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Nutritional strategies for the very low birthweight infant
\"The goal of nutritional management in VLBW and ELBW infants is the achievement of postnatal growth at a rate that approximates the intrauterine growth of a normal fetus at the same postconceptional age. In reality, however, growth lags considerably after birth; although non-nutritional factors are involved, nutrient deficiencies are critical in explaining delayed growth. This practical clinically-oriented pocketbook reviews and summarises all available clinical evidence. It enables the reader to implement parenteral or enteral feeding plans, with the goals of reducing postnatal weight loss, earlier return to birthweight, and improved catch-up growth. Both nutrient balance and growth and the impact on neurodevelopment and health outcomes are evaluated. With many tables and algorithms to summarise key data and management strategies, Nutritional Strategies for the Very Low Birthweight Infant is an invaluable guide for all healthcare professionals caring for premature babies\"--Provided by publisher.
Book
Associations between high temperatures in pregnancy and risk of preterm birth, low birth weight, and stillbirths: systematic review and meta-analysis
AbstractObjectiveTo assess whether exposure to high temperatures in pregnancy is associated with increased risk for preterm birth, low birth weight, and stillbirth.DesignSystematic review and random effects meta-analysis.Data sourcesMedline and Web of Science searched up to September 2018, updated in August 2019.Eligibility criteria for selecting studiesClinical studies on associations between high environmental temperatures, and preterm birth, birth weight, and stillbirths.Results14 880 records and 175 full text articles were screened. 70 studies were included, set in 27 countries, seven of which were countries with low or middle income. In 40 of 47 studies, preterm births were more common at higher than lower temperatures. Exposures were classified as heatwaves, 1°C increments, and temperature threshold cutoff points. In random effects meta-analysis, odds of a preterm birth rose 1.05-fold (95% confidence interval 1.03 to 1.07) per 1°C increase in temperature and 1.16-fold (1.10 to 1.23) during heatwaves. Higher temperature was associated with reduced birth weight in 18 of 28 studies, with considerable statistical heterogeneity. Eight studies on stillbirths all showed associations between temperature and stillbirth, with stillbirths increasing 1.05-fold (1.01 to 1.08) per 1°C rise in temperature. Associations between temperature and outcomes were largest among women in lower socioeconomic groups and at age extremes. The multiple temperature metrics and lag analyses limited comparison between studies and settings.ConclusionsAlthough summary effect sizes are relatively small, heat exposures are common and the outcomes are important determinants of population health. Linkages between socioeconomic status and study outcomes suggest that risks might be largest in low and middle income countries. Temperature rises with global warming could have major implications for child health.Systematic review registrationPROSPERO CRD 42019140136 and CRD 42018118113.
Journal Article
Higher or Lower Hemoglobin Transfusion Thresholds for Preterm Infants
In this open, randomized, multicenter trial involving extremely-low-birth-weight preterm infants, the use of a higher hemoglobin threshold for red-cell transfusion did not improve survival without neurodevelopmental impairment at 22 to 26 months of age, corrected for prematurity.
Journal Article
Controlled Trial of Two Incremental Milk-Feeding Rates in Preterm Infants
In this randomized trial involving very preterm or very-low-birth-weight infants, there was no significant difference in survival without moderate or severe neurodevelopmental disability at 24 months with a strategy of advancing milk feeding volumes in daily increments of 30 ml per kilogram of body weight as compared with 18 ml per kilogram.
Journal Article
Factors associated with weight Z-score in very low birth weight and extremely low birth weight preterm infants during hospitalization
To investigate the behavior of weight-for-age z-score (WAZ) and associated factors in preterm newborns (PTNB) with very low birth weight (VLBW) and extremely low birth weight (ELBW), comparing them to low birth weight (LBW) during four weeks (wk.) of hospitalization in a neonatal intensive care unit (NICU).
Longitudinal study conducted using data from PTNB records in the southern Brazil NICU, between January 2017 and December 2020. Non-twin PTNB with gestational age of ≥ 24 and < 37 wk. and a birth weight (BW) ≥ 500 g were included. The outcome was WAZ, and the exposure was the PTNB’s BW, categorized as VLBW/ELBW (< 1500 g) and LBW (≥ 1500 g up to 2500 g). Energy (kcal/kg/day) and protein (g/kg/day) intakes were also evaluated. Two-way ANOVA and multiple linear regression were used to assess the association between demographic, clinical, and nutritional factors and the WAZ.
The majority of PTNB were male (60 %) and had a birth weight ≥1500 g (65 %). A significant interaction was between the BW category and the length of hospitalization on WAZ (F = 4.0; p = 0.003). In the VLBW and ELBW, the WAZ was significantly lower in the first wk. compared to the LBW [−1.05 (−1.34;−0.75) vs −0.34 (−0.49;−0.18)]. Factors such as male sex, sepsis, initiation of enteral nutrition (EN), and protein intake were associated with WAZ behavior.
The downward trend of the WAZ curve was associated with the interaction between birth weight and length of hospitalization, especially in PTNB with VLBW and ELBW. The study concluded that male sex and sepsis contributed to the observed decline.
Journal Article
Low birth weight and its associated risk factors: Health facility-based case-control study
Low birth weight is a preventable public health problem. It is an important determinant of child survival and development, as well as long-term consequences like the onset of non-communicable disease in the life course. A large number of mortality and morbidity can be prevented by addressing the factors associated with low birth weight. The main objective of this study was to identify associated risk factors of low birth weight. A health facility-based unmatched case-control study was carried out from July 2018 to March 2019 among the mothers who delivered in health facilities of Dang district of Nepal from 17.sup.th August to 16.sup.th November 2018. The total sample size for the study was 369; 123 cases and 246 controls. Cases and controls were randomly selected independent of the exposure status in the ratio of 1:2. Information regarding exposure status was assessed through interviews and medical records. Mothers who delivered outside Dang districts were excluded from the study. Ethical clearance was obtained from the Institutional Review Committee (IRC) of the Institute of Medicine, Tribhuvan University and written consent was taken from each participant after explaining the objectives of the study. Multivariate logistic regression found that having the kitchen in the same living house (AOR 2.7, CI: 1.5-4.8), iron intake less than 180 tablets (AOR 3.2, CI: 1.7-5.7), maternal weight gain during second and third trimester less than 6.53 kg (AOR 2.6, CI: 1.5-4.7), co-morbidity during pregnancy (AOR 2.4, CI: 1.3-4.5), preterm birth (AOR 2.9, CI: 1.4-6.1) were the risk factors associated with low birth weight. Having the kitchen in the same living house, iron intake less than 180 tablets during pregnancy, maternal weight gain less than 6.53 kg during the second and third trimester, co-morbidity during pregnancy and preterm birth were the risk factors associated with low birth weight.
Journal Article
Exposure to Ambient Particulate Matter during Specific Gestational Periods Produces Adverse Obstetric Consequences in Mice
Epidemiological studies associate inhalation of fine-sized particulate matter (PM
) during pregnancy with preterm birth (PTB) and low birth weight (LBW) but disagree over which time frames are most sensitive, or if effects are cumulative.
Our objective was to provide experimental plausibility for epidemiological observations by testing the hypothesis that exposure to PM
during discrete periods of pregnancy results in PTB and LBW.
For the first study, timed-pregnant B6C3F1 mice were exposed to concentrated ambient PM
(CAPs) or filtered air (FA) throughout pregnancy [6 h/d from gestational day (GD) 0.5 through GD16.5]. A follow-up study examined the effects of CAPs exposure during discrete gestational periods (1: GD0.5–5.5; 2: GD6.5–14.5; 3: GD14.5–16.5; 4: GD0.5–16.5) aligning to milestones during human development.
In the first experiment, exposure to 160 μg CAPs/m
throughout pregnancy decreased gestational term by 0.5 d (∼1.1 wk decrease for humans) and birth weight by 11.4% compared with FA. The follow-up experiment investigated timing of CAPs exposure (mean concentrations at 178, 193, 171, and 173 μg/m
for periods 1–4, respectively). Pregnancy was significantly shortened (vs. FA) by ∼0.4d when exposure occurred during gestational periods 2 and 4, and by ∼0.5d if exposure occurred during period 3. Exposure during periods 1, 2, and 4 reduced birth weight by ∼10% compared with FA, and placental weight was reduced (∼8%) on GD17.5 if exposure occurred only during period 3.
Adverse PM
-induced outcomes such as PTB and LBW are dependent upon the periods of maternal exposure. The results of these experimental studies could contribute significantly to air pollution policy decisions in the future. https://doi.org/10.1289/EHP1029.
Journal Article
SAVING BABIES? REVISITING THE EFFECT OF VERY LOW BIRTH WEIGHT CLASSIFICATION
We reconsider the effect of very low birth weight classification on infant mortality. We demonstrate that the estimates are highly sensitive to the exclusion of observations in the immediate vicinity of the 1,500-g threshold, weakening the confidence in the results originally reported in Almond, Doyle, Kowalski, and Williams (2010).
Journal Article
The relationship between the different low birth weight strata of newborns with infant mortality and the influence of the main health determinants in the extreme south of Brazil
Background
Low birth weight (LBW) newborns present different health outcomes when classified in different birth weight strata. This study evaluated the relationship of birth weight with Infant mortality (IM) through the influence of biological, social, and health care factors in a time series.
Methods
Retrospective cohort study with data collected from Information Systems (Live Births and Mortality). The mortality trends were performed for each birth weight stratum: extremely low, < 1000 g; very low, 1000–1499 g; low, 1500–2499 g; insufficient, 2500–2999 g; adequate, 3000–3900 g; and macrosomia, > 4000 g. Chi-square tests analyzed IM rates. Sequential Poisson regression analyzed the impact of the determinant factors.
Results
A total of 277,982 newborns were included in the study and 2088 died before their first year. There was a tendency for a decrease in mortality in all strata of weight. With the exception of macrosomics, all other strata had a higher risk for IM when compared with adequate birth weight. Extremely LBW newborns presented higher risk for mortality when born in a public hospital. A higher percentage of infant deaths were associated with lower maternal age and lower schooling for all strata. Prenatal care with less than three visits demonstrated a risk for IM in low, insufficient, and adequate birth weight strata. The cesarean section was a protective factor for IM in Extremely and Very LBW strata and it was a risk factor in adequate birth weight stratum.
Conclusions
LBW had a greater association with IM, especially those children of younger mothers and those born in public hospitals.
Journal Article
