Infant Analgesia With a Combination of Breast Milk, Glucose, or Maternal Holding

OBJECTIVES: We studied neonatal cortical brain response to 4 types of nonpharmacological analgesia (oral glucose, expressed breast milk, maternal holding plus oral glucose, breastfeeding). We aimed to assess the differential effect of oral solutions (glucose, breast milk) given alone or combined with the maternal-infant relationship (holding, breastfeeding). METHODS: Eighty healthy term newborns undergoing a heel stick were randomly assigned to 4 parallel groups of 20 infants each: group 1, infants received a glucose solution on a changing table; group 2, infants received expressed breast milk on a changing table; group 3, infants received a glucose solution in their mothers' arms; and group 4, infants were breastfed by their mothers. Cortical activation in parietal, temporal, and frontal cortices was assessed by multichannel near-infrared spectroscopy. Pain expression was also evaluated. RESULTS: Oral glucose alone or combined with maternal holding was associated with no cortical activation during heel stick. Expressed breast milk was associated with localized bilateral activation of somatosensory and motor cortices (P < .01). Breastfeeding was associated with extensive bilateral activation of somatomotor, somatosensory, and right parietal cortices (P < .01). Pain expression was lower with the maternal-infant relationship (P = .007). CONCLUSIONS: Oral glucose, either alone or combined with maternal holding, appears to block or weaken cortical pain processing. Breast milk alone is associated with localized cortical activation. Breastfeeding is associated with extensive activation and may act by extending cortical processing. Maternal relationship, both combined with oral glucose and in breastfeeding, shows the greatest analgesic effect, although the neural patterns involved are distributed differently

Longitudinal Growth and Body Composition of Twins versus Singletons in the First Month of Life

Background. Although twin gestation is well recognized to be associated with impaired fetal and postnatal growth, specific data about body composition of twins in the first month of life are scarce. Objective. The aim of this study was to compare the body composition of twins, evaluated with air-displacement plethysmography, to that of singletons of similar gestational age and adequacy of growth, during the first month of life. We tested the hypothesis that the quality of growth would be similar. Methods. Anthropometric and air-displacement plethysmography measurements were performed in 18 pairs of twins and in 36 singleton neonates, longitudinally, from birth to the 30th day of life. Each twin was matched to a singleton infant of similar gestational age and birth weight z-score. Results. With regard to anthropometric measures, the only difference was a lower weight in twins versus singletons on the 15th day of life. With regard to body composition, we did not find any difference between groups at any time point. Fat mass increased significantly from day 1 to day 30 in both twins and singletons. Conclusion. In terms of body composition, twins do not differ from singletons of similar gestational age and weight, either at birth or in early postnatal life

Application of air displacement plethysmography to the study of body composition in late preterm and term newborns

Background: nutrition in early life, growth, and subsequent health over a lifetime are significantly interrelated. Data on body composition of newborns are sparse, due to the long lasting lack of appropriate methods for body composition measurement in infancy. Methods: we analyzed body composition (fat mass, fat free mass) by means of air displacement plethysmography at birth, during the physiological weight loss and in early life up to 3 months of age in 5 categories of newborns: term appropriate for gestational age (AGA), late preterm, small (SGA) and large for gestational age (LGA) and twins. Results: AGA infants resulted to have a similar body composition than those of another Northern Italian population at birth and their % fat mass increased significantly from birth to 3 months of age. During the physiological weight loss, fat free mass was the compartment mostly affected, and this was reproduced in all categories of babies. No difference emerged in body composition between babies born from vaginal delivery or caesarean section or between boys and girls. Late preterm infants, although leaner at birth, resulted to be have a higher fat mass content than term infants at term-equivalent age. SGA infants were smaller and with less fat mass at birth but gained more fat than both AGA and LGA infants in the first month of life. Conversely, LGA infants had a higher fat content at birth but did not differ from AGA infants at one month of life. Body composition of AGA and SGA twins did not differ from that of AGA and SGA singletons, respectively, at birth or in the first three months of life. Conclusions: the application of a novel method for body composition measurement in term and late preterm infants provided novel insights into the study of normal values of body composition in newborns at birth and in early life and of how these components are modified by different patterns of fetal growth and neonatal characteristics. These notions may constitute the basis for the elaboration of individualized feeding strategies aimed at a balanced growth of the various body components, with the final perspective of optimizing the infants’ chances of a better later health.Introduzione: la nutrizione dei primi mesi di vita, la crescita e la salute nelle età successive sono elementi strettamente correlati. I dati sulla composizione corporea dei neonati sono scarsi, a causa della mancanza per lungo tempo di metodi appropriati alla misurazione della composizione corporea nella popolazione neonatale. Metodi: è stata analizzata la composizione corporea (massa grassa, massa magra) mediante pletismografia ad aria alla nascita, durante il fisiologico calo ponderale e nelle prime settimane di vita fino ai 3 mesi in 5 categorie di neonati: neonati a termine di peso appropriato alla nascita (AGA), neonati "late preterm", neonati di peso basso (SGA) e di peso alto per età gestazionale (LGA) e neonati da gravidanza gemellare. Risultati: i neonati a termine AGA sono risultati avere una composizione corporea alla nascita paragonabile a quella riportata in un’altra popolazione neonatale del Nord Italia. La percentuale di massa grassa è aumentata nei primi mesi di vita. Durante il calo ponderale fisiologico, la massa magra è stato il compartimento maggiormente interessato dal calo, e questo risultato è stato riscontrato in tutte le categorie di neonati analizzati. Non è stata riscontrata alcuna differenza nella composizione corporea dei neonati nati da cesareo o da parto vaginale. I neonati "late preterm", nonostante risultassero più magri alla nascita, sono risultati avere significativamente più massa grassa dei neonati a termine a comparabile età post-menstruale. I neonati SGA erano più piccoli e con meno massa grassa alla nascita, ma successivamente la loro massa grassa è andata incontro a un incremento più marcato di quella dei neonati AGA e LGA nel primo mese di vita. Invece i neonati LGA sono risultati avere un maggior contenuto di grasso alla nascita, ma questa differenza non è stata più riscontrata rispetto ai neonati AGA a un mese di vita. I neonati da gravidanza gemellare, AGA e SGA, sono risultati avere la stessa composizione corporea alla nascita e nelle età successive dei neonati singoli rispettivamente AGA e SGA. Conclusione: l’utilizzo di un nuovo metodo per la misurazione della composizione corporea in neonati a termine e "late preterm" ha fornito novità riguardanti i valori normali della composizione corporea nei neonati alla nascita e nei primi mesi di vita e di come essi si modificano in caso di diversi percorsi di crescita fetali e di diverse caratteristiche neonatali. Ciò potrà costituire la base per elaborare strategie di alimentazione personalizzate che consentano una crescita bilanciata delle varie componenti corporee

Clinical Study Longitudinal Growth and Body Composition of Twins versus Singletons in the First Month of Life

Background. Although twin gestation is well recognized to be associated with impaired fetal and postnatal growth, specific data about body composition of twins in the first month of life are scarce. Objective. The aim of this study was to compare the body composition of twins, evaluated with air-displacement plethysmography, to that of singletons of similar gestational age and adequacy of growth, during the first month of life. We tested the hypothesis that the quality of growth would be similar. Methods. Anthropometric and air-displacement plethysmography measurements were performed in 18 pairs of twins and in 36 singleton neonates, longitudinally, from birth to the 30th day of life. Each twin was matched to a singleton infant of similar gestational age and birth weight z-score. Results. With regard to anthropometric measures, the only difference was a lower weight in twins versus singletons on the 15th day of life. With regard to body composition, we did not find any difference between groups at any time point. Fat mass increased significantly from day 1 to day 30 in both twins and singletons. Conclusion. In terms of body composition, twins do not differ from singletons of similar gestational age and weight, either at birth or in early postnatal life

SARS-CoV-2 perinatal transmission and neonatal outcomes across four different waves of COVID-19 pandemic: A nationwide prospective cohort study from the Italian Society of Neonatology

Objectives: To describe how SARS-CoV-2 infection at the time of delivery affected maternal and neonatal outcomes across four major waves of the COVID-19 pandemic in Italy. Methods: This is a large, prospective, nationwide cohort study collecting maternal and neonatal data in case of maternal peripartum SARS-CoV-2 infection between February 2020 and March 2022. Data were stratified across the four observed pandemic waves. Results: Among 5201 COVID-19-positive mothers, the risk of being symptomatic at delivery was significantly higher in the first and third waves (20.8-20.8%) than in the second and fourth (13.2-12.2%). Among their 5284 neonates, the risk of prematurity (gestational age <37 weeks) was significantly higher in the first and third waves (15.6-12.5%). The risk of intrauterine transmission was always very low, while the risk of postnatal transmission during rooming-in was higher and peaked at 4.5% during the fourth wave. A total of 80% of positive neonates were asymptomatic. Conclusion: The risk of adverse maternal and neonatal outcomes was significantly higher during the first and third waves, dominated by unsequenced variants and the Delta variant, respectively. Postnatal transmission accounted for most neonatal infections and was more frequent during the Omicron period. However, the paucity of symptoms in infected neonates should lead us not to separate the dyad

Confirmatory factor analysis of the Patient Assessment of Constipation-Symptoms (PAC-SYM) among patients with chronic constipation

Background and aim: PAC-SYM is widely adopted to asses constipation severity. However, it has been validated in a small sample, few items have been included based on expert opinion and not on empirical grounds, and its factor structure has never been replicated. We aimed at evaluating the psychometric properties of PAC-SYM in patients with chronic constipation. Methods: We enrolled 2,203 outpatients with chronic constipation in two waves. We used wave I sample to test the psychometric properties of the PAC-SYM and wave II sample to cross-validate its factor structure, to assess criterion validity, responsiveness to clinical change, and its minimal clinically important difference. Results: Only a minority of patients reported any rectal tearing (38 %). Deletion of such item leads to a 11-item version (M:PAC-SYM). The remaining items in the rectal domain were moderately correlated with the stool domain. Exploratory factor analysis and confirmatory factor analysis revealed a bifactor structure with two subscales (stool and abdominal symptoms) and a general severity factor. The M:PAC-SYM demonstrated excellent reliability, moderate correlation with SF-12 and treatment satisfaction (r = 0.28-0.45), discrimination across Rome III criteria for functional constipation and abdominal pain, and responsiveness to clinical change (β = -0.49; ω2 = 0.25). M:PAC-SYM minimal clinically important difference was 0.24. Conclusion: Our analysis shows that the rectal domain may not represent a relevant cluster of symptoms for patients with chronic constipation. We developed a modified version of the PAC-SYM which might better represent symptom severity of most patients seeking care in gastroenterology referral centers

Bloating is associated with worse quality of life, treatment satisfaction, and treatment responsiveness among patients with constipation-predominant irritable bowel syndrome and functional constipation

Background: The management of bloating is unclear and its relationship with patients' well-being and treatment satisfaction independent of other abdominal symptoms is uncharacterized. We evaluated the association of bloating with patient-reported outcomes. Methods: Thirty-nine centers for functional gastrointestinal disorders joined the laxative inadequate relief survey. We enrolled 2203 consecutive outpatients with functional constipation (FC) or constipation-predominant irritable bowel syndrome (IBS-C) in two cross-sectional waves. Both wave 1 and 2 included the SF-12, the patient assessment of constipation-symptoms (PAC-SYM), and the treatment satisfaction questionnaire for medication (TSQM-2). Wave 2 only included a global rating of change (GRC) scale to assess patients' assessment of efficacy concerning treatment switches occurred in the 3 months prior to the interview. Bloating in the abdomen was defined on the basis of PAC-SYM item 3. Key Results: The average age was 50.1 years (SD, 16.7) and 82.1% of patients were women. The prevalence of bloating was 91.6% (n = 1970). Bloating was associated with SF-12 Physical Composite Score (p &lt; 0.01), SF-12 Mental Composite Score (p &lt; 0.01), GRC (p &lt; 0.01), Satisfaction with treatment effectiveness (p &lt; 0.01), convenience of administration (p &lt; 0.01), and side effects (p &lt; 0.01) after adjustment for possible confounders. Conclusions &amp; Inferences: Our data suggest that patients regard bloating as a key element in assessing clinical changes and treatments' efficacy as this symptom exerts a strong influence on patient-reported outcomes independent of possible confounders and other symptoms of constipation. Our data provide the rationale to investigate the efficacy and tolerability of new treatments specifically addressing this important, yet disregarded, patients' complain