Effects of aggressive parenteral nutrition on growth and clinical outcome in preterm infants

Can, Emrah; Bülbül, Ali; Uslu, Sinan; Çömert, Serdar; Bolat, Fatih; Nuhoğlu, Asiye

doi:10.1111/j.1442-200x.2012.03713.x

Cited by 46 publications

(49 citation statements)

References 35 publications

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“…In addition, protein deficit is negatively associated with FFM in preterm infants (8), and higher protein intake during the first week of life in preterm infants is associated with higher developmental scores at 18 mo (15). Aggressive nutritional management of preterm infants (through early initiation of parenteral protein) also correlates with higher length and head circumference, in addition to higher levels of insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP3), at 40 wk CGA compared with conventional nutritional management (14). The association of faster latency to P100 with higher FFM (i.e., better protein status) could be explained by the positive effects of protein intake on protein accretion and thus on neuronal differentiation.…”

Section: Discussionmentioning

confidence: 99%

“…They also reflect protein accretion (12), and the brain is highly reliant on protein for neuronal growth and differentiation (13). Higher protein intake early in the postnatal life of preterm infants correlates with increased length and head circumference at term (14) and is associated with higher developmental scores at 18 mo (15). Furthermore, linear stunting has been implicated in poorer neurodevelopmental outcomes in this population (3) and others (16,17).…”

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confidence: 99%

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Exploratory study of the relationship of fat-free mass to speed of brain processing in preterm infants

et al. 2013

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Exploratory study of the relationship of fat-free mass to speed of brain processing in preterm infants

et al. 2013

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“…One of the online screening tools is WINROP (weight, IGF-1, neonatal ROP) to predict development of stage 3 or higher ROP with 100% accuracy [33]. The WINROP tool appears to be a useful adjunct in predicting severe ROP in certain populations when used soon after birth [34,35,36,37,38,39,40,41]. This early prediction may allow early interventions to be implemented that could interrupt or reverse the progression to retinal detachment.…”

Section: Early Low and Late High Oxygen Saturationmentioning

confidence: 99%

“…Low postnatal weight gain has been associated with severe ROP. Early postnatal weight gain is predictive of subsequent development of severe ROP [33,34,35,36,37,38,39,40,41]. One of the online screening tools is WINROP (weight, IGF-1, neonatal ROP) to predict development of stage 3 or higher ROP with 100% accuracy [33].…”

Section: Early Low and Late High Oxygen Saturationmentioning

confidence: 99%

Retinopathy of Prematurity: Therapeutic Strategies Based on Pathophysiology

Cayabyab¹,

Ramanathan²

2016

Neonatology

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Retinopathy of prematurity (ROP) continues to be a major preventable cause of blindness and visual handicaps globally. With improved perinatal care, improved survival of moderately preterm infants, and limited resources for oxygen delivery and monitoring, more mature preterm infants are developing severe ROP in developing countries. The pathophysiology of ROP is characterized by two phases. Phase I ROP is due to vaso-obliteration beginning immediately after birth secondary to a marked decrease in vascular endothelial growth factor (VEGF) and insulin-like growth factor-1 (IGF-1). Phase II begins around 33 weeks' postmenstrual age (PMA). During this phase, VEGF levels increase, especially if there is retinal hypoxia with increasing retinal metabolism and demand for oxygen leading to abnormal vasoproliferation. Since the original description of ROP in 1942 by Terry et al. [Am J Ophthalmol 1942;25:203-204], four epidemics of ROP have been observed. Prevention or early treatment of ROP involves careful titration of oxygen saturation by pulse oximeter (SpO₂). Optimal SpO₂ target remains elusive. Most of the large trials have focused on either a low SpO₂ (85-89%) or a high SpO₂ (91-95%) from the first day of birth to 36 weeks' PMA. Although the incidence of severe ROP and bronchopulmonary dysplasia decreased significantly, predischarge mortality was higher in these studies. Use of graded SpO₂ during the 2 different phases of ROP (early, low SpO₂ during phase I vs. late, high SpO₂ during phase II) may be the best approach to prevent this disabling condition. Further trials should focus on this strategy. Other biological agents that are currently being studied include IGF-1 with IGF-binding protein-3 (rhIGF-1 + rhIGFBP-3) and propranolol. For advanced stages of ROP, laser ablation of avascular retina, early treatment of ROP (ETROP) protocol, intravitreal injection of anti-VEGF antibodies (e.g. bevacizumab) and vitrectomy are used to protect central vision and prevent retinal detachment. Long-term complications such as refractory errors, recurrence of ROP and risk of retinal detachment require continued follow-up with an ophthalmologist through adolescence and beyond. Optimal nutrition including adequate intake of omega-3 polyunsaturated fatty acids and decreasing infection/inflammation to promote normal vascularization are important strategies. Screening guidelines for ROP based on local incidence of ROP in different regions of the world are very important. Oxygen therapy is clearly a modifiable risk factor to decrease ROP that needs further study. Understanding the two phases of ROP will help to identify appropriate therapeutic strategies and improve visual outcomes in many preterm infants globally.

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“…Providing proteins or amino acids to preterm infants during the early postnatal period is critical for adequate growth and neurodevelopment [2,3]. Reduction in malnutrition results in higher postnatal growth rates and is associated with favorable long-term neurodevelopmental outcome [4,5,6,7,8]. Supplementation of amino acids has been shown to improve protein balance by increasing protein synthesis, improving the antioxidant defense system [9], and potentially preventing a catabolic state and neonatal growth retardation [10,11].…”

Section: Introductionmentioning

confidence: 99%

Low- versus High-Dose and Early versus Late Parenteral Amino-Acid Administration in Very-Low-Birth-Weight Infants: A Systematic Review and Meta-Analysis

Leenders

Waard²,

Goudoever³

2017

Neonatology

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Objectives: Providing parenteral amino acids to very-low-birth-weight infants during the first weeks of life is critical for adequate growth and neurodevelopment. However, there is no consensus about what dose is appropriate or when to initiate supplementation. As a result, daily practice varies among neonatal intensive care units. The objective of our study was to determine the effects of early parenteral amino-acid supplementation (within 24 h of birth) versus later initiation and high dose (>3.0 g/kg/day) versus a lower dose on growth and morbidities. Methods: A systematic review and meta-analysis of publications identified by searching PubMed, EMBASE, and Cochrane databases was conducted. Randomized controlled studies were eligible if information on growth was available. Results: The search identified 14 studies. No differences were observed in growth or morbidity after early or high-dose amino-acid supplementation, but for several outcomes, meta-analysis was not possible due to study heterogeneity. Initiation of amino acids within the first 24 h of life appeared to be safe and well tolerated, and leads more rapidly to a positive nitrogen balance. Conclusions: Administering a high dose (>3.0 g/kg/day) or an early dose (≤24 h) of parenteral amino acids is safe and well tolerated but does not offer significant benefits on growth. Further large-scale randomized controlled trials in preterm infants are needed to study the effects of early and high-dose amino acids on growth and morbidity more consistently and extensively.

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Effects of aggressive parenteral nutrition on growth and clinical outcome in preterm infants

Abstract: Aggressive PN seems to positively affect neonates' anthropometric measurements at the 40th gestational week and the development of ROP. These effects may be related to high levels of IGF-I and IGFBP3.

Cited by 46 publications

References 35 publications

Exploratory study of the relationship of fat-free mass to speed of brain processing in preterm infants

Exploratory study of the relationship of fat-free mass to speed of brain processing in preterm infants

Retinopathy of Prematurity: Therapeutic Strategies Based on Pathophysiology

Low- versus High-Dose and Early versus Late Parenteral Amino-Acid Administration in Very-Low-Birth-Weight Infants: A Systematic Review and Meta-Analysis

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