QUANTIFICATION OF LUTEIN + ZEAXANTHIN PRESENCE IN HUMAN PLACENTA AND CORRELATIONS WITH BLOOD LEVELS AND MATERNAL DIETARY INTAKE

Lutein + zeaxanthin are carotenoids most recognized in eye health, but less is known about their status and transfer during pregnancy. While quantified in maternal and umbilical cord blood, they have never been analyzed in placenta tissue. Therefore, the purpose of this dissertation is to firstly quantify lutein + zeaxanthin concentrations in human placenta and to later correlate with levels in maternal dietary intake, maternal serum, and umbilical cord blood. Proportions of lutein + zeaxanthin will also be compared within diet, placenta, maternal serum, and umbilical cord blood among additionally analyzed carotenoids including lycopene, β-cryptoxanthin, α-carotene, and β-carotene. Lutein + zeaxanthin concentrations across all samples will be analyzed for relationships with maternal demographics and infant birth outcomes. An IRB-approved cross-sectional study enrolled 82 mother-infant pairs for infants born at Nebraska Medicine Hospital (Omaha, NE). Placenta, maternal serum, and umbilical cord blood samples were collected and analyzed for carotenoids concentrations. Mothers completed a food frequency questionnaire to identify usual intake. Demographic and birth outcome data were collected from the electronic medical record. Lutein + zeaxanthin were present in human placenta at median 0.105 micrograms/gram (mcg/g) and were significantly correlated with levels in maternal serum (r=0.57;

Early Enteral Feeding in Preterm Infants: A Narrative Review of the Nutritional, Metabolic, and Developmental Benefits

Enteral feeding is the preferred method of nutrient provision for preterm infants. Though parenteral nutrition remains an alternative to provide critical nutrition after preterm delivery, the literature suggests that enteral feeding still confers significant nutritional and non-nutritional benefits. Therefore, the purpose of this narrative review is to summarize health and clinical benefits of early enteral feeding within the first month of life in preterm infants. Likewise, this review also proposes methods to improve enteral delivery in clinical care, including a proposal for decision-making of initiation and advancement of enteral feeding. An extensive literature review assessed enteral studies in preterm infants with subsequent outcomes. The findings support the early initiation and advancement of enteral feeding impact preterm infant health by enhancing micronutrient delivery, promoting intestinal development and maturation, stimulating microbiome development, reducing inflammation, and enhancing brain growth and neurodevelopment. Clinicians must consider these short- and long-term implications when caring for preterm infants

Nutrition Support Practices for Infants Born \u3c750 Grams or \u3c25 Weeks Gestation: A Call for More Research

With advances in medical care and efforts to care for continually smaller and younger preterm infants, the gestational age of viability has decreased, including as young as 21 or 22 weeks of gestation [...]

Feasibility and Application of Early Enteral Feeding Initiation in Extremely Low Birth Weight Infants

Background: Extremely low birth weight (ELBW) infants (\u3c 1000g) have specialized nutritional needs to promote best outcomes, so identifying optimal nutrition therapies is critical. Previous studies indicate that late initiation of enteral feeds (\u3e3 days) is associated with increased inflammation and adverse neonatal outcomes. Delayed breastfeeding after the first hour of life in term infants has also been associated with increased mortality. In consideration of these factors and the heterogeneity that exists between enteral feeding initiation in an ELBW population, there is a lack of studies examining the hour of life in which enteral feeds are initiated in ELBW infants. This study evaluates the feasibility of early initiation of enteral feeds in ELBW infants and describes the impact on time to reach full enteral feeds. Methods: A retrospective chart review was conducted including ELBW infants born from June 2016 to July 2019 in a level III NICU. Infants with congenital or genetic anomalies or who transferred or deceased prior to 30 days of life were excluded. Feeding categories were defined as early (\u3c 12 hours of life), moderate (12-24 hours), or late (\u3e24 hours). The number of days to reach full enteral feeds was also analyzed, as defined by receiving a volume \u3e 145 mL/kg/day of human milk 24 kcal/oz feedings using human milk fortifier and a protein modular. Results: 44 ELBW infants were included. The median time of enteral feeding initiation was 12.4 hours of life (min 4.1 hours, max 178.4 hours). Enteral feeds were started in the early category for 19 infants (43%), moderate for 19 infants (43%), and late for 6 infants (14%). The median time to reach full enteral feeds was 9.5 days of life within the cohort. The median time to reach full enteral feeds was 9 days for infants in the early category, 10 days for moderate, and 14 days for the late category. Conclusions: These results indicate the feasibility of initiating enteral feeds within the first 12 hours of life in the ELBW infant population. Earlier start of enteral feedings—even by hours of life—results in a reduction in the number of days to reach full enteral feeds. These results may be considered in the development of feeding protocols and early enteral nutrition initiation in the ELBW infant population. More studies are needed to assess the impact of early initiation of enteral feeds on neonatal outcomes like growth and morbidities.https://digitalcommons.unmc.edu/chri_forum/1060/thumbnail.jp

Comparison of the effect of two human milk fortifiers on clinical outcomes in premature infants

The use of human milk fortifiers (HMF) helps to meet the high nutritional requirements of the human milk-fed premature infant. Previously available powdered products have not met the protein requirements of the preterm infant population and many neonatologists add powder protein modulars to help meet protein needs. The use of powdered products is discouraged in neonatal intensive care units (NICU) due to concern for invasive infection. The use of a commercially available acidified liquid product with higher protein content was implemented to address these two concerns. During the course of this implementation, poor growth and clinically significant acidosis of infants on Acidified Liquid HMF (ALHMF) was observed. The purpose of this study was to quantify those observations by comparing infant outcomes between groups receiving the ALHMF vs. infants receiving powdered HMF (PHMF). A retrospective chart review compared outcomes of human milk-fed premature infants(n=23) and the PHMF (n=46). Infant growth, enteral feeding tolerance and provision, and incidence of necrotizing enterocolitis (NEC), metabolic acidosis, and diaper dermatitis were compared between the two groups. No infants were excluded from this study based on acuity. Use of ALHMF resulted in a higher incidence of metabolic acidosis (p=0.002). Growth while on HMF as measured in both g/kg/day (10.59 vs. 15.37,

Parenteral nutrition additive shortages: the short-term, long-term and potential epigenetic implications in premature and hospitalized infants.

Nutrition support practitioners are currently dealing with shortages of parenteral nutrition micronutrients, including multivitamins (MVI), selenium and zinc. A recent survey from the American Society of Enteral and Parenteral Nutrition (ASPEN) indicates that this shortage is having a profound effect on clinical practice. A majority of respondents reported taking some aggressive measures to ration existing supplies. Most premature infants and many infants with congenital anomalies are dependent on parenteral nutrition for the first weeks of life to meet nutritional needs. Because of fragile health and poor reserves, they are uniquely susceptible to this problem. It should be understood that shortages and rationing have been associated with adverse outcomes, such as lactic acidosis and Wernicke encephalopathy from thiamine deficiency or pulmonary and skeletal development concerns related to inadequate stores of Vitamin A and D. In this review, we will discuss the current parenteral shortages and the possible impact on a population of very low birth weight infants. This review will also present a case study of a neonate who was impacted by these current shortages

Comparison of a Powdered, Acidified Liquid, and Non-Acidified Liquid Human Milk Fortifier on Clinical Outcomes in Premature Infants.

We previously compared infant outcomes between a powdered human milk fortifier (P-HMF) vs. acidified liquid HMF (AL-HMF). A non-acidified liquid HMF (NAL-HMF) is now commercially available. The purpose of this study is to compare growth and outcomes of premature infants receiving P-HMF, AL-HMF or NAL-HMF. An Institutional Review Board (IRB) approved retrospective chart review compared infant outcomes (born \u3c 2000 g) who received one of three HMF. Growth, enteral nutrition, laboratory and demographic data were compared. 120 infants were included (P-HMF = 46, AL-HMF = 23, NAL-HMF = 51). AL-HMF infants grew slower in g/day (median 23.66 vs. P-HMF 31.27, NAL-HMF 31.74 (p \u3c 0.05)) and in g/kg/day, median 10.59 vs. 15.37, 14.03 (p \u3c 0.0001). AL-HMF vs. NAL-HMF infants were smaller at 36 weeks gestational age (median 2046 vs. 2404 g, p \u3c 0.05). However AL-HMF infants received more daily calories (p = 0.21) and protein (p \u3c 0.0001), mean 129 cal/kg, 4.2 g protein/kg vs. P-HMF 117 cal/kg, 3.7 g protein/kg , NAL-HMF 120 cal/kg, 4.0 g protein/kg. AL-HMF infants exhibited lower carbon dioxide levels after day of life 14 and 30 (p \u3c 0.0001, p = 0.0038). Three AL-HMF infants (13%) developed necrotizing enterocolitis (NEC) vs. no infants in the remaining groups (p = 0.0056). A NAL-HMF is the most optimal choice for premature human milk-fed infants in a high acuity neonatal intensive care unit (NICU)

Effect of Maternal Retinol Status at Time of Term Delivery on Retinol Placental Concentration, Intrauterine Transfer Rate, and Newborn Retinol Status

Retinol (vitamin A) is essential, so the objective of this Institutional Review Board approved study is to evaluate retinol placental concentration, intrauterine transfer, and neonatal status at time of term delivery between cases of maternal retinol adequacy, insufficiency, and deficiency in a United States population. Birth information and biological samples were collected for mother-infant dyads (n = 260). Maternal and umbilical cord blood retinol concentrations (n = 260) were analyzed by HPLC and categorized: deficient (≤0.7 umol/L), insufficient (\u3e0.7-1.05 umol/L), adequate (\u3e1.05 umol/L). Intrauterine transfer rate was calculated: (umbilical cord blood retinol concentration/maternal retinol concentration) × 100. Non-parametric statistics used include Spearman\u27s correlations, Mann-Whitney U, and Kruskal-Wallis tests. p-values \u3c0.05 were statistically significant. Only 51.2% of mothers were retinol adequate, with 38.4% insufficient, 10.4% deficient. Only 1.5% of infants were retinol adequate. Placental concentrations (n = 73) differed between adequate vs. deficient mothers (median 0.13 vs. 0.10 μg/g; p = 0.003). Umbilical cord blood concentrations were similar between deficient, insufficient, and adequate mothers (0.61 vs. 0.55 vs. 0.57 μmol/L; p = 0.35). Intrauterine transfer increased with maternal deficiency (103.4%) and insufficiency (61.2%) compared to adequacy (43.1%), p \u3c 0.0001. Results indicate that intrauterine transfer rate is augmented in cases of maternal retinol inadequacy, leading to similar concentrations in umbilical cord blood at term delivery

Generating Personalized Pregnancy Nutrition Recommendations with GPT-Powered AI Chatbot. In: 20th International Conference on Information Systems for Crisis Response and Management

Low socioeconomic status (SES) and inadequate nutrition during pregnancy are linked to health disparities and adverse outcomes, including an increased risk of preterm birth, low birth weight, and intrauterine growth restriction. AI-powered computational agents have enormous potential to address this challenge by providing nutrition guidelines or advice to patients with different health literacy and demographics. This paper presents our preliminary exploration of creating a GPT-powered AI chatbot called NutritionBot and investigates the implications for pregnancy nutrition recommendations. We used a user-centered design approach to define the target user persona and collaborated with medical professionals to co-design the chatbot. We integrated our proposed chatbot with ChatGPT to generate pregnancy nutrition recommendations tailored to patients’ lifestyles. Our contributions include introducing a design persona of a pregnant woman from an underserved population, co-designing a nutrition advice chatbot with healthcare experts, and sharing design implications for future GPT-based nutrition chatbots based on our preliminary findings

Randomized trial of two doses of vitamin D3 in preterm infants \u3c32 weeks: Dose impact on achieving desired serum 25(OH)D3 in a NICU population.

BACKGROUND: Recommendations for vitamin D supplementation for preterm infants span a wide range of doses. Response to vitamin D supplementation and impact on outcomes in preterm infants is not well understood. OBJECTIVE: Evaluate serum 25(OH)D3 concentration changes after 4 weeks in response to two different doses of vitamin D3 supplementation in a population of premature infants and quantify the impact on NICU outcomes. DESIGN: 32 infants born at 24-32 weeks gestation were prospectively randomized to receive 400 or 800 IU/day vitamin D3 supplementation. Serum 25(OH)D3 levels were measured every 4 weeks. The Wilcoxon signed rank test was used to compare serum levels of 25(OH)D3 at 4 weeks and each subsequent time point. A p-value of RESULTS: Serum 25(OH)D3 levels at birth were 41.9 and 42.9 nmol/l for infants in the 400 IU group and 800 IU group, respectively (p = 0.86). Cord 25(OH)D3 concentrations significantly correlated with gestational age (r = 0.40, p = 0.04). After 4 weeks of D3 supplementation, median 25(OH)D3 levels increased in both groups (84.6vs. 105.3 nmol/l for 400 vs. 800 IU/day respectively, with significantly more improvement in the higher dose (p = 0.048). Infants in the 400 IU group were significantly more likely to have dual energy x-ray absorptiometry (DEXA) bone density measurements(56% vs 16%, p = 0.04). CONCLUSIONS: Improvement in 25(OH)D3 levels at 4 weeks, bone density, and trends towards improvement in linear growth support consideration of a daily dose of 800 IU of vitamin D for infantsNICU