Alimentazione Alimentazione dopo la dopo la

dimissionedimissioneLuca MaggioLuca Maggio

TIN – UCSC – RomaTIN – UCSC – Roma

Lucas A. Nutrition, Growth and Development of Postdischarge Preterm Infants. In: Post-hospital Nutrition of the Preterm Infant. Report of the 106th Ross Conference on Pediatric Research, Colorado Springs, Colorado, August 18–20, 1995. Columbus, OH: Ross Products Div, Abbott Labs; 1996:81-89

Stop Supplementazione LMFormula per Neonati ATDivezzamento Standard

18 mesi > 30 % Peso < 10° pc7-8 anni > 20 % Peso < 10° pc

Dimissione

> 50 % Peso < 10°pc

VLBWVLBW

-1,48

-1,93

-1,81

-1,54

-2,00

-1,75

-1,50

-1,25sd

s1a

3a2aD

ZScore Peso

-0,45 +0,12

+0,27

-0,74

-1,33-1,48

-1,34

-2,00

-1,75

-1,50

-1,25

-1,00

-0,75

-0,50sd

s

ZScore CC

1a

3a2aD

-0,49 -0,15 +0,14

B.Latal-Hajnal, K.Von Siebenthal, H.Kovari, H.U. Bucher, R.H Largo. Postnatal growth in VLBW infants: significant association with neudevelopmental outcome. J Pediatr 2003 143:163-70

Lucas A, King F, Bishop NB. Postdischarge formula consumption in infants born preterm. Arch Dis Child 1992;67:691-2

ml/kg/dml/kg/d

Lucas A, King F, Bishop NB. Postdischarge formula consumption in infants born preterm. Arch Dis Child 1992;67:691-2

Soluzioni ?

1. Calorie Proteine ?

2. [Latte] IperOsm

3.Formula PT Eccessi (Vit D)

Wheeler RE, Hall RT. Feeding of premature infant formula after hospi-tal discharge of infants weighing less than 1800 g at birth. J Perinatol. 1996;16:111–116

Cooke RJ, Griffin IJ, McCormick K, et al. Feeding preterm infants after hospital discharge: effect of dietary manipulation on nutrient intake and growth. Pediatr Res. 1998;43:355–360

Cooke RJ, McCormick K, Griffin IJ, et al. Feeding preterm infants after hospital discharge: effect of diet on body composition. Pediatr Res. 1999;46:461– 464

Cooke RJ, Embleton ND, Griffin IJ, Wells JC and McCormick KP. Feeding Preterm Infants after Hospital Discharge: Growth and Development at 18 Months of Age Pediatr Res 2001; 49: 719–722

Latte per Prematuri Latte per

Prematuri

RJ Cooke, Embleton ND, IJ Griffin, JCK Wells, K.McKormick. Feeding preterm infants after hospital discharge: growth and development at 18 months of age. Pediatr Res 2001;49:719-22

M F

Lucas A, Bishop NJ, King FJ, Cole TJ. Randomised trial of nutrition for preterm infants after discharge. Arch Dis Child. 1992;67:1413–1414

Atkinson SA, Randall-Simpson J, Chang M, Bosco P. Randomized trial of feeding nutrient-enriched vs standard formula to premature infants during the first year of life. Pediatr Res. 1999;45:276A

Jane D. Carver, Paul Y. K. Wu, Robert T. Hall, Ekhard E. Ziegler, Roberto Sosa, Joan Jacobs, Geraldine Baggs, Nancy Auesta and Beate Lloyd. Growth of Preterm Infants Fed Nutrient-Enriched or Term Formula After Hospital Discharge Pediatrics 2001;107:683– 689

Chan GM. Growth and bone mineral status of discharged very low birth weight infants fed different formulas or human milk. J Pediatr. 1993;123: 439–443

Brunton JA, Atkinson SA, Saigal S. Growth and body composition in infants with bronchopulmonary dysplasia up to 3 months corrected age: A randomized trial of high-energy nutrient-enriched formula fed after hospital discharge. J Pediatr 1998;133:340 –345

Lucas A, Fewtrell MS, Morley R, Singhal A, Abbott RA, Isaacs E, StephensonT, MacFadyenUM and Clements H. Randomized Trial of Nutrient-Enriched Formula Versus Standard Formula for Postdischarge Preterm Infants Pediatrics 2001;108:703–711

PDF PDF

Caratteristiche PDF

Tutto Kal/Proteine

Standard formula

Postdischarge formula

Preterm formula

Protein (g) Energy (kcal) Calcium (mg) Prot/100kcal

1.4-1.5 67

35-54 2.2

1.8-1.9 72-74 70-80 2.5

2.2-2.3 80-90

100-108 2.8

Composition of infant formulas (per dl)

Brunton J, Saigal S, Atkinson SA. Growth and body composition in infants with bronchopulmonary dysplasia up to 3 months corrected age:A randomized trial of a high-energy nutrient-enriched formula fed after hospital discharge.J Pediatr 1998;133:340-5

Proteine + 27 %

Calorie + 6 %

Calcio + 79 %

Fosforo + 23 %

Sodio + 29 %

Potassio + 37 %

Zinco + 76 %

Rame + 36 %

Mn + 47 %

Carnitina +

Vit B1 + 56 %

Vit B2 + 82 %

Vit B6 + 128 %

Vit B12 + 43 %

Folati + 635 %

Vit C + 117 %

Vit D + 30 %

Vit E + 212 %

Vit K + 122 %

Ac Pan. + 74 %

Lucas A, Fewtrell MS, Morley R, Singhal A, Abbot RA, Isaacs E, Stephenson T, MacFadyen UM, Clements H. Randomized trial of nutrient-enriched formula versus standard formula for postdischarge preterm infants. Pediatrics 2001;108:703-11

RisultatiAPM

Eff.TraiettoriaPT > ATM > F

JD Carver, PYK Wu, RT Hall, EE Ziegler, R Sosa, J Jacobs, G Baggs, N Auestad, B Lloyd. Growth of preterm infants fed nutrient-enriched or term formula after hospital discharge. Pediatrics 2001;107:683-89

< 1250 g

Brunton J, Saigal S, Atkinson SA. Growth and body composition in infants with bronchopulmonary dysplasia up to 3 months corrected age:A randomized trial of a high-energy nutrient-enriched formula fed after hospital discharge.J Pediatr 1998;133:340-5

Lucas A, Fewtrell MS, Morley R, Singhal A, Abbot RA, Isaacs E, Stephenson T, MacFadyen UM, Clements H. Randomized trial of nutrient-enriched formula versus standard formula for postdischarge preterm infants. Pediatrics 2001;108:703-11

9 Mo PDF TF p

Wt SDs - 0.86 - 1.22 0.03

L SDs - 0.28 - 0.64 0.029

HC SDs - 0.30 - 0.20 0.60

18 Mo PDF TF

Wt SDs - 1.01 - 1.10 0.60

L SDs - 0.28 - 0.60 0.029

HC SDs - 0.88 - 0.58 0.13

Lucas A, Fewtrell MS, Morley R, Singhal A, Abbot RA, Isaacs E, Stephenson T, MacFadyen UM, Clements H. Randomized trial of nutrient-enriched formula versus standard formula for postdischarge preterm infants. Pediatrics 2001;108:703-11

DubbiComposizione

Consumo (cc vs Kal)TargetDurata

Significatività Clinica

Sviluppo NMLatte Materno

Type of milk InfantsInfantsAuthors

Nutritional follow-up studies in preterm infants

Lucas et al

Wheeler et al

Chan et al

Cooke et al

Brunton et al

Carver et al

Lucas A et al

Rigo et al

SF, PDF

HM, SF, PTF

HM, SF, PDF, PTF

SF, PTF

SF, PTF

SF, PDF

SF, PDF

SF, PDF

Preterm <1850g

Preterm <1850g

Preterm <1650g

Preterm <1750g, <34 w.

VLBW <1500g + BDP

< 37 w.; <1800g

< 37 w.; <1750g

< 34 w.; <1800g

DurationDuration N. infants

Follow-up studies in premature infants:standard (SF) versus enriched formula

(EF)

Lucas et al (1992)

Wheleer RE et al (1996)

Chan GM et al (1993)

Brunton JA et al (1997)

Cooke R et al (1998)

Carver JD et al (2001)

Lucas A et al (2001)

Rigo J et al (2001)

9 months

6 months

8 weeks

3 months

6 months

12 months

18 months

2 months

31

54

59

60

96

125

229

33

Lucas A, Fewtrell MS, Morley R, Singhal A, Abbot RA, Isaacs E, Stephenson T, MacFadyen UM, Clements H. Randomized trial of nutrient-enriched formula versus standard formula for postdischarge preterm infants. Pediatrics 2001;108:703-11

9 Mo PDF TF BF

Wt SDs - 0.86 - 1.22 -1.31

L SDs - 0.28 - 0.64 -0.93

HC SDs - 0.30 - 0.20 -0.15

Crescita durante lo studio Crescita durante lo studio (1)(1)

o + 37 g+ 37 g (Ic 95% 10, 64) Peso (Ic 95% 10, 64) Peso

o + 1,2 cm+ 1,2 cm (Ic 95% 0.5, 1.9) (Ic 95% 0.5, 1.9) LunghezzaLunghezza

Crescita dopo lo studioCrescita dopo lo studio (2) – (2) – Fu 18 mFu 18 mo + 24 g (Ic 95% -4, 52) Peso + 24 g (Ic 95% -4, 52) Peso

o + 0.98 cm+ 0.98 cm (Ic 95% 0.3, 1.7) (Ic 95% 0.3, 1.7) LunghezzaLunghezza

o + 0.03 cm (Ic 95% -0.4, 0.4) + 0.03 cm (Ic 95% -0.4, 0.4) C.CranicaC.Cranica

Outcome NPMOutcome NPM (2) (2)o + 0.23 (Ic 95% -3, 3.5) MDI+ 0.23 (Ic 95% -3, 3.5) MDI

o + 0.56 g (Ic 95% -2, 3) PDI+ 0.56 g (Ic 95% -2, 3) PDI