Neonatal visual function in very low birth weight preterm and nutritional factor involved

Background:L’acido docosaesaenoico (DHA) costituisce le membrane neuronali e retiniche e ha un ruolo fondamentale nello sviluppo del sistema nervoso centrale e dell’apparato visivo nel neonato, specie prematuro, fortemente a rischio per lo sviluppo di complicanze. Scopo:Abbiamo valutato se la supplementazione materna con olio di Krill aumenta il contenuto di acidi grassi polinsaturi (LCPUFA) nel latte materno (LM), se l’assunzione del LM supplementato da parte del neonato aumenta i livelli di DHA ematici e le performance visive neonatali. Metodi:Abbiamo arruolato nutrici di neonati in Terapia Intensiva Neonatale (TIN) suddivise in gruppo 1 supplementato con olio di Krill; gruppo 2 controllo. Il LM è stato raccolto all’arruolamento(T0) e dopo 30 giorni(T1) per eseguire le analisi qualitative degli LCPUFA. Successivamente abbiamo arruolato neonati pretermine ricoverati in TIN e suddivisi in gruppo 1: ricevente LM supplementato e gruppo 2: controllo. Abbiamo eseguito i test di funzionalità visiva e analizzato i campioni di LM e di sangue dei neonati. Risultati:Prima fase: 16 nutrici arruolate: 8 supplementate, 8 controlli. I valori basali di DHA%, acido arachidonico (AA%), acido eicosapentaenoico (EPA%) non differivano nei due gruppi. Incremento significativo di DHA% ed EPA% e significativa riduzione di AA% tra T0 e T1 nel gruppo supplementato. Seconda fase: 8 neonati suddivisi in due gruppi. No differenze significative nei valori di LCPUFA nei due gruppi. Nel LM e su sangue trend in aumento dei valori di DHA%, in diminuzione di AA% e di AA:DHA nel gruppo supplementato. Dai test visivi il gruppo supplementato ha performance significativamente migliori a 3 mesi e a 6 mesi. Conclusioni:La supplementazione orale con olio di Krill incrementa i valori di DHA% ed EPA% nel LM. La seconda fase dello studio, in corso, sta valutando i potenziali benefici di tale strategia sullo sviluppo del sistema nervoso e visivo dei neonati prematuri.Docosahexaenoic acid (DHA) is a constituent of neuronal and retinal membranes and plays a role in brain and visual development within the first months of life, especially in preterm infants. We aimed to evaluate whether maternal supplementation with krill oil during breastfeeding increases long-chain polyunsaturated fatty acids (LCPUFAs) BMcontents, whether BM supplemented increases hematic LCPUFAs contents in neonates and neonatal visual function. Mothers of infants admitted to Neonatal Intensive Care Unit (NICU) were allocated in group 1: received krill oil-based supplement for 30 days; group 2 control. BM samples were collected at baseline(T0)and day 30(T1) and underwent a qualitative analysis of LCPUFAs composition. Afterall preterm neonates at NICU were allocated in group 1:received supplemneted BM and group 2: control. Neonatal visual function, qualitative analysis of BM LCPUFA and neonatal blood were performed. First part:Sixteen breastfeeding women were included: 8 received krill-oil supplementation and 8 were control group. Baseline percentage values of DHA, arachidonic acid (%AA), and EPA (%EPA) did not differ between groups. A significant increase in %DHA, %EPA and a significant reduction in %AA between T0 and T1 occurred in supplemented group. Second part:8 preterm neonates were divided in two groups. No significant differences of LCPUFA was found between two groups. An increase of DHA% and a decrease of AA% and AA:DHA on BM and blood was found in supplemented group. A significant better visual function was found at 3 and 6 month on supplemented group. Oral krill oil supplementation effectively increases DHA and EPA contents in BM. Second part of this study is evalueting potential benefits of this strategy on brain and visual development in preterm neonates

Maternal Supplementation With Krill Oil During Breastfeeding and Long-Chain Polyunsaturated Fatty Acids (LCPUFAs) Composition of Human Milk: A Feasibility Study

Background: Docosahexaenoic acid (DHA) is amajor constituent of neuronal and retinal membranes and plays a crucial role in brain and visual development within the first months of life. Dietary intakes are fundamental to provide neonates with adequate DHA supply; hence, maternal supplementation might represent a useful strategy to implement DHA contents in breast milk (BM), with possible benefits on neonatal neurodevelopment. Antarctic krill is a small crustacean rich in highly available phospholipid-bound DHA. This pilot study aimed to evaluate whether maternal supplementation with krill oil during breastfeeding increases long-chain polyunsaturated fatty acids (LCPUFAs) BM contents.Methods: Mothers of infants admitted to the Neonatal Intensive Care Unit were enrolled in this open, randomized-controlled study between 4 and 6 weeks after delivery and randomly allocated in 2 groups. Group 1 received an oral krill oil-based supplement providing 250mg/day of DHA and 70mg/day of eicosapentaenoic acid (EPA) for 30 days; group 2 served as control. BM samples from both groups were collected at baseline (T0) and day 30 (T1) and underwent a qualitative analysis of LCPUFAs composition by gas chromatography/mass spectrometry.Results: Sixteen breastfeeding women were included. Of these, 8 received krill-oil supplementation and 8 were randomized to the control group. Baseline percentage values of DHA (% DHA), arachidonic acid (% AA), and EPA (% EPA) did not differ between groups. A significant increase in % DHA (T0: median 0.23% [IQR 0.19; 0.38], T1: 0.42%[0.32; 0.49], p 0.012) and% EPA (T0: median 0.10%[IQR 0.04; 0.11], T1: 0.11% [0.04; 0.15], p 0.036) and a significant reduction in % AA (T0: median 0.48% [IQR 0.42; 0.75], T1: 0.43% [0.38; 0.61], p 0.017) between T0 and T1 occurred in Group 1, whereas no difference was seen in Group 2. Consistently, a significant between-group difference was observed in percentage changes from baseline of DHA (Delta% DHA, group 1: median 64.2% [IQR 27.5; 134.6], group 2: -7.8% [-12.1;-3.13], p 0.025) and EPA (Delta% EPA, group 1: median 39% [IQR 15.7; 73.4]; group 2: -25.62% [-32.7;-3.4], p 0.035).Conclusions: Oral krill oil supplementation effectively increases DHA and EPA contents in BM. Potential benefits of this strategy on brain and visual development in breastfed preterm neonates deserve further evaluation in targeted studies

Changes in ventilator strategies and outcomes in preterm infants

Background: Although life-saving, intubation and mechanical ventilation can lead to complications including bronchopulmonary dysplasia (BPD). In order to reduce the incidence of BPD, non-invasive ventilation (NIV) is increasingly used. Objective: The aim of our study was to describe changes in ventilator strategies and outcomes between 2006 and 2010 in the Italian Neonatal Network (INN). Design: Multicentre cohort study. Settings: 31 tertiary level neonatal units participating in INN in 2006 and 2010. Patients: 2465 preterm infants 23-30 weeks gestational age (GA) without congenital anomalies. Main outcomes measures: Death, BPD and other variables defined according to Vermont Oxford Network. Logistic regressions, adjusting for confounders and clustering for hospitals, were used. Results: Similar numbers of infants were studied between 2006 and 2010 (1234 in 2006 and 1231 in 2010). The baseline risk of populations studied (GA, birth weight and Vermont Oxford Network Risk-Adjustment score) did not change. After adjusting for confounding variables, infants receiving invasive mechanical ventilation decreased (OR=0.72, 95% CI 0.58 to 0.89) while NIV increased (OR=1.75, 95% CI 1.39 to 2.21); intubation in delivery room decreased (OR=0.64, 95% CI 0.51 to 0.79). Considering outcomes, there was a significant reduction in mortality (OR=0.73, 95% CI 0.55 to 0.96) and in the combined outcome mortality or BPD (OR=0.76, 95% CI 0.62 to 0.94). Conclusions: Despite a stable baseline risk, from 2006 to 2010, we observed a lower level of invasiveness, a reduction of mechanical ventilation and an increase of NIV use, and this was accompanied by a decrease in risk-adjusted mortality and BPD