389 research outputs found
Assessing whether early attention of very preterm infants can be improved by an omega-3 long-chain polyunsaturated fatty acid intervention: a follow-up of a randomised controlled tria
Introduction Docosahexaenoic acid (DHA) accumulates
in the frontal lobes (responsible for higher-order cognitive
skills) of the fetal brain during the last trimester of
pregnancy. Infants born preterm miss some of this in utero
provision of DHA, and have an increased risk of suboptimal
neurodevelopment. It is thought that supplementing infants
born preterm with DHA may improve developmental
outcomes. The aim of this follow-up is to determine
whether DHA supplementation in infants born preterm can
improve areas of the brain associated with frontal lobe
function, namely attention and distractibility.
Methods and analysis We will assess a subset
of children from the N-3 (omega-3) Fatty Acids
for Improvement in Respiratory Outcomes (N3RO)
multicentre double-blind randomised controlled trial
of DHA supplementation. Infants born <29 weeks’
completed gestation were randomised to receive an
enteral emulsion containing 60 mg/kg/day of DHA or a
control emulsion from within the first 3 days of enteral
feeding until 36 weeks’ postmenstrual age. Children will
undergo multiple measures of attention at 18 months’
corrected age. The primary outcome is the average time
to be distracted when attention is focused on a toy.
Secondary outcomes are other aspects of attention, and
(where possible) an assessment of cognition, language
and motor development with the Bayley Scales of Infant
and Toddler Development, Third Edition. A minimum of
72 children will be assessed to ensure 85% power to
detect an effect on the primary outcome. Families, and
research personnel are blinded to group assignment. All
analyses will be conducted according to the intentionto-treat principal.
Ethics and dissemination All procedures were approved
by the relevant institutional ethics committees prior to
commencement of the study. Results will be disseminated
in peer-reviewed journal publications and academic
presentations.
Trial registration number ACTRN12612000503820; Preresults
Comparison of Human Milk Fatty Acid Composition of Women From Cambodia and Australia
Human milk is a rich source of omega-3 long-chain polyunsaturated fatty acids, which are postulated to be important for brain development. There is a lack of data on the human milk fatty acid composition of Cambodian women compared with data from Western women. The aim of this study was to determine the human milk fatty acid composition of women living in Cambodia and compare it with that of women living in Australia. Human milk samples from Cambodian (n = 67) and Australian (n = 200) mothers were collected at 3 to 4 months postpartum. Fatty acid composition was analyzed using capillary gas chromatography followed by Folch extraction with chloroform/methanol (2:1 v/v), and fat content was measured gravimetrically. Compared with Australian participants, human milk from Cambodian participants contained a significantly lower level of total fat (2.90 vs. 3.45 g/dL, p = .028), lower percentages of linoleic acid (9.30% vs. 10.66%, p < .0001) and α-linolenic acid (0.42% vs. 0.95%, p < .0001), but higher percentages of arachidonic acid (0.68% vs. 0.38%, p < .0001) and docosahexaenoic acid (0.40% vs. 0.23%, p < .0001). Differences in human milk fatty acid composition between Cambodian and Australian participants may be explained by differences in the dietary patterns between the two populations.Chang Gao, Ge Liu, Kyly C. Whitfield, Hou Kroeun, Timothy J. Green, Robert A. Gibson, Maria Makrides, and Shao J. Zho
Tissue factor in antiphospholipid antibody-induced pregnancy loss:a pro-inflammatory molecule
Fetal loss in patients with antiphospholipid antibodies (aPL) has been ascribed to thrombosis of placental vessels. However, we have shown that inflammation, specifically complement activation with generation of the anaphylotoxin C5a, is an essential mediator of fetal injury. We have analysed the role of tissue factor (TF) in a mouse model of aPL-induced pregnancy loss. TF is the major cellular activator of the coagulation cascade but also has cell signaling activity. Mice that received aPL-IgG showed strong TF staining throughout the decidua and on embryonic debris. This TF staining was not associated with either fibrin staining or thrombi in deciduas. The absence of fibrin deposition and thrombi suggests that TF-dependent activation of coagulation does not mediate aPL-induced pregnancy loss. We found that either blockade of TF with a monoclonal antibody in wild type mice or a genetic reduction of TF prevented aPL-induced inflammation and pregnancy loss indicated a pathogenic role for TF in aPL-induced pregnancy complications. In response to aPL-generated C5a, neutrophils express TF potentiating inflammation in the deciduas and leading to miscarriages. Importantly, we showed that TF in myeloid cells, but not fetal-derived cells (trophoblasts), was associated with fetal injury, suggesting that the site for pathologic TF expression is neutrophils. We found that TF expression in neutrophils contributes to respiratory burst and subsequent trophoblast injury and pregnancy loss induced by aPL. The identification of TF, acting as an important pro-inflammatory mediator in aPL-induced fetal injury, provides a new target for therapy to prevent pregnancy loss in the aPL syndrome
Growth of Indonesian infants compared with World Health Organization growth standards
OBJECTIVE: The ability of the World Health Organization (WHO) growth standards to represent the growth of South East Asian infants has been questioned. The aim of this study was to provide contemporary data on the growth of Indonesian breast-fed and formula-fed infants, compared with the WHO growth standards. METHODS: A prospective cohort study of 160 normal healthy infants was undertaken in a suburban area of South Jakarta, Indonesia. Infants from 2-6 weeks of age were recruited, and consumed exclusively either breast milk or infant formula for at least 6 months, with follow-up until 12 months of age. RESULTS: Overall, the infants in this study were lighter (weight-for-age), were shorter (length-for-age) and had smaller head circumferences (head circumference-for-age) than the average WHO Growth Reference Study (WGRS) population but were of similar proportion (weight-for-length). Compared with the WGRS, the z-scores for weight-for-age, length-for-age and head circumference-for-age in the Indonesian children fell from birth to 6 weeks of age and then increased until 3 months of age in both the breast-fed infants and the formula-fed infants. At 6 weeks of age, the weight-for-age z-scores fell below -2 standard deviations (SD) for 16 (20.5%) breast-fed and 40 (51.3%) formula-fed infants, and the length-for-age z-scores fell below -2 SD for 31 (39.7%) breast-fed and 41 (52.6%) formula-fed infants. CONCLUSIONS: The WHO growth standards do not reflect the growth of this cohort of Indonesian infants and may overestimate the levels of underweight and stunted children. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01721512This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No-Derivatives 4.0 License, where it is permissible to download and share the work, provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/4.0.Pramita G. Dwipoerwantoro, Muchtaruddin Mansyur, Hanifah Oswari, Maria Makrides, Geoffrey Cleghorn, and Agus Firmansyah
Inverse Association between trans Isomeric and Long-Chain Polyunsaturated Fatty Acids in Pregnant Women and Their Newborns: Data from Three European Countries
Background: trans unsaturated fatty acids are thought to interfere with essential fatty acid metabolism. To extend our knowledge of this phenomenon, we investigated the relationship between trans isomeric and long-chain polyunsaturated fatty acids (LCPUFA) in mothers during pregnancy and in their infants at birth. Methods: Fatty acid composition of erythrocyte phosphatidylcholine (PC) and phosphatidylethanolamine (PE) was determined in Spanish (n = 120), German (n = 78) and Hungarian (n = 43) women at the 20th and 30th week of gestation, at delivery and in their newborns. Results: At the 20th week of gestation, the sum of trans fatty acids in PE was significantly (p < 0.01) lower in Hungarian [0.73 (0.51), % wt/wt, median (IQR)] than in Spanish [1.42 (1.36)] and German [1.30 (1.21)] women. Docosahexaenoic acid (DHA) values in PE were significantly (p < 0.01) higher in Hungarian {[}5.65 (2.09)] than in Spanish [4.37 (2.60)] or German [4.39 (3.3.2)] women. The sum of trans fatty acids significantly inversely correlated to DHA in PCs in Spanish (r = -0.37, p < 0.001), German (n = -0.77, p < 0.001) and Hungarian (r = -0.35, p < 0.05) women, and in PEs in Spanish (r = -0.67, p < 0.001) and German (r = -0.71, p < 0.001), but not in Hungarian (r = -0.02) women. Significant inverse correlations were seen between trans fatty acids and DHA in PEs at the 30th week of gestation (n = 241, r = -0.52, p < 0.001), at delivery (n = 241, r = -0.40, p < 0.001) and in cord lipids (n = 218, r = -0.28, p < 0.001). Conclusion: Because humans cannot synthesize trans isomeric fatty acids, the data obtained in the present study support the concept that high maternal trans isomeric fatty acid intake may interfere with the availability of LCPUFA both for the mother and the fetus. Copyright (C) 2011 S. Karger AG, Base
A randomized trial of prenatal n-3 fatty acid supplementation and preterm delivery
Background: Previous studies have suggested that maternal supplementation with n−3 long-chain polyunsaturated fatty acids may reduce the incidence of preterm delivery but may also prolong gestation beyond term; however, more data are needed regarding the role of n−3 long-chain polyunsaturated fatty acids in pregnancy.
Methods: We performed a multicenter, double-blind, randomized trial in which women who were pregnant with single or multiple fetuses were assigned to receive either fish-oil capsules that contained 900 mg of n−3 long-chain polyunsaturated fatty acids (n−3 group) or vegetable-oil capsules that contained trace n−3 long-chain polyunsaturated fatty acids (control group) daily, beginning before 20 weeks of gestation and continuing to 34 weeks of gestation or delivery, whichever occurred first. The primary outcome was early preterm delivery, defined as delivery before 34 completed weeks of gestation. Other pregnancy and neonatal outcomes were also assessed.
Results: A total of 5544 pregnancies in 5517 women were randomly assigned at six centers in Australia; 5486 pregnancies were included in the primary analysis. Early preterm delivery occurred in the case of 61 of 2734 pregnancies (2.2%) in the n−3 group and 55 of 2752 pregnancies (2.0%) in the control group; the between-group difference was not significant (adjusted relative risk, 1.13; 95% confidence interval [CI], 0.79 to 1.63; P=0.50). There were no significant differences between the groups in the incidence of interventions in post-term (\u3e41 weeks of gestation) deliveries, in adverse events, or in other pregnancy or neonatal outcomes, except that a higher percentage of infants born to women in the n−3 group than in the control group were very large for gestational age at birth (adjusted relative risk, 1.30; 95% CI, 1.02 to 1.65). Percentages of serious adverse events did not differ between the groups. Minor gastrointestinal disturbances were more commonly reported in the n−3 group than in the control group.
Conclusions: Supplementation with n−3 long-chain polyunsaturated fatty acids from early pregnancy (\u3c20 weeks of gestation) until 34 weeks of gestation did not result in a lower incidence of early preterm delivery or a higher incidence of interventions in post-term deliveries than control. (Funded by the Australian National Health and Medical Research Council and the Thyne Reid Foundation; ORIP Australian New Zealand Clinical Trials Registry number, ACTRN12613001142729.
Neurodevelopmental outcomes at 7 years’ corrected age in preterm infants who were fed high-dose docosahexaenoic acid to term equivalent: a follow-up of a randomised controlled trial
This is an Open Access article distributed in accordance with
the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license,
which permits others to distribute, remix, adapt, build upon this work noncommercially,
and license their derivative works on different terms, provided
the original work is properly cited and the use is non-commercial. See: http://
creativecommons.org/licenses/by-nc/4.0/OBJECTIVE:
To determine if improvements in cognitive outcome detected at 18 months' corrected age (CA) in infants born <33 weeks' gestation receiving a high-docosahexaenoic acid (DHA) compared with standard-DHA diet were sustained in early childhood.
DESIGN:
Follow-up of a multicentre randomised controlled trial. Randomisation was stratified for sex, birth weight (<1250 vs ≥1250 g) and hospital.
SETTING:
Five Australian tertiary hospitals from 2008 to 2013.
PARTICIPANTS:
626 of the 657 participants randomised between 2001 and 2005 were eligible to participate.
INTERVENTIONS:
High-DHA (≈1% total fatty acids) enteral feeds compared with standard-DHA (≈0.3% total fatty acids) from age 2-4 days until term CA.
PRIMARY OUTCOME:
Full Scale IQ of the Wechsler Abbreviated Scale of Intelligence (WASI) at 7 years CA. Prespecified subgroup analyses based on the randomisation strata (sex, birth weight) were conducted.
RESULTS:
604 (92% of the 657 originally randomised) consented to participate (291 high-DHA, 313 standard-DHA). To address missing data in the 604 consenting participants (22 for primary outcome), multiple imputation was performed. The Full Scale IQ was not significantly different between groups (high-DHA 98.3, SD 14.0, standard-DHA 98.5, SD 14.9; mean difference adjusted for sex, birthweight strata and hospital -0.3, 95% CI -2.9 to 2.2; p=0.79). There were no significant differences in any secondary outcomes. In prespecified subgroup analyses, there was a significant sex by treatment interaction on measures of parent-reported executive function and behaviour. Scores were within the normal range but girls receiving the high-DHA diet scored significantly higher (poorer outcome) compared with girls receiving the standard-DHA diet.
CONCLUSIONS:
Supplementing the diets of preterm infants with a DHA dose of approximately 1% total fatty acids from days 2-4 until term CA showed no evidence of benefit at 7 years' CA.
TRIAL REGISTRATION NUMBER:
Australian New Zealand Clinical Trials Registry: ACTRN12606000327583
Continuation for thin film hydrodynamics and related scalar problems
This chapter illustrates how to apply continuation techniques in the analysis
of a particular class of nonlinear kinetic equations that describe the time
evolution through transport equations for a single scalar field like a
densities or interface profiles of various types. We first systematically
introduce these equations as gradient dynamics combining mass-conserving and
nonmass-conserving fluxes followed by a discussion of nonvariational amendmends
and a brief introduction to their analysis by numerical continuation. The
approach is first applied to a number of common examples of variational
equations, namely, Allen-Cahn- and Cahn-Hilliard-type equations including
certain thin-film equations for partially wetting liquids on homogeneous and
heterogeneous substrates as well as Swift-Hohenberg and Phase-Field-Crystal
equations. Second we consider nonvariational examples as the
Kuramoto-Sivashinsky equation, convective Allen-Cahn and Cahn-Hilliard
equations and thin-film equations describing stationary sliding drops and a
transversal front instability in a dip-coating. Through the different examples
we illustrate how to employ the numerical tools provided by the packages
auto07p and pde2path to determine steady, stationary and time-periodic
solutions in one and two dimensions and the resulting bifurcation diagrams. The
incorporation of boundary conditions and integral side conditions is also
discussed as well as problem-specific implementation issues
The N3RO trial: a randomised controlled trial of docosahexaenoic acid to reduce bronchopulmonary dysplasia in preterm infants < 29 weeks’ gestation
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