Challenges in breast milk fortification for preterm infants

Rochow, Niels; Landau-Crangle, Erin; Fusch, Christoph

doi:10.1097/mco.0000000000000167

Cited by 56 publications

(65 citation statements)

References 81 publications

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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%

“…Delayed nutritional support, slow postnatal enteral feeding advancement, prolonged use of parenteral nutrition, repeated bouts of feeding intolerance, and/or providing nutrition that does not provide the optimal composition and nutrients needed for Articles high growth rates in preterm infants can aggravate this deficit. The impact seems to be center-specific (1,6,(17)(18)(19)(20).…”

mentioning

confidence: 96%

“…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)(3)(4).…”

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confidence: 99%

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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%

mentioning

confidence: 96%

mentioning

confidence: 99%

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Physiological adjustment to postnatal growth trajectories in healthy preterm infants

et al. 2016

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“…A recent preliminary study that investigated the effects of unpasteurized compared with pasteurized milk in 323 preterm infants found no significant differences between the groups for late-onset sepsis (15.9% compared with 15.1%; P = 0.49) but noted a trend toward decreases in the occurrence of NEC (2.4% compared with 4.4%; P = 0.25) in infants administered pasteurized milk (55). Supplementation and fortification of pasteurized breast milk with specific nutrients, such as vitamin D, proteins, and calcium, increased weight accretion in premature infants (53,56) but not the frequency of NEC (57).…”

Section: Management Strategiesmentioning

confidence: 91%

Probiotics, Prebiotics, and Synbiotics for the Prevention of Necrotizing Enterocolitis

Johnson‐Henry

Abrahamsson

et al. 2016

Advances in Nutrition

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Necrotizing enterocolitis (NEC) is a devastating intestinal disease in preterm infants characterized by barrier disruption, intestinal microbial dysbiosis, and persistent inflammation of the colon, which results in high mortality rates. Current strategies used to manage this disease are not sufficient, although the use of human breast milk reduces the risk of NEC. Mother's milk is regarded as a fundamental nutritional source for neonates, but pasteurization of donor breast milk affects the composition of bioactive compounds. Current research is evaluating the benefits and potential pitfalls of adding probiotics and prebiotics to pasteurized milk so as to improve the functionality of the milk and thereby reduce the burden of illness caused by NEC. Probiotics (live micro-organisms that confer health to the host) and prebiotics (nondigestible oligosaccharides that stimulate the growth of healthy bacteria) are functional foods known to mediate immune responses and modulate microbial populations in the gut. Clinical research shows strain-and compoundspecific responses when probiotics or prebiotics are administered in conjunction with donor breast milk for the prevention of NEC. Despite ongoing controversy surrounding optimal treatment strategies, randomized controlled studies are now investigating the use of synbiotics to reduce the incidence and severity of NEC. Synbiotics, a combination of probiotics and prebiotics, have been proposed to enhance beneficial health effects in the intestinal tract more than either agent administered alone. This review considers the implications of using probiotic-, prebiotic-, and synbioticsupplemented breast milk as a strategy to prevent NEC and issues that could be encountered with the preparations. Adv Nutr 2016;7:928-37.

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“…• Fortificación ajustable dependiendo de la respuesta metabólica: evaluar con NU periódicamente; el rango objetivo es de 9 a 15 mg/dl 24,47,48 . Intervenir con valor menor a 8 mg/dl, aumentando la concentración del fortificante, correlacionando con velocidad de crecimiento: niños que crecen < 15 g/kg/día o desaceleran, probablemente necesiten más proteína; la adición de 0,5-1 g/kg/día de proteína es razonable, se puede usar el fortificante al 5 o 6%.…”

Section: Fortificadores De Leche Maternaunclassified

Nutrición intrahospitalaria del prematuro. Recomendaciones de la Rama de Neonatología de la Sociedad Chilena de Pediatría

Mena

Milad

Vernal

et al. 2016

Revista Chilena de Pediatría

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Recommendations based on current publications are presented for postnatal preterm nutrition, depending on birth weight: less 1000g, between 1000 and 1500g, and above 1500g, as well for the development periods: adaptation, stabilisation, and growth. A review is also presented on the nutritional management of morbidities that affect or may affect nutrition, such as: osteopenia, bronchopulmonary dysplasia, patent ductus arteriosus, red cell transfusion, and short bowel syndrome.

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Challenges in breast milk fortification for preterm infants

Cited by 56 publications

References 81 publications

Physiological adjustment to postnatal growth trajectories in healthy preterm infants

Physiological adjustment to postnatal growth trajectories in healthy preterm infants

Probiotics, Prebiotics, and Synbiotics for the Prevention of Necrotizing Enterocolitis

Nutrición intrahospitalaria del prematuro. Recomendaciones de la Rama de Neonatología de la Sociedad Chilena de Pediatría

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