1,721,132 research outputs found
Fifteen-minute consultation: ABCDE approach to nutritional assessment in preterm infants
No full text\ua9 Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.The last 20 years has seen dramatic improvements in the survival of preterm infants due to improved antenatal and neonatal care. Closer attention to nutrition means early parenteral nutrition and mother\u27s own milk are considered as standard of care. Many uncertainties remain however, such as optimal macronutrient intakes for longer term cognitive and metabolic outcomes, and the optimal probiotic regime to reduce the risk of necrotising enterocolitis. Nutrition involves macronutrients and micronutrients, immunonutrients, microbiomic aspects and nutrient delivery. It is also clear that there are behavioural and psychological aspects, and strongly held beliefs for parents and professionals that affect practice. While many healthcare professionals (HCPs) are aware of several key nutritional concepts on the neonatal intensive care unit (NICU), many HCPs lack a concise, systematic approach. This article provides a brief approach to nutritional assessment for use on the NICU summarised as ABCDE: A - anthropometry, B - biochemistry, C - clinical, D - dietary intakes, E - environment and evaluation
Discriminating necrotising enterocolitis and focal intestinal perforation
No full text\ua9 Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.Discriminating necrotising enterocolitis (NEC) and focal intestinal perforation (FIP) is important for clinical trials, observational cohorts, quality improvement and aetiological understanding. Literature suggests that timing and key features diagnose and discriminate, and that NEC subclassifications exist. We used a detailed 10-year cohort of NEC and FIP cases in preterm infants born <32 weeks\u27 gestation from a single centre to explore antecedent factors, presentation and potential NEC subclassifications. 785 infants had 144 episodes of NEC and 38 of FIP. FIP presented earlier than NEC, but ranges overlapped, and 30% of NEC presented before day 14. Antecedent events (other than feed volumes) and outcomes did not differ between NEC and FIP. Currently used diagnostic/discriminatory features performed poorly, and subclassification identified few cases except transfusion-associated NEC. Contrary to existing literature, postnatal age at NEC presentation was not dependent on gestational age. Detailed review rather than simple definitions are required to separate NEC from FIP
Feeding preterm infants with formula rather than donor breast milk is associated with faster rates of short-term growth, but increased risk of developing necrotising enterocolitis
No full textCommentary on: Quigley M, Embleton ND, McGuire W. Formula versus donor breast milk for feeding preterm or low birth weight infants. Cochrane Database Syst Rev. 2018;6:CD002971
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Optimal protein and energy intakes in preterm infants
No full textThere is compelling evidence that current nutritional practice fails to provide sufficient dietary protein for preterm infants, especially extremely and very low birth weight infants. Nutrient requirements can be estimated by a variety of techniques, but most suggest that these infants will require a protein intake of 3.5-4.0 g/kg/d. Even when these infants are able to tolerate full enteral feeds, most currently available artificial milk formula or breast milk fortifiers will not ensure these protein requirements are met except when fed at high volumes. Energy requirements on the other hand may be currently met, and evidence from controlled studies suggests that intakes higher than 110-135 kcal/kg/d might not be beneficial. The data from studies on neonatal adiposity outcomes, and from studies examining relationship between early growth and later cardiovascular outcome, also suggest that excess nutrient intake might be harmful. In the light of this data, optimal intakes and protein-energy ratios require re-appraisal. \ua9 2007 Elsevier Ireland Ltd. All rights reserved
Response to Letter: How Much Free Sugars Intake Should Be Recommended for Children Younger Than 2 Years Old?
No full text
Early Nutrition and Later Outcomes in Preterm Infants
No full textThe developmental origins of health and disease is an emerging area of interest that amalgamates many areas of scientific studies and encompasses a wide range of diverse disciplines from epidemiology to molecular biology. Evidence has accumulated to show that early life experiences, both in utero and in infancy have long-term effects on many body systems. There are now good data to show that suboptimal in utero growth, especially when combined with rapid growth acceleration in early postnatal life may increase the risk of later life metabolic disease. The mechanisms are complex but likely to involve epigenetic marks such as DNA methylation. Preterm infants frequently experience suboptimal nutrient intakes in early postnatal life and exhibit growth failure within the NICU. They also receive products that may not provide either an optimal quantity or quality of nutrients. Follow-up studies have now shown much higher risks for long-term chronic disease in children and adults who were born preterm. There are higher levels of insulin resistance and abnormal partitioning of fat deposition. The onset of puberty seems earlier, average height is less and blood pressure, measures of vascular health and lipid profiles suggest cardiovascular health is likely to differ from healthy term born controls. Despite this, there are no data to suggest an overall benefit of limiting nutrient intake, or restricting growth in preterm infants. There are strong data to show that the preterm brain is exquisitely vulnerable to undernutrition, and that suboptimal nutrient intakes may permanently affect later cognitive attainment. A clinical focus on early nutrient intakes and breast milk provision is key to optimising long-term health outcomes. Copyright (c) 2013 S. Karger AG, Base
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