RESUMO
OBJECTIVE: To evaluate the effects of hyperglycemia on body composition and neurodevelopment, and how early nutrition and illness modify these relationships in infants born preterm. STUDY DESIGN: Prospective data were collected from infants born <32 weeks of gestational age (N = 97), including inpatient days of hyperglycemia (blood glucose >150 mg/dL) and nutrient intake. Body composition was measured at discharge and 4 months' postmenstrual age (PMA). Bayley Scales of Infant Development III (BSID-III) were administered at 12 months' PMA. Linear regression analysis was performed, adjusting for birth gestational age. Associations between hyperglycemia, body composition, and BSID-III were analyzed in models accounting for first-week nutrition and early illness severity via Score for Neonatal Acute Physiology-II. RESULTS: Mean birth gestational age was 27.8 (SD 2.4) weeks. Hyperglycemia occurred in 48.5% of infants. Hyperglycemia for ≥5 days was negatively associated with fat mass and fat free mass z scores at discharge, and fat free mass z score at 4 months' PMA (P < .05 all). Hyperglycemia for ≥5 days was negatively associated with cognition, language, and motor scores on the BSDI at 12 months (P ≤ .01 all). Associations with body composition and BSID-III were diminished when models included first week nutrition yet remained unchanged when illness severity was included. CONCLUSIONS: In infants <32 weeks, ≥5 days of hyperglycemia is associated with decreased lean mass at 4 months' PMA and poorer neurodevelopmental outcome at 12 months' PMA. These associations may be mediated by decreased first week nutrition, potentially related to reduced glucose infusion rate for management of hyperglycemia.
Assuntos
Desenvolvimento Infantil , Ingestão de Energia , Hiperglicemia/dietoterapia , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido Prematuro/crescimento & desenvolvimento , Adiposidade , Composição Corporal , Feminino , Humanos , Lactente , Recém-Nascido , Doenças do Prematuro/dietoterapia , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Masculino , Estudos ProspectivosRESUMO
Chylous ascites was recognized by abdominal ultrasonography in a 37 week gestational age newborn girl presenting with early transient respiratory distress syndrome, hypoglycemia and progressive abdominal distension. Diagnosis was confirmed by abdominal puncture. Treatment was focussed on dietary management which included oral amino acids, vitamins, medium chain triglycerides, maltose-dextrin; commercial rice starch and cane sugar and was followed by complete recovery at age two months.
Assuntos
Ascite Quilosa/dietoterapia , Doenças do Prematuro/dietoterapia , Ascite Quilosa/diagnóstico , Feminino , Humanos , Recém-Nascido , Doenças do Prematuro/diagnósticoRESUMO
In a prospective randomized trial, we studied the effects of early hypocaloric enteral feedings (PO) begun at 48 hours of age in 19 infants compared with 20 infants who received no enteral feedings (NPO) for at least the first 9 days of life. Both groups initially received the majority of their calories by parenteral alimentation. The groups were similar with respect to birth weight, gestational age, sex, Apgar score, and major neonatal diagnoses. The early enteral feeds proved to be significantly beneficial without an increased incidence of complications. The PO group reached full enteral feedings faster than the NPO group (31.2 vs 47.3 days). The PO group had a greater decline in serum bilirubin concentration over the first 2 weeks of life and spent less time under phototherapy (6.8 vs 9.5 days). Less cholestasis was observed among the PO infants (6.7% vs 33%), and peak direct bilirubin levels were also lower (0.7 vs 2.5 mg/dL). Osteopenia of prematurity, manifested by significantly lower alkaline phosphatase activity, was also decreased in the PO group, perhaps because of greater calcium intake during the first month among PO infants (1.3 vs 0.8 g). Compared with complete bowel rest, early onset of hypocaloric enteral feedings has beneficial effects on indirect hyperbilirubinemia, cholestatic jaundice, and metabolic bone disease of very low birth weight infants.
Assuntos
Nutrição Enteral , Recém-Nascido de Baixo Peso/fisiologia , Fosfatase Alcalina/sangue , Bilirrubina/análise , Peso Corporal , Teste de Tolerância a Glucose , Humanos , Alimentos Infantis , Recém-Nascido , Recém-Nascido Prematuro/fisiologia , Doenças do Prematuro/dietoterapia , Nutrição Parenteral , Estudos Prospectivos , Distribuição Aleatória , gama-Glutamiltransferase/sangueRESUMO
By photon absorptiometry, extrauterine bone mineralization in low-birth-weight infants fed a standard commercial formula lags significantly behind intrauterine bone mineralization. In the present study, infants of 28- to 32-week and 33- to 35-week gestational age were studied. The calcium content in a standard formula was increased to provide a daily calcium intake of 220 to 250 mg/kg/day. Phosphate intake was 110 to 125 mg/kg/day. Extrauterine bone mineralization by photon absorptiometry appeared to approximate the intrauterine bone mineralization rate.
Assuntos
Doenças Ósseas/dietoterapia , Cálcio da Dieta/administração & dosagem , Doenças do Prematuro/dietoterapia , Doenças Ósseas/etiologia , Doenças Ósseas/metabolismo , Calcificação Fisiológica , Cálcio/metabolismo , Humanos , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido , Doenças do Prematuro/etiologia , Doenças do Prematuro/metabolismo , Fósforo/administração & dosagem , Fósforo/metabolismo , Vitamina D/administração & dosagem , Vitamina D/metabolismoRESUMO
PIP: Human milk, particularly colostrum, is rich in host-resistance factors, including immunoglobulins, principally secretory IgA; C4, C3, and C3 proactivators; lactoferrin, the iron-binding protein; a nitrogen-containing compound which promotes growth of Lactobacillus bifidus; a fatty acid with antistaphylococcal properties; interferon, the antiviral protein; and living leukocytes. Storage of human milk, as is done in Europe, reduces or diminishes some of these factors, depending on storage method (freezing or pasteurization). However, all storage methods destroy the living leukocytes, which are particularly abundant in colostrum, and the consequences of this loss are discussed in this editorial. Studies of neonatal rats rendered hypoxic and orally challenged with Klebsiella died if unsuckled. Fresh rat milk was protective, but frozen rat milk was not; hence, the protection from Klebsiella is apparently caused by colostral leukocytes, since washed colostral leukocytes restored the protective effects to cell-free milk. In humans the effects of colostral leukocytes in protection of the maternal mammary gland or the gastrointestinal tract of the recipient infant are unknown, although evidence suggests that fresh human milk also confers resistance. A note of caution is sounded, however; milk from other than the natural mother may not protect the infant in the same manner.^ieng
Assuntos
Imunidade , Leite Humano/imunologia , Humanos , Recém-Nascido , Doenças do Prematuro/dietoterapia , Leucócitos/imunologiaRESUMO
After receiving milk-based formula for one week, 16 preterm infants, weighing 1,300 to 1,800 gm, were fed two isocaloric formulas containing either medium-chain or long-chain triglycerides for 15 days; the alternate formula was given for a second period of identical duration. While receiving MCT, the infants had greater (P smaller than 0.01) percent fat absorption (83.4 leads to 97.1%) and weight gain (7.5 leads to 11.5 gm/kg/100 calories). Because metabolic acidosis occurred with the LCT formula, the chloride content was adjusted to that of the MCT were confirmed and, in addition, there was a higher (P smaller than .01) percent retention of nitrogen (67.3 leads to 82.1).