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Effects of Early Nutrition on Premature Infants

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Pediatric Nutrition".

Deadline for manuscript submissions: closed (5 January 2025) | Viewed by 19761

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Prof. Dr. Renato S. Procianoy

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Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
Interests: newborn; nutrition; perinatal asphyxia; inflammatory reaction in the newborn; growth and development of very low birth weight newborns and retinopathy of the prematurity
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Special Issue Information

Dear Colleagues，

You are invited to submit articles to this Special Issue, “Effects of Early Nutrition on Premature Infants”. It has long been known that malnutrition, whether intrauterine or extrauterine, causes changes in brain development, leading to delays in the development of children and adolescents. We also know that growth and development are linked. Intrauterine and extrauterine malnutrition is becoming increasingly prevalent, especially in low- and middle-income countries, due to socioeconomic problems such as absent or inadequate prenatal care, lack of adequate vaccination, low caloric and/or protein intake, and prematurity. Intrauterine malnutrition is also prevalent in developed countries, mainly due to problems occurring during pregnancy, such as assisted fertilization, multiple pregnancies, and pre-eclampsia. Low intake of essential nutrients for good intra- and extrauterine brain development also occurs in rich and affected by all those situations.

Therefore, malnutrition is a global public health problem highlighting a growing gap between poor and rich countries in somatic growth and neurodevelopment. Thus, we must delve deeper into this topic by studying its consequences and prevention through looking closely at the effects of nutrition in this population.

Prof. Dr. Renato S. Procianoy
Guest Editor

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Keywords

nutrition
child development
malnutrition
intrauterine growth
extrauterine growth
cerebral development
pregnancy nutrients

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Published Papers (9 papers)

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12 pages, 644 KiB

Open AccessArticle

Preeclampsia and Future Implications on Growth and Body Composition in Preterm Infants

by Elisabeth Calek, Julia Binder, Pilar Palmrich, Felix Eibensteiner, Alexandra Thajer, Karin Harreiter, Angelika Berger and Christoph Binder

Nutrients 2024, 16(21), 3627; https://doi.org/10.3390/nu16213627 - 25 Oct 2024

Viewed by 1228

Abstract

Background: Preeclampsia is associated with intrauterine growth restriction (IUGR), which can lead to impaired postnatal growth and neurodevelopment in preterm infants. Preeclampsia can also occur without IUGR and its impact on postnatal nutrition, growth, and body composition remains not fully investigated to the best of our knowledge. Methods: This study included infants born before 37 weeks of gestation who underwent air displacement plethysmography to measure body composition (fat-free mass [FFM] and fat mass [FM]) at term-equivalent age. We compared infants born to mothers with preeclampsia and IUGR (PE-IUGR group) and preeclampsia without IUGR (PE-non-IUGR group) to those born to mothers without preeclampsia (control group). Results: In total, 291 infants were enrolled (control: n = 227; PE-non-IUGR: n = 43; PE-IUGR: n = 21). FFM was significantly lower in the PE-IUGR (mean differences −231 g (IQR: (−373, −88); p < 0.001)) and PE-non-IUGR groups (mean differences −260 g (IQR: (−372, −149); p < 0.001)) in comparison to the control group. FM was not significantly different between the three groups. Conclusions: This study indicates that infants of preeclamptic mothers, even without IUGR, had significantly lower FFM at term-equivalent age compared to the control group. Further research is necessary to determine if these variations can be modified. Full article

(This article belongs to the Special Issue Effects of Early Nutrition on Premature Infants)

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12 pages, 1413 KiB

Open AccessArticle

Impact of Refeeding Syndrome on the Short-Term Clinical Outcomes of Very-Premature Infants

by Mountasser M. Al-Mouqdad, Belal Alshaikh, Haider H. Sumaily, Ameen A. Almotiri, Nabeel A. Alodhaidan, Latifah AlMahmoud, Adli Abdelrahim, Tamadur E. Yousif, Abdullah S. Alghamdi, Yasir A. Albarrak, Aljohara O. Alnafiey, Maha R. Al-Anazi, Thanaa M. Khalil, Raneem S. Asfour and Suzan S. Asfour

Nutrients 2024, 16(20), 3445; https://doi.org/10.3390/nu16203445 - 11 Oct 2024

Viewed by 1569

Abstract

Background: Refeeding syndrome (RFS) is a potentially life-threatening condition that can occur in preterm infants if nutritional support is initiated or increased after a period of starvation or malnutrition. Objectives: The current study aimed to examine the short-term clinical outcomes of RFS in preterm infants born at ≤32 weeks of gestation. Methods: Infants with a gestational age of ≤32 weeks and a birth weight of <1500 g who were born and admitted to the level III neonatal intensive care unit and received parenteral nutrition upon admission were retrospectively evaluated. The modified log Poisson regression with generalized linear models and a robust variance estimator was applied to adjust the outcomes of infants. Results: In total, 760 infants met this study’s inclusion criteria. Of them, 289 (38%) developed RFS. RFS was significantly associated with a composite outcome of mortality and intraventricular hemorrhage. Based on the multivariate Cox regression analysis adjusted for significant potential confounders, RFS was significantly associated with increased mortality risk, with a hazard ratio for death in infants with RFS being 1.74-fold higher compared to those without RFS. Conclusions: Preterm infants born at ≤32 weeks of gestation who develop RFS within the first week of life are at increased risk for both intraventricular hemorrhage and mortality. This study underscores the need for standardized clinical approaches for managing RFS in the neonatal intensive care unit to improve outcomes. Future research should establish a unified RFS definition and conduct clinical trials to optimize parenteral nutrition strategies for this vulnerable population. Full article

(This article belongs to the Special Issue Effects of Early Nutrition on Premature Infants)

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14 pages, 258 KiB

Open AccessArticle

Adherence to Nutritional Practice Guideline in Premature Infants: A Nationwide Survey in Taiwan

by Chi-Shiuan Ting, Po-Nien Tsao, Hung-Chieh Chou, Ting-An Yen, Hsin-Chung Huang and Chien-Yi Chen

Nutrients 2024, 16(18), 3181; https://doi.org/10.3390/nu16183181 - 20 Sep 2024

Viewed by 1629

Abstract

Objectives: This study aimed to assess the current neonatal nutritional practices in Taiwan and promote consensus on standardized protocols. Methods: An online questionnaire comprising 95 items on parenteral nutrition (PN) and enteral nutrition (EN) practices was distributed to neonatal care units across Taiwan via email between August and December 2022. The responses were compared with the recommendations from the European Society for Pediatric Gastroenterology Hepatology and Nutrition for preterm infant care. Results: Most of the 35 neonatal units, comprising 17 level III and 18 level II units, that participated in this study adhered to standard PN protocols; however, only 30% of units used protein-containing solutions as the initial fluid. Over half of the neonatal units provided calcium, phosphate, and magnesium at less than the recommended dosage. Trophic feeding commenced within 48 h in 88% of the units, with the mother’s milk used as the first choice. All the units preferred commencing advanced feeding at <25 mL/kg/day. Conclusions: Most nutrient protocols for preterm infants in neonatal units in Taiwan meet recent guidelines, but discrepancies such as lower mineral supplements in PN and a slower advancement of enteral feeding increase nutritional risk. These issues warrant further research. Full article

(This article belongs to the Special Issue Effects of Early Nutrition on Premature Infants)

11 pages, 716 KiB

Open AccessArticle

Incidence and Risk Factors of Refeeding Syndrome in Preterm Infants

by Suzan S. Asfour, Belal Alshaikh, Maya Mathew, Dina I. Fouda and Mountasser M. Al-Mouqdad

Nutrients 2024, 16(15), 2557; https://doi.org/10.3390/nu16152557 - 3 Aug 2024

Cited by 1 | Viewed by 2293

Abstract

This study aimed to evaluate the incidence and risk factors associated with refeeding syndrome (RFS) in preterm infants (≤32 weeks gestational age) during their first week of life. Infants (gestational age ≤ 32 weeks; birth weight < 1500 g) who were admitted to the neonatal intensive care unit (NICU), level III, and received parenteral nutrition between January 2015 and April 2024 were retrospectively evaluated. Modified log-Poisson regression with generalized linear models and a robust variance estimator was applied to adjust the relative risk of risk factors. Of the 760 infants identified, 289 (38%) developed RFS. In the multivariable regression analysis, male, intraventricular hemorrhage (IVH), and sodium phosphate significantly affected RFS. Male infants had significantly increased RFS risk (aRR1.31; 95% CI 1.08–1.59). The RFS risk was significantly higher in infants with IVH (aRR 1.71; 95% CI 1.27–2.13). However, infants who received higher sodium phosphate in their first week of life had significantly lower RFS risk (aRR 0.67; 95% 0.47–0.98). This study revealed a notable incidence of RFS among preterm infants aged ≤32 gestational weeks, with sex, IVH, and low sodium phosphate as significant risk factors. Refined RFS diagnostic criteria and targeted interventions are needed for optimal management. Full article

(This article belongs to the Special Issue Effects of Early Nutrition on Premature Infants)

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13 pages, 614 KiB

Open AccessArticle

Introduction of Solid Foods in Preterm Infants and Its Impact on Growth in the First Year of Life—A Prospective Observational Study

by Margarita Thanhaeuser, Melanie Gsoellpointner, Margit Kornsteiner-Krenn, David Steyrl, Sophia Brandstetter, Bernd Jilma, Angelika Berger and Nadja Haiden

Nutrients 2024, 16(13), 2077; https://doi.org/10.3390/nu16132077 - 28 Jun 2024

Cited by 2 | Viewed by 1691

Abstract

The aim of this study was to investigate whether age at introduction of solid foods in preterm infants influences growth in the first year of life. This was a prospective observational study in very low birth weight infants stratified to an early (<17 weeks corrected age) or a late (≥17 weeks corrected age) feeding group according to the individual timing of weaning. In total, 115 infants were assigned to the early group, and 82 were assigned to the late group. Mean birth weight and gestational age were comparable between groups (early: 926 g, 26 + 6 weeks; late: 881 g, 26 + 5 weeks). Mean age at weaning was 13.2 weeks corrected age in the early group and 20.4 weeks corrected age in the late group. At 12 months corrected age, anthropometric parameters showed no significant differences between groups (early vs. late, mean length 75.0 vs. 74.1 cm, weight 9.2 vs. 8.9 kg, head circumference 45.5 vs. 45.0 cm). A machine learning model showed no effect of age at weaning on length and length z-scores at 12 months corrected age. Infants with comorbidities had significantly lower anthropometric z-scores compared to infants without comorbidities. Therefore, regardless of growth considerations, we recommend weaning preterm infants according to their neurological abilities. Full article

(This article belongs to the Special Issue Effects of Early Nutrition on Premature Infants)

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10 pages, 2232 KiB

Open AccessArticle

Proactive Use of a Human Milk Fat Modular in the Neonatal Intensive Care Unit: A Standardized Feeding Protocol

by Amanda Salley and Martin L. Lee

Nutrients 2024, 16(8), 1206; https://doi.org/10.3390/nu16081206 - 18 Apr 2024

Cited by 1 | Viewed by 2881

Abstract

An exclusive human milk diet (EHMD) and standardized feeding protocols are two critical methods for safely feeding very low birth weight (VLBW) infants. Our institution initiated a standardized feeding protocol for all VLBW infants in 2018. In this protocol, a human milk fat modular was used only reactively when an infant had poor weight gain, fluid restriction, or hypoglycemia. As part of our NICU quality improvement program, internal utilization review data revealed a potential opportunity to improve growth and reduce costs. While maintaining the EHMD, a simple feeding guideline process change could provide cost savings without sacrificing caloric density or growth. We examined this process change in pre-post cohorts of VLBW infants. Methods: Our revised feeding protocol, established in October 2021, called for a human milk fat modular (Prolact CR) to be added to all infant feeding when parenteral nutrition (PN) and lipids were discontinued. The human milk fat modular concentration is 4 mL per 100 mL feed, providing approximately an additional 2 kcal/oz. We tracked data to compare (1) the use of the human milk fat modular, (2) the use of the human milk +8 fortifier, (3) overall growth before and after feeding protocol changes, and (4) cost differences between protocols. Results: Thirty-six VLBW infants were followed prospectively upon the introduction of the revised feeding protocol. In the revised era, the need for human milk +8 fortifier decreased from 43% to 14%. The decrease in the cost of a more costly fortifier provided a cost savings of USD 2967.78 on average per infant. Overall growth improved from birth to discharge, with severe malnutrition declining from 3.3% to 2.7% and moderate malnutrition declining from 37% to 8%. Conclusions: With the proactive use of a human milk fat modular in a standardized feeding protocol, our VLBW infants showed improved growth, lower malnutrition rates, and decreased use of higher caloric fortifiers. Full article

(This article belongs to the Special Issue Effects of Early Nutrition on Premature Infants)

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10 pages, 557 KiB

Open AccessArticle

Bioelectrical Impedance in Premature Newborns and Its Relationship with Diet Therapy in a Neonatal Intensive Care Unit

by Catiuscie Cabreira da Silva Tortorella, Bárbara Mendes Paz Chao, Estela Iraci Rabito, Mônica Nunes Lima and Ana Lúcia Figueiredo Sarquis

Nutrients 2024, 16(5), 601; https://doi.org/10.3390/nu16050601 - 22 Feb 2024

Cited by 2 | Viewed by 1594

Abstract

(1) Background: To estimate resistance, reactance, and phase angle values among moderate preterm infants and their variation according to neonatal and maternal characteristics and nutritional intake. (2) Methods: This was a cohort that evaluated 43 moderate preterm infants using bioelectrical impedance analysis. The study variables included resistance, reactance, and phase angle measurements, in addition to classification of nutritional intake. (3) Results: Mean resistance was 602.0 ± 118.2 Ω, reactance was 57.2 Ω (IQR = 42.6–65.2), and phase angle was 522° (IQR = 4.1–6.6). Lower resistance values were found in the presence of risky pregnancy (532.2 ± 111.9 Ω vs. 650.9 ± 97.9 Ω, p < 0.001) and lower reactance values, in the presence of harmful maternal lifestyle habits at both the first (p = 0.01) and second assessments (p = 0.01). Eight preterm infants were considered to have insufficient nutritional intake (23.5%); 17, sufficient (50.0%) and 9, partially sufficient (26.5%). There was less reactance among preterm infants with insufficient nutritional intake (p < 0.001). (4) Conclusions: The bioelectrical impedance analysis measurements were within the range of values reported in other studies. There was an association between full diet and adequate nutritional intake with higher resistance values, while a lower reactance value was associated with the presence of risky pregnancy and harmful maternal lifestyle. Full article

(This article belongs to the Special Issue Effects of Early Nutrition on Premature Infants)

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14 pages, 3011 KiB

Open AccessArticle

Biochemical Profiling of Urine Metabolome in Premature Infants Based on LC−MS Considering Maternal Influence

by Jeong-Hun Mok, Junhwan Song, Won-Ho Hahn, Seonghyeon Cho, Jong-Moon Park, Jiwon Koh, Ho Kim and Nam Mi Kang

Nutrients 2024, 16(3), 411; https://doi.org/10.3390/nu16030411 - 31 Jan 2024

Cited by 1 | Viewed by 2026

Abstract

In this study, Liquid Chromatography–Mass Spectrometry (LC-MS)-based metabolomics profiling was conducted to elucidate the urinary profiles of premature infants during early and late postnatal stages. As a result, we discovered significant excretion of maternal drugs in early−stage infants and identified crucial metabolites like hormones and amino acids. These findings shed light on the maternal impact on neonatal metabolism and underscore the beneficial effects of breastfeeding on the metabolism of essential amino acids in infants. This research not only enhances our understanding of maternal–infant nutritional interactions and their long−term implications for preterm infants but also offers critical insights into the biochemical characteristics and physiological mechanisms of preterm infants, laying a groundwork for future clinical studies focused on neonatal development and health. Full article

(This article belongs to the Special Issue Effects of Early Nutrition on Premature Infants)

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11 pages, 283 KiB

Open AccessReview

The Influence of Early Nutrition on Neurodevelopmental Outcomes in Preterm Infants

by Rita C. Silveira, Andrea L. Corso and Renato S. Procianoy

Nutrients 2023, 15(21), 4644; https://doi.org/10.3390/nu15214644 - 1 Nov 2023

Cited by 10 | Viewed by 4078

Abstract

Premature infants, given their limited reserves, heightened energy requirements, and susceptibility to nutritional deficits, require specialized care. Aim: To examine the complex interplay between nutrition and neurodevelopment in premature infants, underscoring the critical need for tailored nutritional approaches to support optimal brain growth and function. Data sources: PubMed and MeSH and keywords: preterm, early nutrition, macronutrients, micronutrients, human milk, human milk oligosaccharides, probiotics AND neurodevelopment or neurodevelopment outcomes. Recent articles were selected according to the authors’ judgment of their relevance. Specific nutrients, including macro (amino acids, glucose, and lipids) and micronutrients, play an important role in promoting neurodevelopment. Early and aggressive nutrition has shown promise, as has recognizing glucose as the primary energy source for the developing brain. Long-chain polyunsaturated fatty acids, such as DHA, contribute to brain maturation, while the benefits of human milk, human milk oligosaccharides, and probiotics on neurodevelopment via the gut-brain axis are explored. This intricate interplay between the gut microbiota and the central nervous system highlights human milk oligosaccharides’ role in early brain maturation. Conclusions: Individualized nutritional approaches and comprehensive nutrient strategies are paramount to enhancing neurodevelopment in premature infants, underscoring human milk’s potential as the gold standard of nutrition for preterm infants. Full article

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