The Effect of Human Milk on Modulating the Quality of Growth in Preterm Infants

Introduction: Human milk is the optimal nutrition for preterm infants. When the mother's own milk is unavailable, donor human milk is recommended as an alternative for preterm infants. The association among early nutrition, body composition and the future risk of disease has recently attracted much interest. The aim of this study was to investigate the effect of human milk on the body composition of preterm infants.Materials and Methods: Very low birth weight infants (VLBW: birth weight <1,500 g) with a gestational age (GA) between 26 and 34 weeks were included. Clinical data, anthropometric measurements and nutritional intake in terms of the volume of human milk were extracted from computerized medical charts. The human milk intake was expressed as a percentage of target fortified donor human milk and/or target fortified fresh mother's milk, compared with the total volume of milk intake during the hospital stay. All included infants underwent anthropometric measurements and body composition analysis (expressed as fat-free mass percentage) at term corrected age (CA) by air-displacement plethysmography. A comparison between infants fed human milk at <50% (group 1) and infants fed human milk at ≥50% of the total volume of milk intake (group 2) was conducted. Multiple linear regression analyses were conducted to explore the modulating effect of fortified human milk on fat-free mass at term CA.Results: Seventy-three VLBW infants were included in the study. The mean weight and GA at birth were 1,248 ± 198 g and 30.2 ± 2.0 weeks, respectively. No differences were found regarding anthropometric measurements at birth, at discharge and at term CA between the two groups. The mean fortified human milk intake was 34.9 ± 12.5 and 80.9 ± 15.5% in groups 1 and 2, respectively (p < 0.001).A multiple regression analysis corrected for sex and birth weight demonstrated that intake of ≥50% fortified human milk was associated with a higher fat-free mass percentage at term CA than intake of <50% fortified human milk.Conclusion: The use of target fortified human milk modulated growth and improved growth quality in vulnerable preterm infants. Thus, the use of donor human milk should be encouraged when fresh mother's milk is insufficient or not available

Effect of nutrition on growth and body composition in infants born preterm

The optimization of the nutritional management of preterm infants has gained importance due to the increased survival of these vulnerable infants. In fact, the achievement of an adequate growth has been associated with a favourable neurodevelopment outcome. Nevertheless, preterm infants still develop severe nutrient deficiencies during the first few weeks of life so that they are frequently growth restricted upon discharge. In addition, preterm infants have been found to show an increased and aberrant adiposity at term-corrected age. The development of strategies immediately after birth has been found to produce excellent results in terms of growth without having any detrimental effect on body composition at term-corrected age. Continuing to monitor growth and body composition changes in relation to different nutrition interventions is essential as growth pattern and body composition appear to have a long term effect on health outcomes. \uc2\ua9 2012 Informa UK, Ltd

Macronutrient content of pooled donor human milk before and after Holder pasteurization

Abstract Background Donor human milk (DHM) is the best alternative for preterm infants when their own mother’s milk is unavailable. DHM should be pasteurized to guarantee microbiological safety; however, this process can influence the macronutrient content. The aim of this study was to investigate the effect of Holder pasteurization (HoP) on DHM macronutrient content. Methods Protein, lactose, lipids (g/100 ml) and energy (kcal/100 ml) of DHM pools were analysed before and after HoP (62.5 °C for 30 min) using mid-infrared spectroscopy (HM analyser Miris AB®). The mean macronutrient content before and after HoP was compared by paired t-test. The percentage decreases (Delta%) were calculated. Results The change in macronutrient content of 460 pools was determined. Protein, lipids and lactose decreased significantly after HoP (0.88 ± 0.20 vs 0.86 ± 0.20 and 2.91 ± 0.89 vs 2.75 ± 0.84 and 7.19 ± 0.41 vs 7.11 ± 0.48 respectively). The Delta% values were − 2.51 ± 13.12, − 4.79 ± 9.47 and − 0.92 ± 5.92 for protein, lipids and lactose, respectively (p ≤ 0.001). Conclusion This study confirms that the macronutrient content of DHM, especially in terms of lipids and protein, is reduced after HoP. Therefore, in order to perform a tailored fortification of DHM, the clinicians need to be aware of the somewhat diminished nutrient content of DHM

Body composition changes in the first 6 months of life according to method of feeding

Background: Early feeding choices may affect long-term health outcomes. Therefore, understanding body composition changes in healthy breastfed infants has become an important research focus. Objectives: The aims of this review were to investigate the body composition changes that occur during weight loss in breastfed term newborns and to examine body composition differences between exclusively/predominantly breastfed and exclusively formula-fed infants in the first 6 months of life. Methods: We performed a review of the existing literature using PubMed. We searched for studies published in English since January 1, 2000, that involved human infants ranging in age from birth to 6 months. We used the following MEDLINE Medical Subject Headings: ((breastfeeding) OR (infant formula)) AND ((body composition) OR (bioelectrical impedance) OR (absorptiometry, photon) OR (total body potassium) OR (isotope dilution) OR (air-displacement plethysmography)). Our search yielded 6 studies. Results: Two studies reported that newborn weight loss was due to a reduction in the quantity of both fat mass and fat-free mass. Three out of 4 articles that evaluated body composition changes according to method of feeding reported no differences in body composition between exclusively/predominantly breastfed and exclusively formula-fed infants in the first 4.5 months of life. One study reported that exclusively breastfed infants at 3 months of age and exclusively breastfed boys at 6 months of age had higher fat mass contents compared to exclusively formula-fed infants. Conclusion: Because of the limited number of studies available, larger studies are needed to clarify the differences in body composition between exclusively/predominantly breastfed and exclusively formula-fed infants. \uc2\ua9 The Author(s) 2014

Energy Expenditure, Protein Oxidation and Body Composition in a Cohort of Very Low Birth Weight Infants

The nutritional management of preterm infants is a critical point of care, especially because of the increased risk of developing extrauterine growth restriction (EUGR), which is associated with worsened health outcomes. Energy requirements in preterm infants are simply estimated, so the measurement of resting energy expenditure (REE) should be a key point in the nutritional evaluation of preterm infants. Although predictive formulae are available, it is well known that they are imprecise. The aim of our study was the evaluation of REE and protein oxidation (Ox) in very low birth weight infants (VLBWI) and the association with the mode of feeding and with body composition at term corrected age. Methods: Indirect calorimetry and body composition were performed at term corrected age in stable very low birth weight infants. Urinary nitrogen was measured in spot urine samples to calculate Ox. Infants were categorized as prevalent human milk (HMF) or prevalent formula diet (PFF). Results: Fifty VLBWI (HMF: 23, PFF: 27) were evaluated at 36.48 ± 0.85 post-conceptional weeks. No significant differences were found in basic characteristics or nutritional intake in the groups at birth and at the assessment. No differences were found in the REE of HMF vs. PFF (59.69 ± 9.8 kcal/kg/day vs. 59.27 ± 13.15 kcal/kg/day, respectively). We found statistical differences in the protein-Ox of HMF vs. PFF (1.7 ± 0.92 g/kg/day vs. 2.8 ± 1.65 g/kg/day, respectively, p < 0.01), and HMF infants had a higher fat-free mass (kg) than PFF infants (2.05 ± 0.26 kg vs. 1.82 ± 0.35 kg, respectively, p < 0.01), measured with air displacement plethysmography. Conclusion: REE is similar in infants with a prevalent human milk diet and in infants fed with formula. The HMF infants showed a lower oxidation rate of proteins for energy purposes and a better quality of growth. A greater amount of protein in HMF is probably used for anabolism and fat-free mass deposition. Further studies are needed to confirm our hypothesis

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

Abstract Following the publication of the original article [1], it was brought to our attention that the authors’ names and surnames were erroneously interchanged

Rapid recovery of fat mass in small for gestational age preterm infants after term

Background: Pretermsmall for gestational age (SGA) infantsmay be at risk for increased adiposity, especially when experiencing rapid postnatal weight gain. Data on the dynamic features of body weight and fatmass (FM) gain that occurs early in life is scarce. We investigated the postnatal weight and FM gain during the first five months after term in a cohort of preterm infants. Methodology/Principal Findings: Changes in growth parameters and FM were prospectively monitored in 195 infants with birth weight \ue2\u89\ua41500 g. The infants were categorized as born adequate for gestational age (AGA) without growth retardation at term (GR-), born AGA with growth retardation at term (GR+), born SGA. Weight and FM were assessed by an air displacement plethysmography system. At five months, weight z-score was comparable between the AGA (GR+) and the AGA (GR-), whereas the SGA showed a significantly lower weight.The mean weight (g) differences (95% CI) between SGA and AGA (GR-) and between SGA and AGA (GR+) infants at 5 months were-613 (-1215;-12) and2573 (-1227;-79), respectively. At term, the AGA (GR+) and the SGA groups showed a significantly lower FM than the AGA (GR-) group. In the first three months, change in FM was comparable between the AGA (GR+) and the SGA groups and significantly higher than that of the AGA (GR-) group.The mean difference (95% CI) in FM change between SGA and AGA (GR-) and between AGA (GR+) and AGA (GR-) from term to 3 months were 38.6 (12; 65); and 37.7 (10; 65). At three months, the FM was similar in all groups. Conclusions: Our data suggests that fetal growth pattern influences the potential to rapidly correct anthropometry whereas the restoration of fat stores takes place irrespective of birth weight. The metabolic consequences of these findings need to be elucidated. \uc2\ua9 2011 Roggero et al

Implementation of Nutritional Strategies Decreases Postnatal Growth Restriction in Preterm Infants

Background: Prevention of postnatal growth restriction of very preterm infants still represents a challenge for neonatologists. As standard feeding regimens have proven to be inadequate. Improved feeding strategies are needed to promote growth. Aim of the present study was to evaluate whether a set of nutritional strategies could limit the postnatal growth restriction of a cohort of preterm infants. Methodology/Principal Findings: We performed a prospective non randomized interventional cohort study. Growth and body composition were assessed in 102 very low birth weight infants after the introduction of a set of nutritional practice changes. 69 very low birth weight infants who had received nutrition according to the standard nutritional feeding strategy served as a historical control group. Weight was assessed daily, length and head circumference weekly. Body composition at term corrected age was assessed using an air displacement plethysmography system. The cumulative parenteral energy and protein intakes during the first 7 days of life were higher in the intervention group than in the historical group (530\uc2\ub181 vs 300\uc2\ub193 kcal/kg, p<0.001 and 21\uc2\ub12.9 vs 15\uc2\ub13.2 g/kg, p<0.01). During weaning from parenteral nutrition, the intervention group received higher parental/enteral energy and protein intakes than the historical control group (1380\uc2\ub158 vs 1090\uc2\ub170 kcal/kg; 52.6\uc2\ub17 vs 42.3\uc2\ub110 g/kg, p<0.01). Enteral energy (kcal/kg/d) and protein (g/kg/d) intakes in the intervention group were higher than in the historical group (130\uc2\ub111 vs 100\uc2\ub113; 3.5\uc2\ub10.5 vs 2.2\uc2\ub10.6, p<0.01). The negative changes in z score from birth to discharge for weight and head circumference were significantly lower in the intervention group as compared to the historical group. No difference in fat mass percentage between the intervention and the historical groups was found. Conclusions: The optimization and the individualization of nutritional intervention promote postnatal growth of preterm infants without any effect on percentage of fat mass. \uc2\ua9 2012 Roggero et al