was born healthy and showed a normal development at the 6th, 18th and 36th month follow-ups. One of the twins from the second woman was hospitalized for hypoglycemia that was attributed to gestational diabetes and low birth weight. The second one was born healthy. CONCLUSION These results suggest a minimal exposure to fluvoxamine during lactation which is in accordance with previously published data. Larger clinical and pharmacokinetic studies assessing the long-term safety of this drug during lactation and the variability of its exposure through breastmilk are warranted

Datamama, bringing pregnancy research into the future: design, development, and evaluation of a citizen science pregnancy mobile application

Background: Pregnancy mobile applications (apps) have grown in popularity over the past decade, with some being used to promote study recruitment or health behaviors. However, no app serves as an all-in-one solution for collecting general data for research purposes and providing women with useful and desirable features. Aim: To create and develop a Swiss pregnancy mobile app as an innovative means to collect research data and provide users with reliable information. Methods: Determining the key features of the app involved a review of the literature and assessment of popular apps in the Swiss AppStore. A team of engineers developed the app, which includes a pregnancy timeline, questionnaires for data collection, medical and psychological articles and a checklist with appointment reminders. The content was written and reviewed by healthcare providers considered experts in the topics adressed. The questionnaires are distributed based on the user’s gestational age, by a chatbot. The project was authorized by the ethics commission in the canton of Vaud. An online survey of ten questions, advertised on Datamama’s home screen, was conducted to assess the users’ use of the app (27.11- 19.12.2022). Results: A review of 84 articles and 25 popular apps showed the need for a comprehensive pregnancy app. The development of Datamama took 2 years and included the creation of 70 medical and psychological articles and 29 questionnaires covering 300 unique variables. Six months after the launch, there were 800 users with a 73% average participation rate in the questionnaires. Sixty-five women completed the survey, with 70.8% using the app once to multiple times per week. The primary reason for using the app was to help research by answering the questionnaires, followed by access to reliable medical information. The reason most frequently ranked first for using the app was to help research by answering the questionnaires (42/65, 67% of women rated it first), followed by access to reliable medical information (34/65, 54% women rated it second). Women rated the information as clear, understandable, and interesting with a trust rating in data handling at 98.5%. The average grade for recommending the app was 8/10, with suggestions for increasing the amount of medical content and tailoring it based on gestational age. Conclusion: Datamama is the first pregnancy app to address the needs of both patients and researchers. Initial feedback from users was positive, highlighting future challenges for success. Future work will consist in improving the app, validating the data and use it to answer specific pregnancy-related research questions

Alternativen zu Säuglingsnahrungen auf Kuhmilchproteinbasis

Die natürliche Ernährung eines gesunden Säuglings ist das Stillen. Ist Stillen oder die Fütterung von Muttermilch nicht möglich, kann Frauenmilch für die Ernährung des Säuglings erwogen werden, sofern diese aus einer qualifizierten Humanmilchbank stammt. Vom Kauf von Frauenmilch aus dem Internet wird wegen Risiken einer Infektionsübertragung und einer unzureichenden Milchqualität strikt abgeraten. Aufgrund der geringen Verfügbarkeit, der hohen Kosten sowie möglicher Nachteile der Ernährung mit Spendermilch im Vergleich zum Stillen sind industriell gefertigte Säuglingsnahrungen das Mittel der Wahl zur Ernährung des gesunden, reifgeborenen Säuglings, wenn Stillen nicht oder nur partiell möglich ist. Kuhmilchprotein ist die am häufigsten verwendete Eiweißkomponente. Die Nachfrage nach anderen auf Tiermilchen basierten sowie vegetarischen bzw. veganen Alternativen steigt. Im Folgenden werden verschiedene Alternativen bezüglich ihrer Eignung betrachtet. Säuglingsnahrungen auf Basis von Ziegenmilchprotein stellen für gesunde, reifgeborene Säuglinge eine zugelassene und geeignete Alternative zu kuhmilchproteinbasierten Säuglingsnahrungen dar. Für Säuglingsnahrungen aus anderen Tiermilchen (z. B. Kamel‑, Schaf‑, Pferde- oder Büffelmilch) sind keine belastbaren Daten zu Eignung und Sicherheit bekannt, und sie sind in der Europäischen Union nicht zugelassen. Säuglingsnahrungen auf der Grundlage von Sojaproteinisolaten sind in der Europäischen Union zugelassen. Sie werden für die allgemeine Verwendung im 1. Lebenshalbjahr durch die Ernährungskommission nicht empfohlen, insbesondere weil potenziell nachteilige Effekte von enthaltenen Isoflavonen nicht ausgeschlossen werden können. Ab der Geburt und in den ersten Lebensmonaten sollte die Gabe von Sojanahrungen auf Indikationen wie eine bestehende Galaktosämie, die sehr seltene kongenitale Laktoseintoleranz sowie bei familiärem Wunsch nach veganer Ernährungsweise und aus anderen weltanschaulichen Gründen begrenzt werden. Im 2. Lebenshalbjahr ist die Zufuhrmenge pro Kilogramm Körpergewicht deutlich niedriger, sodass das Risiko unerwünschter Wirkungen als wesentlich geringer eingeschätzt wird. Zu neuerdings angebotenen Nahrungen auf der Grundlage einer Mischung aus Soja- und Kuhmilchprotein sind keine Daten zur Prüfung von Sicherheit und Eignung bekannt, sodass hierzu keine Empfehlung ausgesprochen werden kann. Von der Verwendung von Säuglingsnahrung auf der Grundlage von hydrolysiertem Reisprotein wird auch aufgrund hoher berichteter Arsengehalte abgeraten. Auch von einer häuslichen Selbstherstellung von Säuglingsnahrungen wird aufgrund eines erhöhten Risikos für eine nichtbedarfsgerechte Nährstoffzufuhr und für Infektionen abgeraten. // The natural nutrition of a healthy infant is breastfeeding. If breastfeeding or feeding of breast milk is not possible, feeding of donor human milk may be considered. The safety of donor milk can only be ensured if it is provided by a qualified human milk bank. The use of informally shared donor milk or the use of human milk purchased through the internet is strongly discouraged because of the risk of transmitting infections and of insufficient milk quality. Due to low availability, high costs and concerns about poorer nutritional quality of donor milk compared to breastfeeding, industrially manufactured infant formula is the preferred alternative for feeding healthy full-term infants that cannot or cannot be fully breastfed. Milk-based infant formula is most frequently made from cow’s milk protein; however, there is an increasing popularity of vegetarian or vegan formulas and of formulas based on different animal milks other than cow’s milk. Goat’s milk-based infant formulas represent an approved and suitable alternative to cow’s milk for healthy, full-term infants. Reliable data on the suitability and safety are unavailable for formulas based on other animal milks (e.g., camel, horse, sheep or buffalo milk), and these are not approved for infant feeding in the European Union. Infant formulas based on soybean protein isolates are approved in the European Union. They are not generally recommended by the Nutrition Committee for infant feeding in the first half year of life because potentially harmful effects of isoflavones derived from soybeans cannot be excluded; however, soybean protein isolate-based formulas may be reservedly used after birth and in the first months of life for infants affected by galactosemia, the very rare hereditary lactose intolerance manifest at birth, a vegan family lifestyle or other familial convictions. In the second half year of life the intake amount per kilogram body weight is much less so that the risk of undesired effects is estimated to be much lower. For the recently provided nutrition based on a mixture of soybean and cow’s milk proteins, no data on testing of the safety and suitability are known, so that no recommendations can be made on this. The use of infant formula based on hydrolyzed rice protein is not recommended because of concerns about possible high arsenic contamination. The use of homemade infant formulas is discouraged due to the high risk of introducing infections and of possible nutritional imbalances of macronutrients and micronutrients

Alimentation du nouveau-né sain (révision des « recommandations pour l’alimentation des nouveau-nés sains durant les premiers jours de vie » du 04.01.2011)

La mise en place de l’alimentation constitue l’un des enjeux majeurs de l’adaptation à la vie extra-utérine. L’allaitement maternel est le mode d’alimentation optimal des nouveau-nés : il est idéalement adapté à leur système digestif, à leur croissance et à leur développement, et confère de nombreux bénéfices à court et à long terme pour les nourrissons, les mères et la société. Les contre-indications absolues à l’allaitement sont rares. Si l’allaitement est le plus souvent possible physiologiquement, il demande des conditions- cadres favorables et un soutien approprié. Les professionnel.les de santé périnatale jouent un rôle fondamental à la fois pour accompagner l’initiation et la poursuite de l’allaitement, et prévenir les interventions délétères. Le peau à peau précoce et prolongé, le rooming-in, l’alimentation à la demande, le positionnement adéquat au sein et l’implication du partenaire sont des exemples de stratégies de soutien simples et éprouvées dans les maternités. Une attention renforcée est nécessaire en présence de facteurs de risque ou d’indices d’allaitement sous-optimal. Les suppléments au lait maternel sont rarement nécessaires pour les nouveau-nés en bonne santé, eutrophiques et à terme. Leurs indications doivent être soigneusement évaluées et limitées aux situations où les autres mesures de soutien ont échoué. La perte de poids du nouveau-né dans les premiers jours de vie requiert une interprétation prudente et intégrée. Lorsque l’allaitement est impossible, insuffisant, ou non souhaité, les préparations infantiles pour nourrissons sont des alternatives appropriées. Dans certaines situations, selon leurs disponibilités, le colostrum exprimé par la mère avant la naissance ou le lait de donneuses issu de banques de lait peuvent être considérés comme des suppléments transitoires. Des compléments en vitamines K et D sont recommandés pour couvrir les besoins du nourrisson. L’état nutritionnel et le régime alimentaire de la mère méritent également d’être pris en considération durant l’allaitement

From barriers to the nutritional support of at risk neonates to improvement perspectives : an integrated approach

L'augmentation de la survie des grands prématurés fait de la réduction des séquelles dans cette population un enjeu majeur. Alors qu'il influence leur devenir, le support nutritionnel des grands prématurés échoue souvent à prévenir le déficit protéino-énergétique, les carences nutritionnelles, et les ralentissements de croissance, aggravant leur pronostic. Nos recherches investiguaient plusieurs axes des stratégies nutritionnelles actuelles, leurs limites ainsi que les perspectives d'améliorations : I) parentérales, II) entérales, III) préventions des complications, IV) évaluation de la croissance. Il s'agissait d'un ensemble d'études cliniques, qui révélaient : I) Des variations significatives d'apports parentéraux à l'intérieur des centres, ainsi qu'une sous-utilisation des lipides, participant au déficit protéino-énergétique précoce. Un impact des lipides sur la croissance, le développement cérébral, voire l'incidence de complications était suggéré. II) Des avantages de l'utilisation de lait maternel frais dans la 1ère semaine de vie sur la poursuite de l'allaitement des nouveau-nés hospitalisés, ainsi que des variations importantes de sa composition. Une augmentation des taux d'allaitement sur les périodes d'études révélait un effet bénéfique de la recherche, même « observationnelle », sur l'allaitement. III) Une augmentation du risque d'hyperglycémie en cas de diminution de la phosphatémie. IV) Des répercussions modérées de la restriction de croissance intra-utérine sur le neuro-développement des prématurés, malgré des réserves auxologiques. Ces travaux permettaient donc d'identifier plusieurs barrières, et d'envisager différentes stratégies d'amélioration du soutien nutritionnel. Ils soulignent la complexité et l'importance des liens entre nutrition, croissance et développement neurologique des enfants à risques. Des efforts supplémentaires sont nécessaires pour optimiser les connaissances, les recommandations et les pratiques dans ce domaineFacing to increasing survival of very preterm neonates, reducing sequelae in this population became a major public issue. Nutritional support of preterm neonates has a durable impact on their future. However, it often fails to prevent the protein-energetic imbalance, nutritional deficiencies, and post-natal growth restriction, which act as aggravating factors. Our researches evaluated different axes of current nutritional strategies, limitations and possible improvements: I) parenteral, II) enteral, III) prevention of complications, IV) growth assessment. Most relevant findings of these clinical studies were: I) Significant variations of parenteral intakes in the centres, as well as inadequate use of lipids, involved in early energetic-protein deficit. Impact of lipids on growth, brain development, and even the incidence of complications were suggested. II) Advantages in using fresh raw mother's own milk in the early days to enhance breastfeeding in hospitalized neonates, as well as important changes in mother's milk composition. An increase in breastfeeding rates over the periods of studies showed a beneficial effect of the research, although "observational", on breastfeeding. III) An increased risk of hyperglycemia in case of low phosphatemia. IV) A moderate impact of being small for gestational age on neuro-development in a preterm cohort, and related auxologic limitations. This work allowed to recognize some barriers of the nutritional support, and to consider different improvement strategies. It emphasizes the close and important links between nutrition, growth and neurological development of vulnerable infants. Further efforts are needed to optimize knowledge, recommendations and practices in this are