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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
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
LC-ESI/MS/MS analysis of neonicotinoids in urine of very low birth weight infants at birth
Objectives Neonicotinoid insecticides are widely used systemic pesticides with nicotinic acetylcholine receptor agonist activity that are a concern as environmental pollutants. Neonicotinoids in humans and the environment have been widely reported, but few studies have examined their presence in fetuses and newborns. The objective of this study is to determine exposure to neonicotinoids and metabolites in very low birth weight (VLBW) infants. Methods An analytical method for seven neonicotinoids and one neonicotinoid metabolite, N-desmethylacetamiprid (DMAP), in human urine using LC-ESI/MS/MS was developed. This method was used for analysis of 57 urine samples collected within 48 hours after birth from VLBW infants of gestational age 23–34 weeks (male/female = 36/21, small for gestational age (SGA)/appropriate gestational age (AGA) = 6/51) who were admitted to the neonatal intensive care unit of Dokkyo Hospital from January 2009 to December 2010. Sixty-five samples collected on postnatal day 14 (M/F = 37/22, SGA/AGA = 7/52) were also analyzed. Results DMAP, a metabolite of acetamiprid, was detected in 14 urine samples collected at birth (24.6%, median level 0.048 ppb) and in 7 samples collected on postnatal day 14 (11.9%, median level 0.09 ppb). The urinary DMAP detection rate and level were higher in SGA than in AGA infants (both p<0.05). There were no correlations between the DMAP level and infant physique indexes (length, height, and head circumference SD scores). Conclusion These results provide the first evidence worldwide of neonicotinoid exposure in newborn babies in the early phase after birth. The findings suggest a need to examine potential neurodevelopmental toxicity of neonicotinoids and metabolites in human fetuses
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
The value of routine evaluation of gastric residuals in very low birth weight infants
Objective:
Little information exists regarding gastric residual (GR) evaluation prior to feedings in premature infants. The purpose of this study was to compare the amount of feedings at 2 and 3 weeks of age, number of days to full feedings, growth and incidence of complications between infants who underwent RGR (routine evaluation of GR) evaluation versus those who did not.
Study Design:
Sixty-one premature infants were randomized to one of two groups. Group 1 received RGR evaluation prior to feeds and Group 2 did not.
Result:
There was no difference in amount of feeding at 2 (
P
=0.66) or 3 (
P
=0.41) weeks of age, growth, days on parenteral nutrition or complications. Although not statistically significant, infants without RGR evaluation reached feeds of 150 ml kg
−1
per day 6 days earlier and had 6 fewer days with central venous access.
Conclusion:
Results suggest RGR evaluation may not improve nutritional outcomes in premature infants.
Journal Article
Factors determining cognitive, motor and language scores in low birth weight infants from North India
Children born with low birth weight (LBW) tend to have lower neurodevelopmental scores compared to term normal birth weight children. It is important to determine factors that influence neurodevelopment in these low birth weight children especially in the first 2-3 years of life that represents a period of substantial brain development.
This secondary data analysis was conducted using data from LBW infants enrolled soon after birth in an individually randomized controlled trial (RCT) and followed up till end of 1st year. Neurodevelopmental assessment was done at 12 months of corrected age by trained psychologists using Bayley Scales of Infant and Toddler Development 3rd edition (Bayley-III). Factors influencing cognitive, motor and language scores were determined using multivariable linear regression model.
Linear growth (i.e., length for age z score, LAZ) [cognitive: Standardized ẞ-coefficient = 2.19, 95% CI; 1.29, 3.10; motor: 2.41, 95% CI; 1.59, 3.23; language: 1.37, 95% CI; 0.70, 2.04], stimulation at home [cognitive: 0.21, 95% CI; 0.15, 0.27; motor: 0.12, 95% CI; 0.07, 0.17; language: 0.21, 95% CI; 0.16, 0.25] and number of diarrhoeal episodes [cognitive: -2.87, 95% CI; -4.34, -1.39; motor: -2.62, 95% CI; -3.93, -1.29; language: -2.25, 95% CI; -3.32, -1.17] influenced the composite scores in all three domains i.e., cognitive, language and motor. While increase in LAZ score and stimulation led to increase in composite scores; an increase in number of diarrhoeal episodes was associated with decrease in scores. Weight for height z scores (WHZ) were associated with motor and language but not with cognitive scores. Additionally, a negative association of birth order with cognitive and language scores was noted.
The findings indicate the possible importance of promoting nutrition and preventing diarrhoea as well as ensuring optimal stimulation and nurturance at home for enhancing child development in LBW infants.
Journal Article
Low birth weight and associated factors among HIV positive and negative mothers delivered in northwest Amhara region referral hospitals, Ethiopia,2020 a comparative crossectional study
Even though pregnancy does not affect HIV infection progression, HIV affects the pregnancy outcome. Maternal HIV infection has many untoward effects which include low birth weight which is the major cause of neonatal, infant, and under-five mortality. However, there is controversy and limited information about the effect of HIV status on birth weight around the world including Ethiopia. Therefore, this study aimed to compare the prevalence of LBW and their associated factors among HIV+ and HIV- mothers delivered in Northwest Amhara region referral hospitals.
A comparative crossectional study was conducted from September 2016 to September 2019. A simple random sampling technique was used to select 474 participants. Data were collected from the mothers' chart by using a data extraction sheet and then entered into Epi-data and exported into SPSS for analysis. Independent variables with p-values < 0.2 in the bivariable analysis were entered into multivariable logistic regression models with backward logistic regressions method to control confounders and identify the factor.
The overall prevalence of LBW was 13.9% (95% CI:10.8%-17.1%). The prevalence was higher among HIV+ 17.7% (95% CI:14.1%-22.8%) than HIV- mothers 10.1% (95% CI:6.3%-13.8%). CD4 count < 200 cells/mm3 [AOR 3.2, 95%CI (1.05, 9.84)] and between 200-350 cells/mm3 [2.81, 95% CI (1,08, 7.28)], Mothers with MUAC <23 cm [AOR 3.39, 95% CI (1.41, 8.18)] and gestational age <37 weeks [AOR 7.34, 95% CI (3.02,17.80)] were significantly associated with LBW in HIV+ mothers. While, rural residence [AOR 3.93,95% CI (1.356,11.40)], PROM during current pregnancy [AOR 4.96, 95% CI (2.55, 15.83)] and gestational age <37 week [AOR 8.21, 95% CI (2.60, 25.89)] were significantly associated with LBW in HIV negative mothers.
The prevalence of LBW was significantly higher among HIV+ mothers as compared to HIV-mothers and this study suggests to emphasize nutritional supplementation of HIV positive mothers, needs to focus on nutritional counseling during ANC/PMTCT follow up and encourage HIV positive mothers to delay their pregnancy until their immune status improve.
Journal Article