Fish oil supplementation in pregnancy and lactation may decrease the risk of infant allergy

Maternal intake of omega- 3 (ω-3) polyunsaturated fatty acids (PUFAs) during pregnancy has decreased, possibly contributing to a current increased risk of childhood allergy.
Aim:  To describe the effects of maternal ω-3 long-chain PUFA supplementation during pregnancy and lactation on the incidence of allergic disease in infancy.
Methods:  One hundred and forty-five pregnant women, affected by allergy themselves or having a husband or previous child with allergies, were included in a randomized placebo-controlled trial. Daily maternal supplementation with either 1.6 g eicosapentaenoic acid and 1.1 g docosahexaenoic acid or placebo was given from the 25^th gestational week to average 3–4 months of breastfeeding. Skin prick tests, detection of circulating specific immunoglobulin E (IgE) antibodies and clinical examinations of the infants were performed.
Results:  The period prevalence of food allergy was lower in the ω-3 group (1/52, 2%) compared to the placebo group (10/65, 15%, p < 0.05) as well as the incidence of IgE-associated eczema (ω-3 group: 4/52, 8%; placebo group: 15/63, 24%, p < 0.05).
Conclusion:  Maternal ω-3 fatty acid supplementation may decrease the risk of food allergy and IgE-associated eczema during the first year of life in infants with a family history of allergic disease.     

Fish oil supplementation improves docosahexaenoic acid status of malnourished infants

AIM—To investigate whether the low docosahexaenoic acid (DHA) status of malnourished, mostly breast fed, Pakistani children can be improved by fish oil (FO) supplementation.
METHODS—Ten malnourished children (aged 8-30 months) received 500 mg FO daily for nine weeks. The supplement contained 62.8 mol% (314mg) long chain polyunsaturated fatty acids of the ω3 series (LCPUFAω3) and 22.5 mol% (112 mg) DHA. Seven FO unsupplemented children served as controls. Red blood cell (RBC) fatty acids were analysed at baseline and at the study end.
RESULTS—FO supplementation augmented mean (SD) RBC DHA from 2.27 (0.81) to 3.35 (0.76) mol%, without significantly affecting the concentrations of LCPUFAω6. Unsupplemented children showed no RBC fatty acid changes. One FO supplemented child with very low initial RBC arachidonic acid showed a remarkable increase from 4.04 to 13.84 mol%, whereas another with high RBC arachidonic acid showed a decrease from 15.64 to 10.46 mol%.
CONCLUSION—FO supplementation improves the DHA status of malnourished children. The supplement is apparently well absorbed and not exclusively used as a source of energy.

     

Fish oil supplementation improves docosahexaenoic acid status of malnourished infants.

AIM: To investigate whether the low docosahexaenoic acid (DHA) status of malnourished, mostly breast fed, Pakistani children can be improved by fish oil (FO) supplementation. METHODS: Ten malnourished children (aged 8-30 months) received 500 mg FO daily for nine weeks. The supplement contained 62.8 mol% (314 mg) long chain polyunsaturated fatty acids of the omega3 series (LCPUFAomega3) and 22.5 mol% (112 mg) DHA. Seven FO unsupplemented children served as controls. Red blood cell (RBC) fatty acids were analysed at baseline and at the study end. RESULTS: FO supplementation augmented mean (SD) RBC DHA from 2.27 (0.81) to 3.35 (0.76) mol%, without significantly affecting the concentrations of LCPUFAomega6. Unsupplemented children showed no RBC fatty acid changes. One FO supplemented child with very low initial RBC arachidonic acid showed a remarkable increase from 4.04 to 13.84 mol%, whereas another with high RBC arachidonic acid showed a decrease from 15.64 to 10.46 mol%. CONCLUSION: FO supplementation improves the DHA status of malnourished children. The supplement is apparently well absorbed and not exclusively used as a source of energy.     

Prevention of neonatal hypoglycaemia by oral lipid supplementation in low birth weight infants

The effect of oral lipid supplementation (2.9 g/day containing 67% medium chain triglycerides) on the prevention of neonatal hypoglycaemia was evaluated in 28 low birth weight infants (mean±1 SD for gestational age: 36±1.2 weeks and birth weight: 1778±230 g) and compared to a control group of 23 infants with similar gestational age, birth weight and sex. The incidence of hypoglycaemic patients with plasma glucose <1.72 mmol/l was 8/23 (35%) in the control group versus 2/28 (7%) in the supplemented group: ₂=6.72; P<0.01. Determinations of plasma beta-hydroxybutyrate concentrations in 11 infants of the supplemented group did not show values higher than 1.2 mmol/l. This prospective study shows that supplementation with lipids can prevent the occurrence of hypoglycaemia in low birth weight infants.Abbreviation FFA free fatty acids     

Trial of vitamin A supplementation in very low birth weight infants at risk for bronchopulmonary dysplasia.

We performed a randomized, double-blind, controlled trial to determine whether vitamin A supplementation in a group of very low birth weight infants would reduce the incidence of bronchopulmonary dysplasia. Forty-nine infants (birth weight 700 to 1100 gm) requiring mechanical ventilation and supplemental oxygen at 96 hours age were randomly assigned to receive either 2000 IU retinyl palmitate (n = 27) or saline placebo (n = 22) intramuscularly every other day for up to 14 doses. There were no differences between treatment groups in the incidences of bronchopulmonary dysplasia at 31 days of postnatal age (vitamin A group 48%, placebo group 55%; p = 0.776), supplemental oxygen requirement at 34 weeks of postconceptional age, or other complications of prematurity. The vitamin A group had higher mean plasma vitamin A concentrations than the placebo group, but mean plasma vitamin A concentrations were greater than 20 micrograms/dl (suggesting sufficiency) in both groups after the first study week. By study day 28, only one fourth of the infants in either group had plasma vitamin A concentrations less than 20 micrograms/dl. In contrast to an earlier report, we found no change in the incidence of BPD with vitamin A supplementation. Our findings may reflect a low baseline incidence of vitamin A deficiency in the study population and recent changes in the respiratory care of very low birth weight infants. The latter may have lessened the potential impact of vitamin A deficiency on lung disease.     

Folic acid supplementation in low birth weight infants.

Low birth weight infants (246) entered a trial to folic acid supplementation from 3 weeks to 12 months of age. The folic acid group had significantly higher mean hemoglobin levels at 6 and 9 months of age but the differences were only about 0.5 gm/dl, there was no significant difference in hematocrit, and in both groups of infants the mean hemoglobin levels were higher than those of normal birth weight infants. The differences in hemoglobin, although statistically significant, are of uncertain clinical significance. Median red cell folate levels remained within the normal adult range in both groups of infants. A minority of infants in the untreated group had low red cell folate levels but this was usually temporary, corrected by dietary folate, and not associated with low hemoglobin. Weight gain was not affected by folic acid supplementation. The infants in this trial were fed with a milk preparation containing 3.5 microgram/100 ml of folic acid which is a similar concentration to that of human milk and we recommend that the folate content of milks fed to low birth weight infants should not fall below this level. We do not have sufficient grounds to recommend routine folic acid supplements for all low birth weight infants throughout the first year of life but there is a possibility that their folate intake may sometimes be suboptimal.     

Enteral glutamine supplementation and morbidity in low birth weight infants

OBJECTIVE: To determine if glutamine-supplemented enteral nutrition decreased the incidence of nosocomial sepsis in neonates. METHODS: In a multicenter (n = 20) clinical trial, we randomly allocated infants (n = 649) with birth weight between 500 and 1250 g, who were <7 days of age, and had no major anomalies to receive enteral glutamine supplementation (0.3 g/kg/day) or sterile water (placebo) for the first 28 days. The primary outcome variable was the number of infants who had blood culture-proven nosocomial sepsis between 7 days' and 36 weeks' postmenstrual age. RESULTS: Infants were assigned to placebo (n = 335) or to glutamine supplementation (n = 314). Neonates assigned to glutamine were similar to those assigned placebo for demographic characteristics and nutritional support during the first week. There was no difference in the occurrence of culture-proven nosocomial sepsis (33.7% vs 30.9%) or suspected sepsis (51.6% vs 47.1%) between the placebo and glutamine groups; however, neonates treated with glutamine less often had gastrointestinal dysfunction (7.5% vs 2.5%, P <.01) and severe neurologic sequelae (15.1% vs 10.4%, P =.08). CONCLUSIONS: At a dose of 0.3 g/kg/day, enteral glutamine does not appear to reduce nosocomial sepsis in premature neonates.     

Obstetrical and neonatal risk factors in very low birth weight infants related to their neurological development

An analysis of pre- and perinatal risks in very low birth weight (VLBW) infants showed that children later suffering from severe neurodevelopmental sequelae were exposed to a significantly higher number of risk factors compared to normally developed VLBW controls. This was not only due to a higher incidence of specific risks, but to the accumulation of risk factors, which consequently made an ischaemic or haemorrhagic brain lesion more likely to occur. This result suggests that brain lesions in VLBW infants are essentially multifactorial. The improved outcome of VLBW infants cared for in the NICU of the Children's Hospital of Tübingen during 1977–1983 was accompanied by a decreasing incidence of obstetrical and neonatal risks. This was mainly due to more frequent transport in utero, earlier obstetrical intervention, and immediate postnatal stabilization of the infant's condition. These changes in perinatal care strategy evidently favoured the postnatal course and thus also improved the neurodevelopmental outcome.Abbreviations VLBW very low birth weight - NICU neonatal intensive care unit - ICH intracranial haemorrhage - IVH intraventricular haemorrhage - CSF cerebrospinal fluid     

Evaluation of the role of the neonatal nurse practitioner in resuscitation of preterm infants at birth

BACKGROUND: Changes in the work patterns and numbers of medical staff in training grades pose a significant challenge to those responsible for the provision of an effective clinical neonatal service. Advanced neonatal nurse practitioners (ANNPs) may have a role in this changing neonatal service. The effectiveness of the ANNP has been established in North America but has not been properly evaluated in the United Kingdom. AIM: To evaluate the effectiveness of ANNPs in resuscitation of preterm babies at birth against the standard set by junior medical staff. SETTING: Regional neonatal intensive care unit. METHOD: Retrospective analysis of resuscitation details, other basic data, and clinical outcomes of 245 preterm (< 33 weeks gestation) babies born in Liverpool Women's Hospital between January 1998 and April 1999. RESULTS: Resuscitation teams led by ANNPs provided the same resuscitation interventions as those provided by medically led teams. Although babies resuscitated by ANNP led teams were no more likely to be intubated, they were intubated more quickly and received surfactant sooner (p = 0.0001) than babies resuscitated by medically led teams. Babies attended by ANNP led teams were less likely to be hypothermic on admission to the neonatal unit (p = 0.013). CONCLUSION: ANNPs are effective in the resuscitation of preterm babies at birth.     

Effect of zinc supplementation on growth in very low birth weight infants

This was a randomized blinded placebo controlled trial undertaken to study the role of zinc supplementation on growth, primarily the linear growth velocity in very low birth weight (VLBW) infants at 3 months corrected age (CA). Out of 134 neonates with birth weight <1500?g, 101 babies were eligible. Due to lack of consent 10 were excluded. The remaining 91 neonates who were comparable for sex, gestational age, birth weight, APGAR and age at enrollment were randomized to receive either 1?ml of zinc sulfate (10?mg elemental zinc) (n?=?46) or 1?ml placebo (n?=?45) from enrollment to 60 days. The infants in the zinc group had significantly higher linear growth velocity (0.98?±?0.12?cm?week(-1)) compared to a placebo group (0.67?±?0.15?cm?week(-1)) (p?相似文献   

Outcome of neonatal stroke in full-term infants without significant birth asphyxia

Seven children with neonatal stroke were identified and six were followed for 13 months to 5 years (mean 28 months). Gestational age ranged between 39 and 42 weeks and none had hypoxic ischaemic encephalopathy. Focal clonic seizures were the presenting feature in six, and one presented with apnoea. The age of the first seizure ranged between 8 and 48 h (mean 26). The total number of seizures ranged between 3 and 10 (mean 5), and all seizures resolved by day 3 in all cases. CT scan showed an ischaemic infarct in six cases, and one child had a haemorrhagic infarct in the right anterior cerebral artery distribution. Phenobarbital was maintained for 3 weeks to 6 months (mean 11 weeks). None had recurrent seizures beyond the 3rd day of life and all were developing normally with no significant focal neurological deficits on follow up assessment. Conclusions Full-term infants with neonatal stroke unrelated to significant birth asphyxia have a favourable neurological outcome. Seizures appear to be restricted to the first 3 days of life. We recommend short-term treatment with anticonvulsants. Received: 15 May 1997 / Accepted in revised form: 5 December 1997