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Author(s): Jie Shao [sup.1] [sup.2] , Blair Richards [sup.3] , Niko Kaciroti [sup.3] , Bingquan Zhu [sup.1] , Katy M. Clark [sup.3] , Betsy Lozoff [sup.3] [sup.4] Author Affiliations: (1) [...], Background/Objectives The contribution of iron status at birth to iron status in infancy is not known. We used a physiologic framework to evaluate how iron status at birth related to iron status at 9 months, taking iron needs and sources into account. Subjects/Methods In a longitudinal birth cohort in China, iron status measures in cord blood and venous blood in infancy (9 months) and clinical data were prospectively collected in 545 healthy term maternal-infant dyads. We used structural equation modeling (SEM) to create a 9-month iron composite and to assess direct and indirect contributions of multiple influences on 9-month iron status. Logistic regression was used to calculate odds ratios for iron deficiency (ID), iron deficiency anemia (IDA), and anemia. Results Approximately 15% (78/523) of infants were born with cord SF Conclusions Indicators of iron status at birth, postnatal iron needs, and iron sources independently related to iron status at 9 months. Sex was an additional factor. Public health policies to identify and protect infants at increased risk of ID should be prioritized.

INTRODUCTION Excess adiposity is a major risk factor for adverse health outcomes and chronic diseases. (1) Body fat assessment in infants is important not only as an indicator of nutritional [...], BACKGROUND/OBJECTIVES: Prediction equations are commonly used to estimate body fat from anthropometric measurements, but are population specific. We aimed to establish and validate a body composition prediction formula for Asian newborns, and compared the performance of this formula with that of a published equation. SUBJECTS/METHODS: Among 262 neonates (174 from day 0, 88 from days 1-3 post delivery) from a prospective cohort study, body composition was measured using air-displacement plethysmography (PEA POD), with standard anthropometric measurements, including triceps and subscapular skinfolds. Using fat mass measurement by PEA POD as a reference, stepwise linear regression was utilized to develop a prediction equation in a randomly selected subgroup of 62 infants measured on days 1-3, which was then validated in another subgroup of 200 infants measured on days 0-3. RESULTS: Regression analyses revealed subscapular skinfolds, weight, gender and gestational age were significant predictors of neonatal fat mass, explaining 81.1% of the variance, but not triceps skinfold or ethnicity. By Bland-Altman analyses, our prediction equation revealed a non-significant bias with limits of agreement (LOA) similar to those of a published equation for infants measured on days 1-3 (95% LOA: (- 0.25, 0.26) kg vs (- 0.23, 0.21) kg) and on day 0 (95% LOA: (- 0.19, 0.17) kg vs (- 0.17, 0.18) kg). The published equation, however, exhibited a systematic bias in our sample. CONCLUSIONS: Our equation requires only one skinfold site measurement, which can significantly reduce time and effort. It does not require the input of ethnicity and, thus, aid its application to other Asian neonatal populations. European Journal of Clinical Nutrition (2013) 67, 922-927;doi: 10.1038/ejcn.2013.69;published online 3 April 2013 Keywords: body composition; neonatal fat mass; prediction equation; skinfolds

The assessment of fluid balance and body composition is critical to many aspects of neonatology. FLUID BALANCE During the first days of life, the distribution of fluid within the body [...], BACKGROUND/OBJECTIVES: There is a critical need for improved technologies to monitor fluid balance and body composition in neonates, particularly those receiving intensive care. Bioelectrical impedance analysis meets many of the criteria required in this environment and appears to be effective for monitoring physiological trends. SUBJECT/METHODS: The literature regarding the use of bioelectrical impedance in neonates was reviewed. RESULTS: It was found that prediction equations for total body water, extracellular water and fat-free mass have been developed, but many require further testing and validation in larger cohorts. Alternative approaches based on Hanai mixture theory or vector analysis are in the early stages of investigation in neonates. CONCLUSIONS: Further research is required into electrode positioning, bioimpedance spectroscopy and Cole analysis in order to realise the full potential of this technology. European Journal of Clinical Nutrition (2013) 67, S28-S33; doi: 10.1038/ejcn.2012.162 Keywords: bioelectrical impedance; neonate; fluid balance; body composition

Introduction Every year perinatal asphyxia contributes to over one million newborn deaths worldwide (Lawn et al. 2005). It is commonly described as a condition of impaired gas exchange leading, if [...], Perinatal asphyxia contributes to over one million newborn deaths worldwide annually, and may progress to multiorgan failure. Cardiac dysfunction, of varying severity, is seen in 50%-70% of asphyxiated newborns. Resuscitation is necessary to restore oxygenation to deprived tissues, including the heart. However, reoxygenation of asphyxiated newborns may lead to generation of reactive oxygen species (ROS) and further myocardial damage, termed reperfusion injury. The newborn heart is especially vulnerable to oxidative stress and reperfusion injury due to immature antioxidant defense mechanisms and increased vulnerability to apoptosis. Currently, newborn myocardial protective strategies are aimed at reducing the generation of ROS through controlled reoxygenation, boosting antioxidant defenses, and attenuating cellular injury via mitochondrial stabilization. Key words: heart, hypoxia-reoxygenation, neonate, oxidative stress, therapy. L'asphyxie perinatale contribue a plus d'un million de deces de neonataux a travers le monde annuellement, et elle peut evoluer vers une insuffisance multi-organes. Un dysfonctionnement cardiaque de severite variable est observe chez 50 % a 70 % des nouveaux-nes en asphyxie. La reanimation est necessaire pour retablir l'oxygenation des tissus prives, incluant le coeur. Cependant, la reoxygenation des nouveaux-nes en asphyxie peut mener a la generation d'especes reactives d'oxygene (ERO) et a davantage de dommages cardiaques, appele dommages de reperfusion. Le coeur du nouveau-ne est specialement vulnerable au stress oxydant et au dommage de reperfusion a cause de mecanismes de defenses anti-oxydantes immatures et a une vulnerabilite accrue a l' apoptose. Actuellement, les strategies de protection du myocarde du nouveau-ne visent a reduire la generation d' ERO par une reoxygenation controlee, une stimulation des defenses anti-oxydantes, et une attenuation des dommages cellulaires par la stabilisation des mitochondries. Mots-cles : coeur, hypoxie-reoxygenation, nouveau-ne, stress oxydant, therapie.

The optimal growth of newborn infants depends on securing an adequate and sufficient supply of energy and indispensable nutrients (Dogan et al, 2005). When a newborn must remain in hospital, [...], Background/Objectives: To quantify the rate of progressive failure of very-low-birth-weight (VLBW) infants over time in the neonatal intensive care unit to meet growth milestones. Subjects/Methods: In a prospective longitudinal study, 114 VLBW preterm infants (≤ 1500g) of both sexes, with normal and/or low weight for gestational age were included. At the start, weight, length, mid-upper arm (MUAC), thigh and cephalic circumferences were measured. Weight/age (W/A), length/age and weight/length (±2 z-score) indices were calculated. All measurements were taken at inclusion, at 7, 15 and 30 days of hospitalization. Chi-square test, analysis of variance and repeated-measures tests were estimated. Results: Thirteen cases (14%) died and were excluded soon after the first determinations. In all, 9 (8.9%) died during the study, 12 (11.9%) were discharged before 30 days of life and 80 (79.2%) completed the study. At 7 days, the percentage of preterm infants with an index of W/A < -2 z-scores increased from 44 to 67% (44-68 subjects; P < 0.01), with no changes afterwards; the indicator MUAC < -2 z-scores increased at 7 days from 23 to 49% (23 to 49 subjects); at 15 from 23 to 65% (23-61 subjects) and at 30 days from 23 to 79% (23-63 subjects; P < 0.001). Conclusions: Clinicians could use these indicators for earlier detection of growth failure in VLBW infants in order to target more aggressive nutrition early. European Journal of Clinical Nutrition (2012) 66, 474-480; doi: 10.1038/ejcn.2011.191; published online 16 November 2011 Keywords: preterm infants; nutritional status; intensive care Introduction

Introduction According to World Health Organization, low birth weight (LBW) is defined as weight at birth less than 2500 g (UNICEF and WHO, 2004). The two major causes of LBW [...], Background/Objectives: Low birth weight (LBW), defined as the body weight at birth of less than 2500g, is a major public health problem in Bangladesh, where 37% of the babies are born with LBW. The objective of this study is to see the impact of nutrition education on growth of LBW babies with early initiation and exclusive breastfeeding compared to control group. Subjects/Methods: A total of 184 LBW babies and their mothers who attended the Maternal Care and Health Training Institute and Dhaka Medical College Hospital were randomly allocated to either intervention or control group. Enrollment of the study population started in May 2008 and was completed in October 2008. Nutrition education was given to mothers twice weekly for 2 months, on initiation of breastfeeding within 1 h, exclusive breastfeeding and increasing their dietary intake. Nutritional status of LBW babies was assessed for length and weight every 2 weeks. Data were analyzed using SPSS/Window's version 12. Comparison of mean of data was done using standard Student's t-test. Results: Mean initial body weight and length of LBW babies were similar in both groups (2261 [+ or-] 198g vs 2241 ± 244g, P = 0.535 and 43.0 [+ or-] 1.3 cm vs 43.0 [+ or-] 1.7 cm, P = 0.77). Body weight and length of the LBW babies after 2 months increased significantly (3620 [+ or-] 229 g vs 3315 [+ or-] 301 g, Po 0.001 and 50.2 [+ or-] 1.3 cm vs 48.7 [+ or-] 1.6cm, Po 0.001). It was found that the intervention group suffered less from respiratory illness compared with the control group (39% vs 66%, Po 0.001). The rate of early initiation of breastfeeding was also significantly higher with nutrition intervention (59.8% vs 37.2%, P < 0.001). Exclusive breastfeeding rate was significantly higher in intervention group (59.8% vs 37%, P = 0.003). Conclusions: The present study showed that weight and length gain of LBW babies significantly increased by breastfeeding and nutrition education. Therefore, nutrition education on breastfeeding proves to be a strong tool to reduce the high risk of malnutrition and mortality of the LBW babies. European Journal of Clinical Nutrition (2012) 66, 376-381; doi: 10.1038/ejcn.2011.182; published online 16 November 2011 Keywords: nutrition education; LBW; weight and length gain; exclusive breastfeeding

Introduction Ammonia, a short-lived metabolite of normal protein catabolism, is neurotoxic, and in excess may produce cerebral edema and irreversible neuronal damage, resulting in encephalopathy and death [1, 2]. Detoxification [...], In a 10-year review of the utilization of continuous veno-venous hemofiltration (CVVH) for the treatment of neonatal hyperammonemia, 14 patients were identified with hyperammonemia due to either a urea cycle defect or an organic acidemia. Intensive care survival was 64%. The pretreatment level of serum ammonia and the rapidity of ammonia clearance did not differ between survivors and non-survivors (p=0.16 and p=0.93, respectively). Likewise, the duration of CVVH therapy did not differ between survivors and non-survivors (p=0.1). Indicators of pretreatment physiological stress showed either a correlation with non-survival [Pediatric Risk of Mortality (PRISM) score, p=0.006, cardioactive drug requirement, p=0.003], or demonstrated a trend to such a correlation (serum lactate, p=0.06). Complications associated with the CVVH technique were infrequent. Hypotension was seen in seven patients, but in only one patient did it arise de novo following the initiation of CVVH. In conclusion, neither the severity of the hyperammonemic state nor the efficacy of ammonia removal correlated with patient outcome. The pre-CVVH PRISM score and requirement for cardio-active medication were significantly greater in those patients who did not survive their acute illness. The pre-CVVH physiological condition of the neonates in this cohort was the main determinant of outcome. Keywords Neonates * Continuous veno-venous hemofiltration * Hyperammonemia

Introduction Efforts to reduce maternal mortality and reach the Millennium Development Goal (MDG) 5A have received increased attention in recent years and the maternal mortality ratio is now falling at [...], Background: Neonatal mortality accounts for 43% of global under-five deaths and is decreasing more slowly than maternal or child mortality. Donor funding has increased for maternal, newborn, and child health (MNCH), but no analysis to date has disaggregated aid for newborns. We evaluated if and how aid flows for newborn care can be tracked, examined changes in the last decade, and considered methodological implications for tracking funding for specific population groups or diseases. Methods and Findings: We critically reviewed and categorised previous analyses of aid to specific populations, diseases, or types of activities. We then developed and refined key terms related to newborn survival in seven languages and searched titles and descriptions of donor disbursement records in the Organisation for Economic Co-operation and Development's Creditor Reporting System database, 2002-2010. We compared results with the Countdown to 2015 database of aid for MNCH (2003-2008) and the search strategy used by the Institute for Health Metrics and Evaluation. Prior to 2005, key terms related to newborns were rare in disbursement records but their frequency increased markedly thereafter. Only two mentions were found of 'stillbirth' and only nine references were found to 'fetus' in any spelling variant or language. The total value of non-research disbursements mentioning any newborn search terms rose from US$38.4 million in 2002 to US$717.1 million in 2010 (constant 2010 US$). The value of non-research projects exclusively benefitting newborns fluctuated somewhat but remained low, at US$5.7 million in 2010. The United States and the United Nations Children's Fund (UNICEF) provided the largest value of non-research funding mentioning and exclusively benefitting newborns, respectively. Conclusions: Donor attention to newborn survival has increased since 2002, but it appears unlikely that donor aid is commensurate with the 3.0 million newborn deaths and 2.7 million stillbirths each year. We recommend that those tracking funding for other specific population groups, diseases, or activities consider a key term search approach in the Creditor Reporting System along with a detailed review of their data, but that they develop their search terms and interpretations carefully, taking into account the limitations described. Please see later in the article for the Editors' Summary.

About 20 million babies weighing less than 2500 g are born worldwide each year, 96.5% of them in developing countries. These babies are at high risk of infectious disease, developmental [...]