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Domellöf, Magnus
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Publications (10 of 133) Show all publications
He, X., Parenti, M., Grip, T., Domellöf, M., Lonnerdal, B., Hernell, O., . . . Slupsky, C. M. (2019). Metabolic phenotype of breast-fed infants, and infants fed standard formula or bovine MFGM supplemented formula: a randomized controlled trial. Scientific Reports, 9, Article ID 339.
Open this publication in new window or tab >>Metabolic phenotype of breast-fed infants, and infants fed standard formula or bovine MFGM supplemented formula: a randomized controlled trial
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2019 (English)In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 9, article id 339Article in journal (Refereed) Published
Abstract [en]

Formula-fed (FF) infants exhibit a different metabolic profile than breast-fed (BF) infants. Two potential mechanisms are the higher protein level in formula compared with breast milk and the removal of the milk fat and associated milk fat globule membranes (MFGM) during production of infant formula. To determine whether MFGM may impact metabolism, formula-fed infants were randomly assigned to receive either an MFGM isolate-supplemented experimental formula (EF) or a standard formula (SF) from 2 until 6 months and compared with a BF reference group. Infants consuming EF had higher levels of fatty acid oxidation products compared to infants consuming SF. Although the protein level in the study formula was approximately 12 g/L (lower than most commercial formulas), a metabolic difference between FF and BF remained such that FF infants had higher levels of amino acid catabolism by-products and a low efficiency of amino acid clearance (preference for protein metabolism). BF infants had higher levels of fatty acid oxidation products (preference for fat metabolism). These unique, energy substrate-driven metabolic outcomes did not persist after diet was shifted to weaning foods and appeared to be disrupted by complementary feeding. Our results suggest that MFGM may have a role in directing infant metabolism.

Place, publisher, year, edition, pages
Nature Publishing Group, 2019
National Category
Pediatrics
Identifiers
urn:nbn:se:umu:diva-156312 (URN)10.1038/s41598-018-36292-5 (DOI)000456392400020 ()30674917 (PubMedID)
Available from: 2019-02-21 Created: 2019-02-21 Last updated: 2019-02-21Bibliographically approved
Späth, C., Zamir, I., Stoltz Sjöström, E. & Domellöf, M. (2019). Use of concentrated parenteral nutrition solutions is associated with improved nutrient intakes and postnatal growth in very low-birth-weight infants. JPEN - Journal of Parenteral and Enteral Nutrition
Open this publication in new window or tab >>Use of concentrated parenteral nutrition solutions is associated with improved nutrient intakes and postnatal growth in very low-birth-weight infants
2019 (English)In: JPEN - Journal of Parenteral and Enteral Nutrition, ISSN 0148-6071, E-ISSN 1941-2444Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: Evidence showing the beneficial effects of enhanced parenteral nutrition (PN) to very low-birth-weight (VLBW,<1500 g) infants is accumulating. However, PN composition and its impact on growth outcomes are questioned. This study aimed to investigate the associations between administration of a concentrated PN regime and intakes of energy and macronutrients as well as postnatal growth in VLBW infants. 

Methods: We compared 2 cohorts of VLBW infants born before (n = 74) and after (n =44) a concentrated PN regime was introduced into clinical use. Daily nutrition and fluid intake during the first 28 postnatal days and all available growth measurements during hospitalization were retrospectively collected from clinical charts. 

Results: Infants who received concentrated PN compared with original PN had higher parenteral intakes of energy (56 vs 45 kcal/kg/d, P < 0.001), protein (2.6 vs 2.2 g/kg/d, P = 0.008), and fat (1.5 vs 0.7 g/kg/d, P < 0.001) during the first postnatal week. Changes in standard deviation scores for weight and length from birth to postnatal day 28 were more positive in the concentrated PN group (mean [95% CI]; weight change: –0.77 [–1.02 to –0.52] vs –1.29 [–1.33 to –1.05], P = 0.005; length change: –1.01 [–1.36 to –0.65] vs –1.60 [–1.95 to –1.25], P = 0.025). There were no significant differences in fluid intake and infant morbidity between the groups. 

Conclusion: Our results suggest that concentrated PN is useful and seems to be safe for improving early nutrition and growth in VLBW infants.

National Category
Pediatrics
Identifiers
urn:nbn:se:umu:diva-148009 (URN)10.1002/jpen.1522 (DOI)
Available from: 2018-05-24 Created: 2018-05-24 Last updated: 2019-03-06
Berglund, S. K., Chmielewska, A., Starnberg, J., Westrup, B., Hägglöf, B., Norman, M. & Domellöf, M. (2018). Effects of iron supplementation of low-birth-weight infants on cognition and behavior at 7 years: a randomized controlled trial. Pediatric Research, 83, 111-118
Open this publication in new window or tab >>Effects of iron supplementation of low-birth-weight infants on cognition and behavior at 7 years: a randomized controlled trial
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2018 (English)In: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 83, p. 111-118Article in journal (Refereed) Published
Abstract [en]

Background Low-birth-weight infants (LBW) are at an increased risk of iron deficiency that has been associated with impaired neurodevelopment. We hypothesized that iron supplementation of LBW infants improves cognitive scores and reduces behavioral problems until school age.

Methods We randomized 285 marginally LBW (2,000-2,500 g) infants to receive 0, 1, or 2 mg/kg/day of iron supplements from 6 weeks to 6 months of age. At 7 years of age, 205 participants were assessed regarding cognition using Wechsler Intelligence Scale for Children (WISC-IV) and behavior using the parental questionnaires Child Behavior Checklist (CBCL) and Five to Fifteen (FTF).

Results There were no significant differences between the intervention groups in WISC-IV or FTF. However, the CBCL scores for externalizing problems were significantly different, in favor of supplemented children (P=0.045). When combining the supplemented groups, they had significantly lower scores for externalizing behavior compared with placebo (median (interquartile range): 44 [34;51] vs. 48.5 [41;56] P=0.013), and their risk ratio (95% confidence interval) for a total behavioral score above the cutoff for clinical problems was 0.31 (0.09-1.0), P=0.054.

Conclusion Lower scores of externalizing behavior in supplemented children support our previous findings at 3 years, and suggest that iron supplementation may have long-lasting effects on behavioral functions.

Place, publisher, year, edition, pages
New York: Nature Publishing Group, 2018
Keywords
weeks gestational age, children born, late preterm, deficiency anemia, brain, growth, childhood, disorder, outcomes, risk
National Category
Pediatrics
Identifiers
urn:nbn:se:umu:diva-145099 (URN)10.1038/pr.2017.235 (DOI)000426175900019 ()28953856 (PubMedID)
Available from: 2018-02-21 Created: 2018-02-21 Last updated: 2018-11-13Bibliographically approved
Mihatsch, W. A., Braegger, C., Bronsky, J., Cai, W., Campoy, C., Carnielli, V., . . . Yan, W. (2018). ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition. Clinical Nutrition, 37(6), 2303-2305
Open this publication in new window or tab >>ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition
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2018 (English)In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 37, no 6, p. 2303-2305Article in journal (Refereed) Published
Place, publisher, year, edition, pages
Churchill Livingstone, 2018
National Category
Nutrition and Dietetics
Identifiers
urn:nbn:se:umu:diva-155227 (URN)10.1016/j.clnu.2018.05.029 (DOI)000454376500001 ()30471662 (PubMedID)
Note

Part: B

Available from: 2019-01-14 Created: 2019-01-14 Last updated: 2019-01-14Bibliographically approved
Domellöf, M., Szitanyi, P., Simchowitz, V., Franz, A. & Mimouni, F. (2018). ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Iron and trace minerals. Clinical Nutrition, 37(6), 2354-2359
Open this publication in new window or tab >>ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Iron and trace minerals
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2018 (English)In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 37, no 6, p. 2354-2359Article in journal (Refereed) Published
Place, publisher, year, edition, pages
Churchill Livingstone, 2018
Keywords
Parenteral Nutrition, Infusions, Parenteral, Trace Elements, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Selenium, Zinc
National Category
Nutrition and Dietetics
Identifiers
urn:nbn:se:umu:diva-155368 (URN)10.1016/j.clnu.2018.06.949 (DOI)000454376500008 ()30078716 (PubMedID)
Note

Part: B

Available from: 2019-01-14 Created: 2019-01-14 Last updated: 2019-01-14Bibliographically approved
Zamir, I., Tornevi, A., Abrahamsson, T., Ahlsson, F., Engström, E., Hallberg, B., . . . Domellöf, M. (2018). Hyperglycemia in extremely preterm infants: insulin treatment, mortality and nutrient intakes. Journal of Pediatrics, 200, 104-110
Open this publication in new window or tab >>Hyperglycemia in extremely preterm infants: insulin treatment, mortality and nutrient intakes
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2018 (English)In: Journal of Pediatrics, ISSN 0022-3476, E-ISSN 1097-6833, Vol. 200, p. 104-110Article in journal (Refereed) Published
Abstract [en]

Objective: To explore the prevalence of hyperglycemia and the associations between nutritional intakes, hyperglycemia, insulin treatment, and mortality in extremely preterm infants.

Study design: Prospectively collected data from the Extremely Preterm Infants in Sweden Study (EXPRESS) was used in this study and included 580 infants born <27 gestational weeks during 2004-2007. Available glucose measurements (n = 9850) as well as insulin treatment and nutritional data were obtained retrospectively from hospital records for the first 28 postnatal days as well as 28- and 70-day mortality data.

Results: Daily prevalence of hyperglycemia >180 mg/dL (10 mmol/L) of up to 30% was observed during the first 2 postnatal weeks, followed by a slow decrease in its occurrence thereafter. Generalized additive model analysis showed that increasing parenteral carbohydrate supply with 1 g/kg/day was associated with a 1.6% increase in glucose concentration (P < .001). Hyperglycemia was associated with more than double the 28-day mortality risk (P < .01). In a logistic regression model, insulin treatment was associated with lower 28- and 70-day mortality when given to infants with hyperglycemia irrespective of the duration of the hyperglycemic episode (P < .05).

Conclusions: Hyperglycemia is common in extremely preterm infants throughout the first postnatal month. Glucose infusions seem to have only a minimal impact on glucose concentrations. In the EXPRESS cohort, insulin treatment was associated with lower mortality in infants with hyperglycemia. Current practices of hyperglycemia treatment in extremely preterm infants should be reevaluated and assessed in randomized controlled clinical trials.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
neonatology, nutrition
National Category
Pediatrics
Research subject
Pediatrics
Identifiers
urn:nbn:se:umu:diva-146880 (URN)10.1016/j.jpeds.2018.03.049 (DOI)2-s2.0-85046719751 (Scopus ID)
Available from: 2018-04-20 Created: 2018-04-20 Last updated: 2018-10-10Bibliographically approved
Westin, V., Klevebro, S., Domellöf, M., Vanpée, M., Hallberg, B. & Stoltz Sjöström, E. (2018). Improved nutrition for extremely preterm infants: a population based observational study. Clinical Nutrition ESPEN, 23, 245-251
Open this publication in new window or tab >>Improved nutrition for extremely preterm infants: a population based observational study
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2018 (English)In: Clinical Nutrition ESPEN, ISSN 2405-4577, Vol. 23, p. 245-251Article in journal (Refereed) Published
Abstract [en]

Background and aims Extremely preterm (EPT) infants are at high risk for malnutrition due to immaturity and medical complications and they often accumulate nutritional deficits and experience growth faltering during treatment at neonatal intensive care units (NICUs). Enhanced intake of energy and protein during the first weeks of life improves weight gain and head circumference growth. The optimal nutritional strategy for these infants' health and long-term development remains unknown. Nutritional regiments have been identified as a potential area for improvement in Swedish NICUs. The aim of this study was to evaluate changes in nutritional intake over time during the first 56 postnatal days in EPT (<27 gestational weeks; n = 316) infants, who were treated in NICUs during 2004–2011 in Stockholm, using a population-based study approach.

Methods Several different nutritional interventions were implemented over the 8-year period. Nutrition and growth data were obtained retrospectively from hospital records. All intakes of enteral and parenteral nutrients were retrieved daily during the first 28 postnatal days and on days 35, 42, 49 and 56.

Results Energy intake (median) increased from 77 kcal/kg/d during the 2004–2005 period to 98 kcal/kg/d during the 2010–2011 period on days 4–6. Median protein intake increased from 2.4 g/kg/d during 2004–2005 to 3.6 g/kg/d during 2010–2011. Energy and protein intake during postnatal days 0–6 increased continuously over the 8 years and protein intake increased during all 56 postnatal days. Full enteral feeds were reached earlier and the proportion of enteral feeds during the first week was higher during 2008–2009 compared to all other years. A significant improvement in growth was primarily noted by comparing the 2004–2005 period to subsequent years.

Conclusions Neonatal nutrition improved significantly in Stockholm from 2004 to 2011. Above all, parenteral nutrition was initiated more promptly during the first week and was provided at higher quantities. However, many of the EPT infants born during the later years still did not reach the recommended macronutrient intake levels. A significant weight gain improvement was observed between 2004–2005 and 2006–2011.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Enteral nutrition, energy, parenteral nutrition, preterm infant, protein
National Category
Pediatrics Nutrition and Dietetics
Research subject
Pediatrics
Identifiers
urn:nbn:se:umu:diva-140687 (URN)10.1016/j.clnesp.2017.09.004 (DOI)000444125800038 ()29460807 (PubMedID)
Available from: 2017-10-16 Created: 2017-10-16 Last updated: 2019-02-20Bibliographically approved
Thunqvist, P., Tufvesson, E., Bjermer, L., Winberg, A., Fellman, V., Domellöf, M., . . . Hallberg, J. (2018). Lung function after extremely preterm birth: A population-based cohort study (EXPRESS). Pediatric Pulmonology, 53(1), 64-72
Open this publication in new window or tab >>Lung function after extremely preterm birth: A population-based cohort study (EXPRESS)
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2018 (English)In: Pediatric Pulmonology, ISSN 8755-6863, E-ISSN 1099-0496, Vol. 53, no 1, p. 64-72Article in journal (Refereed) Published
Abstract [en]

Background and objectives: Follow-up studies of children and young adults born very-to-moderately preterm show persistent and significant lung function deficits. The aim of the study was to determine lung function and airway mechanics in school-aged children born in 2004 to 2007 and extremely preterm (after 22-26 weeks of gestation).

Methods: In a population-based cohort of children born extremely preterm and controls born at term (n=350), follow-up at 61/2-years-of-age was performed using spirometry and impulse oscillometry. Associations to gestational age, smallness for gestational age (SGA), and bronchopulmonary dysplasia (BPD) were assessed.

Results: Children born extremely preterm had lower forced vital capacity (FVC, z-score: -0.7, 95%CI: -1.0;-0.4), forced expiratory volume (FEV1, z-score: -1.1, 95%CI: -1.4; -0.8), higher frequency-dependence of resistance (R5-20, 0.09, 95%CI: 0.05; 0.12 kPaL(-1)s(-1)) and larger area under the reactance curve (AX, 0.78, 95%CI: 0.49; 1.07kPaL(-1)) than controls. In children born at 22-24 weeks of gestation, 24% had FVC and 44% had FEV1 below the lower limit of normal. SGA and severe BPD only marginally contributed to pulmonary outcomes. Asthma-like disease was reported in 40% of extremely preterm children and 15% of controls.

Conclusion: Many children born extremely preterm have altered airway mechanics and significant obstructive reduction in lung function. This warrants consideration for treatment and continued follow-up.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
lung function tests, preterm birth, respiratory mechanics
National Category
Respiratory Medicine and Allergy Pediatrics
Identifiers
urn:nbn:se:umu:diva-143630 (URN)10.1002/ppul.23919 (DOI)000418247800013 ()29152899 (PubMedID)
Available from: 2018-01-29 Created: 2018-01-29 Last updated: 2019-02-08Bibliographically approved
van den Akker, C. H., van Goudoever, J. B., Szajewska, H., Embleton, N. D., Hojsak, I., Reid, D. & Shamir, R. (2018). Probiotics for Preterm Infants: A Strain-Specific Systematic Review and Network Meta-analysis. Journal of Pediatric Gastroenterology and Nutrition - JPGN, 67(1), 103-122
Open this publication in new window or tab >>Probiotics for Preterm Infants: A Strain-Specific Systematic Review and Network Meta-analysis
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2018 (English)In: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 67, no 1, p. 103-122Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Several randomized controlled trials (RCTs) on the use of probiotics to reduce morbidity and mortality in preterm infants have provided inconsistent results. Although meta-analyses that group all of the used strains together are suggesting efficacy, it is not possible to determine the most effective strain that is more relevant to the clinician. We therefore used a network meta-analysis (NMA) approach to identify strains with greatest efficacy.

METHODS: A PubMed search identified placebo-controlled or head-to-head RCTs investigating probiotics in preterm infants. From trials that recorded mortality, necrotizing enterocolitis, late-onset sepsis, or time until full enteral feeding as outcomes, data were extracted and Bayesian hierarchical random-effects models were run to construct a NMA.

RESULTS: Fifty-one RCTs involving 11,231 preterm infants were included. Most strains or combinations of strains were only studied in one or a few RCTs. Only 3 of 25 studied probiotic treatment combinations showed significant reduction in mortality rates. Seven treatments reduced necrotizing enterocolitis incidence, 2 reduced late-onset sepsis, and 3 reduced time until full enteral feeding. There was no clear overlap of strains, which were effective on multiple outcome domains.

CONCLUSIONS: This NMA showed efficacy in reducing mortality and morbidity only in a minority of the studied strains or combinations. This may be due to an inadequate number, or size, of RCTs, or due to a true lack of effect for certain species. Further large and adequately powered RCTs using strains with the greatest apparent efficacy will be needed to more precisely define optimal treatment strategies.

Place, publisher, year, edition, pages
Wolters Kluwer, 2018
National Category
Pediatrics Nutrition and Dietetics
Identifiers
urn:nbn:se:umu:diva-156234 (URN)10.1097/MPG.0000000000001897 (DOI)29384838 (PubMedID)
Available from: 2019-03-22 Created: 2019-03-22 Last updated: 2019-03-22Bibliographically approved
Löfving, A., Domellöf, M., Hellström-Westas, L. & Andersson, O. (2018). Reference intervals for reticulocyte hemoglobin content in healthy infants. Pediatric Research, 84(5), 657-661
Open this publication in new window or tab >>Reference intervals for reticulocyte hemoglobin content in healthy infants
2018 (English)In: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 84, no 5, p. 657-661Article in journal (Refereed) Published
Abstract [en]

Objectives: Iron deficiency anemia in childhood is a serious public health problem worldwide. Reticulocyte hemoglobin content (Ret-He) is a novel biomarker of iron deficiency adopted for adults but there is a lack of reference intervals for Ret-He in infants. The aim of this study was to provide data from healthy infants.

Methods: Swedish infants (n = 456), born at term after normal pregnancies were included. Ret-He was measured at birth (umbilical cord sample), 48–72 h, 4 months, and 12 months. Reference intervals were calculated as ±2 standard deviations from the mean of Ret-He.

Results: Reference intervals for newborn Ret-He were 27.4 to 36.0 pg/L (N = 376) in the cord sample, 28.1–37.7 pg/L (N = 253) at 48–72 h, 25.6–33.4 pg/L (N = 341) at four months and 24.9–34.1 pg/L (N = 288) at 12 months. Ret-He was significantly lower among iron-deficient infants, at 4 months mean difference (95% CI) −4.2 pg/L (−6.1 to −2.4) and at 12 months mean difference (95% CI) −3.4 pg/L (−5.0 to −1.8).

Conclusions: This longitudinal study presents Ret-He reference intervals based on non-anemic and non-iron-deficient infants and constitutes a step towards standardizing Ret-He as a pre-anemia biomarker of iron deficiency in children.

Place, publisher, year, edition, pages
Nature Publishing Group, 2018
National Category
Pediatrics
Identifiers
urn:nbn:se:umu:diva-155118 (URN)10.1038/s41390-018-0046-4 (DOI)000453019100021 ()30140071 (PubMedID)
Available from: 2019-01-08 Created: 2019-01-08 Last updated: 2019-02-20Bibliographically approved
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