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Intake and macronutrient content in human milk given to extremely preterm infants
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: Human milk (HM) is the preferred basis of nutrition for infants, including those born prematurely. Information on macronutrient content in HM is necessary to optimize nutritional support of preterm infants.

Objectives: To describe the types and amounts of enteral feeds given to Swedish extremely preterm infants during hospitalization and to investigate the energy and macronutrient content in HM given to these infants.

­Methods: A population-based study of Swedish extremely preterm infants (n=586) born before 27 gestational weeks. Data on ingested volumes of different milks during hospitalization and analyses of macronutrient content in HM samples were obtained from hospital records. Nutritional content of HM was determined by mid-infrared spectrophotometry analysis.

Results: During the first four weeks of life, 99% of the infants were exclusively fed HM and at four weeks of life, 70% of the infants received only mother’s own milk (MOM). Nutritional content in 821 MOM samples were analyzed. Protein content in MOM decreased significantly from 2.2g to 1.2g/100 mL during the first 112 postpartum days, while fat and energy content were highly variable within and between MOM samples. Additionally, 354 samples of donor milk were analyzed. Content of protein, fat and energy in pooled donor milk (n=129) were lower compared to single donor milk.

Conclusions: Swedish extremely preterm infants receive MOM to a large extent during hospitalization. Protein, carbohydrates and energy in MOM changed significantly with time. Weekly analyses of MOM during the first month of lactation would allow a more individualized nutritional support to these vulnerable infants.

Keyword [en]
Donor milk, Enteral nutrition, Extremely preterm infants, Human milk, Neonatal nutrition, Protein
National Category
Medical and Health Sciences
Research subject
Pediatrics
Identifiers
URN: urn:nbn:se:umu:diva-88462OAI: oai:DiVA.org:umu-88462DiVA: diva2:715733
Available from: 2014-05-06 Created: 2014-05-06 Last updated: 2014-05-07Bibliographically approved
In thesis
1. The impact of early nutrition on extremely preterm infants
Open this publication in new window or tab >>The impact of early nutrition on extremely preterm infants
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background Modern neonatal care has improved the survival rate of extremely preterm infants. These infants are at high risk of malnutrition and growth failure during 3-4 months of hospital care. The objectives of this study was to investigate nutritional intakes during hospitalization and explore associations between nutritional intakes, postnatal growth and retinopathy of prematurity (ROP). Perioperative nutrition in infants undergoing surgery for patent ductus arteriosus (PDA) was also investigated.

Methods This is a population-based study of Swedish extremely preterm infants (<27 weeks) born during 2004-2007 (n=602). Detailed data on nutritional supply and anthropometric measurements during hospitalization were retrospectively retrieved from hospital records. Comprehensive data on cohort characteristics, neonatal morbidity and infant mortality were obtained from the Extremely Preterm Infants in Sweden Study (EXPRESS).

Results During the first 70 days of life, intakes of energy, protein and several micronutrients, with the exception of iron and some vitamins, were less than estimated requirements, and infants showed severe postnatal growth failure. Energy and protein intake predicted growth in all anthropometric outcomes even when adjusting for severity of illness, and fat intake was positively associated with head growth. Low folate intake was positively correlated with poor weight and length gain while high iron intake, mainly explained by blood transfusions, was negatively associated with poor length gain. Furthermore, a low energy intake was associated with severe ROP (stage 3-5). An increased energy intake of 10 kcal/kg/d was associated with 24% decrease in severe ROP (p=0.01). During the first month, 99% of the infants were exclusively fed human milk. Infants who underwent surgery for PDA (n=140) were malnourished, with energy and macronutrient intakes below minimum estimated requirements before, during and after surgery.

Conclusions The severe postnatal growth failure observed in Swedish extremely preterm infants may be prevented by improved intakes of energy, protein, fat and folate and a reduction of the number of blood transfusions. Human milk is the main enteral food source and analyses of human milk macronutrient contents facilitates individualized fortification. Provision of adequate energy intakes during the first four weeks of life may be an effective way to reduce the risk of severe ROP. Perioperative nutrition in infants undergoing PDA surgery needs to be improved. The study results have important implications for nutritional regimens, postnatal growth and health outcome in this new generation of survivors.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2014. 65 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1642
Keyword
Energy intake, enteral intake, extremely preterm infants, folate, growth failure, human milk, iron, macronutrients, malnutrition, micronutrients, nutrient intake, patent ductus arteriosus, protein, retinopathy of prematurity, surgery
National Category
Pediatrics Nutrition and Dietetics
Identifiers
urn:nbn:se:umu:diva-88461 (URN)978-91-7601-039-6 (ISBN)
Public defence
2014-05-28, Sal 135, by 9A, Norrlands Universitetssjukhus, Umeå, 13:00 (English)
Opponent
Supervisors
Available from: 2014-05-07 Created: 2014-05-06 Last updated: 2014-05-07Bibliographically approved

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