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Objective:The present study aims to determine the knowledge, attitudes and views of the Muslim religious officers regarding infant feeding, breast milk, wet nursing, milk kinship and human milk banks (HMBs).Study Design:A total of 401 religious officers were included in the study. Participants included 355 community service religious officers and 46 faculty religious officers.Results:Two hundred fifty-four (63.3%) participants were in favor of administering donor human milk when breast milk is not available from the mothers. To the question 'What kind of human milk bank would you approve as far as the religious sensitivity is concerned?' a majority of the religious officers (71.3%) responded that they would only approve if the milk pool contained a restricted HMB where a limited number of recipients were allowed to use the mixtures in these milk pools. Only 7 (1.7%) participants advocated initiating Western-style HMBs in Turkey.Conclusion:Turkish religious officers have revealed that they would only approve the establishment of an alternative HMB by a maximum three donors where up to three recipients whose identities are known by one another are allowed to use donor milk from each milk pool. [ABSTRACT FROM AUTHOR]

Objective:To compare the incidence of metabolic acidosis and feeding intolerance associated with powdered or acidified liquid human milk fortifier (HMF).Study Design:This retrospective study evaluated infants ⩽32 weeks gestational age or ⩽1500 g birth weight who received human milk with either powdered or acidified liquid HMF (50 consecutively born infants per group). Primary outcomes tracked were metabolic acidosis (base excess less than −4 mmol l−1 or bicarbonate less than 18 mmol l−1), feeding intolerance (gastric residual >50% feed volume, >3 loose stools or emesis per day, abdominal tenderness or distention), necrotizing enterocolitis, late-onset infection, death, length of hospital stay and ability to remain on HMF. Demographics, feeding practices, growth parameters and laboratory data were also collected.Result:Significantly more infants who received acidified liquid HMF developed metabolic acidosis (P<0.001). Base excess and bicarbonate were both significantly decreased after HMF addition in the liquid HMF group (base excess P=0.006, bicarbonate P<0.001). More infants were switched off liquid HMF due to metabolic acidosis or feeding intolerance than those on powdered HMF (P<0.001). Despite increased protein intake in the liquid HMF group (P=0.009), both groups had similar enteral caloric intakes with no difference in growth rates between the two groups. There was no significant difference in any of the other primary outcomes.Conclusion:Infants receiving acidified liquid human milk fortifier were more likely to develop metabolic acidosis and to be switched off HMF than those who received powdered HMF. Growth in the liquid HMF group was no different than the powdered group, despite higher protein intake. [ABSTRACT FROM AUTHOR]

Objective:To examine the relationship between blood urea nitrogen (BUN) during the first 3 weeks of life and protein intake and creatinine (Cr) and to quantify the effect of protein intake on postnatal growth in preterm infants.Study Design:This is a 4-year, single-center, retrospective cohort study. We used multivariable linear regression models to examine the relationships between mean weekly BUN and protein intake adjusted for mean weekly Cr and potential confounders. We used additional regression models to examine the effect of protein intake on growth during this period.Result:Overall, 249 infants met study criteria. As protein intake increased over the first 3 weeks of life, both BUN and Cr decreased significantly. Linear regression models showed protein intake and Cr were each significantly associated with mean BUN for each study week.Conclusion:Protein intake and Cr were each significantly associated with BUN. Significant amelioration of growth failure was seen with higher protein intake. [ABSTRACT FROM AUTHOR]

Objective:With China's rapid economic growth in the past 3 decades, an increase in rate of macrosomia has been reported in China. Fetal growth is a result of multiple factors including genetic potential for growth, maternal nutrition, maternal metabolism, endocrine factors and placental perfusion and function. However, the detailed mechanism of how macrosomia happened remains poorly known. Recent studies showed that the expression of a number of microRNAs (miRNAs) in placentas is involved in fetal growth. We hypothesized that aberrant expression of microRNA-21 (miR-21) and microRNA-16 (miR-16) in placenta is associated with macrosomia.Study design:Using quantitative real time PCR, we analyzed the expression level of miR-21 and miR-16 in terminal placentas of macrosomia pregnancies (n=35) and normal controls (n=35). Potential target genes of miRNA were predicted using TargetScan, miRanda and PicTar. Target genes were mapped to KEGG pathways using KEGG Mapper with an in-house Perl script with KEGG Gene IDs.Result:MiR-21 showed significant up-regulation in macrosomia (P=0.037). After controlling the potential confounders, multivariable logistic regression analysis suggested the risk of macrosomia increased, multivariable adjusted ORs of macrosomia for those in the highest tertile was 3.931 (95%CI: 1.049-14.736) compared with those in the lowest tertile in terms of miR-21 level. The target genes of miR-21 were involved in eight possible signaling pathways. They were pathways in P53 signaling pathway, MAPK signaling pathway, HIF-1 signaling pathway, TGF-beta signaling pathway and PI3K-Akt signaling pathway (P<0.001), Wnt signaling pathway, Jak-STAT signaling pathway and mTOR signaling pathway (P<0.05).Conclusion:Our study is the first to investigate the association between placental miRNA expression and macrosomia. Our results indicate that the expression level of miR-21 in placental tissue may be involved in the development of macrosomia. [ABSTRACT FROM AUTHOR]

Objective:Better measures are needed to identify infants at risk for developing necrotizing enterocolitis (NEC) and facilitate communication about risk across transitions. Although NEC is multi-factorial, quantification of composite risk for NEC in an individual infant is not clearly defined. The objective of this study was to describe the derivation, validation and calibration testing of a novel clinical NEC risk index, GutCheckNEC. Individual risk factors were weighted to assess composite odds of developing NEC. GutCheckNEC is designed to improve communication about NEC risk and coordination of care among clinicians across an infant's clinical course.Study design:On the basis of a synthesis of research evidence about NEC risk and an e-Delphi study including 35 neonatal experts, we identified NEC risk factors believed by the experts to be most relevant for a NEC risk index, then applied a logistic model building process to derive and validate GutCheckNEC. De-identified data from the Pediatrix BabySteps Clinical Data Warehouse (discharge date 2007 to 2011) were split into three samples for derivation, validation and calibration. By comparing infants with medical NEC, surgical NEC and those who died to infants without NEC, we derived the logistic model using the un-matched derivation set. Discrimination was then tested in a case-control matched validation set and an un-matched calibration set using receiver operating characteristic curves.Result:Sampled from a cohort of 58 820 infants, the randomly selected derivation set (n=35 013) revealed nine independent risk factors (gestational age, history of packed red blood cell transfusion, unit NEC rate, late-onset sepsis, multiple infections, hypotension treated with inotropic medications, Black or Hispanic race, outborn status and metabolic acidosis) and two risk reducers (human milk feeding on both days 7 and 14 of life, and probiotics). Unit NEC rate carried the most weight in the summed score. Validation using a 2:1 matched case-control sample (n=360) demonstrated fair to good discrimination. In the calibration set (n=23 447), GutCheckNEC scores (range 0 to 58) discriminated those infants who developed surgical NEC (area under the curve (AUC)=0.84, 95% confidence interval (CI) 0.82 to 0.84) and NEC leading to death (AUC=0.83, 95% CI 0.81 to 0.85), more accurately than medical NEC (AUC= 0.72, 95% CI 0.70 to 0.74).Conclusion:GutCheckNEC represents weighted composite risk for NEC and discriminated infants who developed NEC from those who did not with very good accuracy. We speculate that targeting modifiable NEC risk factors could reduce national NEC prevalence. [ABSTRACT FROM AUTHOR]

Objective:To perform a quantitative review of the evidence on the diagnostic value of inflammatory markers in maternal serum or umbilical cord blood for the diagnosis of early-onset neonatal sepsis (EONS).Study Design:We searched multiple databases for studies published through March 2013 that evaluated the diagnostic performance of procalcitonin (PCT), C-reactive protein (CRP) and interleukin-6 (IL-6), and leukocyte count (white blood cell, WBC) in either umbilical cord blood or maternal serum for diagnosis of EONS. We summarized test performance characteristics with the use of forest plots, hierarchical summary receiver operating characteristic curves and bivariate random effects models.Result:Our search identified 3874 citations, of which 15 studies evaluating 2178 episodes of suspected neonatal infection were included for analysis. IL-6 in cord blood with a pooled-positive likelihood ratio (LR+) of 9.47 (95% confidence interval: 3.86 to 23.3), PCT in cord blood with a LR+ of 5.72 (1.56 to 21.0) and IL-6 in maternal serum with a LR+ of 5.47 (2.10 to 14.2) can be qualified as a valid rule-in test. IL-6 in cord blood with a LR− of 0.10 (0.05 to 0.21) and PCT in cord blood with a LR− of 0.20 (0.12-0.37) can be qualified as a useful rule-out test. Either CRP or WBC was inadequate for diagnosis of EONS.Conclusion:For cord blood sample, IL-6 or PCT can be used as reliable rule-in and rule-out tool. For maternal serum, only IL-6 appeared to be sufficient for rule-in diagnosis. An interventional study may be needed to answer whether the addition of these tests will improve the outcome of patients with EONS. [ABSTRACT FROM AUTHOR]

Objective:To investigate the impact of probiotic Bifidobacterium longum ssp. infantis on the fecal microbiota and plasma cytokines in neonates with congenital heart disease.Study design:Sixteen infants with congenital heart disease were randomly assigned to receive either B. infantis (4.2 × 109 colony-forming units two times daily) or placebo for 8 weeks. Stool specimens from enrolled infants and from six term infants without heart disease were analyzed for microbial composition. Plasma cytokines were analyzed weekly in the infants with heart disease.Results:Healthy control infants had increased total bacteria, total Bacteroidetes and total bifidobacteria compared to the infants with heart disease, but there were no significant differences between the placebo and probiotic groups. Plasma interleukin (IL)10, interferon (IFN)γ and IL1β levels were transiently higher in the probiotic group.Conclusion:Congenital heart disease in infants is associated with dysbiosis. Probiotic B. infantis did not significantly alter the fecal microbiota. Alterations in plasma cytokines were found to be inconsistent. [ABSTRACT FROM AUTHOR]

Objective:To study the possible influences of amino acid (AA) intakes on growth and bone status in preterms.Study Design:Newborns, weighing <1250 g, received standard (S) or higher (H) parenteral AA intakes (3 or 4 g kg−1 per day). Anthropometry, biochemistry and quantitative ultrasound (metacarpus bone transmission time (mcBTT), in μs) were measured prospectively.Result:A total of 55 patients in group S and 60 in group H were studied. Significantly better growth rate was found in the H group during the study without signs of intolerance. We found a significant decrease in mcBTT from birth to 21 days in the H group; nonetheless, mcBTT at 36 weeks of gestational age significantly positively correlated with early AA and energy intakes. A significant positive correlation between mcBTT and lower limb length (LLL) at 21 days was found.Conclusion:Early higher AA intakes improved growth without short-term AA intolerance. Nutritional parameters could influence bone growth. LLL was the anthropometric parameter that best correlated to bone status. [ABSTRACT FROM AUTHOR]

Objective:To study the effect of physical therapy on bone mineralization, weight gain and growth in preterm infants.Method:After fulfilling the inclusion criteria, preterm infants were matched for gestational age and birth weight and then randomly assigned to the physiotherapy group (PG, n=15) and control group (CG, n=14). The PG received motor physical therapy for 15 min daily, 5 times per week until hospital discharge. Bone mineralization was measured by total body dual energy X-ray beam absorptiometry (DEXA) at the onset and end of the study. Statistical analysis was realized by ANCOVA and linear correlation tests.Result:The physical therapy group (PG) presented greater body weight gain per day (27.4±2.4 vs 21.01±4.4 g, P<0.001) and length (1.3±0.3 vs 0.8±0.2 cm week−1, P<0.001) than did the control group (CG). Body composition values verified by DEXA were greater for the PG. The mean gain in bone mineral content (BMC) (mg) was greater in the PG (434±247.5 vs −8.9±11.4, P<0.001), as was the mean bone mineral density (BMD) gain (mg cm−2) (8.4±5.6 vs −3.1±5.5, P<0.001). The gain in bone area (BA,cm2) was 10.3±5 in the PG vs 1.5 ±2 in the CG (P<0.001). The gain in lean mass (LM) (g) in the PG was also greater than in the CG (271.1±21.4 vs 109.1±1.0, P<0.009). The fat mass (g) was similar between the groups (P=0.432).Conclusion:These results showed that physiotherapy in preterm infants produced greater gains in growth, body weight, BMC, BMD, BA and LM.Journal of Perinatology (2008) 28, 624–631; doi:10.1038/jp.2008.60; published online 17 July 2008 [ABSTRACT FROM AUTHOR]

Objective:To determine if physical activity delivered by an infant's mother would be as effective in promoting bone mineral acquisition in preterm very low birth weight (VLBW) infants as the same intervention administered by a trained therapist.Patients and methods:Preterm VLBW infants were randomized to receive daily physical activity administered by the infant's mother (MOM, n=11) or a trained therapist (OT, n=11), or control (n=11). Physical activity consisted of range of motion movements against passive resistance to all extremities for 5 to 10 min daily. All infants were fed mother's milk with fortification to 24 kcal oz−1. Dual energy x-ray of the forearm bone area (BA, cm2), mineral content (BMC, g), and density (BMD, g/cm2) and measurement of bone formation (bone-specific alkaline phosphatase, BAP) and resorption (urine pyridinium crosslinks of collagen, Pyd) were obtained at study entry and at 2.0 kg of body weight.Result:Forearm BA and BMC gains were greater in MOM and OT infants compared to the control infants despite similar postnatal growth rate and nutrient intake. Serum BAP levels decreased in controls but remained unchanged in MOM and OT infants. Urine Pyd levels were similar at baseline to 2.0 kg for all groups. These findings suggest greater bone growth and mineral acquisition in MOM and OT infants than control infants.Conclusion:This study demonstrates that a physical activity program administered by the infant's own mother is as equally effective as therapist-administered physical activity in promoting greater bone growth and mineral acquisition in preterm VLBW infants.Journal of Perinatology (2008) 28, 432–437; doi:10.1038/jp.2008.17; published online 13 March 2008 [ABSTRACT FROM AUTHOR]

Objective:To evaluate accuracy of mid-forehead (MFH) thermometry compared with digital axilla (DAT) temperatures in infants in newborn intensive care.Study design:A comparative study of MFH and DAT temperatures of newborn infants receiving tertiary-level intensive care. All admissions were considered and the following exclusion criteria applied: 'in extremis', hypoxic ischemic encephalopathy or non-English-speaking parents. Foot temperatures, infant and environmental variables were measured.Result:In all, 783 readings were obtained in 100 infants with a birth weight range 515 to 4885 g (mean 2152 g). The between-person correlation was 0.30 (P<0.001) and the within-person correlation was 0.52 (P<0.001). Bland-Altman plots showed wide 95% confidence intervals in the differences between MFH and DAT measurements (−0.87 to 1.16 °C). Differences were affected by infant variables measured. MFH more accurately predicted DAT measurements in smaller neonates and were less accurate in neonates requiring Bubble Continuous Positive Airway Pressure (CPAP).Conclusion:MFH thermometry is not able to replace DAT temperature recording in the newborn intensive care. [ABSTRACT FROM AUTHOR]

Objective:Long-term storage of human milk (HM) requires freezing at low temperatures, the consequences of which upon macronutrients are unclear. To test the null hypothesis that HM freezing and storage for a range of 1 to 10 weeks at −80 °C does not affect HM fat, protein, lactose and energy contents.Study design:Samples of HM were obtained from 20 mothers (60 samples) of preterm infants (25 to 35 weeks gestation), who routinely expressed their milk, every 3 h, using an electric pump, from the second to the seventh week after delivery. All samples were frozen at −80 °C for 8 to 83 days (43.8 days average). After thawing and homogenization, energy and macronutrient contents were measured using an HM analyzer.Result:Fat, carbohydrates and energy contents were significantly lower in thawed HM than in fresh HM (fat, fresh vs thawed: 3.72±1.17 vs 3.36±1.19 g/100 ml, P<0.001; carbohydrates, fresh vs thawed: 5.86±0.71 vs 4.09±0.96 g/100 ml, P<0.001; energy, fresh vs thawed: 64.93±12.97 vs 56.63±16.82 kcal/100 ml, P<0.0001), whereas protein content remained unchanged (protein, fresh vs thawed: 1.14±0.36 vs 1.15±0.37 g/100 ml, P=0.7). The decline in carbohydrates content but not in fat and energy correlated significantly with freezing duration.Conclusion:Freezing at −80 °C significantly decreases the energy content of HM, both from fat and carbohydrates. Since quantitatively the decrease in macronutrients was much higher than that published for HM storage at −20 °C, our results do not support freezing HM at −80 °C as the gold standard for long-term storage. We suggest that caloric intake calculations in preterm infants cannot be established based upon fresh HM data. [ABSTRACT FROM AUTHOR]

Nutrient-enriched diets for preterm infants after hospital discharge (preterm formula or postdischarge formula (PDF)) results in improved growth and these differences appear to persist beyond the period of nutrient intervention. The PDF diet effect is greatest in males, possibly reflecting their higher growth rates. The critical growth epoch appears to be the first 2 months post-term, suggesting a finite period and therefore opportunity for enhanced growth. Whether the observed growth effects persist further or have consequences for other aspects of health or development requires further investigation.Journal of Perinatology (2006) 26, S27–S30. doi:10.1038/sj.jp.7211469 [ABSTRACT FROM AUTHOR]