| 1. |
- Stoltz Sjöström, Elisabeth, 1967-, et al.
(author)
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Low energy intake during the first 4 weeks of life increases the risk for severe retinopathy of prematurity in extremely preterm infants
- 2016
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In: Archives of Disease in Childhood-Fetal and Neonatal Edition. - London, UK : BMJ. - 1359-2998 .- 1468-2052. ; 101:2
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Journal article (peer-reviewed)abstract
- Objectives Poor weight gain during the first weeks of life in preterm infants is closely associated with the risk of developing the retinopathy of prematurity (ROP) and insufficient nutrition might be an important contributing factor. This study aimed to evaluate the effect of energy and macronutrient intakes during the first 4 weeks of life on the risk for severe ROP (stages 3-5). Study design A population-based study including all Swedish extremely preterm infants born before 27 gestational weeks during a 3-year period. Each infant was classified according to the maximum stage of ROP in either eye as assessed prospectively until full retinal vascularisation. The detailed daily data of actual intakes of enteral and parenteral nutrition and growth data were obtained from hospital records. Results Of the included 498 infants, 172 (34.5%) had severe ROP and 96 (19.3%) were treated. Energy and macronutrient intakes were less than recommended and the infants showed severe postnatal growth failure. Higher intakes of energy, fat and carbohydrates, but not protein, were significantly associated with a lower risk of severe ROP. Adjusting for morbidity, an increased energy intake of 10 kcal/kg/day was associated with a 24% decrease in severe ROP. Conclusions We showed that low energy intake during the first 4 weeks of life was an independent risk factor for severe ROP. This implies that the provision of adequate energy from parenteral and enteral sources during the first 4 weeks of life may be an effective method for reducing the risk of severe ROP in extremely preterm infants.
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| 2. |
- Stoltz Sjöström, Elisabeth, et al.
(author)
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Nutrient intakes independently affect growth in extremely preterm infants: results from a population-based study
- 2013
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In: Acta Paediatrica. - : Wiley-Blackwell. - 0803-5253 .- 1651-2227. ; 102:11, s. 1067-1074
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Journal article (peer-reviewed)abstract
- AimTo explore associations between energy and macronutrient intakes and early growth in extremely low gestational age (ELGA) infants. less thanbrgreater than less thanbrgreater thanMethodsRetrospective population-based study of all ELGA infants (andlt;27weeks) born in Sweden during 2004-2007. Detailed data on nutrition and anthropometric measurements from birth to 70days of postnatal age were retrieved from hospital records. less thanbrgreater than less thanbrgreater thanResultsStudy infants (n=531) had a meanSD gestational age of 25.3 +/- 1.1weeks and a birth weight of 765 +/- 170g. Between 0 and 70days, average daily energy and protein intakes were 120 +/- 11kcal/kg and 3.2 +/- 0.4g/kg, respectively. During this period, standard deviation scores for weight, length and head circumference decreased by 1.4, 2.3 and 0.7, respectively. Taking gestational age, baseline anthropometrics and severity of illness into account, lower energy intake correlated with lower gain in weight (r=+0.315, pandlt;0.001), length (r=+0.215, pandlt;0.001) and head circumference (r=+0.218, pandlt;0.001). Protein intake predicted growth in all anthropometric outcomes, and fat intake was positively associated with head circumference growth. less thanbrgreater than less thanbrgreater thanConclusionExtremely low gestational age infants received considerably less energy and protein than recommended and showed postnatal growth failure. Nutrient intakes were independent predictors of growth even after adjusting for severity of illness. These findings suggest that optimized energy and macronutrient intakes may prevent early growth failure in these infants.
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| 3. |
- Gialamas, Spyros, et al.
(author)
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Amino acid infusions in umbilical artery catheters enhance protein administration in infants born at extremely low gestational age
- 2022
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In: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 111:3, s. 536-545
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Journal article (peer-reviewed)abstract
- AIM: It is challenging to provide extremely low gestational age neonates (ELGANs) with adequate protein supply. This study aimed to investigate whether amino acid (AA) infusion in the umbilical artery catheter (UAC) in ELGANs is safe and enhances protein supply and growth.METHOD: A before and after study including infants born <27 weeks, treated in Uppsala, Sweden, during 2004-2007, compared those receiving normal saline/10% dextrose in water with those receiving AA infusion in the UAC. Data were retrieved from the Extremely Preterm Infants in Sweden Study, hospital records and the Swedish Neonatal Quality Register. Group comparisons, univariate and multivariate analyses were conducted.RESULTS: AA group (n = 41, females 39%) received on average approximately 0.3 g/kg/day more protein during the first postnatal week, compared to control group (n = 30, females 40%) (unstandardised coefficient (B) 0.26, p .001) but no difference was noted during 8-28 postnatal days. The type of infusion was not associated with growth variables. The incidence of neonatal morbidities and UAC-related thrombosis did not differ between the groups.CONCLUSION: AA infusions in the UACs in ELGANs is safe and enhances protein supply during the first postnatal week. However, this practice is not associated with growth during the first 28 postnatal days.
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| 4. |
- Lundgren, Pia, 1967, et al.
(author)
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The Specificity of the WINROP Algorithm Can Be Significantly Increased by Reassessment of the WINROP Alarm
- 2015
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In: Neonatology. - : S. Karger AG. - 1661-7800 .- 1661-7819. ; 108:2, s. 152-156
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Journal article (peer-reviewed)abstract
- Background: Retinopathy of prematurity (ROP) is a sight-threatening disease affecting extremely preterm infants. The introduction of new ROP screening surveillance systems, with higher sensitivity and specificity than established ROP screening guidelines, has the potential to reduce the number of stressful eye examinations in these infants. Objectives: To improve the specificity of the WINROP (Weight, Insulin-like growth factor-I, Neonatal, ROP) surveillance system, identifying extremely preterm infants requiring treatment for ROP. Methods: Two cohorts that had previously been subjected to WINROP analyses were included and reevaluated in this study. The weight at WINROP alarm for extremely preterm infants, born at gestational age <27 weeks, was reevaluated and by establishing 'safe' WINROP alarm weight limits, an intersample reassessment of WINROP alarm was performed. The two cohorts were as follows: (1) the Extremely Preterm Infants in Sweden Study (EXPRESS) cohort, infants born in Sweden during 2004-2007 (n = 407), and (2) extremely preterm infants in a North American co-hort, born during 2006-2009 (n = 566). Results: In the EXPRESS cohort, 12.5% (40/319) of the infants who previously received a WINROP alarm were now reassessed as having no alarm; the specificity of WINROP in EXPRESS increased from 23.9% (86/360) to 35.0% (126/360). In the North American cohort, 15.4% (81/526) were reassessed as having no alarm; the specificity increased from 8.5% (38/447) to 26.6% (119/447). The sensitivity persisted as 97.5% in EXPRESS (45/47) and 98.3% (117/119) in the North American cohort. Conclusions: The specificity of the WINROP surveillance system for extremely preterm infants can be significantly improved by reassessment using the weight at WINROP alarm. (c) 2015 S. Karger AG, Basel
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| 5. |
- Lundgren, Pia, 1967-, et al.
(author)
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WINROP identifies severe retinopathy of prematurity at an early stage in a nation-based cohort of extremely preterm infants
- 2013
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In: PLOS ONE. - San Francisco : Public Library of Science, PLoS. - 1932-6203. ; 8:9
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To evaluate the ability of a postnatal weight-gain algorithm (WINROP) to identify sight-threatening retinopathy of prematurity (ROP type 1) in a nation-based extremely preterm infant cohort.METHODS: This study enrolled all 707 live-born extremely preterm (gestational age [GA] <27 weeks) infants, born 2004-2007 in Sweden; the Extremely preterm Infants in Sweden Study (EXPRESS). WINROP analysis was performed retrospectively in 407 of the infants using weekly weight gain to assess the preterm infant's risk of developing ROP type 1 requiring treatment. GA, birthweight (BW), and weekly postnatal weight measurements were entered into WINROP. WINROP signals with an alarm to indicate if the preterm infant is at risk for ROP type 1.RESULTS: In this extremely preterm population, WINROP correctly identified 96% (45/47) of the infants who required treatment for ROP type 1. The median time from alarm to treatment was 9 weeks (range, 4-20 weeks).CONCLUSIONS: WINROP, an online surveillance system using weekly weight gain, identified extremely preterm infants at risk for ROP type 1 requiring treatment at an early stage and with high sensitivity in a Swedish nation-based cohort.
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| 6. |
- Späth, Cornelia, et al.
(author)
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Sodium supply from administered blood products was associated with severe intraventricular haemorrhage in extremely preterm infants
- 2022
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In: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 111:9, s. 1701-1708
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Journal article (peer-reviewed)abstract
- Aim: The aim of this study was to investigate the associations between sodium supply, fluid volume, sodium imbalances and severe intraventricular haemorrhage (IVH) in extremely preterm (EPT) infants.Methods: We used data from the EXtremely PREterm infants in Sweden Study (EXPRESS) cohort consisting of all infants born at 22 to 26 gestational weeks from 2004 to 2007 and conducted a nested case–control study. For every infant with severe IVH (grade 3 or peri-ventricular haemorrhagic infarction), one IVH-free control infant with the birthday closest to the case infant and matched for hospital, sex, gestational age and birth weight was selected (n = 70 case–control pairs).Results: Total sodium supply and fluid volume were higher in infants with severe IVH compared with controls [daily total sodium supply until postnatal Day 2: mean ± SD (mmol/kg/day): 5.49 ± 2.53 vs. 3.95 ± 1.91, p = 0.009]. These differences were accounted for by sodium and fluid from transfused blood products. High plasma sodium concentrations or large sodium fluctuations were not associated with severe IVH.Conclusion: Our results suggest a relationship between sodium-rich transfusions of blood products and severe IVH in EPT infants. It is unclear whether this is an effect of sodium load, volume load or some other transfusion-related factor.
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| 7. |
- Späth, Cornelia, et al.
(author)
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Sodium supply influences plasma sodium concentration and the risks of hyper- and hyponatremia in extremely preterm infants
- 2017
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In: Pediatric Research. - : Nature Publishing Group. - 0031-3998 .- 1530-0447. ; 81, s. 455-460
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Journal article (peer-reviewed)abstract
- Background: Hyper- and hyponatremia occur frequently in extremely preterm infants. Our purpose was to investigate plasma sodium (P-Na) concentrations, the incidence of hyper and hyponatremia, and the impact of possible predisposing factors in extremely preterm infants.Methods: In this observational study, we analyzed data from the EXtremely PREterm (< 27 wk.) infants in Sweden Study (EXPRESS, n = 707). Detailed nutritional, laboratory, and weight data were collected retrospectively from patient records.Results: Mean ± SD P-Na increased from 135.5 ± 3.0 at birth to 144.3 ± 6.1 mmol/l at a postnatal age of 3 d and decreased thereafter. Fifty percent of infants had hypernatremia (P-Na >145 mmol/l) during the first week of life while 79% displayed hyponatremia (P-Na < 135 mmol/l) during week 2. Initially, the main sodium sources were blood products and saline injections/infusions, gradually shifting to parenteral and enteral nutrition towards the end of the first week. The major determinant of P-Na and the risks of hyper- and hyponatremia was sodium supply. Fluid volume provision was associated with postnatal weight change but not with P-Na.Conclusion: The supply of sodium, rather than fluid volume, is the major factor determining P-Na concentrations and the risks of hyper- and hyponatremia.
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| 8. |
- Stoltz Sjöström, Elisabeth, 1967-, et al.
(author)
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Intake and macronutrient content in human milk given to extremely preterm infants
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Other publication (other academic/artistic)abstract
- 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.
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| 9. |
- Stoltz Sjöström, Elisabeth, 1967-, et al.
(author)
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Intakes of micronutrients is associated with early growth in extremely preterm infants : a population-based study
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Other publication (other academic/artistic)abstract
- Objectives: To describe micronutrient intakes and explore possible correlations to growth during the first 70 days of life in extremely preterm infants.Methods: Retrospective population-based study including extremely preterm infants (<27 weeks) born in Sweden during 2004-2007. Detailed nutritional and growth data were derived from hospital records.Results: Included infants (n=531), had a mean gestational age of 25 weeks+2 days and a mean birth weight of 765 g. Intakes of calcium, phosphorus magnesium, zinc, copper, iodine, vitamin D and folate were lower than estimated requirements while intakes of iron, vitamin K and several water-soluble vitamins were higher than estimated requirements. High iron intakes were explained by blood transfusions. During the first 70 days of life, taking macronutrient intakes and severity of illness into account, folate intakes were positively correlated with weight (p=0.001) and length gain (p=0.003) and iron intake was negatively associated with length gain (p=0.006).Conclusions: Intakes of many micronutrients were insufficient. Even when considering macronutrient intakes and severity of illness, several micronutrients were independent predictors of early growth. Low intakes of folate were associated with poor weight and length growth. Further, high iron intakes were associated with poor length and head circumference growth. Optimized early micronutrient intakes may improve early growth in extremely preterm infants.
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| 10. |
- Stoltz Sjöström, Elisabeth, 1967-
(author)
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The impact of early nutrition on extremely preterm infants
- 2014
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Doctoral thesis (other academic/artistic)abstract
- 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.
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