Insulin-like growth factor 1 has multisystem effects on foetal and preterm infant development.

UNLABELLED: Poor postnatal growth after preterm birth does not match the normal rapid growth in utero and is associated with preterm morbidities. Insulin-like growth factor 1 (IGF-1) axis is the major hormonal mediator of growth in utero, and levels of IGF-1 are often very low after preterm birth. We reviewed the role of IGF-1 in foetal development and the corresponding preterm perinatal period to highlight the potential clinical importance of IGF-1 deficiency in preterm morbidities. CONCLUSION: There is a rationale for clinical trials to evaluate the potential benefits of IGF-1 replacement in very preterm infants.This work was supported by a European Commission FP7 project 305485 PREVENT-ROP grant to all of the authors.This is the final version of the article. It first appeared from Wiley via https://doi.org/10.1111/apa.1335

On the identification of visual defects in children in general and prematurely born children in particular

Aims: Papers I & II: To evaluate the consequences of changes in the criteria for referral to an eye clinic following general pre-school vision screening. According to the former criteria all 4 year old children in the Göteborg area, with visual acuity (VA) 70%) of the children with slightly reduced vision at the age of 4 years had a visual acuity of 0.8 or better. Few had visual defects needing treatment and among those who were treated, the results were good. Papers III-V: Ophthalmologic abnormalities were common in children born before 29 gestational weeks. These children had a smaller optic disc area, neuroretinal rim area and more than normal tortuosity of retinal vessels. Reduced visual perception was observed in 40% of the children born before 29 weeks of gestation and in 67% of children in the patient-based group with brain lesions or signs that might indicate a brain lesion.Conclusions: Papers I & II: The alteration of the screening criteria has resulted in a reduction of unnecessarily referred children while few children in need of treatment are missed. Papers III-V: Prematurely born children are at increased risk for visual problems and ocular abnormalities. Reduced visual perception is common in preterm children even in those without a diagnosis of a brain lesion. Strabismus and subnormal visual acuity in a prematurely born child should alert the ophthalmologist to the possible existence of visual perceptual problems

Nutrition, insulin-like growth factor-1 and retinopathy of prematurity

Retinopathy of prematurity is a potentially blinding disease starting with impaired retinal vessel growth in the neonatal period. Weeks to months later, peripheral retinal hypoxia induces pathologic neovascularization that may lead to retinal detachment and blindness. Current treatment strategies target late stage disease and it would be advantageous if retinopathy of prematurity could be prevented. Poor general growth after very preterm birth is a universal problem associated with increased risk of retinopathy. Loss of the maternal-fetal interaction results not only in loss of nutrients but also of other factors provided in utero. The importance of nutrition and factors such as insulin-like growth factor-1 and ω-3 long chain fatty acids for proper retinal vascularization has been defined in animal studies. Increasing evidence of the applicability of these findings to human infants is accumulating. This review focuses on factors essential for neonatal growth and possible strategies to improve growth and prevent retinopathy

Early Surge in Circulatory Adiponectin Is Associated With Improved Growth at Near Term in Very Preterm Infants.

Adiponectin enhances insulin sensitivity and may play a role in fetal and postnatal growth

Unpasteurised maternal breast milk is positively associated with growth outcomes in extremely preterm infants

Aim: Extrauterine growth restriction is common among extremely preterm infants. We explored whether intake of unpasteurised maternal milk (MM) and pasteurised donor milk (DM) was associated with longitudinal growth outcomes and neonatal morbidities in extremely preterm infants. Methods: Observational study of 90 preterm infants born between 2013 and 2015 in Gothenburg, Sweden. Data were prospectively collected on nutritional and breast milk intakes during the first 28 days. Results: Ninety infants (39 girls and 51 boys) with a median gestational age of 25.3 (22.7-27.9) weeks were evaluated. MM intake (mL/kg/d) correlated positively with almost all z-scores for weight, length and head circumference at 28 postnatal days and at postmenstrual age (PMA) 32 and 36 weeks. After multivariable adjustment, MM intake and weight z-score at 28 postnatal days and at PMA 32 and 36 weeks remained significantly associated. Infants consuming ≥80% MM had more favourable weight z-scores at PMA 32 and 36 weeks. Intake of DM did not correlate with any growth outcomes. Infants without retinopathy of prematurity had a significantly higher intake of MM (mL/kg/d). Conclusion: Unpasteurised MM was positively associated with longitudinal growth outcomes. Motivating mothers to provide their infants with their own milk after preterm birth should be emphasised

Review shows that donor milk does not promote the growth and development of preterm infants as well as maternal milk

Aim: This nonsystematic review examined differences in the composition of raw maternal breastmilk and pasteurised donor milk and possible health effects on preterm infants. Methods: We searched PubMed up to July 2018 for studies published in English that focused on four comparisons as follows: raw maternal milk versus donor milk, human milk before and after Holder pasteurisation, milk from mothers who delivered preterm and at term and milk collected during early and late lactation. We also searched for possible effects of the milk components, as well as the effects of maternal and donor milk on preterm infants’ health. Results: Raw maternal milk contained factors involved in antioxidant and anti-inflammatory defence, gut microbiome establishment and the maturation of immune defences, food tolerability and metabolism. Many of these factors were reduced or abolished in processed donor milk. Both maternal milk and donor milk have been associated with a reduced incidence of necrotising enterocolitis. High-dose feeding with maternal milk during the neonatal period reportedly reduced the risk of other morbidities and promoted growth and neurodevelopment. Conclusion: Many of the components in raw maternal breastmilk were lacking in pasteurised donor milk, which was inferior in promoting the growth and development of very preterm infants

Implementing higher oxygen saturation targets reduced the impact of poor weight gain as a predictor for retinopathy of prematurity

ABSTRACT Aim This study evaluated poor weight gain as a risk factor for infants who required treatment for retinopathy of prematurity (ROP), by comparing those born before and after the implementation of higher oxygen saturation (SpO2) targets at the Queen Silvia Children's Hospital, Gothenburg, Sweden. Methods: We compared infants born at less than 31 weeks, who were screened and, or, treated for ROP: 127 in 2011–2012 when SpO2 targets were 88–92% and 142 in 2015–2016 when they were 91–95%. The subjects were reviewed for birth characteristics, weekly weight and ROP treatment. Data were analysed using the weight, insulin‐like growth factor 1, neonatal, ROP (WINROP) prediction tool. Results: The 2011–2012 infants who needed ROP treatment (12.6%) had significantly poorer postnatal weight gain than those who did not, but this was not seen in the treated (17.6%) and nontreated ROP groups in 2015–2016. WINROP sensitivity decreased from 87.5% in 2011–12 to 48% in 2015–2016. Conclusion: After the SpO2 target range was increased from 88–92% to 91–95%, postnatal weight gain was no longer a significant risk factor and WINROP lost its ability to predict ROP requiring treatment. Risk factors clearly change as neonatal care develops