Individualized Postnatal Growth Trajectories for Preterm Infants

Landau-Crangle, Erin; Rochow, Niels; Fenton, Tanis R.; Li, Kai; Ali, Anaam; So, Hon Yiu; Fusch, Gerhard; Marrin, Michael; Fusch, Christoph

doi:10.1002/jpen.1138

Cited by 44 publications

(38 citation statements)

References 46 publications

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“…The clinical value of FBA is twofold. First, tracking of individual growth trajectories is becoming an important part of individualized medicine for preterm infants (58)(59)(60). Tracking…”

Section: Discussionmentioning

confidence: 99%

Automated cot-side tracking of functional brain age in preterm infants

Stevenson

Oberdorfer

Tataranno

et al. 2019

Preprint

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AbstractObjectiveA major challenge in the care of preterm infants is the early identification of compromised neurological development. While several measures are routinely used to track anatomical growth, there is a striking lack of reliable and objective tools for tracking maturation of early brain function; a cornerstone of lifelong neurological health. We present a cot-side method for measuring the functional maturity of the newborn brain based on routinely-available neurological monitoring with electroencephalography (EEG).MethodsWe used a dataset of 177 EEG recordings from 65 preterm infants to train a multivariable prediction of functional brain age (FBA) from EEG. The FBA was validated on an independent set of 99 EEG recordings from 42 preterm infants. The difference between FBA and postmenstrual age (PMA) was evaluated as a predictor for neurodevelopmental outcome.ResultsThe FBA correlated strongly with the PMA of an infant, with a median prediction error of less than 1 week. Moreover, individual babies follow well-defined individual trajectories. The accuracy of the FBA applied to the validation set was statistically equivalent to the training set accuracy. In a subgroup of infants with repeated EEG recordings, a persistently negative predicted age difference was associated with poor neurodevelopmental outcome.InterpretationThe FBA enables the tracking of functional neurodevelopment in preterm infants. This establishes proof of principle for growth charts for brain function, a new tool to assist clinical management and identify infants who will benefit most from early intervention.

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“…The clinical value of FBA is twofold. First, tracking of individual growth trajectories is becoming an important part of individualized medicine for preterm infants (58)(59)(60). Tracking…”

Section: Discussionmentioning

confidence: 99%

Automated cot-side tracking of functional brain age in preterm infants

Stevenson

Oberdorfer

Tataranno

et al. 2019

Preprint

View full text Add to dashboard Cite

show abstract

“…However, this long duration of measurement is difficult to translate to shorter durations of growth velocity measurement as needed for clinical care decisions during hospitalization. Other innovative measures such as weight gain ratios [ 23 ] or growth velocity calculations with postnatal adjustment are relatively new methods for preterm infant growth monitoring and, therefore, require further investigation as methods to control for the errors in preterm infant growth assessment [ 23 , 26 ]. In our study, the HGQ demonstrated significantly higher growth velocity when compared to the LGQ group.…”

Section: Discussionmentioning

confidence: 99%

Factors in Early Feeding Practices That May Influence Growth and the Challenges That Arise in Growth Outcomes Research

2020

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Growth in preterm infants is associated with improved outcomes during both the initial hospitalization and long-term. A single center investigation evaluated preterm infant in-hospital growth trajectory and how it related to early nutritional practices as a way to identify areas for quality improvement. Infants born <34 weeks’ gestational age and with discharge at or prior to 40 weeks’ gestational age were included and were divided into quartiles based on their change in weight z-score through hospitalization. Early nutritional factors were compared between the lowest and highest growth quartiles. Although the highest growth quartile experienced less days of parenteral nutrition and higher enteral caloric density in the first week, as the data was analyzed, potential statistical pitfalls became apparent. Therefore, the aim of this study was to investigate selection bias and cohort effect related to both the inclusion criteria for this cohort as well as the inherent challenges in comparison of preterm infant growth trajectories by standard fetal growth charts.

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“…The sample size required to compare two means in two-sided equality test was estimated based on results from a prior double blind, randomized clinical trial, investigating the effect of TG vs SF of breast milk on the changes of anthropometric parameters and body composition in preterm children [ 23 , 24 ]. It was determined that a mean difference of weight gain 1.9 g/kg/day between groups would be clinically important and feasible during intervention.…”

Section: Methods: Participants Interventions and Outcomesmentioning

confidence: 99%

Effect of targeted vs standard fortification of breast milk on growth and development of preterm infants (≤ 32 weeks): study protocol for a randomized controlled trial

Seliga‐Siwecka

Chmielewska

Jasińska

2020

Trials

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Background Human milk is recommended for all very low birth weight infants. Breastmilk is highly variable in nutrient content, failing to meet the nutritional demands of this group. Fortification of human milk is recommended to prevent extrauterine growth retardation and associated poor neurodevelopmental outcome. However, standard fortification with fixed dose multicomponent fortifier does not account for the variability in milk composition. Targeted fortification is a promising alternative and needs further investigation. Methods This randomized controlled trial will recruit preterm infants (≤ 32 weeks of gestation) within the first 7 days of life. After reaching 80 ml/kg/day of enteral feeding, patients will be randomized to receive standard fortification (HMF, Nutricia) or targeted fortification (modular components: Bebilon Bialka, Nutricia—protein; Polycal, Nutricia—carbohydrates; Calogen, Nutricia—lipids). The intervention will continue until 37 weeks of post-conception age or hospital discharge. Parents and outcome assessors will be blinded to the intervention. The primary outcome measure is velocity of weight, length, and head growth until 36 weeks post-conceptional age or discharge. Secondary outcomes include neurodevelopment at 12 months assessed with Bayley Scale of Development III, repeated at 36 months; body composition at discharge and at 4 months; and incidence of necrotizing enterocolitis, sepsis, retinopathy of prematurity, and bronchopulmonary dysplasia. Discussion Targeted fortification has previously been shown as doable in the neonatal intensive care unit context. If it shows to improve growth and neonatal outcome, choosing the targeted fortification as a first line nutritional approach in very low birth weight infants may become a recommendation. Trial registration ClinicalTrials.govNCT03775785, Registered on July 2019.

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Individualized Postnatal Growth Trajectories for Preterm Infants

Cited by 44 publications

References 46 publications

Automated cot-side tracking of functional brain age in preterm infants

Automated cot-side tracking of functional brain age in preterm infants

Factors in Early Feeding Practices That May Influence Growth and the Challenges That Arise in Growth Outcomes Research

Effect of targeted vs standard fortification of breast milk on growth and development of preterm infants (≤ 32 weeks): study protocol for a randomized controlled trial

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