1,720,966 research outputs found
Oxidative Stress and Necrotizing Enterocolitis: Pathogenetic Mechanisms, Opportunities for Intervention, and Role of Human Milk
Full text linkThis review will examine the role of oxidative stress (OS) in the pathogenesis of necrotizing enterocolitis (NEC) and explore potential preventive and therapeutic antioxidant strategies. Preterm infants are particularly exposed to OS as a result of several perinatal stimuli and constitutive defective antioxidant defenses. For this reason, OS damage represents a contributing factor to several complications of prematurity, including necrotizing enterocolitis (NEC). Being NEC a multifactorial disease, OS may act as downstream component of the pathogenetic cascade. To counteract OS in preterm infants with NEC, several antioxidant strategies have been proposed and different antioxidant compounds have been experimented. It is well known that human milk (HM) is an important source of antioxidants. At the same time, the role of an exclusive HM diet is well recognized in the prevention of NEC. However, donor HM (DHM) processing may impair antioxidant properties. As DHM is becoming a common nutritional intervention for high risk PI, the antioxidant status of preterm and DHM and potential ways to preserve its antioxidant capacity may merit further investigation
Feed-related Splanchnic Oxygenation in Preterm Infants with Abnormal Antenatal Doppler Developing Gut Complications
No full textPreterm infants with antenatal absent or reversed end diastolic flow (AREDF) in umbilical arteries are at major risk for gastrointestinal (GI) complications, such as necrotizing enterocolitis, intestinal perforation and feeding intolerance. Near-infrared spectroscopy (NIRS) provides continuous monitoring of splanchnic oxygenation (SrSO2) and might represent a useful tool to predict GI outcomes in this high-risk population.This observational, pilot study assessed feed-related SrSO2 patterns at enteral feeding introduction and full enteral feeding (FEF) achievement in twenty AREDF infants with gestational age ≤34 weeks. Enrolled infants were divided into two groups according to the development vs. lack of GI complications.Infants developing GI complications showed significantly lower SrSO2 and increased splanchnic oxygen extraction in response to enteral feeds at both enteral feeding introduction and FEF.The potential role of these findings in predicting GI complications in AREDF preterm infants seems promising and deserves further evaluation
Early-life gut microbiota and neurodevelopment in preterm infants: a narrative review
Full text linkInfants born preterm are at a high risk of both gut microbiota (GM) dysbiosis
and neurodevelopmental impairment. While the link between early dysbiosis
and short-term clinical outcomes is well established, the relationship with longterm infant health has only recently gained interest. Notably, there is a significant overlap in the developmental windows of GM and the nervous system in early life. The connection between GM and neurodevelopment was first described in animal models, but over the last decade a growing body of research has also identified GM features as one of the potential mediators for human neurodevelopmental and neuropsychiatric disorders. In this narrative review, we provide an overview of the developing GM in early life and its prospective relationship with neurodevelopment, with a focus on preterm infants. Animal models have provided evidence for emerging pathways linking early-life GM with brain development. Furthermore, a relationship between both dynamic patterns and static features of the GM during preterm infants’ early life and brain maturation, as well as neurodevelopmental outcomes in early childhood, was documented.
Future human studies in larger cohorts, integrated with studies on animal models, may provide additional evidence and help to identify predictive biomarkers and potential therapeutic targets for healthy neurodevelopment in preterm infants
To Feed or Not to Feed: A Critical Overview of Enteral Feeding Management and Gastrointestinal Complications in Preterm Neonates with a Patent Ductus Arteriosus
Full text linkThe management of enteral feeds in preterm infants with a hemodynamically significant patent ductus arteriosus (hs-PDA) is a major challenge for neonatologists due to the fear of gastrointestinal (GI) complications. This review aims to analyze the available evidence on the complex relation between the presence and management of PDA, enteral feeding practices, and GI outcomes in the preterm population. There is limited evidence, based on small and heterogeneous trials, that hs-PDA may affect the splanchnic hemodynamic response to enteral feeds. While the presence of PDA seems a risk factor for adverse GI outcomes, the benefits of feeding withholding during pharmacological PDA treatment are controversial. The lack of robust evidence in support of or against a timely feeding introduction or feeding withholding during pharmacological PDA closure in preterm neonates does not allow to draw any related recommendation. While waiting for further data, the feeding management of this population should be carefully evaluated and possibly individualized on the basis of the infants’ hemodynamic and clinical characteristics. Large, multicentric trials would help to better clarify the physiological mechanisms underlying the development of gut hypoperfusion, and to evaluate the impact of enteral feeds on splanchnic hemodynamics in relation to PDA features and treatment
Probiotics for Preventing Necrotizing Enterocolitis in Preterm Infants: A Network Meta-Analysis
Full text linkBackground: Recent evidence supports a role of probiotics in preventing necrotizing
enterocolitis (NEC) in preterm infants. Methods: A systematic review and network meta-analysis of
randomized controlled trials (RCTs) on the role of probiotics in preventing NEC in preterm infants,
focusing on the differential effect of type of feeding, was performed following the Preferred Reporting
Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A random-effects model
was used; a subgroup analysis on exclusively human milk (HM)-fed infants vs. infants receiving
formula (alone or with HM) was performed. Results: Fifty-one trials were included (10,664 infants,
29 probiotic interventions); 31 studies (19 different probiotic regimens) were suitable for subgroup
analysis according to feeding. In the overall analysis, Lactobacillus acidophilus LB revealed the most
promising effect for reducing NEC risk (odds ratio (OR), 0.03; 95% credible intervals (CrIs), 0.00–0.21).
The subgroup analysis showed that Bifidobacterium lactis Bb-12/B94 was associated with a reduced
risk of NEC stage 2 in both feeding type populations, with a discrepancy in the relative effect
size in favour of exclusively HM-fed infants (OR 0.04; 95% CrIs <0.01–0.49 vs. OR 0.32; 95% CrIs
0.10–0.36). Conclusions: B. lactis Bb-12/B94 could reduce NEC risk with a different size effect
according to feeding type. Of note, most probiotic strains are evaluated in few trials and relatively
small populations, and outcome data according to feeding type are not available for all RCTs. Further
trials are needed to confirm the present findings
Antenatal and Postnatal Sequelae of Oxidative Stress in Preterm Infants: A Narrative Review Targeting Pathophysiological Mechanisms
Full text linkThe detrimental effects of oxidative stress (OS) can start as early as after conception. A growing body of evidence has shown the pivotal role of OS in the development of several pathological conditions during the neonatal period, which have been therefore defined as OS-related neonatal diseases. Due to the physiological immaturity of their antioxidant defenses and to the enhanced antenatal and postnatal exposure to free radicals, preterm infants are particularly susceptible to oxidative damage, and several pathophysiological cascades involved in the development of prematurity-related complications are tightly related to OS. This narrative review aims to provide a detailed overview of the OS-related pathophysiological mechanisms that contribute to the main OS-related diseases during pregnancy and in the early postnatal period in the preterm population. Particularly, focus has been placed on pregnancy disorders typically associated with iatrogenic or spontaneous preterm birth, such as intrauterine growth restriction, pre-eclampsia, gestational diabetes, chorioamnionitis, and on specific postnatal complications for which the role of OS has been largely ascertained (e.g., respiratory distress, bronchopulmonary dysplasia, retinopathy of prematurity, periventricular leukomalacia, necrotizing enterocolitis, neonatal sepsis). Knowledge of the underlying pathophysiological mechanisms may increase awareness on potential strategies aimed at preventing the development of these conditions or at reducing the ensuing clinical burden
Necrotizing Enterocolitis: Overview on In Vitro Models
Full text linkNecrotizing enterocolitis (NEC) is a gut inflammatory disorder which constitutes one of the leading causes of morbidity and mortality for preterm infants. The pathophysiology of NEC is yet to be fully understood; several observational studies have led to the identification of multiple factors involved in the pathophysiology of the disease, including gut immaturity and dysbiosis of the intestinal microbiome. Given the complex interactions between microbiota, enterocytes, and immune cells, and the limited access to fetal human tissues for experimental studies, animal models have long been essential to describe NEC mechanisms. However, at present there is no animal model perfectly mimicking human NEC; furthermore, the disease mechanisms appear too complex to be studied in single-cell cultures. Thus, researchers have developed new approaches in which intestinal epithelial cells are exposed to a combination of environmental and microbial factors which can potentially trigger NEC. In addition, organoids have gained increasing attention as promising models for studying NEC development. Currently, several in vitro models have been proposed and have contributed to describe the disease in deeper detail. In this paper, we will provide an updated review of available in vitro models of NEC and an overview of current knowledge regarding its molecular underpinnings
Biotics in neonatal period: what's the evidence?
No full textBreastfeeding is considered the gold standard for infants' nutrition and provides unique benefits for infants' health
Can general movements trajectories predict neurodevelopment as early as six months corrected age in very preterm infants?
No full textObjective: To evaluate whether prenatal and postnatal clinical variables, General Movements (GMs), and Hammersmith Neurological Examination (HNE) would predict developmental delay. at 6 months corrected age (CA) in preterm infants.
Methods: Infants born <32 weeks gestational age or <1500 g were enrolled in the first days of life and underwent neurodevelopmental follow-up until 6 months CA. Potential associations between motor, cognitive, and language development assessed by the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) at 6 months CA, and clinical variables, GMs at term equivalent age (TEA) and Fidgety period, HNE at TEA and 3 months CA, were investigated by Mann Whitney U test, chi-square test, Spearman correlation test, multiple logistic regression.
Results: Ninety-eight infants were included. GMs anomalies at TEA predicted an increased risk of motor delay at 6 months CA, regardless of Fidgety quality at 3 months GA (GMs anomalies at TEA and pathological Fidgety, OR 16.05 [95 % CI 1.02–253.50]; GMs anomalies at TEA and normal Fidgety, OR 11.16 [95 % CI 1.18–105.31]).
Despite several variables, including GMs, were associated to cognitive and language delay at 6 months CA (p < 0.05), none was found predictive at the multivariate analysis.
Conclusions: GMs at specific timepoints and GMs trajectories are predictive of early motor delay assessed as early as 6 months CA. Further research is needed to develop standardised protocols for neurodevelopmental longitudinal assessment and to investigate GMs trajectories and their integration with other predictors of neurodevelopment
- …
