Growth and total body water in premature infants fed "in-utero" or "ex-utero"

Total body water and anthropometric measurements were compared in two groups of premature infants. The first group included infants with birthweights less than 1,501 g who were fed under usual clinical circumstances and studied at a bodyweight of 1,800-2,100 g ("Ex-utero"); the second group of infants had a birthweight of 1,800 to 2,100 g and were studied within the first week of life ("In-utero"). Triceps and subscapular skinfold thicknesses were significantly greater in "Ex-utero" infants than in "In-utero" infants, whereas body length was significantly greater in the latter group compared to the former. There were no difference in total body water, abdominal skinfold thickness, or midarm circumference between the two groups. These data suggest that feeding premature infants a standard premature infant formula under established guidelines leads to differences in body and fat distribution but not total body water compared to infants nourished "in utero".     

Leptin levels in breast-fed and formula-fed infants

Aim: Leptin, a hormone that regulates food intake and energy metabolism, is present in breast milk and thus may be involved in body composition differences between breastfed and formula-fed infants. The aim of this study was to evaluate whether diet and gender affect plasma leptin concentration in breastfed and formula-fed infants during the first months of life. Methods: Anthropometric and bioelectrical impedance measurements [total body water (TBW) calculated with the Fjeld equation] were made and venous blood plasma samples were analysed for leptin concentration in healthy, exclusively breastfed or formula-fed Italian infants in the first year of life. Infants were subdivided in two ways: three groups (periods) in relation to age, and five groups in relation to weight. Results: The average serum concentration of leptin was 7.35 ng ml -1 . Serum leptin values were higher in breastfed than in formula-fed infants. Breastfed infants in group 1 had a statistically higher serum leptin concentration (2500-3749 g). There were no significant differences in anthropometric measurements, body mass index or skinfold thickness between breastfed and formula-fed infants. In the periods I and II, breastfed infants had a significantly higher TBW than formula-fed infants. Males had a significantly higher TBW than females in periods I and II. Breastfed infants in group 2 (3750-4999 g) had a significantly higher TBW than formula-fed infants.

Conclusion: The data on TBW, weight and skinfold thickness suggest that the higher leptin concentration observed in breastfed infants in the first months of life may be due not only to adipose tissue production but also to human milk.     

Plasma and red cell folate values and folate requirements in formula-fed premature infants

Plasma and red cell folate concentrations (Lactobacillus casei activity) and other pertinent blood values have been studied during the 1st year of life in 41 premature infants (mean gestational age 31.6, range 26–35 weeks). They were formula-fed, 48.5 nmol (21 g) folate per 1, from 1 month of age. The infants were divided into two groups according to their birth weights (BW): group A, BW1750 g and group B, BW>1750 g, respectively. One-half of the infants in each group received an extra 113.5 nmol (50 g) folic acid daily. The premature infants were compared with 35 breast-fed term infants considered to have an optimal folate status. The infants not receiving folic acid supplementation had low plasma and red cell folate concentrations during the first months of life, while those receiving supplementation had values comparable to the breast-fed infants. No significant differences in the gain in weight and increase in length were observed when the folic acid supplemented infants in group A were compared with the non-supplemented infants. However, in the case of group B a significant increase in length and a somewhat greater weight gain were observed for infants with folic acid supplementation in comparison with those not given extra folate. No significant differences were observed between the haemoglobin, RBC and VPRC values in the folic acid supplemented and non-supplemented infants. It is estimated that the optimal folate intake during the first months of life in formula-fed premature infants is about 150 nmol (65 g) per day. This amount is higher than previously recommended. The infants from all groups had a folate intake similar to, or above, the minimal daily requirement needed for erythropoiesis.     

Water, energy and early postnatal growth in preterm infants

Non-invasive methods, including stable isotope techniques, indirect calorimetry, nutritional balance and skinfold thickness, have given a new insight into early postnatal growth in neonates. Neonates and premature infants in particular, create an unusual opportunity to study the fluid and metabolic adaptation to extrauterine life because their physical environment can be controlled, fluid and energy balance can be measured and the link between metabolism and the energetics of their postnatal growth can be assessed accurately. Thus the postnatal time course of total body water, heat production, energy cost of growth and composition of weight gain have been quantified in a series of "healthy" low-birth-weight premature infants. These results show that total body water is remarkably stable between postnatal days 3-21. Energy expenditure and heat production rates increase postnatally from mean values of 40 kcal/kg/day during the first week to 60 kcal/kg/day in the third week. An apparent energy balance deficit of 180 kcal/kg can be ascribed to premature delivery. The cost of protein metabolism is the highest energy demanding process related to growth. The fact that nitrogen balance becomes positive within 72 h after birth places the newborn in a transitional situation of dissociated balance between energy and protein metabolism during early postnatal growth: skinfold thickness, dry body mass and fat decrease, while there is a gain in protein and increase in supine length. This particular situation ends during the second postnatal week and soon thereafter the rate of weight gain matches statural growth. The goals of the following review are to summarize data on total body water and energy metabolism in premature infants and to discuss how they correlate with physiological aspects of early postnatal growth     

早产儿早期静脉营养耐受性的探讨

目的 探讨早产儿生后1～2d对静脉营养的耐受性。方法 将不能完全耐受肠道营养的早产儿34例(胎龄29～36周，体重900～1800g)，随机分为两组，实验组于生后48h内添加氨基酸及脂肪乳；对照组采用传统的静脉营养方法，即生后第3天应用氨基酸，第5天应用脂肪乳，同时均根据病情尽早经口微量喂养。两组患儿均于生后第1天及第7天采血，监测血清游离脂肪酸、总胆红素、直接胆红素、白蛋白、甘油三脂、总胆固醇，每天监测体重、微量血糖及经皮胆红素值。比较两组患儿恢复出生体重的时间、血清游离脂肪酸、胆红素及血脂的变化。结果 1)实验组患儿恢复出生体重的时间较对照组短；2)两组患儿生后相同日龄测得血清游脂肪酸、总胆红素、直接胆红素、甘油三脂、总胆固醇及血清游离脂肪酸与白蛋白的摩尔比均无显著差异。结论 早产儿生后1～2d可耐受全或部分肠道外营养。     

Cell hydration in the normally grown, the premature and the low weight for gestational age infant

Total body water (TBW), extracellular volume (ECV) and intracellular water (ICW) were measured in a cross-sectional study of 107 infants up to four weeks after birth. Three groups of infants were selected for study: (1) mature normally grown infants, (2) mature low weight for gestational age (LWGA) infants and (3) premature normally grown infants. In the normal mature infants there was no significant change in TBW during the first 6 days after birth but there was a small but significant (P less than 0.02) redistribution of extracellular water into the cells by the sixth postnatal day. This suggests that the normal weight loss in infants after birth is due to a relative starvation rather than cell dehydration. In the LWGA infants, TBW levels were higher than normal and ICW significantly increased. This index of cell mass further increased throughout the 14-day period studied (P less than 0.01) and was the highest of all groups studied. It is argued that the changes are due to cytoplasmic growth. Premature babies (mean weight approximately 2000 g and greater than 30 weeks gestation) had higher TBW values than their mature normally grown counterparts. Hyponatraemia was infrequent and no shift of water into cells was detected. All groups of infants revealed loss of ECV over the first two weeks and in premature infants the loss was commensurate with that of TBW.     

Skinfold thickness and adiposity index in premature infants

In order to assess the validity of the weight per square of length ratio as an index of adiposity during the neonatal period, 37 premature infants (gestational age, mean +/- SD, = 31.5 +/- 1.1 weeks, birthweight, mean +/- SD, = 1.448 +/- 147 g) were studied for weight, length and skinfold thickness at 5 sites (biceps, triceps, subscapular, suprailiac and quadriceps) during their stay in the Neonatal Unit of the University Hospital in Lausanne. The results show a significant correlation between the adiposity index and the sum of 5 skinfold thickness sites in premature infants. The adiposity index gives a fair estimate of the body fat mass during the postnatal growth in premature infants.     

Assessment of total body fat using the skinfold technique in full-term and preterm infants

BACKGROUND: Assessment of body composition may be of interest when the nutritional status of infants is evaluated but is often difficult since simple and valid methods are lacking. With appropriate validation, measurements based on skinfold thickness (SFT) may be useful for this purpose. AIMS: To evaluate the potential of a published method, based on measurements of SFT, to assess total body fat (TBF) of infants; and to calculate the fat content of adipose tissue (AT) in infants using previously published information regarding AT volume and total body water. SUBJECTS AND METHODS: Forty-five full-term infants and eight infants born in gestational weeks 31-33 were studied at a postnatal age of 4-131 and 44-75 d, respectively. The body water dilution method was used to obtain reference estimates of TBF (TBF-BWD). RESULTS: In full-term infants, TBF assessed using the skinfold method (TBF-SFT) minus TBF-BWD was 1.5+/-10.8% (mean+/-2 SD). Furthermore, TBF-SFT minus TBF-BWD (%, y) was correlated (p<0.0001) with the average of TBF-SFT and TBF-BWD (%, x), showing that TBF-SFT was too high in lean infants and too low in infants with more TBF. In the full-term infants, AT contained 0.68+/-0.14 g fat/ml. In the premature infants, TBF-SFT (%), TBF-BWD (%) and the AT fat content were similar to the corresponding figures in nine full-term newborns. CONCLUSION: The results indicate that the SFT method produced inaccurate and biased estimates of TBF in infants. A considerable variation between infants regarding their AT fat content may be an important reason for these findings.     

Comparing the effects of neonatal intensive care unit intervention on premature infants at different weights.

This study investigated the efficacy of an intervention program in the neonatal intensive care unit (NICU) on the development of premature infants from low socioeconomic status (SES) backgrounds. Sixty premature infants born at a county hospital over an 8-month period and their mothers were the focus of this study. The infants were assigned to either a control group or an experimental group. The experimental group received teaching and reinforcement about their babies' behavior from a child development specialist when they visited the NICU. Of the initial 60 infants, 49 completed the study at 8 months, but because data from only the first born of twin pairs were used, 41 infants were included in the final analysis. Infants were divided into two weight groups: one below and one above 1500 g. There was a significant effect of the intervention on the infants' mental and motor scores at 4 and 8 months. Significant differences on the total Home Observation for Measurement of the Environment (HOME) were noted between the groups. There were some significant differences between intervention and control groups on the interaction of the mother with the infant at 4 months but not in the play situation at 8 months. The lighter premature infants had a greater boost from the intervention than did the heavier premature infants. The intervention had no effect on the mother's perception of her infant's temperament or on her confidence skills. In line with other research findings, the infants who weighed less than 1500 g seemed to have benefited most from the intervention, and the effect of the intervention was most notable at 4 months.(ABSTRACT TRUNCATED AT 250 WORDS)     

Comparative growth and biochemical response of very low birthweight infants fed own mother's milk, a premature infant formula, or one of two standard formulas

Very low birthweight (VLBW) infants weighing less than 1,600 g at birth were fed their own mother's milk (OMM) or randomly assigned to receive one of three formulas: a "humanized" formula (SF), a partially modified casein-predominant cow's milk formula (CF), or a premature formula (PF). All infants were fed at 120 kcal/kg/day where possible. PF infants had significantly greater weight increments (28.0 g/day) than those on OMM (19.4 g/day), SF (18.9 g/day), and CF (18.2 g/day). Those on PF also had greater increments of length, head circumference, and skin-fold thickness than those on the other two formulas and greater length increments than those on OMM. Dynamic skinfold measurements suggested that no infants accumulated excessive amounts of interstitial fluid. Infants on the two standard formulas had significantly greater base deficits, whereas those on CF also had higher urea values. Those on OMM had lower phosphate and higher alkaline phosphatase values than the other groups. Thus VLBW infants fed a premature formula had better growth and fewer biochemical problems than those on standard formulas, whereas supplementation of OMM may be necessary to ensure optimal growth and bone mineralization.     

Growth and mineral metabolism in very low birth weight infants. I. Comparison of the effects of two modes of NaHCO3 treatment of late metabolic acidosis.

Twenty-six infants weighing less than 1,300 g at birth were divided into pairs according to birth weight (900-1,100 and 1,101-1,300 g) and gestational age ("appropriate" (AGA) = mean 31 weeks; and "small" (SGA) = mean 34 weeks). One member of the pairs was then allocated randomly to one of two treatment regimens with oral sodium bicarbonate. Group A was treated whenever base excess was greater than -8mEq/liter as detected on twice weekly testing and/or when suspected to be acidotic from failure to gain weight. In group B, base excess was maintained within 1 SD of normal (-3.2 +/- 1.7 mEq/liter). The infants received Enfalac 200 ml/kg/24 hr, at 67 cal/100 ml, with vitamin D 400 IU/24 hr added from age 2 weeks. The following measurements were made: daily weight, weekly length, skinfold thickness, head circumference, twice weekly blood pH, PaCO2, base excess, and weekly plasma total calcium, ionic calcium, total magnesium, inorganic phosphorus, and total protein. There were six pairs of each of AGA and SGA infants and two unpaired group A infants. Weekly weight gains did not differ between group A and group B or between AGA and SGA. Length increment was greater in AGA than in SGA babies (0.94 +/- 0.02 vs 0.85 +/- 0.04 cm/week) but not significantly so (P less than 0.1), and in group B babies compared to group A babies (0.973 +/- 0.029 vs 0.83 +/- 0.037 cm/week) (P less than 0.01). Plasma pH was lower in group A (7.23 +/- 0.02) than in group B (7.30 +/- 0.02) and calcium ion activity higher (group A 2.72 +/- 0.04; group B 2.51 +/- 0.06 mEq/liter) between ages 20 and 29 days. Plasma magnesium was higher in group A (1.77 +/- 0.04 mEq/liter) than in group B (1.56 +/- 0.06 mEq/liter) from age 20 to 39 days. Inorganic phosphorus concentrations were consistently higher in group A than in group B, but the differences did not reach significance. Mean total protein concentrations did not rise above 4.5 g/100 ml and tended to be higher in babies of group A than of group B. Bone age was retarded in all babies. Radiographs available for 7 of 13 SGA infants were normal, whereas 6 of 11 radiographs of AGA babies showed some osteoporotic changes.     

WATER REQUIREMENT OF PREMATURE NEWBORN INFANTS

Bell, E. F. and Oh, W. (Department of Pediatrics, Women and Infants Hospital of Rhode Island, and the Program in Medicine, Brown University, Providence, Rhode Island, USA). Water requirement of premature newborn infants. Acta Paediatr Scand, Suppl. 305: 21–26, 1983.—Two groups of studies related to the water requirement of premature infants are reviewed. The first examined the effects of several environmental factors on insensible water loss (IWL) and oxygen consumption of 20 low-birth-weight infants. Incubator air temperature above the neutral zone increased IWL, as did the use of a radiant heat source instead of a conventional incubator. A plastic heat shield slightly reduced IWL of infants in incubators. The second group of studies examined the effects of excess water intake in premature infants. 170 infants were randomly assigned to receive "low" (average estimated requirement for birth weight and age) or "high" (excess) volume water intake. The high-volume group became dehydrated less often but had a greater incidence of patent ductus arteriosus and necrotizing enterocolitis.     

Body composition at birth of growth-retarded newborn infants demonstrating catch-up growth in the first year of life

Total body, extracellular, and intracellular water volume and solids, determined at birth in a group of newborn infants small for date (n = 10) who demonstrated catch-up growth in the first year of life, were compared to similar measurements in newborn infants appropriate for date (n = 11). No significant differences with regard to body water compartment volumes and solids could be found between the 2 groups. It is concluded that intrauterine growth retardation in infants who are capable of catching up in growth after birth is the result of a proportional reduction of the daily increments in fetal solids and body water.     

早产儿低出生体重儿两种静脉营养方式的对比研究

目的：静脉营养已经成为低出生体重儿现代综合治疗中不可缺少的一环,对于早产儿静脉营养时何时加用氨基酸和脂肪乳,国内外有很大差别,国内传统静脉营养法为生后48h后加用氨基酸,72h后加用脂肪乳,而国外早期静脉营养法为生后第1天即给予氨基酸和脂肪乳。该实验对比研究两种静脉营养方法的效果。方法：将40例不能耐受全肠道营养的符合条件早产儿低出生体重儿随机分为两组,实验组采用早期静脉营养法,对照组采用传统静脉营养法,记录两组患儿生后1周内营养摄入及2周内体重增长情况、过渡到全肠道喂养时间、静脉营养相关并发症,并于生后第1,3,7天采静脉血测血清前白蛋白。对其中21例(实验组11例,对照组10例)于生后6个月测量身长和体重。结果：①实验组生后1周内每日摄入的非蛋白热卡量、2周内平均每日增重均高于对照组(P<0.001);②相同日龄血清前白蛋白检测结果:第1天实验组与对照组无差异;第3日及第7日实验组均高于对照组,分别为(61±11.2mg/Lvs31.5±8.5mg/L;91.5±10.8mg/Lvs78±10.9mg/L,P<0.001);③实验组与对照组过渡到全肠道喂养时间无差异;④两组均无静脉炎、血栓形成、氮质血症、高脂血症及胆汁淤积的发生,两组呼吸暂停、高血糖、高胆红素血症的发生率差异无显著性(P>0.05)。随访生后6个月的体重,实验组高于对照组,但无统计学意义(P>0.05)。结论：早产儿低出生体重儿采用早期静脉营养比传统静脉营养摄入热卡多,体重增长快;可以避免早产儿早期营养不良的发生;对胃肠功能的恢复无明显作用;不会增加静脉营养相关并发症的发生。     

极低出生体重早产儿288例体重增长速度和相关影响因素调查

目的探讨极低出生体重早产儿住院期间日均体重增长速度及其相关影响因素。方法回顾性调查广东省珠江三角洲地区9个城市的9家医院新生儿科于2010年7月至2011年6月期间出院的极低出生体重早产儿的住院资料,根据住院期间日均体重增长的不同分为3组:低体重增长组[日均体重增长<10g/(kg·d)],适宜体重增长组[日均体重增长10～15g/(kg·d)],高体重增长组[日均体重增长>15g/(kg·d)],对影响其生长速度的相关因素进行分析。结果各组随着日均体重增长速度的增加,生后1周、2周、4周、达完全经口喂养前、整个住院期间的日均热卡、蛋白质摄入量均相应增加,热卡、蛋白质累计缺失量则相应减少;高体重增长组(31例)禁食总时间、开始喂养时间、完全经口喂养时间、最低体重出现时间、最低体重下降百分数、恢复出生体重时间、热卡摄入达标时间、蛋白质摄入达标时间等均小于低体重增长组(68例),适宜体重增长组(189例)上述指标介于高体重增长组与低体重增长组之间。结论营养摄入是影响极低出生体重早产儿早期体重增长的最主要因素,改善早产儿生后早期的热卡、蛋白质摄入可明显改善其生长速度。     

A comparison of rice-based oral rehydration solution and "early feeding" for the treatment of acute diarrhea in infants

To compare the use of rice-based oral rehydration solution (R-ORS), with the introduction of food immediately after rehydration ("early feeding"), using standard glucose-based oral rehydration solution (G-ORS) in the management of acute diarrhea, we conducted a four-cell randomized, controlled trial among 200 hospitalized Egyptian infants between 3 and 18 months of age. During the rehydration phase (first 4 hours), three groups were given G-ORS and a fourth group was given R-ORS. During the subsequent maintenance phase, the control group was given a soy-based, lactose-free formula (G-ORS + SF), a second group (G-ORS + RF) was given a rice-based formula, and a third group (G-ORS + rice) was given boiled rice. The fourth group (R-ORS + SF) continued to receive R-ORS for the first 24 hours of the maintenance period, followed by a soy-based lactose-free formula. During the first and second 24 hours of the maintenance period, infants in the three treatment groups had a lower mean stool output in comparison with the control group (p = 0.006 and 0.03, respectively). The mean total stool output in the R-ORS + SF group was significantly lower than in the control group (p = 0.02). There were no statistically significant differences among the four groups in the mean duration of diarrhea. We conclude that (1) infants who were given R-ORS had reduced total stool output (by 35%) compared with the control group and (2) feeding of boiled rice or a rice-based formula immediately after rehydration therapy was as efficacious as treatment with R-ORS alone for 24 hours, followed by feeding with a soy-based, lactose-free formula.     

Differences in subcutaneous fat in breast- and formula-fed infants.

During the first 6 weeks of life, 87 breast-fed infants had a significantly greater increase in skinfold thickness than 173 infants fed only with artificial milk formulae. The two groups were similar in respect of racial origin, gestational age, birthweight, and weight gain in the first 6 weeks of life. These findings show that formula-fed infants have a different distribution of body fat from breast-fed infants.     

The effect of feeding human milk and adapted milk formulae on serum lipid and lipoprotein levels in young infants

The effect of feeding with human milk and commercially available milk substitutes was studied in a group of 154 healthy infants during the first 3 months of life by assessment of body weight, body length, head circumference, skinfold thickness, serum lipid and lipoprotein concentrations. Human milk and the different milk formulae have the same energy content (kcal/100 ml) and total fat, total protein and total carbohydrate contents are comparable but they differ in respect of their fatty acid compositions. The various diets were chosen freely by the parents and the newborns were exclusively fed either human milk (n=56), Multival 1 (n=31), Humana 1 (n=33), or Pre Aptamil (n=34). No significant differences in body, weight, body length or head circumference were observed between any of the different dietary groups. Fat storage, as assessed by measurements of skinfold thickness, was significantly less in breast-fed children compared to those on the formula diets. Breast-fed and Pre Aptamil-fed infants had the highest levels of total serum cholesterol, low density lipoprotein (LDL)-cholesterol and LDL. No differences were observed in the levels of total serum triglycerides, very low density lipoprotein (VLDL)- and high density lipoproteins (HDL)-cholesterol, VLDL and HDL. There were no strong correlations between the physical and the biochemical parameters. No indication of an increased risk of developing atherosclerosis was associated with any of the dietary treatments for the duration of this study. However, these investigations support the hypothesis that subtle early nutritional variation can influence mechanisms that regulate lipoprotein and cholesterol levels in later life.Abbreviations VLDL very low density lipoproteins - LDL low density lipoproteins - HDL high density lipoproteins - HMG-CoA reductase 3-hydroxy-3-methylglutaryl coenzyme A reductase     

Earlier discharge of very low birthweight infants from an under-resourced African hospital: a randomised trial

BACKGROUND: Very low birthweight (VLBW) infants contribute substantially to the workload and expenditure of any neonatal unit. Earlier discharge might offer advantages to the infant, the family and the health service. AIM: To establish the outcome of preterm, VLBW infants discharged at a weight of > or = 1650 g compared with the unit's practise of discharging at a weight of > or = 1800 g. METHODS: A total of 120 infants (62 early discharges, 58 routine discharges) were followed up for 3 months after discharge from Chris Hani Baragwanath Hospital in Soweto, South Africa. The early-discharge group was discharged at > or = 1650 g and the routine-discharge group at > or = 1800 g. Growth, morbidity and mortality at 1 and 3 months after discharge were compared. RESULTS: At 3 months, the rate of weight gain (mean 30 vs 33 g/kg/day, p=0.06) and head circumference growth (38.9 vs 39.5 cm, p=0.10) were similar in both groups. There were no differences between the early- and routine-discharge groups in the number of outpatient visits (24 vs 16, p=0.18), frequency of re-admission (9 vs 4, p=0.17) or mortality [1 (1.6%) vs 3 (5.2%), p=0.27] following discharge. CONCLUSION: If home circumstances are adequate, it is as safe to discharge well, singleton VLBW infants from hospital at a weight of > or = 1650 g as at > or = 1800 g.