1. Nutricion gestacion
3
ORIGINAL ARTICLE Small for gestational age preterm infants: nutritional strategies and quality of growth after discharge Paola Roggero, Maria Lorella Giannì, Nadia Liotto, Francesca T aroni, Daniela Morniroli & Fabio Mosca Neonatal Intensive Care Unit, Fondazione IRCCS “Cà Granda” Ospedale Maggiore Policlinico, Department of Maternal and Pediatric Sciences, University of Milan, Italy The Journal of Maternal-Fetal and Neonatal Medicine, 2011; 24(S(1)): 144-146 Copyright © 2011 Informa UK, Ltd. ISSN 1476-7058 print/ISSN 1476-4954 online DOI: 10.3109/14767058.2011.607657 Correspondence: P. Roggero, Neonatal Intensive Care Unit, Fondazione IRCCS “Cà Granda” Ospedale Maggiore Policlinico, Department o Maternal and Pediatric Sciences, University o Milan, Italy. E-mail: [email protected] Infants born preterm are at high risk for poor growth achieve- ment. Small for gestational age (SGA (bir th weight below the 10th percentile) preterm infants are even more prone to develop postnatal growth retardation in the early neonatal period, as they do not have a large storage of protein/energy. Both SGA and appropriate for gestational age (AGA : birth weight between the 10th and 90th percentiles) infants show persistent postnatal growth failure after discharge. Although the available data clearly demonstrate that preterm infants, especially if born SGA, exhibit postnatal growth retardation at the time of hospital discharge, the importance of the nutritional post discharge management has not been sufficiently taken into account. We have recently conducted a randomized controlled trial to assess whether infants born SGA may benefit from an enriched post discharge formula . This study suggests that the growth pattern in SGA preterm infants is not affected by the consump- tion of an enriched post discharge formula. The ponderal and linear growth of these inf ants does not accelerate to achieve early catch up growth. However , as far as the quality of growth is concerned, the fat mass accretion after term decelerates, so that an increase of f at free mass accretion takes place. Future research effort should be directed toward longer follow up and personalized nutrition management. Keywords: small for gestational age preterm infants, quality of growth, postdischarge nutrition Introduction Inants born preterm are at high risk or poor growth achieve- ment [1]. Small or gestational age (SGA) preterm inants are even more prone to develop postnatal growth retardation in the early neonatal period, as they do not have a large storage o protein/ energy. Indeed, they have developed under adverse intrauterine conditions that lead to lack o lean and at mass accretion. Even though nutritional requirements or optimal neonatal growth in preterm inants beore discharge rom neonatal unit are to a certain extent defined, available data on quality o growth and nutritional management in this subgroup o preterm inants are still limited. Tis could be attributable to the heterogeneity o the SGA definition utilized in different studies. SGA and intrauterine growth retardation (IUGR) are ofen interpreted erroneously as synonymous. Particularly, the term SGA reers not to etal growth, but to the size o the inant at birth, whereas the term IUGR suggests a decreased growth velocity pattern during intra- uterine lie. A child who is born SGA did not necessarily undergo IUGR, and inants who are born afer a short period o IUGR are not necessarily SGA [2]. Growth and quality of growth at discharge As ar as the quality o growth is concerned, ull-term SGA inants at birth have been reported to be shorter and thinner and to have a lower percentage o at mass when compared to inants born appropriate or gestational age (AGA: birth weight between the 10th and 90th percentiles) [3]. Our data have demonstrated that the SGA preterm inants (birth weight below the 10th percentile according to Fenton’s chart [4]), assessed at term corrected age, develop not only a postnatal growth retardation, but also a higher at mass content in comparison to the ull-term SGA newborns. In addition, the at mass content is negatively associated with gestational age [5]. Considering this scenario, the accurate and non-invasive assessment o the quality o growth in these vulner- able inants is essential. Indeed, it is increasingly recognized that being born SGA is associated with a high risk o developing increased and aberrant adiposity and metabolic diseases later in lie, particularly hypertensi on, increased cardiovascula r mortality , and type 2 diabetes mellitus. Growth and quality of growth following discharge Both SGA and AGA inants show persistent postnatal growth ailure afer discharge [6,7]. Bertino et al. reported significant weight impairment in SGA preterm inants at two years o age. Campos et al. [6] compared post discharge growth in AGA and SGA very low birth weight inants. Te authors ound that 81.4%, o SGA inants did not achieve catch-up growth within 12 months o corrected age, whereas the percentage o AGA inants that maintained adequate growth was only 42.1%. We have recently longitudinally investigated the postnatal weight and at mass gain during the first five months afer term in a cohort o preterm inants, who were classified according to their intra- uterine growth pattern and their postnatal growth [ 8]. Te SGA preterm inants showed the lowest mean z score or weight at term in comparison to the AGA inants with or without postnatal growth retardation. We speculated that the impaired intrauterine growth and the cumulative postnatal nutritional deficit could explain this finding. As a consequence, inants who were born J M a t e r n F e t a l N e o n a t a l M e d D o w n l o a d e d f r o m i n f o r m a h e a l t h c a r e . c o m b y H I N A R I o n 0 8 / 2 8 / 1 2 F o r p e r s o n a l u s e o n l y .
-
Upload
jon-rojas-pino -
Category
Documents
-
view
216 -
download
0
Transcript of 1. Nutricion gestacion
8112019 1 Nutricion gestacion
httpslidepdfcomreaderfull1-nutricion-gestacion 13
983089983092983092
ORIGINAL ARTICLE
Small for gestational age preterm infants nutritional strategies andquality of growth after discharge
Paola Roggero Maria Lorella Giannigrave Nadia Liotto Francesca Taroni Daniela Morniroli amp Fabio Mosca
Neonatal Intensive Care Unit Fondazione IRCCS ldquoCagrave Grandardquo Ospedale Maggiore Policlinico Department of Maternal and PediatricSciences University of Milan Italy
The Journal of Maternal-Fetal and Neonatal Medicine 2011 24(S(1)) 144-146
Copyright copy 2011 Informa UK Ltd
ISSN 1476-7058 printISSN 1476-4954 online
DOI 103109147670582011607657
Correspondence P Roggero Neonatal Intensive Care Unit Fondazione IRCCS ldquoCagrave Grandardquo Ospedale Maggiore Policlinico Department o Maternal andPediatric Sciences University o Milan Italy E-mail paolaroggeromangiagalliit
Infants born preterm are at high risk for poor growth achieve-ment Small for gestational age (SGA (birth weight below the10th percentile) preterm infants are even more prone to developpostnatal growth retardation in the early neonatal period asthey do not have a large storage of proteinenergy Both SGAand appropriate for gestational age (AGA birth weight betweenthe 10th and 90th percentiles) infants show persistent postnatalgrowth failure after discharge Although the available dataclearly demonstrate that preterm infants especially if born SGAexhibit postnatal growth retardation at the time of hospitaldischarge the importance of the nutritional post dischargemanagement has not been sufficiently taken into accountWe have recently conducted a randomized controlled trial toassess whether infants born SGA may benefit from an enrichedpost discharge formula This study suggests that the growthpattern in SGA preterm infants is not affected by the consump-tion of an enriched post discharge formula The ponderal andlinear growth of these infants does not accelerate to achieveearly catch up growth However as far as the quality of growth
is concerned the fat mass accretion after term decelerates sothat an increase of fat free mass accretion takes place Futureresearch effort should be directed toward longer follow up andpersonalized nutrition management
Keywords small for gestational age preterm infants quality ofgrowth postdischarge nutrition
Introduction
Inants born preterm are at high risk or poor growth achieve-ment [1] Small or gestational age (SGA) preterm inants are evenmore prone to develop postnatal growth retardation in the earlyneonatal period as they do not have a large storage o protein
energy Indeed they have developed under adverse intrauterineconditions that lead to lack o lean and at mass accretion Eventhough nutritional requirements or optimal neonatal growthin preterm inants beore discharge rom neonatal unit are to acertain extent defined available data on quality o growth andnutritional management in this subgroup o preterm inants arestill limited Tis could be attributable to the heterogeneity o theSGA definition utilized in different studies SGA and intrauterinegrowth retardation (IUGR) are ofen interpreted erroneouslyas synonymous Particularly the term SGA reers not to etal
growth but to the size o the inant at birth whereas the termIUGR suggests a decreased growth velocity pattern during intra-uterine lie A child who is born SGA did not necessarily undergoIUGR and inants who are born afer a short period o IUGR arenot necessarily SGA [2]
Growth and quality of growth at dischargeAs ar as the quality o growth is concerned ull-term SGA inantsat birth have been reported to be shorter and thinner and to havea lower percentage o at mass when compared to inants bornappropriate or gestational age (AGA birth weight between the10th and 90th percentiles) [3] Our data have demonstrated thatthe SGA preterm inants (birth weight below the 10th percentileaccording to Fentonrsquos chart [4]) assessed at term corrected agedevelop not only a postnatal growth retardation but also a higherat mass content in comparison to the ull-term SGA newbornsIn addition the at mass content is negatively associated withgestational age [5] Considering this scenario the accurate andnon-invasive assessment o the quality o growth in these vulner-able inants is essential Indeed it is increasingly recognized
that being born SGA is associated with a high risk o developingincreased and aberrant adiposity and metabolic diseases later inlie particularly hypertension increased cardiovascular mortalityand type 2 diabetes mellitus
Growth and quality of growth following discharge
Both SGA and AGA inants show persistent postnatal growthailure afer discharge [67] Bertino et al reported significantweight impairment in SGA preterm inants at two years o ageCampos et al [6] compared post discharge growth in AGAand SGA very low birth weight inants Te authors ound that814 o SGA inants did not achieve catch-up growth within12 months o corrected age whereas the percentage o AGA
inants that maintained adequate growth was only 421 Wehave recently longitudinally investigated the postnatal weight andat mass gain during the first five months afer term in a cohorto preterm inants who were classified according to their intra-uterine growth pattern and their postnatal growth [8] Te SGApreterm inants showed the lowest mean z score or weight atterm in comparison to the AGA inants with or without postnatalgrowth retardation We speculated that the impaired intrauterinegrowth and the cumulative postnatal nutritional deficit couldexplain this finding As a consequence inants who were born
8112019 1 Nutricion gestacion
httpslidepdfcomreaderfull1-nutricion-gestacion 23
Nutritional strategies afer discharge or SGA inants 145
Copyright copy 98309098308810486251048625 Inorma UK Ltd
SGA although exhibiting an increased growth rate between termand the fifh month attained mean z-score values or weight thatwere persistently lower than that attained by inants born AGAwith or without postnatal growth retardation Te persistence opostnatal growth retardation in the SGA inants may suggest thateither these inants have an intrinsic lower growth potential orthat the growth constraint experienced during the intrauterinelie may delay the occurrence o recovery o growth With respectto body composition both SGA and AGA inants with postnatal
growth retardation showed percentage o at mass at term signifi-cantly lower than that o AGA inants without postnatal growthretardation suggesting that the postnatal growth retardation isaccompanied by a relative lack o at mass accretion From termto the third month o corrected age both SGA and AGA inantswith growth retardation showed a higher change in at mass thanthe AGA inants without growth retardation so that no differencein percentage o at mass between groups was detected at threemonths From the third month up to the end o the study SGAand AGA inants with or without growth retardation showedcomparable change in at mass Hence etal growth pattern influ-ences the potential to rapidly correct anthropometry whereas therestoration o at storing takes place irrespective o birth weight
Nutritional strategiesAlthough the available data clearly demonstrate that preterminants especially i born SGA exhibit postnatal growth retarda-tion at the time o hospital discharge the importance o the nutri-tional post discharge management has not been sufficiently takeninto account Actually there is urgent need or implementingnutritional post discharge strategies to avoid not only short-termbut also probably longer-term health consequences
Te European Society or Pediatric GastroenterologyHepatology and Nutrition (httpwwwespghanmeduppt)recommends in SGA inants the multi-nutrient ortificationo expressed breast milk when the inants are breasted Whenhuman milk is lacking a nutrient-enriched post dischargeormula with high contents o protein minerals and trace
elements as well as a long-chain polyunsaturated atty acidsupply possibly until 52 weeks postconceptional age is advis-able However the existing evidence to support these strategies islimited [9] Indeed at present only one randomized controlledtrial conducted on a relatively small sample size (n = 39) opreterm inants suggest that ortification o expressed breast milkmay offer an advantage in growth during inancy No consistentfindings have been reported on the effect o commercially avail-able nutrient-enriched ormula (ldquopretermrdquo or ldquopost-dischargerdquo)
compared with standard ormula on growth and neurodevelop-ment Te possible explanation or the lack o evidence may relyon the act that the different groups o inants studied were nothomogenous and that the duration and the type o interven-tions were not comparable In addition it has been suggestedthat inants regulate their milk intake in relation to the energyor nutrient density so that they regulate the milk volume intakebased on their individual dietary requirements
Fewtrell [10] drew the attention toward the necessity oselecting which sub-groups o inants could benefit mainly romnutrient-enriched ormula afer hospital discharge not only interms o quantity o growth but also o lean mass and skeletalgrowth Indeed the growth potential o the inant is unknownand the requirements or achieving catch-up growth will be
broadly different in relation to birth weight gestational age andgender It has been demonstrated that the smaller inants exhibitthe more severe cumulative nutritional deficit and that the growthrate and body composition gain differ between boys and girlsTe optimal duration o eeding with nutrient enriched ormulaalso needs to be clarified
We have recently conducted a randomized controlled trial toassess whether inants born SGA may benefit rom an enrichedpost discharge ormula (PDF) [12] Te inants born SGA wererandomly assigned to receive a PDF (n = 40) or erm Formula(F) (n = 44) when reaching term corrected age Te inants wereed ad libitum and the daily intakes were recorded
Growth and body composition by means o an air displace-ment plethysmography (PEA PODreg COSMED USA Concord
Table III Mean (SD) weight at ree mass and at mass values at each study point
Weight (g) Fat ree mass (g) Fat mass ()
TF PDF TF PDF TF PDF
40 weeks 23152 (2948) 24085 (4161) 19747 (2484) 20212 (3060) 145 (44) 151 (33)
1 month 32549 (4999) 32567 (5419) 25936 (3446) 26642 (3931) 187 (44) 179 (39)
3 months 47827 (7080) 47928 (7002) 36692 (4981) 37482 (4911) 231 (45) 218 (39)
6 months 63103 (8500) 62329 (7361) 44547 (5096) 46969 (6621) 237 (42) 228 (43)
Table I Mean (SD) daily volume and energy and protein intakes at each study point
Energy intake (kcalkgday) Protein intake (gkgday) Volume (mlday)
TF PDF TF PDF TF PDF
1 month 1347 (258) 1461 (200) 28 (08) 33 (06) 6367 (1337) 5437 (890)
3 months 1054 (163) 1041 (155) 22 (04) 27 (05) 8819 (1820) 7330 (1520)
6 months 990 (152) 950 (164) 20 (03) 25 (05) 8296 (2798) 6966 (1839)
PDF vs TF p lt 005
Table II Mean (SD) weight length and head circumerence values at each study point
Weight (g) Length (cm) Head circumerence (cm)
TF PDF TF PDF TF PDF
40 weeks 23152 (2948) 24085 (4161) 439 (19) 444 (20) 331 (09) 332 (13)
1 month 32549 (4999) 32567 (5419) 480 (32) 487 (31) 358 (12) 357 (18)
3 months 47827 (7080) 47928 (7002) 544 (22) 558 (26) 392 (13) 401 (17)
6 months 63103 (8500) 62329 (7361) 618 (25) 625 (26) 419 (15) 423 (15)
8112019 1 Nutricion gestacion
httpslidepdfcomreaderfull1-nutricion-gestacion 33
146 P Roggero et al
Te Journal o Maternal-Fetal and Neonatal Medicine
CA USA) were assessed in 84 (44 males) SGA preterm inantsat term corrected age 1 3 6 months o corrected age Meangestational age (weeks) and mean birth weight (g) were 316 (19)and 11205 (272) respectively Although the volume intakes werehigher in the F group in comparison with the PDF group theprotein intakes o the inants belonging to F group were signifi-cantly lower (able I)
Te growth pattern through the study was not differentbetween the two groups Te mean weight z-score in emales
increased romminus22 at term corrected age tominus18 at six monthso corrected age independently rom the ormula consumed Noincrease in mean weight z-score in males during the study wasobserved No catch-up in length was recorded up to six months ocorrected age in both groups independently rom gender Meanhead circumerence z-score value did not change through out thestudy (able II)
No difference in the quality o growth in terms o at ree massand at mass in the two groups was detected (able III) Accordingto our previously published results [11] mean percentage o atmass at term corrected age was higher than that shown by theull-term AGA newborns at birth probably because o an adap-tive mechanism to extra uterine lie However the mean valueo percentage o at mass ound at six months o corrected age
suggests that being born SGA is accompanied by a relative lack oat mass accretion during the first months afer term As a conse-quence the weight gain composition was characterized mainly byan increase in lean body mass ( gain = 234)
In conclusion this study suggests that the growth pattern inSGA preterm inants is not affected by the consumption o anenriched post discharge ormula Te ponderal and linear growtho these inants does not accelerate to achieve early catch upgrowth However as ar as the quality o growth is concerned theat mass accretion afer term decelerates so that an increase oat ree mass accretion takes place Future research effort shouldbe directed toward longer ollow up and personalized nutritionmanagement
Declaration of interest Te authors declare no conflict ointerest
References1 Stoll BJ Hansen NI Bell EF Shankaran S Laptook AR Walsh MC
Hale EC et al Eunice Kennedy Shriver National Institute o ChildHealth and Human Development Neonatal Research NetworkNeonatal outcomes o extremely preterm inants rom the NICHDNeonatal Research Network Pediatrics 2010126443ndash456
2 Peter A Lee Steven D Chernausek Anita CS Hokken-KoelegaPaul Czernichow International small or gestational age advisoryboard consensus development conerence statement Managemento short children born small or gestational age Pediatrics 20031111253ndash1261
3 Verkauskiene R Beltrand J Claris O Chevenne D DeghmounS Dorgeret S Alison M et al Impact o etal growth restrictionon body composition and hormonal status at birth in inants osmall and appropriate weight or gestational age Eur J Endocrinol 2007157605ndash612
4 Fenton TR A new growth chart or preterm babies Babson andBendarsquos chart updated with recent data and a new ormat BMC Pediatr 2003163ndash13
5 Giannigrave ML Roggero P Taroni F L iotto N Piemontese PMosca F Adiposity in small or gestational age preterm inantsassessed at term equivalent age Arch Dis Child Fetal Neonatal Ed 200994F368ndashF372
6 Bertino E Coscia A Mombrograve M Boni L Rossetti G Fabris CSpada E Milani S Postnatal weight increase and growth velocityo very low birthweight inants Arch Dis Child Fetal Neonatal Ed 200691F349ndashF356
7 Campos M Reyes G Garciacutea L Comparison o postdischarge growthin adequate or gestational age and small or gestational age very lowbirthweight inants Ethn Dis 200818S2ndash118
8 Roggero P Giannigrave ML Liotto N Taroni F Orsi A Amato O MorlacchiL et al Rapid recovery o at mass in small or gestational age preterminants afer term PLoS ONE 20116e14489
9 Morgan JA Young L McCormick FM McGuire W Promoting growthor preterm inants ollowing hospital discharge Arch Dis Child FetalNeonatal Ed 2011
10 Fewtrell MS Growth and nutrition afer discharge Semin Neonatol 20038169ndash176
11 Roggero P Giannigrave ML Amato O Liotto N Morlacchi L Orsi APiemontese P Taroni F Mosca F Growth and at mass in preterm inantsed a protein-enriched postdischarge ormula (PDF) A randomizedcontrolled trial Accepted or oral presentation at European Society orPediatric Society Newcastle 2011
12 Roggero P Giannigrave ML Orsi A Piemontese P Amato O LiottoN Morlacchi L et al Quality o growth in exclusively breast-edinants in the first six months o lie an italian study Pediatr Res 201068542ndash544
8112019 1 Nutricion gestacion
httpslidepdfcomreaderfull1-nutricion-gestacion 23
Nutritional strategies afer discharge or SGA inants 145
Copyright copy 98309098308810486251048625 Inorma UK Ltd
SGA although exhibiting an increased growth rate between termand the fifh month attained mean z-score values or weight thatwere persistently lower than that attained by inants born AGAwith or without postnatal growth retardation Te persistence opostnatal growth retardation in the SGA inants may suggest thateither these inants have an intrinsic lower growth potential orthat the growth constraint experienced during the intrauterinelie may delay the occurrence o recovery o growth With respectto body composition both SGA and AGA inants with postnatal
growth retardation showed percentage o at mass at term signifi-cantly lower than that o AGA inants without postnatal growthretardation suggesting that the postnatal growth retardation isaccompanied by a relative lack o at mass accretion From termto the third month o corrected age both SGA and AGA inantswith growth retardation showed a higher change in at mass thanthe AGA inants without growth retardation so that no differencein percentage o at mass between groups was detected at threemonths From the third month up to the end o the study SGAand AGA inants with or without growth retardation showedcomparable change in at mass Hence etal growth pattern influ-ences the potential to rapidly correct anthropometry whereas therestoration o at storing takes place irrespective o birth weight
Nutritional strategiesAlthough the available data clearly demonstrate that preterminants especially i born SGA exhibit postnatal growth retarda-tion at the time o hospital discharge the importance o the nutri-tional post discharge management has not been sufficiently takeninto account Actually there is urgent need or implementingnutritional post discharge strategies to avoid not only short-termbut also probably longer-term health consequences
Te European Society or Pediatric GastroenterologyHepatology and Nutrition (httpwwwespghanmeduppt)recommends in SGA inants the multi-nutrient ortificationo expressed breast milk when the inants are breasted Whenhuman milk is lacking a nutrient-enriched post dischargeormula with high contents o protein minerals and trace
elements as well as a long-chain polyunsaturated atty acidsupply possibly until 52 weeks postconceptional age is advis-able However the existing evidence to support these strategies islimited [9] Indeed at present only one randomized controlledtrial conducted on a relatively small sample size (n = 39) opreterm inants suggest that ortification o expressed breast milkmay offer an advantage in growth during inancy No consistentfindings have been reported on the effect o commercially avail-able nutrient-enriched ormula (ldquopretermrdquo or ldquopost-dischargerdquo)
compared with standard ormula on growth and neurodevelop-ment Te possible explanation or the lack o evidence may relyon the act that the different groups o inants studied were nothomogenous and that the duration and the type o interven-tions were not comparable In addition it has been suggestedthat inants regulate their milk intake in relation to the energyor nutrient density so that they regulate the milk volume intakebased on their individual dietary requirements
Fewtrell [10] drew the attention toward the necessity oselecting which sub-groups o inants could benefit mainly romnutrient-enriched ormula afer hospital discharge not only interms o quantity o growth but also o lean mass and skeletalgrowth Indeed the growth potential o the inant is unknownand the requirements or achieving catch-up growth will be
broadly different in relation to birth weight gestational age andgender It has been demonstrated that the smaller inants exhibitthe more severe cumulative nutritional deficit and that the growthrate and body composition gain differ between boys and girlsTe optimal duration o eeding with nutrient enriched ormulaalso needs to be clarified
We have recently conducted a randomized controlled trial toassess whether inants born SGA may benefit rom an enrichedpost discharge ormula (PDF) [12] Te inants born SGA wererandomly assigned to receive a PDF (n = 40) or erm Formula(F) (n = 44) when reaching term corrected age Te inants wereed ad libitum and the daily intakes were recorded
Growth and body composition by means o an air displace-ment plethysmography (PEA PODreg COSMED USA Concord
Table III Mean (SD) weight at ree mass and at mass values at each study point
Weight (g) Fat ree mass (g) Fat mass ()
TF PDF TF PDF TF PDF
40 weeks 23152 (2948) 24085 (4161) 19747 (2484) 20212 (3060) 145 (44) 151 (33)
1 month 32549 (4999) 32567 (5419) 25936 (3446) 26642 (3931) 187 (44) 179 (39)
3 months 47827 (7080) 47928 (7002) 36692 (4981) 37482 (4911) 231 (45) 218 (39)
6 months 63103 (8500) 62329 (7361) 44547 (5096) 46969 (6621) 237 (42) 228 (43)
Table I Mean (SD) daily volume and energy and protein intakes at each study point
Energy intake (kcalkgday) Protein intake (gkgday) Volume (mlday)
TF PDF TF PDF TF PDF
1 month 1347 (258) 1461 (200) 28 (08) 33 (06) 6367 (1337) 5437 (890)
3 months 1054 (163) 1041 (155) 22 (04) 27 (05) 8819 (1820) 7330 (1520)
6 months 990 (152) 950 (164) 20 (03) 25 (05) 8296 (2798) 6966 (1839)
PDF vs TF p lt 005
Table II Mean (SD) weight length and head circumerence values at each study point
Weight (g) Length (cm) Head circumerence (cm)
TF PDF TF PDF TF PDF
40 weeks 23152 (2948) 24085 (4161) 439 (19) 444 (20) 331 (09) 332 (13)
1 month 32549 (4999) 32567 (5419) 480 (32) 487 (31) 358 (12) 357 (18)
3 months 47827 (7080) 47928 (7002) 544 (22) 558 (26) 392 (13) 401 (17)
6 months 63103 (8500) 62329 (7361) 618 (25) 625 (26) 419 (15) 423 (15)
8112019 1 Nutricion gestacion
httpslidepdfcomreaderfull1-nutricion-gestacion 33
146 P Roggero et al
Te Journal o Maternal-Fetal and Neonatal Medicine
CA USA) were assessed in 84 (44 males) SGA preterm inantsat term corrected age 1 3 6 months o corrected age Meangestational age (weeks) and mean birth weight (g) were 316 (19)and 11205 (272) respectively Although the volume intakes werehigher in the F group in comparison with the PDF group theprotein intakes o the inants belonging to F group were signifi-cantly lower (able I)
Te growth pattern through the study was not differentbetween the two groups Te mean weight z-score in emales
increased romminus22 at term corrected age tominus18 at six monthso corrected age independently rom the ormula consumed Noincrease in mean weight z-score in males during the study wasobserved No catch-up in length was recorded up to six months ocorrected age in both groups independently rom gender Meanhead circumerence z-score value did not change through out thestudy (able II)
No difference in the quality o growth in terms o at ree massand at mass in the two groups was detected (able III) Accordingto our previously published results [11] mean percentage o atmass at term corrected age was higher than that shown by theull-term AGA newborns at birth probably because o an adap-tive mechanism to extra uterine lie However the mean valueo percentage o at mass ound at six months o corrected age
suggests that being born SGA is accompanied by a relative lack oat mass accretion during the first months afer term As a conse-quence the weight gain composition was characterized mainly byan increase in lean body mass ( gain = 234)
In conclusion this study suggests that the growth pattern inSGA preterm inants is not affected by the consumption o anenriched post discharge ormula Te ponderal and linear growtho these inants does not accelerate to achieve early catch upgrowth However as ar as the quality o growth is concerned theat mass accretion afer term decelerates so that an increase oat ree mass accretion takes place Future research effort shouldbe directed toward longer ollow up and personalized nutritionmanagement
Declaration of interest Te authors declare no conflict ointerest
References1 Stoll BJ Hansen NI Bell EF Shankaran S Laptook AR Walsh MC
Hale EC et al Eunice Kennedy Shriver National Institute o ChildHealth and Human Development Neonatal Research NetworkNeonatal outcomes o extremely preterm inants rom the NICHDNeonatal Research Network Pediatrics 2010126443ndash456
2 Peter A Lee Steven D Chernausek Anita CS Hokken-KoelegaPaul Czernichow International small or gestational age advisoryboard consensus development conerence statement Managemento short children born small or gestational age Pediatrics 20031111253ndash1261
3 Verkauskiene R Beltrand J Claris O Chevenne D DeghmounS Dorgeret S Alison M et al Impact o etal growth restrictionon body composition and hormonal status at birth in inants osmall and appropriate weight or gestational age Eur J Endocrinol 2007157605ndash612
4 Fenton TR A new growth chart or preterm babies Babson andBendarsquos chart updated with recent data and a new ormat BMC Pediatr 2003163ndash13
5 Giannigrave ML Roggero P Taroni F L iotto N Piemontese PMosca F Adiposity in small or gestational age preterm inantsassessed at term equivalent age Arch Dis Child Fetal Neonatal Ed 200994F368ndashF372
6 Bertino E Coscia A Mombrograve M Boni L Rossetti G Fabris CSpada E Milani S Postnatal weight increase and growth velocityo very low birthweight inants Arch Dis Child Fetal Neonatal Ed 200691F349ndashF356
7 Campos M Reyes G Garciacutea L Comparison o postdischarge growthin adequate or gestational age and small or gestational age very lowbirthweight inants Ethn Dis 200818S2ndash118
8 Roggero P Giannigrave ML Liotto N Taroni F Orsi A Amato O MorlacchiL et al Rapid recovery o at mass in small or gestational age preterminants afer term PLoS ONE 20116e14489
9 Morgan JA Young L McCormick FM McGuire W Promoting growthor preterm inants ollowing hospital discharge Arch Dis Child FetalNeonatal Ed 2011
10 Fewtrell MS Growth and nutrition afer discharge Semin Neonatol 20038169ndash176
11 Roggero P Giannigrave ML Amato O Liotto N Morlacchi L Orsi APiemontese P Taroni F Mosca F Growth and at mass in preterm inantsed a protein-enriched postdischarge ormula (PDF) A randomizedcontrolled trial Accepted or oral presentation at European Society orPediatric Society Newcastle 2011
12 Roggero P Giannigrave ML Orsi A Piemontese P Amato O LiottoN Morlacchi L et al Quality o growth in exclusively breast-edinants in the first six months o lie an italian study Pediatr Res 201068542ndash544
8112019 1 Nutricion gestacion
httpslidepdfcomreaderfull1-nutricion-gestacion 33
146 P Roggero et al
Te Journal o Maternal-Fetal and Neonatal Medicine
CA USA) were assessed in 84 (44 males) SGA preterm inantsat term corrected age 1 3 6 months o corrected age Meangestational age (weeks) and mean birth weight (g) were 316 (19)and 11205 (272) respectively Although the volume intakes werehigher in the F group in comparison with the PDF group theprotein intakes o the inants belonging to F group were signifi-cantly lower (able I)
Te growth pattern through the study was not differentbetween the two groups Te mean weight z-score in emales
increased romminus22 at term corrected age tominus18 at six monthso corrected age independently rom the ormula consumed Noincrease in mean weight z-score in males during the study wasobserved No catch-up in length was recorded up to six months ocorrected age in both groups independently rom gender Meanhead circumerence z-score value did not change through out thestudy (able II)
No difference in the quality o growth in terms o at ree massand at mass in the two groups was detected (able III) Accordingto our previously published results [11] mean percentage o atmass at term corrected age was higher than that shown by theull-term AGA newborns at birth probably because o an adap-tive mechanism to extra uterine lie However the mean valueo percentage o at mass ound at six months o corrected age
suggests that being born SGA is accompanied by a relative lack oat mass accretion during the first months afer term As a conse-quence the weight gain composition was characterized mainly byan increase in lean body mass ( gain = 234)
In conclusion this study suggests that the growth pattern inSGA preterm inants is not affected by the consumption o anenriched post discharge ormula Te ponderal and linear growtho these inants does not accelerate to achieve early catch upgrowth However as ar as the quality o growth is concerned theat mass accretion afer term decelerates so that an increase oat ree mass accretion takes place Future research effort shouldbe directed toward longer ollow up and personalized nutritionmanagement
Declaration of interest Te authors declare no conflict ointerest
References1 Stoll BJ Hansen NI Bell EF Shankaran S Laptook AR Walsh MC
Hale EC et al Eunice Kennedy Shriver National Institute o ChildHealth and Human Development Neonatal Research NetworkNeonatal outcomes o extremely preterm inants rom the NICHDNeonatal Research Network Pediatrics 2010126443ndash456
2 Peter A Lee Steven D Chernausek Anita CS Hokken-KoelegaPaul Czernichow International small or gestational age advisoryboard consensus development conerence statement Managemento short children born small or gestational age Pediatrics 20031111253ndash1261
3 Verkauskiene R Beltrand J Claris O Chevenne D DeghmounS Dorgeret S Alison M et al Impact o etal growth restrictionon body composition and hormonal status at birth in inants osmall and appropriate weight or gestational age Eur J Endocrinol 2007157605ndash612
4 Fenton TR A new growth chart or preterm babies Babson andBendarsquos chart updated with recent data and a new ormat BMC Pediatr 2003163ndash13
5 Giannigrave ML Roggero P Taroni F L iotto N Piemontese PMosca F Adiposity in small or gestational age preterm inantsassessed at term equivalent age Arch Dis Child Fetal Neonatal Ed 200994F368ndashF372
6 Bertino E Coscia A Mombrograve M Boni L Rossetti G Fabris CSpada E Milani S Postnatal weight increase and growth velocityo very low birthweight inants Arch Dis Child Fetal Neonatal Ed 200691F349ndashF356
7 Campos M Reyes G Garciacutea L Comparison o postdischarge growthin adequate or gestational age and small or gestational age very lowbirthweight inants Ethn Dis 200818S2ndash118
8 Roggero P Giannigrave ML Liotto N Taroni F Orsi A Amato O MorlacchiL et al Rapid recovery o at mass in small or gestational age preterminants afer term PLoS ONE 20116e14489
9 Morgan JA Young L McCormick FM McGuire W Promoting growthor preterm inants ollowing hospital discharge Arch Dis Child FetalNeonatal Ed 2011
10 Fewtrell MS Growth and nutrition afer discharge Semin Neonatol 20038169ndash176
11 Roggero P Giannigrave ML Amato O Liotto N Morlacchi L Orsi APiemontese P Taroni F Mosca F Growth and at mass in preterm inantsed a protein-enriched postdischarge ormula (PDF) A randomizedcontrolled trial Accepted or oral presentation at European Society orPediatric Society Newcastle 2011
12 Roggero P Giannigrave ML Orsi A Piemontese P Amato O LiottoN Morlacchi L et al Quality o growth in exclusively breast-edinants in the first six months o lie an italian study Pediatr Res 201068542ndash544
