Intra-abdominal Adiposity In Preterm Infants: An Explorative Study

Objective: The aim of the present study was to compare the total body fat mass and the intra-abdominal adipose tissue between preterm infants assessed at term corrected age and full-term newborns. Methods: An observational explorative study was conducted. 25 preterm and 10 full term infants were evaluated at 0-1 month of corrected and postnatal age, respectively. The total body fat mass was assessed by means of an air displacement plethysmography system (Pea Pod COSMED, USA) and the intra-abdominal adipose tissue by means of magnetic resonance imaging (software program SliceOMatic, Version 4.3,Tomovision, Canada). Results: Total body fat mass (g) of preterm and term infants was 633 (±183) and 538 (±203) respectively while intra-abdominal fat mass (g) was 14.2 (±4.9) and 19.9 (±11.4). Conclusions: Preterm infants, although exhibiting a total body fat mass higher than full term infants, do not show an increased intra-abdominal adipose tissue

Does human milk modulate body composition in late preterm infants at term-corrected age?

(1) Background: Late preterm infants account for the majority of preterm births and are at risk of altered body composition. Because body composition modulates later health outcomes and human milk is recommended as the normal method for infant feeding, we sought to investigate whether human milk feeding in early life can modulate body composition development in late preterm infants; (2) Methods: Neonatal, anthropometric and feeding data of 284 late preterm infants were collected. Body composition was evaluated at term-corrected age by air displacement plethysmography. The effect of human milk feeding on fat-free mass and fat mass content was evaluated using multiple linear regression analysis; (3) Results: Human milk was fed to 68% of the infants. According to multiple regression analysis, being fed any human milk at discharge and at term-corrected and being fed exclusively human milk at term-corrected age were positively associated with fat-free mass content \u3b2 = - 47.9, 95% confidence interval (CI) = -95.7; p = 0.18; p = -0.049; = \u3b2=-89.6, 95% CI = -131.5; -47.7; p < 0.0001; - = -104.1, 95% CI = -151.4; -56.7, p < 0.0001); (4) Conclusion: Human milk feeding appears to be associated with fat-free mass deposition in late preterm infants. Healthcare professionals should direct efforts toward promoting and supporting breastfeeding in these vulnerable infants

Growth and Fat Mass in Preterm Infants Fed A Protein-Enriched Postdischarge Formula (PDF): A Randomized Controlled Trial

Background and aims: Male infants with BW< 1250 g benefit from PDF. Fetal growth seems to influence growth recovery whereas fat restoration occurs irrespective of BW. To evaluate whether being fed a PDF determines a growth benefit in two subgroups of infants. Methods: 123 preterm infants born AGA (BW=1193.4\ub1 230 g; GA=29\ub11.9 wks) and 84 born SGA (BW=1127\ub1 262g; GA=31.3\ub11.9 wks) were randomized at term corrected age (CA) in G1: 59 AGA fed PDF (2.9 g/100 kcal), G2: 64 AGA fed term formula (TF) (2.1 g/100 kcal), G3: 41 SGA fed PDF, G4: 43 SGA fed TF. From 6 months infants were fed a follow on formula and weaned according to ESPGHAN recommendations. Growth and body composition were assessed by an air displacement plethysmography system at term, 1, 3, 5, 6, 12 months. ANOVA, regression analysis. Results: G1 and G3 protein intakes were higher than those of G2 (p< 0.005) and G4(p< 0.05), respectively, whereas weight, length and fat mass were similar at each study point. G1 mean HC (cm) was bigger than that of G2 at six months (43.5\ub1 1.9 vs 42.6\ub11.6, p=0.03) whereas at 12 months no difference was found (45.4\ub11.6 vs 46\ub11.6). In AGA infants being fed a PDF formula, being male, not having a postnatal growth retardation at term correlated with bigger HC at six months [(p< 0.001), unstandardized B coefficient (SE) 0.9 (0.36); 1.2 (0.36); 1.2 (0.37), respectively]. Conclusions: Male AGA without postnatal growth retardation at term but not SGA infants appear to benefit from being fed PDF

Breastfeeding difficulties and risk for early breastfeeding cessation

Although breast milk is the normative feeding for infants, breastfeeding rates are lower than recommended. We investigated breastfeeding difficulties experienced by mothers in the first months after delivery and their association with early breastfeeding discontinuation. We conducted a prospective observational study. Mothers breastfeeding singleton healthy term newborns at hospital discharge were enrolled and, at three months post-delivery, were administered a questionnaire on their breastfeeding experience. Association among neonatal/maternal characteristics, breastfeeding difficulties and support after hospital discharge, and type of feeding at three months was assessed using multivariate binary logistic regression analysis. We enrolled 792 mothers, 552 completed the study. Around 70.3% of mothers experienced breastfeeding difficulties, reporting cracked nipples, perception of insufficient amount of milk, pain, and fatigue. Difficulties occurred mostly within the first month. Half of mothers with breastfeeding issues felt wellsupported by health professionals. Maternal perception of not having a sufficient amount of milk, infant\u2019s failure to thrive, mastitis, and the return to work were associated with a higher risk of nonexclusive breastfeeding at three months whereas vaginal delivery and breastfeeding support after hospital discharge were associated with a decreased risk. These results underline the importance of continued, tailored professional breastfeeding support

Clinical evaluation of two different protein content formulas fed to full-term healthy infants: A randomized controlled trial

Background: A high early protein intake is associated with rapid postnatal weight gain and altered body composition. We aimed to evaluate the safety of a low-protein formula in healthy full-term infants. Methods: A randomized controlled trial was conducted. A total of 118 infants were randomized to receive two different protein content formulas (formula A or formula B (protein content: 1.2 vs. 1.7g/100mL, respectively)) for the first 4 months of life. Anthropometry and body composition by air displacement plethysmography were assessed at enrolment and at two and 4 months. The reference group comprised 50 healthy, exclusively breastfed, full-term infants. Results: Weight gain (g/day) throughout the study was similar between the formula groups (32.5\ub16.1 vs. 32.8\ub16.8) and in the reference group (30.4\ub15.4). The formula groups showed similar body composition but a different fat-free mass content from breastfed infants at two and 4 months. However, the formula A group showed a fat-free mass increase more similar to that of the breastfed infants. The occurrence of gastrointestinal symptoms or adverse events was similar between the formula groups. Conclusions: Feeding a low-protein content formula appears to be safe and to promote adequate growth, although determination of the long-term effect on body composition requires further study

Is nutritional support needed in late preterm infants?

Background: Late preterm birth accounts for 70 % of all preterm births. While the impact of feeding problems in very preterm infants has been widely investigated, data on late preterm infants' feeding issues are scarce. The aim of the present study was to investigate the need of nutritional support during hospital stay in a cohort of late preterm infants and to identify the factors that most contribute to its occurrence. Methods: We analyzed the medical records of late preterm infants, born 2011-2013, admitted to a single institution. Neonatal data, the need for nutritional support, defined as the need for parenteral nutrition or intravenous fluids or tube feeding, and the feeding status at discharge were retrieved. The occurrence of respiratory distress syndrome, congenital malformations/chromosomal diseases, cardiac diseases, sepsis, hypoglycemia, poor feeding and the need for surgical intervention were also collected. Results: A total of 1768 late preterm infants were included. Among the 592 infants requiring a nutritional support, 228 developed a respiratory distress syndrome, two developed a sepsis, one presented with a cardiac disease, 24 underwent a surgical intervention, eight had a chromosomal disease/congenital malformation, 80 had hypoglycemia. In addition, 100 infants required nutritional support due to poor feeding and 149 were born small for gestational age. Birth weight 642000 g (adjusted OR = 12.2, 95 % CI 7.5-19.9, p < 0.0001), gestational age of 34 weeks (adjusted OR = 4.08, 95 % CI 2.8-5.9, p < 0.0001), being small for gestational age (adjusted OR = 2.17, 95 % CI 2.8-5.9, p=0.001), having a respiratory distress syndrome (adjusted OR = 79.6, 95 % CI 47.2-134.3, p < 0.0001) and the need of surgical intervention (adjusted OR = 49.4, 95 % CI 13.9-174.5, p < 0.0001) were associated with a higher risk of need of nutritional support during hospital stay. Conclusions: Late preterm infants are at relatively high risk of requiring nutritional support during hospital stay, especially if they have a birth weight 642000 g, a gestational age of 34 weeks, are born small for gestational age, develop a respiratory distress syndrome and require a surgical intervention. The present findings add to the knowledge of late preterm infants' feeding issues and may contribute to tailoring nutritional approaches for these infants

Body composition changes in early postnatal life of late preterm infants

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Factors Determining Late Reopening of Ductus Arteriosus in Very Preterm Infants

BACKGROUND: A significant proportion of premature infants undergoes to late reopening of ductus arteriosus after an initial functional closure. Lower gestational age, infections and excessive fluid administration are frequently considered risk factors for ductal reopening(DR)but weight of each factor is still to determine. OBJECTIVE: To evaluate the incidence of DR and to verify which risk factors are associated with late DR and what is the contribution of each of them. DESIGN/METHODS: Clinical data in all infants with a gestational age below 28 wks born between January 2006 and June 2009 were retrospectively analyzed. To document initial ductal closure and ductal reopening echocardiography was used in all cases. GA,BW, gender, twin birth, IUGR, sepsis (both culture proven and suspected), previous treatment with ibuprofen or indomethacin and excessive fluide intake were considered. We used multiple-random effects logistic regression to calculate adjusted odds ratio of ductal reopening. The final model included the variables associated with DR in univariate analysis. RESULTS: 151 infants (84/151 male) with mean GA 26,1\ub11,6 wks and BW 813\ub1251g were included. 23% were SGA and 71% were singleton. 44/151 (28%) infants experienced one or more episodes of DR after a previous echocardiographically proven closure (71 episodes in all). First episode occurred at a mean postnatal age of 12 days and never occurred beyond 26 days. We defined as sepsis-related a DR occurring within 3 days from the sepsis diagnosis. 52/71 (73%) DR were sepsis-related. DR was more frequent in infants with at least 1 episode of sepsis (OR 7,2 p<0,027). DR was also strongly positively associated with male gender (OR 10.4 p=0.037), previous course of cox-inhibitors (OR 16,6 p=0,024) and inversely related with GA (OR=0,4, p=0,015). Excessive fluid intake or excessive weight gain were related only to 7% of sepsis-related and to 18% of non-sepsis related reopenings. CONCLUSIONS: Late reopening of ductus arteriosus is associated to a systemic infection in most cases. Male gender and lower gestational age are also significative risk factors. An excessive fluid intake does not appear to be relevant