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Updates on Assessment and Monitoring of the Postnatal Growth of Preterm Infants.
Cordova, EG, Belfort, MB
NeoReviews. 2020;(2):e98-e108
Abstract
Assessing and monitoring the physical growth of preterm infants is fundamental to NICU care. The goals of nutritional care are to approximate the growth and body composition of the healthy fetus and to support optimal brain development while minimizing future cardiometabolic risk. Both poor and excessive growth predict adverse long-term health outcomes. Growth curves are clinical tools used to assess the preterm infant's growth status. Several growth curves for preterm infants were developed in the past decade. To use them effectively, clinicians need to understand how each growth curve was developed; the underlying reference population; intended use; and strengths and limitations. Intrauterine growth curves are references that use size at birth to represent healthy fetal growth. These curves serve 2 purposes-to assign size classifications at birth and to monitor postnatal growth. The INTERGROWTH-21 st preterm postnatal growth standards were developed to compare the postnatal growth of preterm infants to that of healthy preterm infants rather than the fetus. Individualized weight growth curves account for the water weight loss that frequently occurs after birth. In addition, body mass index (BMI) curves are now available. In this review, we discuss the main characteristics of growth curves used for preterm infants as well as the use of percentiles, z scores, and their change over time to evaluate size and growth status. We also review the differences in body composition between preterm infants at term-equivalent age and term-born infants and the potential role of monitoring proportionality of growth using BMI curves.
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Feeding modifications and additional primary caregiver support for infants exposed to Zika virus or diagnosed with congenital Zika syndrome: a rapid review of the evidence.
Martinez, SS, Pardo-Hernandez, H, Palacios, C
Tropical medicine & international health : TM & IH. 2020;(11):1353-1361
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Abstract
OBJECTIVE Infants exposed to Zika virus (ZIKV) or diagnosed with congenital Zika syndrome (CZVS) may present dysphagia, regurgitation and other feeding difficulties. They may require special feeding practices to minimise the risk of mortality, morbidity and developmental problems. Improving knowledge, skills and behaviours of caregivers may preserve health, maximise development and promote quality of life among affected infants. We reviewed intervention studies of modified feeding practices and additional primary caregiver support to improve outcomes among infants 0 to 12 months of age exposed to ZIKV or diagnosed with CZVS. METHODS Rapid review and meta-analysis. We searched PubMed/MEDLINE and contacted experts. The search is current to 18 July 2020. We planned a meta-analysis using fixed-effect models; if unfeasible, we intended to summarise studies narratively. We planned to assess risk of bias of included studies and quality of evidence using Cochrane guidance. RESULTS We identified 42 records for title and abstract screening; 14 were eligible for full-text assessment. Among these, no intervention studies were found. Eight observational studies reported on the nutritional status, feeding practices and outcomes among infants affected by ZIKV or diagnosed with CZVS. They are presented and discussed to provide a basis for future research. CONCLUSIONS While no intervention studies were found, evidence from eight observational studies highlights the need for early nutrition interventions and caregiver support among infants affected by ZIKV or diagnosed with CZSV. More research is needed to assess whether modifications of feeding practices and provision of additional primary caregiver support will impact outcomes of interest.
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Carbohydrate composition in breast milk and its effect on infant health.
Berger, PK, Plows, JF, Demerath, EW, Fields, DA
Current opinion in clinical nutrition and metabolic care. 2020;(4):277-281
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PURPOSE OF REVIEW This narrative review presents the current state of available evidence regarding the role of breast milk carbohydrates on infant outcomes, with a primary focus on growth and body composition. RECENT FINDINGS To date, there is a paucity of available data that exists in this realm. The current literature focuses on the role of two carbohydrate fractions in breast milk, and their relationships with infant outcomes in the first six months of life: oligosaccharides and fructose. A small but growing body of research indicates robust associations of both oligosaccharides and fructose in breast milk with infant weight and length, as well as bone, fat, and lean mass. There is also emerging evidence to support the role of these same carbohydrate fractions in breast milk in infant cognitive development. SUMMARY The present state of the science suggests that oligosaccharides and fructose in breast milk play a role in infant growth and body composition and introduces intriguing associations of these two carbohydrate fractions with infant cognitive development as well.
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Environmental and Physiological Barriers to Child Growth and Development.
Prentice, AM
Nestle Nutrition Institute workshop series. 2020;:125-132
Abstract
Aggregated analyses of child growth in low- and middle-income countries (LMICs) reveal a remarkably consistent picture of serious growth failure compared to the WHO reference growth curves. Impoverished diets with low dietary diversity are a key driver of poor growth, but there are important additional environmental factors that limit the uptake and utilization of nutrients. This paper considers such factors. A large proportion of the rapid growth deterioration in later infancy can be ascribed to infections and to wider nonspecific effects of living in an unhygienic environment, including the ingestion of toxins such as aflatoxin. Despite never revealing themselves as clinical syndromes, the great majority of children in rural low-income settings of Africa and Asia are antibody positive to numerous pathogens (CMV, EB, HepB, Helicobacter pylori, and many more) by 24 m; these infections must take their toll. Additionally, there is a syndrome widely termed environmental enteric disease that combines gut leakage with a chronic inflammation leading to nutrient losses and cytokine-mediated growth retardation. Systemic inflammation also inhibits nutrient uptake and utilization. Elimination of these environmental barriers will be key to achieving optimal child growth and development in LMICs.
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Feeding and Swallowing Difficulties in Neonates: Developmental Physiology and Pathophysiology.
Viswanathan, S, Jadcherla, S
Clinics in perinatology. 2020;(2):223-241
Abstract
Development of enteral and oral feeding milestones in infants is intricately linked to physiologic maturation of the gastrointestinal tract and its complex interplay with cardiorespiratory and central nervous system control and coordination. Assessment of an infant's developmental skills and maturation can guide us with targeted management approaches and prediction of feeding outcomes. In this article, we review and summarize the developmental aspects of oral feeding and swallowing physiology, and current understanding of the pathophysiological changes associated with feeding difficulties in infants.
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Minerals in Pregnancy and Their Impact on Child Growth and Development.
Farias, PM, Marcelino, G, Santana, LF, de Almeida, EB, Guimarães, RCA, Pott, A, Hiane, PA, Freitas, KC
Molecules (Basel, Switzerland). 2020;(23)
Abstract
During pregnancy, women undergo metabolic and physiological changes, and their needs are higher, to maintain growth and development of the fetus. If the nutritional status of the expectant mother is not satisfactory, some maternal and neonatal complications can occur. In the second and third trimester of pregnancy, there is a reserve of nutrients in the fetus that can be utilized after birth; thereby, children present an accelerated growth in the first years of life, which is a proven response to the available nutrition pattern. However, if such a pattern is insufficient, there will be deficits during development, including brain function. Therefore, despite many recent published works about gestational nutrition, uncertainties still remain on the mechanisms of absorption, distribution, and excretion of micronutrients. Further elucidation is needed to better understand the impacts caused either by deficiency or excess of some micronutrients. Thus, to illustrate the contributions of minerals during prenatal development and in children, iodine, selenium, iron, zinc, calcium, and magnesium were selected. Our study sought to review the consequences related to gestational deficiency of the referred minerals and their impact on growth and development in children born from mothers with such deficiencies.
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Developmental fluoride neurotoxicity: an updated review.
Grandjean, P
Environmental health : a global access science source. 2019;(1):110
Abstract
BACKGROUND After the discovery of fluoride as a caries-preventing agent in the mid-twentieth century, fluoridation of community water has become a widespread intervention, sometimes hailed as a mainstay of modern public health. However, this practice results in elevated fluoride intake and has become controversial for two reasons. First, topical fluoride application in the oral cavity appears to be a more direct and appropriate means of preventing caries. Second, systemic fluoride uptake is suspected of causing adverse effects, in particular neurotoxicity during early development. The latter is supported by experimental neurotoxicity findings and toxicokinetic evidence of fluoride passing into the brain. METHOD An integrated literature review was conducted on fluoride exposure and intellectual disability, with a main focus on studies on children published subsequent to a meta-analysis from 2012. RESULTS Fourteen recent cross-sectional studies from endemic areas with naturally high fluoride concentrations in groundwater supported the previous findings of cognitive deficits in children with elevated fluoride exposures. Three recent prospective studies from Mexico and Canada with individual exposure data showed that early-life exposures were negatively associated with children's performance on cognitive tests. Neurotoxicity appeared to be dose-dependent, and tentative benchmark dose calculations suggest that safe exposures are likely to be below currently accepted or recommended fluoride concentrations in drinking water. CONCLUSION The recent epidemiological results support the notion that elevated fluoride intake during early development can result in IQ deficits that may be considerable. Recognition of neurotoxic risks is necessary when determining the safety of fluoride-contaminated drinking water and fluoride uses for preventive dentistry purposes.
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Examining Childhood Obesity From Infancy: The Relationship Between Tummy Time, Infant BMI-z, Weight Gain, and Motor Development-An Exploratory Study.
Koren, A, Kahn-D'angelo, L, Reece, SM, Gore, R
Journal of pediatric health care : official publication of National Association of Pediatric Nurse Associates & Practitioners. 2019;(1):80-91
Abstract
INTRODUCTION This exploratory study investigated the infant time spent in tummy time (TT) in relation to body mass index z score (BMI-z), weight gain, and motor development in infants from birth to 4 months. METHOD Mothers and their infants were telephone surveyed at 2 and 4 months. Mother demographics; TT; feeding practices; and infant length, and height, and development were collected each time. RESULTS Results from Cochran-Mantel-Haenszel and single logistic regression showed a significant association between development, level of BMI-z, and time spent in TT at 2 months of age (p < .0001). The threshold model showed there was a decline in BMI-z at 4 months as daily time in TT increases past the threshold value of approximately 12 minutes per day. Mother education and TT at 2 months were significant predictors of BMI-z at 4 months. DISCUSSION Study outcomes suggest that infant positioning and time in TT promote infant motor development and may moderate rapid infant weight gain.
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Early Caregiver-Child Interaction and Children's Development: Lessons from the St. Petersburg-USA Orphanage Intervention Research Project.
McCall, RB, Groark, CJ, Hawk, BN, Julian, MM, Merz, EC, Rosas, JM, Muhamedrahimov, RJ, Palmov, OI, Nikiforova, NV
Clinical child and family psychology review. 2019;(2):208-224
Abstract
We review a series of interrelated studies on the development of children residing in institutions (i.e., orphanages) in the Russian Federation or placed with families in the USA and the Russian Federation. These studies rely on a single population, and many potential parameters that typically vary in the literature are similar across studies. The conceptual focus is on the role of early caregiver-child interactions and environmental factors that influence those interactions in children's development. Generally, children residing in institutions that provided minimal caregiver-child interactions displayed delayed physical, cognitive, and social-emotional development. Children and adolescents adopted from such institutions at 18 months of age or older had higher rates of behavioral and executive function problems, even many years after adoption. An intervention that improved the institutional environment by increasing the quality of caregiver-child interactions-without changes in nutrition, medical care, sanitation, and safety-led to substantial increases in the physical, cognitive, and social-emotional development of resident children with and without disabilities. Follow-up studies of children in this intervention who were subsequently placed with USA and Russian families revealed some longer-term benefits of the intervention. Implications are discussed for theoretical understanding of the role of early caregiver-child interactions in development as well as for practice and policy.
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Choline and choline-related nutrients in regular and preterm infant growth.
Bernhard, W, Poets, CF, Franz, AR
European journal of nutrition. 2019;(3):931-945
Abstract
BACKGROUND Choline is an essential nutrient, with increased requirements during development. It forms the headgroup of phosphatidylcholine and sphingomyelin in all membranes and many secretions. Phosphatidylcholine is linked to cell signaling as a phosphocholine donor to synthesize sphingomyelin from ceramide, a trigger of apoptosis, and is the major carrier of arachidonic and docosahexaenoic acid in plasma. Acetylcholine is important for neurodevelopment and the placental storage form for fetal choline supply. Betaine, a choline metabolite, functions as osmolyte and methyl donor. Their concentrations are all tightly regulated in tissues. CLINCAL IMPACT During the fetal growth spurt at 24-34-week postmenstrual age, plasma choline is higher than beyond 34 weeks, and threefold higher than in pregnant women [45 (36-60) µmol/L vs. 14 (10-17) µmol/L]. The rapid decrease in plasma choline after premature birth suggests an untimely reduction in choline supply, as cellular uptake is proportional to plasma concentration. Supply via breast milk, with phosphocholine and α-glycerophosphocholine as its major choline components, does not prevent such postnatal decrease. Moreover, high amounts of liver PC are secreted via bile, causing rapid hepatic choline turnover via the enterohepatic cycle, and deficiency in case of pancreatic phospholipase A2 deficiency or intestinal resection. Choline deficiency causes hepatic damage and choline accretion at the expense of the lungs and other tissues. CONCLUSION Choline deficiency may contribute to the impaired lean body mass growth and pulmonary and neurocognitive development of preterm infants despite adequate macronutrient supply and weight gain. In this context, a reconsideration of current recommendations for choline supply to preterm infants is required.