Improving head growth in very preterm infants - a randomised controlled trial I: neonatal outcomes

Tan, Maw; Cooke, Richard

doi:10.1136/adc.2007.124230

Cited by 109 publications

(140 citation statements)

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“…The impact seems to be center-specific (1,6,(17)(18)(19)(20). Preterm infants with undisturbed postnatal adaptation who are not exposed to growth-affecting conditions may represent the most appropriate model to study physiological postnatal weight loss and early weight gain in order to determine which postnatal growth trajectory preterm infants best adapt to.…”

Section: Preterm Infant Growth Trajectoriesmentioning

confidence: 99%

Physiological adjustment to postnatal growth trajectories in healthy preterm infants

et al. 2016

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Background: International guidelines suggest that growth of preterm infants should match intrauterine rates. However, the trajectory for extrauterine growth may deviate from the birth percentile due to an irreversible, physiological loss of extracellular fluid during postnatal adaptation to extrauterine conditions. To which "new" physiological growth trajectory preterm infants should adjust to after completed postnatal adaptation is unknown. This study analyzes the postnatal growth trajectories of healthy preterm infants using prospective criteria defining minimal support, as a model for physiological adaptation. Methods: International, multi-center, longitudinal, observational study at five neonatal intensive care units (NICUs). Daily weights until day of life (DoL) 21 of infants with undisturbed postnatal adaptation were analyzed (gestational ages: (i) 25-29 wk, (ii) 30-34 wk). results: 981 out of 3,703 admitted infants included. Maximum weight loss was 11% (i) and 7% (ii) by DoL 5, birth weight regained by DoL 15 (i) and 13 (ii). Infants transitioned to growth trajectories parallel to Fenton chart percentiles, 0.8 z-scores below their birth percentiles. The new trajectory after completed postnatal adaptation could be predicted for DoL 21 with R 2 = 0.96. conclusion: This study provides a robust estimate for physiological growth trajectories of infants after undisturbed postnatal adaptation. In the future, the concept of a target postnatal trajectory during NICU care may be useful. i mproved survival rates of very-low-birth-weight (<1,500 g birth weight) infants have shifted the focus of neonatal care onto improving postnatal growth and nutrition, aiming to achieve growth rates that optimize later health outcomes (1). Pediatric societies in North America and Europe have recommended that postnatal growth of preterm infants match the in utero growth rates of fetuses that remain in utero until full-term (2-4). These recommendations gain importance in light of the Developmental Origins of Health and Disease (DOHaD) hypothesis (5). The DOHaD concept suggests that suboptimal growth of a fetus or a newborn infant can impact the early onset of adult metabolic and cardiovascular diseases. In utero, the growth rate of an individual fetus is determined by its genetic potential and modified by "environmental" factors such as maternal nutrition, body composition, pathologies, or altitude above sea level. After birth, growth patterns of preterm infants are under external control by neonatal staff who modify the infants' nutrient intake. Figure 1 shows three hypothetical postnatal trajectories for a given preterm infant (27 wk of gestation, birth weight 1,000 g). It is of interest to note that these trajectories have similar slopes and hence not dramatically different growth rates. However, postnatal adjustment to different percentiles during the phase of stable growth will lead to different body compositions-potentially affecting later health outcomes.The current evidence for optimal postnatal growth trajectories is scarce....

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Section: Preterm Infant Growth Trajectoriesmentioning

confidence: 99%

Physiological adjustment to postnatal growth trajectories in healthy preterm infants

et al. 2016

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“…Preterm infants had a significantly reduced LBM and pattern of AT distribution associated with metabolic complications. 19 Tan et al 32,33 studied the effect of hyperalimentation on head growth. No differences between the two groups were found, but non-randomised analyses showed protein and energy deficits to be correlated with poor head growth.…”

Section: Previous Studies Of Parenteral Nutritionmentioning

confidence: 99%

Nutritional Evaluation and Optimisation in Neonates (NEON) trial of amino acid regimen and intravenous lipid composition in preterm parenteral nutrition: a randomised double-blind controlled trial

et al. 2016

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Health. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising.The WestminsterResearch online digital archive at the University of Westminster aims to make the research output of the University available to a wider audience. Copyright and Moral Rights remain with the authors and/or copyright owners.Whilst further distribution of specific materials from within this archive is forbidden, you may freely distribute the URL of WestminsterResearch: ((http://westminsterresearch.wmin.ac.uk/).In case of abuse or copyright appearing without permission e-mail repository@westminster.ac.uk This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/). EFFICACY AND MECHANISM EVALUATION Efficacy and Mechanism EvaluationEditorial contact: nihredit@southampton.ac.ukThe full EME archive is freely available to view online at www.journalslibrary.nihr.ac.uk/eme. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Efficacy and Mechanism Evaluation journalReports are published in Efficacy and Mechanism Evaluation (EME) if (1) they have resulted from work for the EME programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors. EME programmeThe Efficacy and Mechanism Evaluation (EME) programme was set up in 2008 as part of the National Institute for Health Research (NIHR) and the Medical Research Council (MRC) coordinated strategy for clinical trials. The EME programme is broadly aimed at supporting 'science driven' studies with an expectation of substantial health gain and aims to support excellent clinical science with an ultimate view to improving health or patient care.Its remit includes evaluations of new treatments, including therapeutics (small molecule and biologic), psychological interventions, public health, diagnostics and medical devices. Treatments or interventions intended to prevent disease are also included.The EME programme supports laboratory based or similar studies that are embedded within the main study if relevant to the remit of the EME programme. Studies that use validated surrogate markers as indicators of health outcome are also considered.For more information about the EME programme please visit the website: http://www.nets.nihr.ac.uk/programmes/eme This reportThe research reported in this issue of the journal was funded by the EME programme as project number 08/99/04. The contractual start date was in February 2010. The final report began editorial review in January 2015 and was accepted for publication in October 2015. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The EME edit...

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“…Это обусловлено анатомо-физиологичекими особенностями недоношенного ребен-ка (незрелостью желудочно-кишечного тракта) [17,18] на фоне синдрома полиорганной дисфункции, или недо-статочности, имеющего место при любом критическом состоянии [19].…”

Section: обзор литературыunclassified

Application of Parenteral Nutrition in Premature Infants

Molokanova¹,

Гавриков²

2015

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Improving head growth in very preterm infants - a randomised controlled trial I: neonatal outcomes

Abstract: Cumulative energy/protein deficit is predictive of poor head growth, but the delivery of adequate intakes remains a challenge in the preterm.

Cited by 109 publications

References 39 publications

Physiological adjustment to postnatal growth trajectories in healthy preterm infants

Physiological adjustment to postnatal growth trajectories in healthy preterm infants

Nutritional Evaluation and Optimisation in Neonates (NEON) trial of amino acid regimen and intravenous lipid composition in preterm parenteral nutrition: a randomised double-blind controlled trial

Application of Parenteral Nutrition in Premature Infants

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