RESUMEN
OBJECTIVE: To describe trends in mortality, major morbidity, and perinatal care practices of very low birth weight infants born at NEOCOSUR Neonatal Network centers from January 1, 2001, through December 31, 2016. STUDY DESIGN: A retrospective analysis of prospectively collected data from all inborn infants with a birthweight of 500-1500 g and 23-35 weeks of gestation. RESULTS: We examined data for 13 987 very low birth weight infants with a mean birth weight of 1081 ± 281 g and a gestational age of 28.8 ± 2.9 weeks. Overall mortality was 26.8% without significant changes throughout the study period. Decreases in early onset sepsis from 6.3% to 2.8% (P <.001), late onset sepsis from 21.1% to 19.5% (P = .002), retinopathy of prematurity from 21.3% to 13.8% (P <.001), and hydrocephalus from 3.8% to 2.4% (P <.001), were observed. The incidence for bronchopulmonary dysplasia decreased from 17.3% to 16% (P = .043), incidence of severe intraventricular hemorrhage was 10.4%, necrotizing enterocolitis 11.1%, and periventricular leukomalacia 3.8%, and did not change over the study period. Administration of antenatal corticosteroids increased from 70.2% to 82.3% and cesarean delivery from 65.9% to 75.4% (P <.001). The use of conventional mechanical ventilation decreased from 67.7% to 63.9% (P <.001) and continuous positive airway pressure use increased from 41.3% to 64.3% (P <.001). Survival without major morbidity increased from 37.4% to 44.5% over the study period (P <.001). CONCLUSIONS: Progress in perinatal and neonatal care at network centers was associated with an improvement in survival without major morbidity of very low birth weight infants during a 16-year period. However, overall mortality remained unchanged.
Asunto(s)
Recién Nacido de muy Bajo Peso , Atención Perinatal/organización & administración , Atención Perinatal/tendencias , Corticoesteroides/uso terapéutico , Adulto , Displasia Broncopulmonar/epidemiología , Displasia Broncopulmonar/mortalidad , Hemorragia Cerebral/epidemiología , Hemorragia Cerebral/mortalidad , Cesárea , Enterocolitis Necrotizante/epidemiología , Enterocolitis Necrotizante/mortalidad , Femenino , Edad Gestacional , Humanos , Hidrocefalia/epidemiología , Hidrocefalia/mortalidad , Recién Nacido , Recien Nacido Prematuro , Enfermedades del Prematuro/epidemiología , Enfermedades del Prematuro/mortalidad , Edad Materna , Retinopatía de la Prematuridad/epidemiología , Retinopatía de la Prematuridad/mortalidad , Estudios Retrospectivos , Sepsis/epidemiología , Sepsis/mortalidad , Resultado del TratamientoRESUMEN
INTRODUCTION: Multiple factors influence the risk of morbidity and mortality of premature infants with intrauterine growth restriction (IUGR). The comparison of twins with different intrauterine growth allows evaluating the effect of the restriction, excluding maternal factors and prenatal mana gement. Our objective was to assess the effect of IUGR on acute and chronic morbidity, and mortality of extreme preterm twins. PATIENTS AND METHOD: Twins weighing less than 1500 grams and gesta tion equal to or less than 30 weeks, of the Neocosur Network. Separate analyses were performed on concordant twin pairs, and on mild and severe discordant twins, evaluating the effect of IUGR on morbidity and mortality. A multivariate analysis was performed in order to establish the impact of this effect. RESULTS: 459 twin pairs, 227 concordant twins, 110 of mild discordance, and 122 of severe discordance. Among the concordant ones, there was only a difference in oxygen uptake at 36 weeks. In those of mild discordance, the smaller twin presented a lower frequency of hyaline membrane disease and required fewer doses of surfactant, but had a higher risk of bronchopulmonary dysplasia (BPD) or death. In severe discordant twins, the smaller one presented higher mortality, sepsis, use and permanence in mechanical ventilation, despite the lower frequency of hyaline membrane disease. In multiple regression analysis, the combined risk of BPD or death was higher in the smaller twin and of severe discordance. CONCLUSION: In discordant twins, the acute respiratory pathology was more frequent in the larger one, although the risk of BPD or death was higher in the one with IUGR.
Asunto(s)
Displasia Broncopulmonar/etiología , Enfermedades en Gemelos/etiología , Retardo del Crecimiento Fetal/fisiopatología , Sepsis Neonatal/etiología , Displasia Broncopulmonar/diagnóstico , Displasia Broncopulmonar/mortalidad , Estudios de Casos y Controles , Enfermedades en Gemelos/diagnóstico , Enfermedades en Gemelos/mortalidad , Femenino , Humanos , Recién Nacido , Recien Nacido Prematuro , Recién Nacido de muy Bajo Peso , Modelos Logísticos , Masculino , Sepsis Neonatal/diagnóstico , Sepsis Neonatal/mortalidad , Embarazo , Pronóstico , Estudios Retrospectivos , Factores de RiesgoRESUMEN
INTRODUCCIÓN: Múltiples factores influyen en el riesgo de morbimortalidad del prematuro con restricción del crecimiento intrauterino (RCIU). La comparación de gemelos con crecimiento intrauterino discordante permite evaluar su efecto, excluyendo factores maternos y manejo prenatal. Nuestro objetivo fue evaluar el efecto de la RCIU sobre la morbilidad aguda, crónica y mortalidad, en parejas de recién nacidos gemelares prematuros extremos. PACIENTES Y MÉTODO: Gemelos menores de 1500 g y 30 semanas de gestación, de la Red Neocosur. Se realizaron análisis separados de pares de gemelos concordantes, discordantes leves y severos, evaluando el efecto de la RCIU sobre morbi-mortalidad. Se realizó análisis multivariado para establecer magnitud del efecto. RESULTADOS: 459 pares de gemelos, 227 concordantes, 110 discordantes leves y 122 severos. Entre los concordantes solo hubo diferencia en uso de oxígeno a las 36 semanas. En discordantes leves, el menor tuvo menos enfermedad de membrana hialina y requirió menos dosis de surfactante, pero tuvo un mayor riesgo de Displasia broncopulmonar (DBP) o muerte. En discordantes severos, el menor presentó mayor mortalidad, sepsis, utilización y permanencia en ventilación mecánica, pese a menor frecuencia de enfermedad de membrana hialina. En regresión múltiple, el riesgo combinado de DBP o muerte fue mayor en gemelo menor y discordante severo. CONCLUSIÓN: En gemelos discordantes, la patología respiratoria aguda fue más frecuente en el gemelo mayor, aunque el riesgo de DBP o muerte fue mayor en el gemelo con RCIU.
INTRODUCTION: Multiple factors influence the risk of morbidity and mortality of premature infants with intrauterine growth restriction (IUGR). The comparison of twins with different intrauterine growth allows evaluating the effect of the restriction, excluding maternal factors and prenatal mana gement. Our objective was to assess the effect of IUGR on acute and chronic morbidity, and mortality of extreme preterm twins. PATIENTS AND METHOD: Twins weighing less than 1500 grams and gesta tion equal to or less than 30 weeks, of the Neocosur Network. Separate analyses were performed on concordant twin pairs, and on mild and severe discordant twins, evaluating the effect of IUGR on morbidity and mortality. A multivariate analysis was performed in order to establish the impact of this effect. RESULTS: 459 twin pairs, 227 concordant twins, 110 of mild discordance, and 122 of severe discordance. Among the concordant ones, there was only a difference in oxygen uptake at 36 weeks. In those of mild discordance, the smaller twin presented a lower frequency of hyaline membrane disease and required fewer doses of surfactant, but had a higher risk of bronchopulmonary dysplasia (BPD) or death. In severe discordant twins, the smaller one presented higher mortality, sepsis, use and permanence in mechanical ventilation, despite the lower frequency of hyaline membrane disease. In multiple regression analysis, the combined risk of BPD or death was higher in the smaller twin and of severe discordance. CONCLUSION: In discordant twins, the acute respiratory pathology was more frequent in the larger one, although the risk of BPD or death was higher in the one with IUGR.
Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Displasia Broncopulmonar/etiología , Enfermedades en Gemelos/etiología , Retardo del Crecimiento Fetal/fisiopatología , Sepsis Neonatal/etiología , Pronóstico , Displasia Broncopulmonar/diagnóstico , Displasia Broncopulmonar/mortalidad , Recien Nacido Prematuro , Estudios de Casos y Controles , Modelos Logísticos , Estudios Retrospectivos , Factores de Riesgo , Recién Nacido de muy Bajo Peso , Enfermedades en Gemelos/diagnóstico , Enfermedades en Gemelos/mortalidad , Sepsis Neonatal/diagnóstico , Sepsis Neonatal/mortalidadRESUMEN
La relación entre neurodesarrollo y contexto social ha sido poco estudiada. Este artículo buscó caracterizar a las familias donde crecen los prematuros de muy bajo peso al nacer con nivel socioeconómico bajo y medio bajo y explorar la posible asociación entre las características socio-familiares y el neurodesarrollo a los dos años. Métodos: Prematuros en seguimiento de un hospital público de Santiago de Chile nacidos entre 2009 y 2012 con encuestas retrospectivas sobre aspectos familiares y sociales, y datos de la evolución clínica fueron analizados. Se evaluó la relación entre los datos biológicos y sociales con neurodesarrollo normal o en déficit. Resultados: 162 casos fueron analizados, 32 por ciento fueron considerados con déficit de neurodesarrollo. Las variables biológicas asociadas con el déficit de neurodesarrollo fueron peso al nacer menor a 1000 g. (p < 0,001), uso de ventilación mecánica (p < 0,001), oxígeno dependencia a las 36 semanas edad corregida (EC) (p < 0,001), sepsis tardía (p < 0,001), hemorragia intra-cerebral (p < 0,05), leucomalacia (p < 0,05), hidrocefalia (p < 0,05), convulsiones en período neonatal (p < 0,01) y enterocolitis necrotizante (p < 0,01). Los padres contaban con educación media y superior y se mantuvieron como parejas estables durante el período evaluado. El problema de consumo de alcohol a nivel familiar se asoció con déficit de neurodesarrollo (p<0,05). Conclusiones: Las familias en general tienen los recursos socioeconómicos y de estructura relacionados con desarrollo infantil. Los determinantes biológicos pesaron más que los sociales para el desarrollo infantil.(AU)
Research is scarce on the association between neurodevelopment and social context. This paper aimed to characterize the families of children born preterm, with very low birthweight and of low socioeconomic status, and to explore the relation between socio-familial variables and neurodevelopment when children were two years old. Methods: We used a sample of infants who attended the well-child visits at a public hospital in Santiago de Chile, who were born between 2009 and 2012. Data came from the medical register and a retrospective survey applied to the children's primary caregivers, which covered the social variables. We analyzed the relation between biological and social characteristics of children and their neurodevelopmental deficit. Results: Out of 162 cases, 2 percent were considered to have neurodevelopmental deficit. The biological variables related to neurodevelopmental deficit were extreme low birthweight (p < 0.001), mechanic ventilation (p < 0.001), oxygen therapy at week 36 (p < 0.001), late-onset sepsis (p < 0.001), intraventricular hemorrhage (p < 0.05), leukomalacia (p < 0.05), hydrocephalus (p < 0.05), seizures (p < 0.01) and necrotising enterocolitis (p < 0.01). Most parents had at least complete secondary education and remained and as stable couple during the observed period. Problematic alcohol use by any member of the family was negatively related to the children's neurodevelopmental deficit (p<0.05). Conclusion: Most families have the socioeconomic resources and the family structure typically related with child development. The biological determinants of child development were more important than its social determinants.(AU)
Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Adulto , Recien Nacido Prematuro , Composición Familiar , Trastornos del Neurodesarrollo , Chile , Factores Sociológicos , Hospitales PúblicosRESUMEN
Resumen Antecedentes: Los antimicrobianos (ATM) son uno de los medicamentos más utilizados en recién nacidos (RN) hospitalizados. El uso indiscriminado de ATM trae consecuencias negativas como son el predominio de bacterias resistentes a los ATM usualmente utilizados y asociaciones individuales a morbilidad relevante como son la displasia broncopulmonar, enterocolitis necrosante, sepsis tardía y/o muerte. Objetivo: Registrar y evaluar las tendencias del uso de ATM a lo largo del tiempo en RN hospitalizados en el Servicio de Neonatología (SRN) del Complejo Asistencial Dr. Sótero del Río, con el fin de objetivar los cambios en la práctica habitual de la indicación de ATM. Un objetivo secundario fue evaluar el impacto de estas conductas sobre la resistencia antimicrobiana. Métodos: Estudio de cohorte, prospectivo, observacional, unicéntrico, en todos los pacientes hospitalizados entre enero de 2011 y diciembre de 2014. Se registró el peso al nacer, días de hospitalización, indicación y días de uso de ATM para cada paciente. El uso de ATM fue cuantificado por medio de distintas tasas: días de indicación de un o más ATM para el consumo global (TUA), sumatoria total de días de uso (STUA) como para los ATM más frecuentemente utilizados. Cada tasa calculada por 100 días hospitalizados. Además, se registró la susceptibilidad antimicrobiana de las bacterias más frecuentemente aisladas en nuestro servicio: Staphylococcus coagulasa negativa (SCN) y bacilos gramnegativos (BGNs). Resultados: El 34,7% de los pacientes hospitalizados recibió algún tipo de antimicrobiano, correspondiendo 32,3% a antibacterianos. El ATM más utilizado fue ampicilina (20,2% del total) y luego cefadroxilo (11,6%). El TUA no cambió entre 2011 y 2014. La STUA disminuyó en 10,7% entre 2011 y 2014 (p < 0,05). En el análisis por rangos de peso, en el grupo < 750 g disminuyó la tendencia de uso de vancomicina (descenso de uso en 9,9%) y un aumento de 18,8% para metronidazol. Por otra parte, hubo un aumento en el uso del régimen de piperacilina/tazobactam en el grupo > 1.500 g. Al evaluar la susceptibilidad antimicrobiana, hubo una disminución de la susceptibilidad a cloxacilina en SCN entre 2011 y 2014 desde 27 a 10,3%, respectivamente. Para BGN hubo una disminución desde 76,9 a 40,5% en la susceptibilidad a cefalosporinas de tercera generación, principalmente debido a Klebsiella pneumoniae que pasó a ser el BGN predominante, con un aumento de 6,7 a 50% en los años 2011 y 2014, respectivamente. Para Klebsiella pneumoniae la susceptibilidad a cefalosporinas de tercera generación descendió desde 77 a 22%. Por último, amikacina mostró una actividad sobre 85% en todos los BGNs entre 2011 y 2014. Conclusiones: Es recomendable planificar y mantener un registro continuo del consumo de ATM tanto como terapia y profilaxis, idealmente llevar el TUA, el STUA y siendo categorizado por tipo de ATM y rango de peso de los RN. En forma concomitante, es de considerable importancia analizar y evaluar la susceptibilidad de microorganismos. Es esencial que un equipo interdisciplinario prepare este registro, y que continuamente proporcione retroalimentación a los profesionales que mantienen el funcionamiento de las unidades de cuidados neonatales.
Background: Antibiotics (ATB) are drugs widely used in hospitalized newborns. The indiscriminate use of ATBs promote the rise of resistant bacteria to the most commonly indicated antimicrobials. In addition, ATB prescription presents associations to morbidity, such as bronchopulmonary dysplasia, necrotizing enterocolitis, late sepsis and even death. All of the above leads to an increase in health care costs. Aim: To record and to evaluate trends of antibiotic use over time in hospitalized NB in the Neonatology Unit at Dr. Sótero del Río Hospital, in order to objectify the changes in the usual practice of the ATM indication. A secondary objective was to assess its impact on antimicrobial resistance. Methods: Cohort, observational, prospective unicenter study which included all hospitalized patients between January 2011 and December 2014. Birth weight, hospitalization days, ATB indication and days of ATB use were recorded for each patient. The use of ATB was quantified by means of different rates; days of indication of one or more ATBs for global consumption (RUA), total sum of days of use (TSUA) and for the most frequently used ATBs. Each calculated rate for 100 days hospitalized. In addition, the antimicrobial susceptibility of the most frequently isolated bacteria in our service: coagulase-negative Staphylococcus (SCN) and Gram-negative bacilli (BGN) were recorded continuously. Results: The 34.7% of the hospitalized patients received some type of antimicrobial agent. ATBs were 32.3% of medicines used. The most widely used was ampicillin (with 20.2% of the total) and cefadroxyl (with 11.6%). The RUA did not change during the study time, but STUA decreased by 10.7% between 2011 and 2014 with p < 0.05. When subgroup analyzes were divided by weight ranges, in the < 750 g group, the use of vancomycin decreased in use by 9.9% and an increase of 18.8% for metronidazole was observed. On the other hand, there was an increase in the use of the piperacillin-tazobactam regimen in the range > 1,500 g. When evaluating antimicrobial susceptibility, there was a decrease in susceptibility for oxacillin in SCN between 2011 and 2014 from 27% to 10.3% respectively. In addition, for Gram negative there was a decrease from 76.9% to 40.5% in susceptibility to third generation cephalosporins, mainly due to Klebsiella pneumoniae, which became the predominantly isolated BGN with an increase of 6.7% to 50% between 2011 and 2014, respectively. For K. pneumoniae the loss of susceptibility to third generation cephalosporins decreased from 77% to 22%. Finally, amikacin showed an activity over 85% in all BGNs between 2011 and 2014. Conclusions: It is advisable to plan and to maintain a continuous record of ATB consumption, as well as therapy and prophylaxis, being categorized by ATB type and range of newborn weight. It is of considerable importance to analyze and to evaluate the susceptibility of microorganisms. It is essential that an interdisciplinary team prepare this recording, and to continuously provide feedback to professionals who maintain the functioning of neonatal care units.
Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Unidades de Cuidado Intensivo Neonatal/estadística & datos numéricos , Farmacorresistencia Bacteriana , Programas de Monitoreo de Medicamentos Recetados , Programas de Optimización del Uso de los Antimicrobianos/métodos , Antibacterianos/uso terapéutico , Factores de Tiempo , Pruebas de Sensibilidad Microbiana , Chile , Estudios Prospectivos , Factores de Riesgo , Estadísticas no Paramétricas , Mal Uso de Medicamentos de Venta con RecetaRESUMEN
BACKGROUND: Antibiotics (ATB) are drugs widely used in hospitalized newborns. The indiscriminate use of ATBs promote the rise of resistant bacteria to the most commonly indicated antimicrobials. In addition, ATB prescription presents associations to morbidity, such as bronchopulmonary dysplasia, necrotizing enterocolitis, late sepsis and even death. All of the above leads to an increase in health care costs. AIM: To record and to evaluate trends of antibiotic use over time in hospitalized NB in the Neonatology Unit at Dr. Sótero del Río Hospital, in order to objectify the changes in the usual practice of the ATM indication. A secondary objective was to assess its impact on antimicrobial resistance. METHODS: Cohort, observational, prospective unicenter study which included all hospitalized patients between January 2011 and December 2014. Birth weight, hospitalization days, ATB indication and days of ATB use were recorded for each patient. The use of ATB was quantified by means of different rates; days of indication of one or more ATBs for global consumption (RUA), total sum of days of use (TSUA) and for the most frequently used ATBs. Each calculated rate for 100 days hospitalized. In addition, the antimicrobial susceptibility of the most frequently isolated bacteria in our service: coagulase-negative Staphylococcus (SCN) and Gram-negative bacilli (BGN) were recorded continuously. RESULTS: The 34.7% of the hospitalized patients received some type of antimicrobial agent. ATBs were 32.3% of medicines used. The most widely used was ampicillin (with 20.2% of the total) and cefadroxyl (with 11.6%). The RUA did not change during the study time, but STUA decreased by 10.7% between 2011 and 2014 with p < 0.05. When subgroup analyzes were divided by weight ranges, in the < 750 g group, the use of vancomycin decreased in use by 9.9% and an increase of 18.8% for metronidazole was observed. On the other hand, there was an increase in the use of the piperacillin-tazobactam regimen in the range > 1,500 g. When evaluating antimicrobial susceptibility, there was a decrease in susceptibility for oxacillin in SCN between 2011 and 2014 from 27% to 10.3% respectively. In addition, for Gram negative there was a decrease from 76.9% to 40.5% in susceptibility to third generation cephalosporins, mainly due to Klebsiella pneumoniae, which became the predominantly isolated BGN with an increase of 6.7% to 50% between 2011 and 2014, respectively. For K. pneumoniae the loss of susceptibility to third generation cephalosporins decreased from 77% to 22%. Finally, amikacin showed an activity over 85% in all BGNs between 2011 and 2014. CONCLUSIONS: It is advisable to plan and to maintain a continuous record of ATB consumption, as well as therapy and prophylaxis, being categorized by ATB type and range of newborn weight. It is of considerable importance to analyze and to evaluate the susceptibility of microorganisms. It is essential that an interdisciplinary team prepare this recording, and to continuously provide feedback to professionals who maintain the functioning of neonatal care units.
Asunto(s)
Antibacterianos/uso terapéutico , Programas de Optimización del Uso de los Antimicrobianos/métodos , Farmacorresistencia Bacteriana , Unidades de Cuidado Intensivo Neonatal/estadística & datos numéricos , Programas de Monitoreo de Medicamentos Recetados , Chile , Femenino , Humanos , Recién Nacido , Masculino , Pruebas de Sensibilidad Microbiana , Mal Uso de Medicamentos de Venta con Receta , Estudios Prospectivos , Factores de Riesgo , Estadísticas no Paramétricas , Factores de TiempoRESUMEN
Recommendations based on current publications are presented for postnatal preterm nutrition, depending on birth weight: less 1000g, between 1000 and 1500g, and above 1500g, as well for the development periods: adaptation, stabilisation, and growth. A review is also presented on the nutritional management of morbidities that affect or may affect nutrition, such as: osteopenia, bronchopulmonary dysplasia, patent ductus arteriosus, red cell transfusion, and short bowel syndrome.
Asunto(s)
Enfermedades del Prematuro/terapia , Necesidades Nutricionales , Apoyo Nutricional/métodos , Peso al Nacer , Chile , Hospitalización , Humanos , Recién Nacido , Recien Nacido Prematuro , Enfermedades del Prematuro/fisiopatologíaRESUMEN
Introducción: La leche materna es recomendada como el alimento más adecuado en el primer año de vida, ya que proporciona los sustratos necesarios para el crecimiento del recién nacido. En los últimos años se ha ampliado el estudio de la composición de la leche materna y su relación sobre el efecto de la nutrición en los recién nacidos de pre termino. Objetivo: investigar la composición de macronutrientes en leche materna de recién nacidos prematuros (<33 semanas). Métodos: análisis de contenido de proteínas, carbohidratos y lípidos en muestras de leche materna de recién nacidos prematuros (menor que 33 semanas) recolectadas longitudinalmente, según protocolo de estudio. Resultados: Se presenta variabilidad en muestras recolectadas en tres semanas consecutivas de edad posnatal, dando contenido de proteína que vario de 1,34g/dl (DS +/- 0.11) a 1,05 g/dl (DS +/- 0.10) con (p menor que 0,05). Hidratos de carbono vario de 6,20 g/dl (DS +/- 0.17) a 6.77 g/dl (DS+/-±0.22) con (p menor que 0,05). Lípidos vario de 4.10 g/dl (DS +/- 0.39) a 4.33 g/dl (DS +/- 0.26) con (p=0,075).Discusión: Estos datos proporcionan una visión más detallada de la ingesta de nutrientes de los recién nacidos prematuros alimentados con leche materna.
Introduction: Breast milk is recommended as the most suitable food in the first year of life, as it provides the substrates required for growth of the newborn. In recent years it has expanded the study of the composition of breast milk and their relationship on the effect of nutrition in preterm infants. Objective: To investigate the macronutrient composition of breast milk in preterm infants (33 weeks). Methods: Analysis of protein, carbohydrates and lipids in breast milk samples from preterm (<33 weeks) collected longitudinally, according study protocol. Results: We present variability in samples collected in three consecutive weeks of postnatal age, giving protein content ranged from 1.34 g / dl (SD +/- 0.11) to 1.05 g / dl (SD +/- 0.10) with (p < 0.05). Carbon hydrates 6.20 g / dl (SD +/- 0.17) to 6.77 g / dl (SD +/- 0.22) with (p <0.05). Fat of 4.10 g / dl (SD +/- 0.39) to 4.33 g / dl (SD +/- 0.26) with (p = 0.075).Discussion: These data provide a more detailed picture of the nutrient intake ofpreterm infants fed breast milk.
Asunto(s)
Humanos , Masculino , Adulto , Femenino , Recién Nacido , Carbohidratos de la Dieta/análisis , Grasas de la Dieta/análisis , Leche Humana/química , Nutrientes , Recien Nacido Prematuro , Proteínas de la Leche/análisisRESUMEN
PURPOSE OF REVIEW: Extremely low birth weight and very low birth weight infants are born immature and are commonly sick and are, therefore, not able to receive appropriate enteral or sufficient parenteral nutrition to meet the needs for optimal brain, lung and gut growth and development. RECENT FINDINGS: We provide an updated view of essential fatty acid metabolism and discuss the potential protective effect of fatty acids that serve as precursors for eicosanoids and docosanoids. The balance of n-3 or n-6 long-chain polyunsaturated fatty acids (LCPUFAs) supplied may enhance or ameliorate the effects of hypoxia, inflammation, infection, thrombosis and oxidative damage of key organs (lung, brain and retina). In addition, n-3 and n-6 LCPUFAs are necessary for normal structure and function of the central nervous system and sensory organ development. These lipids generate eicosanoids that are mediators of oxidative damage, as well as potential protectors of retina, brain cortex, lung and vascular endothelium. SUMMARY: n-3 and n-6 LCPUFAs may condition in part the long-term consequences of preterm birth. Early n-3 and n-6 LCPUFA supply may moderate the impact of hypoxia and oxidative damage, thus affecting the recovery from injury, later organ (brain, retina, lung, gut, liver and skin) growth and neurodevelopmental outcomes.
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Ácidos Grasos Insaturados/administración & dosificación , Fórmulas Infantiles/administración & dosificación , Nutrición Parenteral/métodos , Suplementos Dietéticos , Ácidos Grasos Insaturados/metabolismo , Humanos , Fenómenos Fisiológicos Nutricionales del Lactante , Recién Nacido , Recien Nacido Prematuro , Recién Nacido de muy Bajo Peso , Absorción Intestinal , Necesidades Nutricionales , Guías de Práctica Clínica como AsuntoAsunto(s)
Humanos , Femenino , Recién Nacido , Lactante , Bancos de Leche Humana/normas , Leche Humana , ChileRESUMEN
Growth assessment is the most common measure of nutritional adequacy in pediatrics, especially when evaluating nutrition of preterm neonates. The American Academy of Pediatrics defines postnatal nutrient intake to promote growth as one that "approximates the rate of growth...for a normal fetus of the same post-menstrual age." It is known that in the fetus, fat and lean body mass are accreted progressively as gestation progresses, whereas postnatal growth and observed accretion of fat and lean body mass differ. This review discusses anthropometric measures used to assess growth, biochemical markers used to monitor nutritional sufficiency, and the effect of growth trajectory in preterm infants on health outcomes later in life.
Asunto(s)
Desarrollo Infantil/fisiología , Proteínas en la Dieta , Ingestión de Energía , Fenómenos Fisiológicos Nutricionales del Lactante , Recien Nacido Prematuro/fisiología , Estado Nutricional/fisiología , Biomarcadores/sangre , Estatura , Peso Corporal , Métodos de Alimentación , Cabeza/crecimiento & desarrollo , Humanos , Cuidado del Lactante/métodos , Recién Nacido , Recien Nacido Prematuro/sangre , Recien Nacido Prematuro/crecimiento & desarrollo , Recién Nacido de muy Bajo Peso/crecimiento & desarrollo , Recién Nacido de muy Bajo Peso/fisiología , Evaluación Nutricional , Aumento de PesoRESUMEN
This study evaluated the arachidonic acid (AA) and docosahexaenoic acid (DHA) formation from d5-labeled linoleic acid (d5-LA) and alpha-linolenic acid (d5-LNA) precursors in infants with intrauterine growth restriction (IUGR) compared with control groups matched by gestational age (GA) or birth weight. We compared DHA and AA formation from deuterated precursors d5-LA and d5-LNA in 11 infants with IUGR with 13 and 25 control subjects who were appropriate for GA and matched by GA and by birth weight, respectively. After an enteral administration of d5-LA and d5-LNA, we determined unlabeled and d5-labeled fatty acids at 24, 48, and 96 h in plasma. Absolute concentrations and area under the curve (AUC) over the 96-h study were used for analysis. Absolute concentration of d5-DHA and the product/precursor ratio of the d5-labeled AUCs indicated a less active DHA formation from LNA in infants with IUGR compared with their GA-matched (2-fold) and birth weight-matched (3-fold) control subjects. The ratios of eicosapentaenoic and n-3 docosapentaenoic acid to DHA were also affected. Similar evaluation for the n-6 series was not significant. DHA metabolism is affected in infants with IUGR; the restricted DPA to DHA conversion step seems to be principally responsible for this finding.
Asunto(s)
Ácidos Docosahexaenoicos/química , Retardo del Crecimiento Fetal/patología , Área Bajo la Curva , Peso al Nacer , Deuterio/metabolismo , Ácidos Docosahexaenoicos/metabolismo , Ácido Eicosapentaenoico/metabolismo , Ácidos Grasos/metabolismo , Ácidos Grasos Insaturados/metabolismo , Humanos , Recién Nacido , Isótopos/metabolismo , Ácido Linoleico/química , Ácido Linoleico/farmacología , Factores de Tiempo , Ácido alfa-Linolénico/farmacologíaAsunto(s)
Ácidos Grasos Esenciales/administración & dosificación , Ácidos Grasos Esenciales/metabolismo , Fenómenos Fisiológicos Nutricionales del Lactante , Recién Nacido/crecimiento & desarrollo , Encéfalo/efectos de los fármacos , Encéfalo/crecimiento & desarrollo , Ácidos Grasos Esenciales/fisiología , Regulación del Desarrollo de la Expresión Génica/efectos de los fármacos , Humanos , Sistema Nervioso/efectos de los fármacos , Sistema Nervioso/crecimiento & desarrollo , Necesidades NutricionalesRESUMEN
Healthy term infants who are not breast-fed may need long-chain polyunsaturated fatty acids (LCPUFA) in their feeding, based on the changes in plasma and tissue fatty composition. However, consistent functional effects across different studies conducted over the past two decades has been more difficult to document. The interpretation of these data has scientific and public interest with the introduction of LCPUFA supplemented formula. There are 14 controlled trials in term infants that have included formula feeding with or without LCPUFA and functional assessment of visual and other measures of neural development; in addition, 7 have evaluated specific measures related to cognitive development. We chose to examine the effect of DHA dose provided daily on the development of visual acuity to explain the differences in visual acuity responses across randomized studies. A "meta-regression" was performed with the use of a DHA effective dose as the independent variable and visual acuity at 4 months as the dependent variable. Since the two main dietary determinants of DHA status are the LNA provided and the preformed DHA consumed, we defined DHA equivalent dose across studies by assuming a 1%, 5%, and 10% conversion of LNA to DHA. Results indicate a strong and significant effect of DHA equivalent dose on magnitude of the visual acuity response at all conversions tested; greatest significance was found when using a 10% bioequivalency (r(2)=0.68, and P=.001). We conclude that there is a significant relation between the total DHA equivalents provided and effectiveness as defined by visual acuity measurements at 4 months of age.
Asunto(s)
Ácido Araquidónico/administración & dosificación , Ácidos Docosahexaenoicos/administración & dosificación , Fórmulas Infantiles , Agudeza Visual/efectos de los fármacos , Factores de Edad , Lactancia Materna , Cognición/fisiología , Humanos , Lactante , Fórmulas Infantiles/química , Fórmulas Infantiles/normas , Leche Humana/química , Ensayos Clínicos Controlados Aleatorios como Asunto , Agudeza Visual/fisiología , DesteteAsunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Regulación de la Temperatura Corporal/fisiologíaRESUMEN
La nutrición del RNMBPN adquiere gran importancia en la medida que aumenta la sobrevida. El crecimiento post-natal inmediato es determinante del pronóstico de crecimiento y desarrollo a más largo plazo. Para alimentar al RNMBPN deben considerarse sus características de inmadurez en la composición corporal, funciones digestivas, metabólicas y renales. Se ha recomendado en energía 130 - 150 Kcal, por kg por día y 4,25 g por kg por día de proteína. La leche materna de su propia madre tiene una composición más adecuada para las necesidades, lo que se suma a sus ventajas digestivas e inmunológica. Sin embargo, su bajo contenido de calcio y fósforo y su variable contenido energético han inducido el desarrollo de formulas artificiales para enriquecer la leche materna y mejorar la ganancia de peso y la mineralización ósea. Estos recién nacidos requieren también suplementos de Fe, sodio, vitaminas