Eligible infants: 29 to 33 weeks of gestation
This is an unmasked randomized clinical trial in which 80 infants born very preterm receiving early and exclusive enteral nutrition will be assigned to one of two groups. Half of the infants will receive early fortification, starting between day 4 and 7 after birth, while the other half will receive delayed fortification, starting between day 10 and 14. The goal is to investigate whether providing early protein supplementation through early fortification in infants receiving early and exclusive enteral nutrition leads to higher lean mass accretion and greater diversity in the gut microbiome.
Eligible infants: 28 weeks of gestation or less
This clinical trial aims to investigate the effects of different vitamin D doses on extremely preterm infants who are fed human milk. A total of 126 infants will be enrolled and randomly assigned to either the intervention group, which will receive the highest recommended vitamin D dose, or the control group, which will receive the lowest recommended dose, during the first 14 days after birth. The main outcomes that will be assessed are the severity of respiratory morbidity, measured by a scoring system based on ventilatory support and oxygen supplementation, and pulmonary mechanics, measured using a non-invasive oscillometry device. Specifically, the area under the reactance curve (AX) will be determined using the tremoflo N-100 Neo Oscillometry device.
Eligible infants: 32 weeks of gestation or less, birthweight below the 25th percentile
This is a masked randomized clinical trial in which very preterm infants fed human milk are randomly assigned to receive a DHA/ARA supplement during the first 3 weeks after birth.
Eligible infants: 32 weeks of gestation or less
This is a prospective cohort study of human milk diets during the early postnatal development of premature babies. We want to establish the correlation between skeletal muscle mass (SMM) measured by the D3-creatine (D3Cr) dilution method and FFM measured by air-displacement plethysmography. The D3Cr method involves a one-time oral dose of D3Cr.
Eligible infants: 28 - 32 weeks of gestation
This prospective cohort study aims to assess whether preterm neonates born between 28-32 weeks of gestation retain excess water during periods of stagnant weight loss by measuring total body water at four time points using non-invasive bioelectrical impedance analysis (BIA).
Assessing growth quality in preterm infants is challenging, particularly with standard fat-free mass (FFM) measurements. This study demonstrated a moderate correlation between skeletal muscle mass (SMM) measured by the D3-creatine (D3Cr) dilution method and FFM measured by air-displacement plethysmography. The D3Cr method involves a one-time oral dose of D3Cr, which integrates into the sarcomere’s creatine pool, enabling precise SMM assessment. With 98% of creatine stored in muscle and consistently converted to creatinine for excretion, this innovative approach could position SMM as a key marker of growth quality in preterm infants, complementing traditional FFM metrics.
We evaluated the risk of cognitive impairment in extremely preterm infants using INTERGROWTH-21st standards, focusing on growth parameters at birth and 36 weeks postmenstrual age (PMA). Among 5393 infants born at 24-26 weeks gestation, growth failure (weight z-score ≤-1.8 at 36 weeks PMA) and growth faltering (weight z-score decline ≥1.1 from birth to 36 weeks PMA) were linked to higher cognitive impairment risk at 2 years. Length z-scores < -1 had the highest sensitivity (80%) for detecting cognitive impairment, while a head circumference z-score decline ≥2.43 had the highest specificity (86%). These findings highlight the importance of monitoring length and head circumference to identify at-risk infants early, enabling timely interventions to potentially mitigate cognitive impairment.
This study investigated the association between race and fat accretion in a cohort of 888 very preterm infants (<32 weeks gestation) from seven U.S. neonatal units. Black infants, comprising 53% of the cohort, had lower birthweights than white infants (1112 ± 334 g vs. 1228 ± 366 g; p < 0.0001). However, after adjusting for key covariates, black infants exhibited higher weight gain velocity (adjusted mean difference: 0.5 g/kg/day; p = 0.03) but similar body fat percentage (BF%) z-scores at discharge (adjusted mean: 1.2 vs. 1.3; p = 0.14). These findings highlight the complexity of racial disparities in neonatal growth, emphasizing the importance of targeted nutritional strategies to address inequities in the NICU.
This randomized controlled trial examined the effects of early and exclusive enteral nutrition in 102 very preterm infants (280/7–326/7 weeks gestation) admitted to a tertiary NICU. Infants in the intervention group received 60–80 mL/kg/day of maternal or donor milk within the first 36 hours after birth, compared to standard trophic feeding (20–30 mL/kg/day) in the control group. Early enteral feeding significantly increased the number of full enteral feeding days within the first 28 days (+2 days; p=0.004), improved fat-free mass-for-age z-scores at day 14 (+0.5; p=0.02) and length-for-age z-scores at discharge (+0.6; p=0.002), and reduced hospitalisation costs by $28,754 on average (p=0.04). These findings suggest early exclusive enteral nutrition may optimize growth and reduce costs in very preterm infants.
This masked, randomized trial evaluated the impact of early fortified human milk diets on growth outcomes in 150 extremely preterm infants (≤28 weeks gestation) fed maternal or donor milk. Infants were randomized on feeding day 2 to receive either human milk fortified with a human-based product (intervention) or standard, unfortified human milk (control) until transitioning to a bovine-based fortifier. While fat-free mass (FFM)-for-age z scores at 36 weeks postmenstrual age (PMA) did not differ between groups, the intervention group exhibited higher length gain velocities and smaller declines in head circumference-for-age z scores. These findings suggest early fortification may support linear growth and head circumference preservation in extremely preterm infants.After measuring body fat by air-displacement plethysmography in preterm infants randomized to receive either high-volume (180-200 mL/kg/day) or usual volume feeding (140-160 mL/kg/day), we concluded that there are no significant differences in the amount of body fat between infants receiving high or usual-volume feeds.
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