Lafeber, H.N.

The effect of neutral and acidic oligosaccharides on stool viscosity, stool frequency and stool pH in preterm infants (Article)

2011-04-27T00:00:00Z

Aim: To determine the effect of neutral oligosaccharides [small-chain galacto-oligosaccharides/long-chain fructo-oligosaccharides (scGOS/lcFOS)] in combination with acidic oligosaccharides (pAOS) on stool viscosity, stool frequency and stool pH in preterm infants. Methods: In this explorative RCT, preterm infants with gestational age <32weeks and/or birth weight <1500g received enteral supplementation with scGOS/lcFOS/pAOS or placebo (maltodextrin) between days 3 and 30 of life. Stool samples were collected at day 30 after birth. Results: In total, 113 infants were included. Baseline and nutritional characteristics were not different between both groups. Stool viscosity at day 30 was lower in the prebiotics group (16.8N) (3.9-67.8) compared with the placebo group (26.3N) (1.3-148.0) (p=0.03; 95% CI -0.80 to 0.03). There was a trend towards higher stool frequency in the prebiotics group (3.1±0.8) compared with the placebo group (2.8±0.7) (p=0.15; 95% CI -0.08 to 0.52). Stool pH at day 30 was lower in the in the prebiotics group (5.9±0.6) compared with the placebo group (6.2±0.3) (p=0.009; 95% CI 0.08 to 0.53). Conclusions: Enteral supplementation of a prebiotic mixture consisting of neutral (scGOS/lcFOS) and acidic oligosaccharides (pAOS) decreases stool viscosity and stool pH with a trend towards increased stool frequency in preterm infants. The inclusion of pAOS in a formula containing a mixture of scGOS/lcFOS does not add specific advantages to the formula in terms of stool viscosity, frequency, pH as well as feeding tolerance. © 2011 The Author(s)/Acta Pædiatrica

Neutral and acidic oligosaccharides in preterm infants: A randomized, double-blind, placebo-controlled trial (Article)

2010-03-01T00:00:00Z

Background: Serious infectious morbidity is high in preterm infants. Enteral supplementation of prebiotics may reduce the incidence of serious infections, especially infections related to the gastrointestinal tract. Objective: The objective was to determine the effect of enteral supplementation of a prebiotic mixture consisting of neutral oligosaccharides (SCGOS/LCFOS) and acidic oligosaccharides (AOS) on serious infectious morbidity in preterm infants. Design: In a randomized controlled trial, preterm infants (gestational age <32 wk and/or birth weight <1500 g) received enteral supplementation of 80%SCGOS/LCFOS and 20% AOS (1.5 g·kg-1·d-1) or placebo (maltodextrin) between days 3 and 30 of life. Serious infectious morbidity was defined as a culture positive for sepsis, meningitis, pyelonephritis, or pneumonia. The analysis was performed by intention-to-treat and per-protocol, defined as ≥50% supplementation dose during the study period. Results: In total, 113 preterm infants were included. Baseline and nutritional characteristics were not different between groups. In the intention-to-treat analysis, the incidence of ≥1 serious infection, ≥1 serious endogenous infection, or ≥2 serious infectious episodes was not significantly different in theSCGOS/LCFOS/AOS-supplemented and placebo groups. In the per-protocol analysis, there was a trend toward a lower incidence of ≥1 serious endogenous infection and ≥2 serious infectious episodes in theSCGOS/LCFOS/AOS-supplemented group than in the placebo group (P = 0.09 and P = 0.07, respectively). Conclusions: Enteral supplementation ofSCGOS/LCFOS/AOS does not significantly reduce the risk of serious infectious morbidity in preterm infants. However, there was a trend toward a lower incidence of serious infectious morbidity, especially for infections with endogenous bacteria. This finding suggests a possible beneficial effect that should be evaluated in a larger study. This trial was registered at isrctn.org as ISRCTN16211826.

Majority of dietary glutamine is utilized in first pass in preterm infants (Article)

2010-02-01T00:00:00Z

Glutamine is a conditionally essential amino acid for very low-birth weight infants by virtue of its ability to play an important role in several key metabolic processes of immune cells and enterocytes. Although glutamine is known to be used to a great extend, the exact splanchnic metabolism in enterally fed preterm infants is unknown. We hypothesized that preterm infants show a high splanchnic first-pass glutamine metabolism and the primary metabolic fate of glutamine is oxidation. Five preterm infants (mean ± SD birth weight 1.07 ± 0.22 kg and GA 29 ± 2 wk) were studied by dual tracer ([U-C]glutamine and [N2]glutamine) cross-over techniques on two study days (at postnatal week 3 ± 1 wk). Splanchnic and whole-body glutamine kinetics were assessed by plasma isotopic enrichment of [U-C]glutamine and [N2]glutamine and breath CO2 enrichments. Mean fractional first-pass glutamine uptake was 73 ± 6% and 57 ± 17% on the study days. The splanchnic tissues contributed for a large part (57 ± 6%) to the total amount of labeled carbon from glutamine retrieved in expiratory air. Dietary glutamine is used to a great extent by the splanchnic tissues in preterm infants and its carbon skeleton has an important role as fuel source.

Short-term growth and substrate use in very-low-birth-weight infants fed formulas with different energy contents (Article)

2000-01-01T00:00:00Z

BACKGROUND: Currently available preterm formulas with energy contents of 3350 kJ (800 kcal)/L promote weight and length gain at rates at or above intrauterine growth rates but disproportionately increase total body fat. OBJECTIVE: The objective of this study was to determine whether fat accretion in formula-fed, very-low-birth-weight (VLBW) infants could be decreased and net protein gain maintained by reducing energy intakes from 502 kJ (80 kcal)*kg(-)(1)*d(-)(1) [normal-energy (NE) formula] to 419 kJ (100 kcal)*kg(-)(1)*d(-)(1) [low-energy (LE) formula] while providing similar protein intakes (3.3 g*kg(-)(1)*d(-)(1)). DESIGN: The study was a randomized, controlled trial enrolling 20 appropriate-for-gestational-age (AGA) and 16 small-for-gestational-age (SGA) VLBW infants (mean birth weight: 1.1 kg; mean gestational age: 31 wk); energy expenditure and nutrient balance were measured at 4 wk of age and anthropometric measurements were made when infants weighed 2 kg. RESULTS: The percentage of fat in newly formed tissue was significantly lower in AGA infants fed the LE formula (n = 9) than in those fed the NE formula (n = 10) (9% compared with 23%; analysis of variance, P = 0.001). Energy expenditure was higher in AGA infants fed the NE formula than in those fed the LE formula. Skinfold thickness was markedly lower in AGA infants fed the LE formula than in those fed the NE formula, resulting in a lower estimated percentage body fat (8.0 +/- 1.9% and 10.8 +/- 3.5%, respectively; P < 0.05). Three of 6 SGA infants fed the LE formula were excluded during the study because of poor weight gain. CONCLUSIONS: Body composition can easily be altered by changing the energy intakes of formula-fed VLBW infants. Energy intakes in these infants should be >419 kJ (100 kcal)*kg(-)(1)*d(-)(1).

Experimental intra-uterine growth retardation in the guinea pig (Doctoral Thesis)

1981-05-22T00:00:00Z

In the Western world perinatal mortality rates have been reduced to low levels for various reasons but mainly because of better perinatal care. However morbidity is still relatively high and the concern of every parent for the quality of life of his newborn child demands continuing research into the development of the fetus and the newborn. One of the major groups of infants at risk are those that are born with a low birthweight. Approximately 5-14% of all live born children in Western Europe and the "United States have a birth weight of less than 2500 grams. Of these about two-thirds are born too early and are called "pre term" and one-third is born too small and is called "small for gestational age." Although this division seems logical it took clinicians a long time to realize the differences between these groups that hence require different treatment. ~early fifteen years ago the introduction of the so-called "intrauterine growth charts". that indicated the normal fetal growth for a certain population. offered the opportunity of categorising normal or abnormal fetal growth patterns. During recent years it has become possible to assess human fetal growth by means of ultrasound techniques and thus identify and time growth retardation in utero. At the same time follow-up studies of infants that were born small for gestational age have demonstrated that growth retardation in utero may have permanent effects on later growth and development. For ethical reasons good clinical research studies are difficult. Most research has therefore been concentrated on animals. During recent years much has become known on normal growth and development of the fetus in several species. There are numerous examples that show that fetal development is for instance under endocrine control. However the precise sequence of causal events leading to tissue differentiation late in fetal development remains unclear. Some parameters that influence fetal development may become more clear by studying abnormal fetal growth. Examples of these are the naturally occuring "runts" or the large fetuses that are frequently seen in diabetic pregnancy. Another approach to investigate the regulation of fetal growth is to experimentally reduce mean growth rate in utero. This is the approach used in this thesis which studies intrauterine growth retardation in the guinea pig and investigates some of the consequences of this condition. Such a comparative approach provides a broad background of information and thus general principles that allow specific questions of the human condition to be asked and interpreted adequately