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By this novel approach, we measured endogenous LCP synthesis in infants receiving dietary LCPs over long periods. By age 7 mo, LCP synthesis was dramatically lower in preterm infants fed LCPs.

Aim-To evaluate the eVect of fortification on the osmolality of human milk. Methods-The osmolality of 47 samples of human milk was determined at baseline, just after, and 24 hours after supplementation with five diVerent human milk fortifiers (HMF) at 4°C. Results-Ten minutes after HMF supplementation the osmolality of human milk was significantly higher than the sum of the respective values of HMF dissolved in water and human milk, measured separately at baseline (p<0.0001), with the exception of the HMF containing only proteins. After 24 hours a further increase in osmolality was observed. Linear regression analysis showed that total dextrin content (r=0.84) was the main determinant of the increase. Conclusions-Human milk and HMF interact to induce a rapid increase in osmolality higher than would be expected from composition alone. This rise could be explained by the amylase activity of human milk, inducing hydrolysis of the dextrin content of HMF, leading to small osmotically active molecules of oligosaccharides. The high osmolality of fortified human milk should be considered in the nutritional management of preterm infants. (Arch Dis Child Fetal Neonatal Ed 1999;81:F141-F143)

Postnatal growth failure of very‐low‐birthweight (VLBW) infants may result from a complex interaction of genetic and environmental factors, including inadequate nutrition, morbidities affecting nutrient requirements, endocrine abnormalities and treatments. Among VLBW infants, those small for gestational age (SGA) at birth and those with postnatal growth restriction at the time of discharge are at higher risk of later growth failure and long‐term consequences. Nutritional intervention with an “aggressive nutrition” during the first weeks of life may be able to minimize the interruption of nutrients that occurs at birth, and reduce as much as possible the incidence of growth restriction at the time of discharge and later. Even though aggressive parenteral and enteral nutrition appear to be effective and safe in VLBW infants, further evaluations of their long‐term effect on growth and health consequences are needed. Several studies evaluating the effect of enriched nutrient formulas after hospital discharge on growth and neurodevelopment have produced conflicting results, whereas the potential deleterious long‐term effects of prolonged use of high protein and/or of later catch‐up growth have been questioned. In contrast, recent data seem to indicate that the use of human milk after hospital discharge could be the most beneficial diet for subsequent health and development. Conclusion: VLBW infants SGA at birth and those with early postnatal growth restriction are at high risk of later growth failure and long‐term consequences. Therefore, the first objective of early nutrition should be to reduce the incidence of growth restriction at the time of discharge. Further studies on VLBW infants to evaluate the safety and beneficial effects of prolonged dietary manipulation during the first year of life are needed.

Whole body composition was investigated using dual energy x-ray absorptiometry in 54 healthy preterm infants, birth weight Ͻ 1750 g, who were fed fortified human milk (n ϭ 20) and preterm formula (n ϭ 34) when full enteral feeding was attained and then again 3 wk later at around the time of discharge. Weight gain composition was calculated from the difference between the earlier and later measurement. The minimal detectable changes in whole body composition over time according to the variance of the population (within groups of 20 infants) and the minimal detectable changes according to the dietary intervention (between two groups of 20 infants) were determined at 5% significance and 80% power. Whole body composition was similar in the two groups at the initial measurement, but all the measured variables differed at the time of the second measurement. Formula-fed infants showed a greater weight gain (19.9 Ϯ 3.2 versus 15.9 Ϯ 2.2 g⅐kg -1 ⅐d -1 , p Ͻ 0.05), fat mass deposition (5.1 Ϯ 1.9 versus 3.3 Ϯ 1.3 g⅐kg -1 ⅐d -1 , p Ͻ 0.05), bone mineral content gain (289 Ϯ 99 versus 214 Ϯ 64 mg⅐kg -1 ⅐d -1 , p Ͻ 0.05), and increase in bone area (1.6 Ϯ 0.4 versus 1.3 Ϯ 0.3 cm 2 ⅐kg -1 ⅐d -1 , p Ͻ 0.05) compared with the fortified human milk group. From these data, a minimal increase from the first measurement of 111 g lean body mass, 68 g fat mass, and 3.1 g bone mineral content is needed to be detectable in a longitudinal study that includes 20 infants. For significance between two groups of 20 infants around the time of discharge, dietary intervention needs to achieve minimal differences of 160 g lean body mass, 86 g fat mass, and 4.1 g bone mineral content. With respect to weight gain composition, the minimal differences required to reach significance are 2.1 g⅐kg In recent decades, with the progressive increase in the survival of preterm infants, there has been increased interest in their nutritional evaluation in the light of knowledge that adequate feeding in the early weeks of life influences shortand long-term development (1, 2). Measurement of body composition is of fundamental importance in the nutritional care for preterm infants, and many techniques have been developed (3-7). Metabolic balances associated with indirect calorimetry allowed the composition of weight gain in preterm infants to be defined (8, 9). The complexity of such techniques and the fact that weight gain composition could only be obtained over a short period of time resulted in the need for a new and reliable method of study. DXA has emerged as an accurate, precise, and reproducible technique for measuring whole body composition in vivo in humans. Determination of lean body mass, fat mass, bone area, and bone mineral content can all be done using DXA (10 -14). Reference values of body composition in preterm and term infants at birth have been reported (11,12). Our aim in the present study was to measure body composition and weight gain composition by DXA in preterm infants fed exclusively on either FHM or PTF and to evaluate the sensitivity of t...

VLBW infants SGA at birth and those with early postnatal growth restriction are at high risk of later growth failure and long-term consequences. Therefore, the first objective of early nutrition should be to reduce the incidence of growth restriction at the time of discharge. Further studies on VLBW infants to evaluate the safety and beneficial effects of prolonged dietary manipulation during the first year of life are needed.

OL is a named inventor on several patents relating to vaccine adjuvants. Category of study: Review • Neonatal sepsis is a leading cause of early life mortality and there is an unmet need to address it. • Emerging evidence indicates that immunometabolism is relevant to the pathophysiology of neonatal sepsis, but much remains to be learned regarding its distinct features and regulation. • We discuss the interconnection of metabolism and immunity in early life and how distinct immunometabolism may be leveraged to improve prevention, diagnosis, and therapy of neonatal sepsis.

Development of posttraumatic stress disorder (PTSD) in parents of premature neonates has been recently described. Several source of stress have been hypothesized, however causes of PTDS and emotional reaction of the parents of premature birth hospitalized in a neonatal intensive care unit (NICU) remain largely undefined. We demonstrated that alteration of parental role and a history of anxiety have a crucial role in the development of PTSD in the parents of premature neonates. Familiarization with neonatal intensive care unit environment and increasing participation of the parents in the care of neonates during the first weeks of life improves parental role perception. Early involvement of the parents and especially of the mothers in the neonatal care, in particular if the risk of anxiety is consistent, should be considered a primary objective to prevent a PTSD.