RESUMO
BACKGROUND: Oligosaccharides are the third most abundant component in human milk. They are a potential protective agent against neonatal sepsis. OBJECTIVES: We aimed to explore the association between human milk oligosaccharides (HMOs) and late-onset sepsis in very-low-birth-weight infants, and to describe the composition and characteristics of HMOs in Peruvian mothers of these infants. METHODS: This is a secondary data analysis of a randomized clinical trial. We conducted a retrospective cohort study of mothers and their very-low-birth-weight (<1500 g) infants with ≥1 milk sample and follow-up data for >30 d. HMOs were measured by high performance liquid chromatography (HPLC). We used factor analysis and the Mantel-Cox test to explore the association between HMOs and late-onset neonatal sepsis. RESULTS: We included 153 mother-infant pairs and 208 milk samples. Overall, the frequency of the secretor phenotype was 93%. Secretors and nonsecretors were defined by the presence and near-absence of α1-2-fucosylated HMOs, respectively. The most abundant oligosaccharides were 2'-fucosyllactose, lacto-N-fucopentaose (LNFP) I, and difucosyllacto-N-tetraose in secretors and lacto-N-tetraose and LNFP II in nonsecretors. Secretors had higher amounts of total oligosaccharides than nonsecretors (11.45 g/L; IQR: 0.773 g/L compared with 8.04 g/L; IQR: 0.449 g/L). Mature milk samples were more diverse in terms of HMOs than colostrum (Simpson's Reciprocal Diversity Index). We found an association of factor 3 in colostrum with a reduced risk of late-onset sepsis (HR: 0.63; 95% CI: 0.41, 0.97). Fucosyl-disialyllacto-N-hexose (FDSLNH) was the only oligosaccharide correlated to factor 3. CONCLUSIONS: These findings suggest that concentrations of different HMOs vary from one individual to another according to their lactation period and secretor status. We also found that FDSLNH might protect infants with very low birth weight from late-onset neonatal sepsis. Confirming this association could prove 1 more mechanism by which human milk protects infants against infections and open the door to clinical applications of HMOs.This trial was registered at clinicaltrials.gov as NCT01525316.
Assuntos
Recém-Nascido de muito Baixo Peso/metabolismo , Leite Humano/química , Leite Humano/metabolismo , Sepse Neonatal/metabolismo , Oligossacarídeos/metabolismo , Adulto , Idade de Início , Colostro/química , Colostro/metabolismo , Feminino , Humanos , Lactente , Masculino , Oligossacarídeos/análise , Peru , Estudos Retrospectivos , Adulto JovemRESUMO
OBJECTIVE: To test the hypothesis that feeding and antibiotic exposures affect intestinal barrier maturation in preterm infants, we serially measured intestinal permeability (IP) biomarkers in infants <33 weeks gestation (gestational age [GA]) during the first 2 weeks of life. STUDY DESIGN: Eligible infants <33 weeks GA were enrolled within 4 days of birth in a prospective study of IP biomarkers (NCT01756040). Study participants received the nonmetabolized sugars lactulose/rhamnose enterally on study days 1, 8, and 15 and lactulose/rhamnose were measured in urine by high-performance liquid chromatography. Serum zonulin and fecal alpha-1-anti-trypsin, 2 other IP markers, were measured by semiquantitative Western blot and ELISA, respectively. RESULTS: In a cohort of 43 subjects, the lactulose/rhamnose ratio was increased on day 1 and decreased over 2 weeks, but remained higher in infants born at ≤28 weeks of gestation compared with IP in infants born at >28 weeks of gestation. Exclusive breastmilk feeding was associated with more rapid maturation in intestinal barrier function. A cluster analysis of 35 subjects who had urine samples from all time points revealed 3 IP patterns (cluster 1, normal maturation: n = 20 [57%]); cluster 2, decreased IP during the first week and subsequent substantial increase: n = 5 [14%]); and cluster 3, delayed maturation: n = 10 [29%]). There were trends toward more prolonged antibiotic exposure (P = .092) and delayed initiation of feeding ≥4 days (P = .064) in infants with abnormal IP patterns. CONCLUSIONS: Intestinal barrier maturation in preterm infants is GA and postnatal age dependent, and is influenced by feeding with a maturational effect of breastmilk feeding and possibly by antibiotic exposures. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01756040.
Assuntos
Antibacterianos/administração & dosagem , Recém-Nascido de muito Baixo Peso/metabolismo , Absorção Intestinal/fisiologia , Leite Humano/metabolismo , Análise de Variância , Antibacterianos/farmacocinética , Biomarcadores/análise , Estudos de Casos e Controles , Desenvolvimento Infantil/fisiologia , Métodos de Alimentação , Feminino , Seguimentos , Idade Gestacional , Humanos , Lactente , Fórmulas Infantis , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido , Mucosa Intestinal/metabolismo , Intestinos/efeitos dos fármacos , Lactose/administração & dosagem , Lactose/farmacocinética , Masculino , Permeabilidade/efeitos dos fármacos , Estudos Prospectivos , Ramnose/administração & dosagem , Ramnose/farmacocinéticaRESUMO
OBJECTIVE: To report the prevalence of hypophosphatemia during the first week of life in preterm infants receiving aggressive parenteral nutrition and to analyze population variables associated with severe hypophosphatemia. STUDY DESIGN: A retrospective cohort of 61 neonates below 1250 g birth weight consecutively born at Hospital Italiano de Buenos Aires exposed to high caloric and protein intake from the first day of birth. Primary outcome was hypophosphatemia (phosphate <4 mg dl(-1)). A one-sample mean comparison test was used to compare our sample with a hypothesized population mean. RESULTS: The prevalence of hypophosphatemia was 91% (95% confidence interval (CI) 82 to 97%). The mean phosphatemia value was 2.52 mg dl(-1) (95% CI 2.18 to 2.86), significantly different from the hypothesized population mean (P<0.001). Patients with severe hypophosphatemia (<2 mg dl(-1)) were smaller. They presented with sepsis more frequently and received more vasoactive drugs and mechanical ventilation. CONCLUSION: The prevalence of hypophosphatemia in this group of preterm infants is high. The potential association with adverse clinical outcomes deserves further research.
Assuntos
Proteínas Alimentares , Hipofosfatemia , Doenças do Prematuro , Recém-Nascido Prematuro/metabolismo , Recém-Nascido de muito Baixo Peso/metabolismo , Nutrição Parenteral Total , Argentina/epidemiologia , Proteínas Alimentares/administração & dosagem , Proteínas Alimentares/efeitos adversos , Ingestão de Energia , Feminino , Humanos , Hipofosfatemia/diagnóstico , Hipofosfatemia/epidemiologia , Hipofosfatemia/etiologia , Hipofosfatemia/prevenção & controle , Recém-Nascido , Doenças do Prematuro/diagnóstico , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/etiologia , Doenças do Prematuro/prevenção & controle , Masculino , Nutrição Parenteral Total/efeitos adversos , Nutrição Parenteral Total/métodos , Gravidez , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Prevalência , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Sepse/epidemiologia , Índice de Gravidade de DoençaRESUMO
BACKGROUND/AIMS: A rapid catch-up growth in very low birth weight has been associated both with a higher height growth and a higher risk to metabolic disturbances, including insulin resistance and its consequences. Abdominal fat distribution in early postnatal life may play a role in these outcomes and can help in addressing this neonatal dilemma. This study aimed to compare abdominal fat distribution among very low birth weight (VLBW) children with and without rapid catch-up growth. MATERIALS AND METHODS: A cohort study followed 86 VLBW (<1500) children born in Brazil, during the first 3 years of life. Rapid catch-up growth was considered as an increased in length >2 Z score during the first year of life. Abdominal subcutaneous and preperitoneal fat thickness was determined by ultrasound. χ²-Test and Student's t-test were used to compare the groups. RESULTS: A total of 79 VLBW children completed the study, of whom 22 (27.8%) showed rapid catch-up growth. Abdominal subcutaneous and preperitoneal fat thickness showed no differences among children with or without rapid catch-up growth at 3.3 mm vs. 3.8 mm, respectively (p=0.79) and 4.0 mm vs. 4.0 mm (p=0.55), respectively. VLBW children with rapid catch-up growth were also taller. CONCLUSIONS: Rapid catch-up growth during the first year of life in VLBW children does not seem to change abdominal fat distribution until the third year of life.
Assuntos
Gordura Abdominal/crescimento & desenvolvimento , Distribuição da Gordura Corporal , Desenvolvimento Infantil/fisiologia , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Aumento de Peso/fisiologia , Adulto , Brasil , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Recém-Nascido de muito Baixo Peso/metabolismo , Masculino , GravidezRESUMO
OBJECTIVE: To assess whether an oxygen saturation (Spo2) target of 85%-89% compared with 91%-95% reduced the incidence of the composite outcome of death or major disability at 2 years of age in infants born at <28 weeks' gestation. STUDY DESIGN: A total 340 infants were randomized to a lower or higher target from <24 hours of age until 36 weeks' gestational age. Blinding was achieved by targeting a displayed Spo2 of 88%-92% using a saturation monitor offset by ±3% within the range 85%-95%. True saturations were displayed outside this range. Follow-up at 2 years' corrected age was by pediatric examination and formal neurodevelopmental assessment. Major disability was gross motor disability, cognitive or language delay, severe hearing loss, or blindness. RESULTS: The primary outcome was known for 335 infants with 33 using surrogate language information. Targeting a lower compared with a higher Spo2 target range had no significant effect on the rate of death or major disability at 2 years' corrected age (65/167 [38.9%] vs 76/168 [45.2%]; relative risk 1.15, 95% CI 0.90-1.47) or any secondary outcomes. Death occurred in 25 (14.7%) and 27 (15.9%) of those randomized to the lower and higher target, respectively, and blindness in 0% and 0.7%. CONCLUSIONS: Although there was no benefit or harm from targeting a lower compared with a higher saturation in this trial, further information will become available from the prospectively planned meta-analysis of this and 4 other trials comprising a total of nearly 5000 infants.
Assuntos
Doenças do Prematuro/metabolismo , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso/metabolismo , Oxigenoterapia/métodos , Oxigênio/sangue , Austrália , Pré-Escolar , Avaliação da Deficiência , Método Duplo-Cego , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Doenças do Prematuro/mortalidade , Doenças do Prematuro/terapia , Masculino , Avaliação de Resultados em Cuidados de Saúde , Medição de RiscoRESUMO
Introducción: la malnutrición intraútero ha sido postulada con vinculación a afecciones del desarrollo embrionario que determinan el desarrollo ulterior de obesidad, diabetes mellitus tipo 2, dislipidemias, disfunción mitocondrial y aterosclerosis. Objetivo: determinar las complicaciones metabólicas en adolescentes obesos con antecedentes de bajo peso al nacer. Métodos: estudio descriptivo y de corte transversal. Se incluyeron 50 pacientes obesos, con antecedentes de bajo peso al nacer y embarazo a término, de ambos sexos, en las edades comprendidas entre 9 y 17 años de edad, que asistieron a la consulta externa del servicio de Endocrinología del Hospital Pediátrico Docente Juan Manuel Márquez, en el período comprendido de enero de 2011 a enero de 2012. Se realizaron determinaciones de colesterol, triglicéridos, aminotransferasas hepáticas, glucemia, e insulinemia en ayunas y posprandial de dos horas. Resultados: las variables bioquímicas estudiadas no mostraron diferencias entre los puntos de corte utilizados para clasificar el peso al nacer. La transaminasa glutámico pirúvica mostró valores más altos en los adolescentes entre 15 y 17 años de edad. Conclusiones: la hipertrigliceridemia fue más elevada en el sexo femenino, mientras que la hiperglucemia y la hiperinsulinemia lo fueron en el masculino
Introduction: intrauterine malnutrition has been considered as being related to embrionary development problems that determine further occurrence of obesity, diabetes mellitus type 2, dyslipidemias, mitochondrial dysfunction and atherosclerosis.Objective: to determine the metabolic complications in obese adolescents with history of low birthweight.Methods: cross-sectional descriptive study of 50 obese patients of both sexes and aged 9 to 17 years and with a history of low birthweight. They had all been attended to in the outpatient endocrinology service of Juan Manuel Marquez teaching pediatric hospital from January 2011 to January 2012. Cholesterol, triglyceride, hepatic aminotransferase, glycemia and insulinemia on fasting and postprandially after 2 hours were estimated. Results: the studied biochemical variables did not show differences among the cutoffs used to classify birthweight. Piruvic gluthamic transaminase showed higher values in 15-17 years-old adolescents.Conclusions: hypertriglyceridemia was more elevated in females whereas hyperglycemia and hyperinsulinemia were elevated in males
Assuntos
Humanos , Masculino , Feminino , Adolescente , Biomarcadores/análise , Obesidade/etiologia , Obesidade/metabolismo , Recém-Nascido de Baixo Peso/metabolismo , Recém-Nascido de muito Baixo Peso/metabolismo , Estudos Transversais , Epidemiologia DescritivaRESUMO
OBJECTIVE: To assess the efficacy and safety of early parenteral lipid and high-dose amino acid (AA) administration from birth onwards in very low birth weight (VLBW, birth weight <1500 g) infants. STUDY DESIGN: VLBW infants (n = 144; birth weight 862 ± 218 g; gestational age 27.4 ± 2.2 weeks) were randomized to receive 2.4 g of AA kg(-1) · d(-1) (control group), or 2.4 g AA kg(-1) · d(-1) plus 2-3 g lipids kg(-1) · d(-1) (AA + lipid group), or 3.6 g AA kg(-1) · d(-1) plus 2-3 g lipids kg(-1) · d(-1) (high AA + lipid group) from birth onwards. The primary outcome was nitrogen balance. The secondary outcomes were biochemical variables, urea rate of appearance, growth rates, and clinical outcome. RESULTS: The nitrogen balance on day 2 was significantly greater in both intervention groups compared with the control group. Greater amounts of AA administration did not further improve nitrogen balance compared with standard AA dose plus lipids and was associated with high plasma urea concentrations and high rates of urea appearance. No differences in other biochemical variables, growth, or clinical outcomes were observed. CONCLUSIONS: In VLBW infants, the administration of parenteral AA combined with lipids from birth onwards improved conditions for anabolism and growth, as shown by improved nitrogen balance. Greater levels of AA administration did not further improve the nitrogen balance but led to increased AA oxidation. Early lipid initiation and high-dose AA were well tolerated.
Assuntos
Aminoácidos/administração & dosagem , Recém-Nascido de muito Baixo Peso/fisiologia , Lipídeos/administração & dosagem , Soluções de Nutrição Parenteral/química , Nutrição Parenteral/métodos , Biomarcadores/sangue , Biomarcadores/urina , Método Duplo-Cego , Feminino , Humanos , Recém-Nascido , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Recém-Nascido de muito Baixo Peso/metabolismo , Modelos Lineares , Modelos Logísticos , Masculino , Nitrogênio/urina , Soluções de Nutrição Parenteral/administração & dosagem , Ureia/sangueRESUMO
Rapid early growth is associated with adverse metabolic outcome. The aim of this study was to determine whether there are differences in body composition (BC) between very-low-birth-weight preterm (VLBWPT) infants born appropriate for gestational age (AGA) and small for gestational age (SGA) and whether these differences relate to first-year growth. Twenty-six VLBWPT (15 AGA and 11 SGA). The BC was analyzed by dual X-ray absorptiometry at 2 years, and insulin-like growth factors (IGFs) I and II and leptin were administered weekly for 8 weeks and at 1, 3, 6, and 12 months. At 24 months, the VLBW SGA infants were lighter and had less peripheral fat and lean mass than VLBW AGA infants. In all patients, the percentage of fat mass correlated inversely with the change in weight [standard deviation scores (SDS)] from newborn to 2 and 4 weeks and the 1-month leptin and lean mass (SDS) correlated inversely with the change in weight (SDS) from newborn to 2, 4, and 8 weeks and with 4-week IGF-I and 8-week IGF-II. Lean mass (SDS) inversely correlated with 6-month IGF-I and directly correlated with 1-week and 3-month IGF-I in SGA VLBW infants only. A longer follow-up period will show whether additional differences will develop later.
Assuntos
Composição Corporal , Recém-Nascido de muito Baixo Peso/metabolismo , Fator de Crescimento Insulin-Like II/análise , Fator de Crescimento Insulin-Like I/análise , Leptina/sangue , Pré-Escolar , Humanos , Recém-NascidoRESUMO
OBJECTIVE: To evaluate the effects of early bronchopulmonary dysplasia (BPD) on calcium (Ca) metabolism and growth in very low birth weight (VLBW) infants. STUDY DESIGN: A dual-tracer, stable isotope method was used to assess Ca absorption in VLBW infants. Infants with early BPD received energy-dense feedings and mild fluid restriction. RESULTS: Sixteen of 41 preterm infants were classified as having early BPD. Fractional Ca absorption (early BPD, 58.4 ± 4.6% versus no early BPD, 50.3 ± 4.0%, P = .2), total Ca absorption (early BPD, 127 ± 14 mg/kg/d versus no early BPD, 104 ± 9 mg/kg/d, P = .9), and Ca retention (early BPD, 99.6 ± 10.0 mg/kg/d versus no early BPD, 91.0 ± 9.8 mg/kg/d, P = .2) were similar among groups. There was no significant difference in weight gain, linear growth, or head circumference growth between groups. CONCLUSIONS: The ability of VLBW infants with early BPD and fluid restriction to grow and accrete calcium is similar to those without early BPD. The use of high caloric density feedings in VLBW infants with early BPD can help achieve bone and overall growth outcomes close to those achievable in utero.