Publications by authors named "Miguel Saenz de Pipaon"

42 Publications

Bone Mineral Density, Body Composition, and Metabolic Health of Very Low Birth Weight Infants Fed in Hospital Following Current Macronutrient Recommendations during the First 3 Years of Life.

Nutrients 2021 Mar 20;13(3). Epub 2021 Mar 20.

Department of Neonatology, Hospital Universitario La Paz, Department of Pediatrics, Universidad Autonoma de Madrid, 28046 Madrid, Spain.

The present study longitudinally evaluated growth, bone mineral density, body composition, and metabolic health outcome in very low birth weight (VLBW) infants whose in-hospital target nutrient intake was within recent recommendations. From six months to three years, bone mineral density (dual-energy X-ray absorptiometry, DXA), body composition, and metabolic health outcome were compared with a reference group of term infants. The aim was to test whether in-hospital achieved weight gain until 36 weeks of gestation (light or appropriate for term equivalent age; LTEA or ATEA) predicts later growth, bone mineral density (BMD), abdominal obesity, or metabolic health outcomes such as insulin resistance, relative to term infants, during the first three years of life. Target in-hospital energy and protein intake was not achieved. Growth in weight, length and head circumference, mid arm circumference, adiposity, fat free mass (FFM), and bone mineralization in VLBW infants was less than those in term infants and influenced by nutritional status at discharge. Preterm infants had poorer motor and cognitive outcomes. Post-discharge body composition patterns indicate FFM proportional to height but lower fat mass index in LTEA preterm infants than term infants, with no evidence of increased truncal fat in preterm infants. The hypothesis of early BMD catch-up in VLBW infants after discharge was not supported by the present data. The clinical significance of these findings is unclear. The data may suggest a reduced obesity risk but an increased osteoporosis risk. Since postnatal growth restriction may have permanent negative health effects, LTEA VLBW infants would especially appear to benefit from targeted preventive interventions. Further follow-up of the infants is required.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/nu13031005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8003951PMC
March 2021

[Occupational exposures, diet and storing: Recommendations to reduce environmental pollutants in breastfeeding].

An Pediatr (Barc) 2021 Apr 27;94(4):261.e1-261.e9. Epub 2021 Feb 27.

Comité de Salud Medioambiental, Asociación Española de Pediatría, Madrid, España.

The pollution of the planet also reaches the breastfeeding ecosystem, one of the most intimate and inviolable that links us as an animal species to the rest of mammals. Nursing mothers may be concerned about whether the quality of their milk will be adequate for their baby and whether environmental pollutants through work, diet, and storing may adversely affect their child. Breast milk is a source of exposure to environmental pollutants, and at the same time it counteracts much of the effects of these exposures. An approach based on the principles of reality and precaution of environmental health to avoid, reduce or eliminate the production and use of harmful chemicals during pregnancy and lactation would improve the human and planetary health for the offspring.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.anpedi.2021.01.017DOI Listing
April 2021

Gut microbes and health.

Gastroenterol Hepatol 2021 Feb 27. Epub 2021 Feb 27.

Ecología Microbiana, Nutrición y Salud, Instituto de Agroquímica y Tecnología de Alimentos, Consejo Superior de Investigaciones Científicas (IATA-CSIC), Valencia, España.

The human body is populated by myriads of microorganisms throughout its surface and in the cavities connected to the outside. The microbial colonisers of the intestine (microbiota) are a functional and non-expendable part of the human organism: they provide genes (microbiome) and additional functions to the resources of our species and participate in multiple physiological processes (somatic development, nutrition, immunity, etc.). Some chronic non-communicable diseases of developed society (atopias, metabolic syndrome, inflammatory diseases, cancer and some behaviour disorders) are associated with dysbiosis: loss of species richness in the intestinal microbiota and deviation from the ancestral microbial environment. Changes in the vertical transmission of the microbiome, the use of antiseptics and antibiotics, and dietary habits in industrialised society appear to be at the origin of dysbiosis. Generating and maintaining diversity in the microbiota is a new clinical target for health promotion and disease prevention.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.gastrohep.2021.01.009DOI Listing
February 2021

Promoting Breastfeeding and Interaction of Pediatric Associations With Providers of Nutritional Products.

Front Pediatr 2020 25;8:562870. Epub 2020 Nov 25.

European Society for Paediatric Infectious Diseases (ESPID), University Children's Hospital Zurich, Zurich, Switzerland.

Pediatric associations have been urged not to interact with and not to accept support from commercial providers of breast milk substitutes (BMSs), based on the assumption that such interaction would lead to diminished promotion and support of breastfeeding. The leadership of seven European pediatric learned societies reviewed the issue and share their position and policy conclusions here. We consider breastfeeding as the best way of infant feeding and strongly encourage its active promotion, protection, and support. We support the World Health Organization (WHO) Code of Marketing of BMSs. Infant formula and follow-on formula for older infants should not be advertised to families or the public, to avoid undermining breastfeeding. With consistently restricted marketing of BMSs, families need counseling on infant feeding choices by well-informed pediatricians. Current and trustworthy information is shared through congresses and other medical education directed and supervised by independent pediatric organizations or public bodies. Financial support from commercial organizations for congresses, educational, and scientific activities of pediatric organizations is an acceptable option if scientific, ethical, societal, and legal standards are followed; any influence of commercial organizations on the program is excluded, and transparency is ensured. Public-private research collaborations for improving and evaluating pharmaceuticals, vaccines, medical devices, dietetic products, and other products and services for children are actively encouraged, provided they are guided by the goal of enhancing child health and are performed following established high standards. We support increasing investment of public funding for research aiming at promoting child health, as well as for medical education.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fped.2020.562870DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7723897PMC
November 2020

Commentary: Consumer Reports of "Keto Flu" Associated With the Ketogenic Diet.

Front Nutr 2020 4;7:113. Epub 2020 Sep 4.

Metabolism and Investigation Unit, Institute Maimónides of Biomedicine Investigation of Córdoba, Reina Sofia University Hospital, University of Córdoba, Córdoba, Spain.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fnut.2020.00113DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7498532PMC
September 2020

[The importance of water consumption in health and disease prevention: the current situation].

Nutr Hosp 2020 Oct;37(5):1072-1086

Facultad de Ciencias de la Salud. Universidad de Zaragoza.

Introduction: Water is an essential nutrient for life and the most abundant component in the human body. However, its dietary recommendations or clinical management guidelines do not receive as much attention as they deserve. In addition, there are some obstacles to establishing optimal values, both for the amount of water the body must contain and for water ingestion. Water intake and elimination depend on unsteady factors that are difficult to measure and, at the same time, compensated by the body's ability to regulate homeostasis. Since scientific evidence is lacking for establishing recommendations, "adequate intakes" (to maintain an adequate hydration state) have been estimated using data on water intake from groups of healthy people. The European Food Safety Authority (EFSA) also considers desirable the use of urine osmolarity to estimate the adequacy of water intake in adults. Clinical studies have generally shown the benefits of adequate hydration and the damage caused by water imbalance, whether quantitative (dehydration and overhydration) or qualitative (extracellular and intracellular water). Unfortunately, these studies are few and often have poor cross-sectional, case-control, or prospective designs, and use small samples or indirect methods to assess hydration status. This article presents up-to-date information on subjects such as: 1) compliance with water consumption recommendations and suggestions for improvement; 2) techniques available to measure hydration status and their clinical applications; 3) effects of hydration/dehydration on physical or cognitive activities and chronic diseases; and 4) existing Spanish regulations on the quality and salubrity of water.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.20960/nh.03160DOI Listing
October 2020

Influence of Maternal Age and Gestational Age on Breast Milk Antioxidants During the First Month of Lactation.

Nutrients 2020 Aug 25;12(9). Epub 2020 Aug 25.

Department of Physiology, Faculty of Medicine, Universidad Autónoma de Madrid, C/Arzobispo Morcillo 2, 28029 Madrid, Spain.

Breast milk (BM) is beneficial due to its content in a wide range of different antioxidants, particularly relevant for preterm infants, who are at higher risk of oxidative stress. We hypothesize that BM antioxidants are adapted to gestational age and are negatively influenced by maternal age. Fifty breastfeeding women from two hospitals (Madrid, Spain) provided BM samples at days 7, 14 and 28 of lactation to assess total antioxidant capacity (ABTS), thiol groups, reduced glutathione (GSH), superoxide dismutase (SOD) and catalase activities, lipid peroxidation (malondialdehyde, MDA + 4-Hydroxy-Trans-2-Nonenal, HNE), protein oxidation (carbonyl groups) (spectrophotometry) and melatonin (ELISA). Mixed random-effects linear regression models were used to study the influence of maternal and gestational ages on BM antioxidants, adjusted by days of lactation. Regression models evidenced a negative association between maternal age and BM melatonin levels (β = -7.4 ± 2.5; -value = 0.005); and a negative association between gestational age and BM total antioxidant capacity (β = -0.008 ± 0.003; -value = 0.006), SOD activity (β = -0.002 ± 0.001; -value = 0.043) and protein oxidation (β = -0.22 ± 0.07; -value = 0.001). In conclusion, BM antioxidants are adapted to gestational age providing higher levels to infants with lower degree of maturation; maternal ageing has a negative influence on melatonin, a key antioxidant hormone.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/nu12092569DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551022PMC
August 2020

Incidence, Treatment, and Outcome Trends of Necrotizing Enterocolitis in Preterm Infants: A Multicenter Cohort Study.

Front Pediatr 2020 13;8:188. Epub 2020 May 13.

Neonatology Department, Complexo Hospitalario Universitario de Santiago de Compostela, Health Research Institute of Santiago de Compostela, A Coruña, Spain.

Data regarding the incidence and mortality of necrotizing enterocolitis trends are scarce in the literature. Recently, some preventive strategies have been confirmed (probiotics) or increased (breastfeeding rate). This study aims to describe the trends of necrotizing enterocolitis incidence, treatment, and mortality over the last decade in Spain. Multicenter cohort study with data from the Spanish Neonatal Network-SEN1500 database. The study period comprised from January 2005 to December 2017. Preterm infants <32 weeks of gestational age at birth without major congenital malformations were included for analysis. The main study outcomes were necrotizing enterocolitis incidence, co-morbidity (bronchopulmonary dysplasia, late-onset sepsis, cystic periventricular leukomalacia, retinopathy of prematurity, acute kidney injury), mortality, and surgical/non-surgical treatment. Among the 25,821 included infants, NEC incidence was 8.8% during the whole study period and remained stable when comparing 4-year subperiods. However, more cases were surgically treated (from 48.8% in 2005-2008 to 70.2% in 2015-2017, < 0.001). Mortality improved from 36.7% in the 2005-2008 to 26.6% in 2015-2017 ( < 0.001). Breastfeeding rates improved over the studied years (24.3% to 40.5%, < 0.001), while gestational age remained invariable (28.5 weeks, = 0.20). Prophylactic probiotics were implemented during the study period in some units, reaching 18.6% of the patients in 2015-2017. The incidence of necrotizing enterocolitis remained stable despite the improvement regarding protective factors frequency. Surgical treatment became more frequent over the study period, whereas mortality decreased.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fped.2020.00188DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7237564PMC
May 2020

Genomics of Isolates Causing Outbreaks in the Same Pediatric Unit 47 Years Apart: Position in an Updated Phylogeny of the Species.

Front Microbiol 2020 31;11:451. Epub 2020 Mar 31.

Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain.

The first documented nosocomial outbreak caused by in Spain occurred in 1969 at the neonatal intensive care unit (NICU) of the tertiary La Paz Children's Hospital in Madrid, Spain, and based on the available phenotyping techniques at this time, it was considered as a monoclonal outbreak. Only 47 years later, another outbreak of an equivalent dimension occurred at the same NICU. The aim of the present study was to study isolates from these historical and contemporary outbreaks by phenotypic analysis and whole-genome sequencing techniques and to position these strains along with 444 publicly available genomes, separately comparing core genome and accessory genome contents. Clades inferred by both approaches showed high correlation, indicating that core and accessory genomes seem to evolve in the same manner for Nine clusters were identified, and isolates were grouped in two of them according to sampling year. One exception was isolate 13F-69, the most genetically distant strain, located in a different cluster. Categorical functions in the annotated accessory genes of both collections were preserved among all isolates. No significant differences in frequency of insertion sequences in historical (0.18-0.20)-excluding the outlier strain-versus contemporary isolates (0.11-0.19) were found despite the expected resting effect. The most dissimilar isolate, 13F-69, contains a highly preserved plasmid previously described in This strain exhibited a few antibiotic resistance genes not resulting in a resistant phenotype, suggesting the value of gene down expression in adaptation to long-term starvation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fmicb.2020.00451DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7136904PMC
March 2020

[Prevention, diagnosis and treatment of necrotising enterocolitis in newborns less than 32 weeks at birth in Spain].

An Pediatr (Barc) 2020 Sep 26;93(3):161-169. Epub 2020 Feb 26.

Servicio de Neonatología, Hospital Clínico Universitario de Santiago de Compostela. Universidad de Santiago, IDIS; CIBERER, Santiago de Compostela, A Coruña, España.

Objectives: To describe preventive, diagnostic and therapeutic strategies regarding necrotising enterocolitis in Spain and to identify the strengths, areas of further improvement, and future research lines.

Methods: Two questionnaires on the management of preterm infants less than 32 weeks, at risk of, or with diagnosed necrotising enterocolitis, were distributed among selected representatives of the surgeons and neonatologists of the Spanish Neonatal Network (SEN1500) participant hospitals with a Paediatric Surgery Department.

Results: Percentage of response was 77.1% of contacted surgeons and 88.6% of neonatologists. There is a written protocol on the diagnosis and medical management of necrotising enterocolitis in 52% of the hospitals, and as regards surgical treatment in 33%. There is wide access to donor bank milk and to staff dedicated to breastfeeding promotion (87%). On the contrary, only 52% of the centres perform delayed cord clamping, and probiotics are used in just 23%. The use of abdominal ultrasound is increasing. There are no large differences as regards duration of antibiotic use and bowel rest, whereas there was as regards antibiotic selection, surgical indication, and type of intervention.

Conclusions: As regards prevention, delayed cord clamping and extended access to donor milk are two possible aspects of further improvement. The observed discrepancies noted in diagnostic and therapeutic aspects are common in precisely the areas where evidence in the literature is weakest.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.anpedi.2019.12.023DOI Listing
September 2020

The Influence of Donor Milk Supplementation on Duration of Parenteral Nutrition in Preterm Infants.

J Hum Lact 2020 May 8;36(2):245-253. Epub 2020 Jan 8.

16268 Department of Neonatology, Hospital Universitario La Paz, Red de Salud Materno Infantil y Desarrollo - SAMID, Universidad Autónoma de Madrid, Madrid, Spain.

Background: Data are limited on the association between the use of donor human milk and improvements in feeding tolerance.

Objective: To determine the influence of the duration of parenteral nutrition on the growth and morbidity of the breastfed newborn when using donated human milk in the absence of mother's own milk.

Methods: We conducted a retrospective study before and after the intervention that compared two groups of newborns ( = 284; each group = 142). We used a convenience sample of all newborns ≤32 weeks gestation consecutively admitted in a single unit before (Group 1 between December 2012 and May 2014) or after (Group 2 between October 2014 and December 2016) the availability of donor human milk. In Group 2, donor human milk was administered at least 3 to 4 weeks or until the baby weighed 1,500 g. Weight was recorded daily and length and head circumference weekly. Parenteral nutrition was continued until enteral feeding volume reached 120 ml/kg/day. Additional variables measured were the number of days with a central venous catheter, age that the enteral feeding volume reached 150 ml/kg/day, and duration of stay.

Results: The duration of parenteral feeding was the same before and after: 12 (8.23) and 11 (7.19) days ( = .822). The scores for weight and height of newborns was lower in Group 2 = -1.8 (1.0) and -2.3 (1.1) and Group 1 = -1.2 (1.1) ( < .001) and -1.8 (1.4) ( = .005).

Conclusion: We did not find an association between the administration of donor human milk as a supplement to mother's own milk and reduced number of days of parenteral nutrition. Back translation by Laurence Grummer-Strawn.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0890334419892908DOI Listing
May 2020

The Evolving Microbiome from Pregnancy to Early Infancy: A Comprehensive Review.

Nutrients 2020 Jan 2;12(1). Epub 2020 Jan 2.

Department of Paediatrics-Neonatology Quironsalud, Madrid University Hospital and Biomedical Research Foundation-IDIPAZ, La Paz University Hospital, 28046 Madrid, Spain.

Pregnancy induces a number of immunological, hormonal, and metabolic changes that are necessary for the mother to adapt her body to this new physiological situation. The microbiome of the mother, the placenta and the fetus influence the fetus growth and undoubtedly plays a major role in the adequate development of the newborn infant. Hence, the microbiome modulates the inflammatory mechanisms related to physiological and pathological processes that are involved in the perinatal progress through different mechanisms. The present review summarizes the actual knowledge related to physiological changes in the microbiota occurring in the mother, the fetus, and the child, both during neonatal period and beyond. In addition, we approach some specific pathological situations during the perinatal periods, as well as the influence of the type of delivery and feeding.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/nu12010133DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019214PMC
January 2020

Plasma Oxidative Status in Preterm Infants Receiving LCPUFA Supplementation: A Pilot Study.

Nutrients 2020 Jan 1;12(1). Epub 2020 Jan 1.

Department of Physiology, Faculty of Medicine, Universidad Autónoma de Madrid, C/ Arzobispo Morcillo, 2, 28029 Madrid, Spain.

After birth, preterm infants are deficient in arachidonic acid (ARA), docosahexaenoic acid (DHA), and antioxidants, increasing their risk of oxidative stress-related pathologies. The principal aim was to evaluate if supplementation with long-chain polyunsaturated fatty acids (LCPUFAs) improves antioxidant defenses. In total, 21 preterm infants were supplemented with ARA and DHA in a 2:1 ratio (ARA:DHA-S) or with medium-chain triglycerides (MCT-S). Plasma -3 and -6 LCPUFAs were measured at birth, postnatal day 28, and 36 weeks of postmenstrual age (36 WPA) by gas chromatography-mass spectroscopy. Plasma antioxidants (glutathione (GSH), catalase, and thiols) and oxidative damage biomarkers (malondialdehyde (MDA), carbonyls) were analyzed at the same time points by spectrophotometry, and scores of antioxidant status (Antiox-S) and oxidative damage (Proxy-S) were calculated. At 36 WPA, linoleic acid (LA) and dihomo--linolenic acid (DGLA) were decreased in ARA:DHA-S compared to the MCT-S group (LA: ARA:DHA-S = 18.54 1.68, MCT-S = 22.80 1.41; = 0.018; DGLA: ARA:DHA-S = 1.68 0.38, MCT-S = 2.32 0.58; = 0.018). Furthermore, α-linolenic acid (ALA) was increased in ARA:DHA-S (ARA:DHA-S = 0.52 0.33, MCT-S = 0.22 0.10; = 0.018). Additionally, LA:DHA ratio was decreased in the ARA:DHA-S compared to control group (ARA:DHA-S = 6.26 2.35, MCT-S = 8.21 2.65; = 0.045). By the end of supplementation (36 WPA), catalase, thiol groups, and Antiox-S were significantly higher in neonates receiving ARA:DHA-S compared to those receiving MCT-S, with no differences in oxidative stress biomarkers. In conclusion, ARA:DHA supplementation in preterm neonates resulted in an overall improvement in antioxidant to oxidant balance and a decrease in early fatty acid precursors of the n-6 relative to the n-3 pathway. These effects may reduce oxidative stress and inflammation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/nu12010122DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019959PMC
January 2020

The Impact of Postnatal Systemic Steroids on the Growth of Preterm Infants: A Multicenter Cohort Study.

Nutrients 2019 Nov 11;11(11). Epub 2019 Nov 11.

Neonatology Department, Hospital Universitario La Paz, 28046 Madrid, Spain.

Postnatal steroids, often used to prevent and treat bronchopulmonary dysplasia, may influence the growth of preterm infants, although data are scarce in the literature. This is a multicenter cohort study including surviving preterm infants <32 weeks at birth ( = 17,621) from the Spanish Neonatal Network SEN1500 database, without major congenital malformations. Linear regression models were adjusted for postnatal steroids, respiratory severity course (invasive mechanical ventilation at 28 days), progression to moderate-severe bronchopulmonary dysplasia (O at 36 weeks), length of stay, sex, gestational age and z-scores at birth. A subgroup analysis depending on the timing of administration, ventilation status at 28 days and moderate-severe BPD diagnosis was also performed. Overall, systemic postnatal steroids were not independently associated with poorer weight gain (0.1; 95% CI: -0.05 to 0.2 g/kg/day), linear growth (0; 95% CI: -0.03 to 0.01 cm/week) or head circumference growth (-0.01; 95% CI: -0.02 to 0 cm/week). Patients who received steroids after 28 days or who were not O dependent at 36 weeks after having received steroids gained more weight (0.22; 95% CI: 0.04 to 0.4 and 0.2; 95% CI: 0.004 to 0.5 g/kg/day, respectively). Globally, systemic postnatal steroids had no significant adjusted effect on postnatal growth.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/nu11112729DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6893656PMC
November 2019

A Review of Bioactive Factors in Human Breastmilk: A Focus on Prematurity.

Nutrients 2019 Jun 10;11(6). Epub 2019 Jun 10.

Department of Physiology, Faculty of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain.

Preterm birth is an increasing worldwide problem. Prematurity is the second most common cause of death in children under 5 years of age. It is associated with a higher risk of several pathologies in the perinatal period and adulthood. Maternal milk, a complex fluid with several bioactive factors, is the best option for the newborn. Its dynamic composition is influenced by diverse factors such as maternal age, lactation period, and health status. The aim of the present review is to summarize the current knowledge regarding some bioactive factors present in breastmilk, namely antioxidants, growth factors, adipokines, and cytokines, paying specific attention to prematurity. The revised literature reveals that the highest levels of these bioactive factors are found in the colostrum and they decrease along the lactation period; bioactive factors are found in higher levels in preterm as compared to full-term milk, they are lacking in formula milk, and decreased in donated milk. However, there are still some gaps and inconclusive data, and further research in this field is needed. Given the fact that many preterm mothers are unable to complete breastfeeding, new information could be important to develop infant supplements that best match preterm human milk.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/nu11061307DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6628333PMC
June 2019

Influence of a Serratia marcescens outbreak on the gut microbiota establishment process in low-weight preterm neonates.

PLoS One 2019 21;14(5):e0216581. Epub 2019 May 21.

Servicio de Microbiología y Parasitología, Hospital Universitario Ramón y Cajal, and Instituto Ramón y Cajal de Investigaciones Sanitarias (IRYCIS), Madrid, Spain.

Adequate gut microbiota establishment is important for lifelong health. The aim was to sequentially analyze the gut microbiota establishment in low-birth-weight preterm neonates admitted to a single neonatal intensive care unit during their first 3 weeks of life, comparing two epidemiological scenarios. Seven control infants were recruited, and another 12 during a severe S. marcescens outbreak. Meconium and feces from days 7, 14, and 21 of life were collected. Gut microbiota composition was determined by 16S rDNA massive sequencing. Cultivable isolates were genotyped by pulsed-field gel electrophoresis, with four S. marcescens submitted for whole-genome sequencing. The expected bacterial ecosystem expansion after birth is delayed, possibly related to antibiotic exposure. The Proteobacteria phylum dominates, although with marked interindividual variability. The outbreak group considerably differed from the control group, with higher densities of Escherichia coli and Serratia to the detriment of Enterococcus and other Firmicutes. Curiously, obligate predators were only detected in meconium and at very low concentrations. Genotyping of cultivable bacteria demonstrated the high bacterial horizontal transmission rate that was confirmed with whole-genome sequencing for S. marcescens. Preterm infants admitted at NICU are initially colonized by homogeneous microbial communities, most of them from the nosocomial environment, which subsequently evolve according to the individual conditions. Our results demonstrate the hospital epidemiology pressure, particularly during outbreak situations, on the gut microbiota establishing process.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0216581PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6529157PMC
January 2020

Cohort study showed that growth rate increment has not been enough to prevent growth retardation of preterm infants and raised concerns about unbalanced growth.

Acta Paediatr 2019 10 21;108(10):1793-1800. Epub 2019 May 21.

Red Samid, Maternal and Child Health and Development Research Network, Carlos III Health Institute, Madrid, Spain.

Aim: We describe the postnatal weight gain, linear and head growth trends of surviving preterm infants from 2005 to 2017.

Methods: Multicentre cohort study, including surviving preterm infants <32 weeks (n = 21 084), from the Spanish Neonatal Network database, without major congenital malformations who were less than 50 weeks postmenstrual age at discharge. Outcomes were weight gain (g/kg/day), linear and head growth (cm/week) and changes in weight, length and head circumference z-scores from birth to discharge. The study period was divided into 2005-8, 2009-11, 2012-14 and 2015-17.

Results: Weight gain, linear growth and head growth were slightly higher in 2015-2017 than in 2005-2008: 12.2 ± 2.6 to 13.1 ± 2.5 g/kg/day, 0.98 ± 0.6 to 1.03 ± 0.6 cm/week and 0.76 ± 0.2 to 0.77 ± 0.3 cm/week, respectively. It was associated with a decreased fall in weigh, length and head circumference z-scores from birth to discharge (-1.32 ± 0.9 to -1.01 ± 0.84, -1.38 ± 1.2 to -1.18 ± 1.2 and -0.41 ± 1.2 to -0.33 ± 1.3, respectively).

Conclusion: Postnatal growth restriction remained a common complication of prematurity despite some increment over the last years. Growth disproportionality seemed to be worsening as weight gain was increased more than linear growth.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/apa.14819DOI Listing
October 2019

The Effect of Morbidity and Sex on Postnatal Growth of Very Preterm Infants: A Multicenter Cohort Study.

Neonatology 2019 20;115(4):348-354. Epub 2019 Mar 20.

Neonatology Department, Hospital Universitario La Paz, Madrid, Spain.

Background: Extrauterine growth restriction is common in the preterm infant, and it is associated with poor neurodevelopment. Nutrition plays an important role in postnatal growth, but growth is also influenced by other factors like co-morbidity, and, also, there might be sex differences.

Methods: This is a cohort study including preterm infants < 32 weeks at birth (n = 21,825) from the Spanish Neonatal Network database. The effect of sex and morbidity (patent ductus arteriosus, bronchopulmonary dysplasia, necrotizing enterocolitis and late-onset sepsis) on weight gain as well as linear and head growth from birth to discharge/death was assessed with linear regression models adjusted by gestational age and Z-scores at birth.

Results: The 4 selected morbidities had an independent effect on all 6 growth parameters studied, which was greater in the case of necrotizing enterocolitis: changes in weight, length and head Z-scores were -0.60 (95% CI: -0.66 to -0.55), -0.62 (95% CI: -0.70 to -0.54) and -0.63 (95% CI: -0.71 to -0.56), respectively. Weight gain and linear growth were overall more affected than head growth. Girls lost slightly more weight Z-scores (-0.03; 95% CI: -0.06 to -0.002) than boys after adjustment by morbidity. There were no significant gender differences regarding linear and head growth velocity (cm/week), although girls lost more head Z-scores (-0.14; 95% CI: -0.18 to -0.10).

Conclusions: Main co-morbidities associated with prematurity have an impact on postnatal growth. Head growth is less affected than length and weight. Girls are at slightly higher risk of postnatal weight and head restriction after adjustment by morbidity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000497221DOI Listing
December 2019

[The first 1000 days: an opportunity to reduce the burden of noncommunicable diseases].

Nutr Hosp 2019 Mar;36(1):218-232

CIBER de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN). Instituto de Salud Carlos III.

Introduction: Growth and development are determined by genetic and environmental factors since the very early embryonic life. Long-term health risks, as obesity and other non-communicable diseases (NCD), could be programmed since these early stages. Early life, characterized by plasticity, is the ideal time to intervene and to prevent the risk of suffering a NCD (window of opportunity). Optimal nutrition during the first 1,000 days, since conception to the end of the second year of life, has a determinant role for long-term health. Pregnancy, infancy and toddler periods have specific nutritional requirements. Intestinal microbiota enhances maturation and functioning of the immune system. The interactions between host and intestinal microbiota are potential factors influencing early programming of the intestinal function. Alterations in intestinal colonization are associated to a higher risk of allergic diseases in childhood. Scientific evidence supports the fact that the first 1,000 days are crucial to achieve a better long-term health and represents a strategic period to intervene under the perspective of prevention and public health.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.20960/nh.02453DOI Listing
March 2019

Effects of Arachidonic and Docosohexahenoic Acid Supplementation during Gestation in Rats. Implication of Placental Oxidative Stress.

Int J Mol Sci 2018 Dec 4;19(12). Epub 2018 Dec 4.

Department of Physiology, Faculty of Medicine, University Autónoma of Madrid, 28029 Madrid, Spain.

Arachidonic and docosahexaenoic acids (ARA and DHA) are important during pregnancy. However, the effects of dietary supplementation on fetal growth and oxidative stress are inconclusive. We aimed to assess the effect of high ARA and DHA diet during rat gestation on: (1) ARA and DHA availability in plasma and placenta, (2) fetal growth, and (3) placental oxidative stress, analyzing the influence of sex. Experimental diet (ED) was prepared by substituting soybean oil in the control diet (CD) by a fungi/algae-based oil containing ARA and DHA (2:1). Rats were fed with CD or ED during gestation; plasma, placenta, and fetuses were obtained at gestational day 20. DHA, ARA, and their precursors were analyzed in maternal plasma and placenta by gas chromatography/mass spectrophotometry. Fetuses and placentas were weighed, the proportion of fetuses with intrauterine growth restriction (IUGR) determined, and placental lipid and protein oxidation analyzed. ED fetuses exhibited lower body weight compared to CD, being >40% IUGR; fetal weight negatively correlated with maternal plasma ARA, but not DHA. Only ED female placenta exhibited higher lipid and protein oxidation compared to its CD counterparts; lipid peroxidation is negatively associated with fetal weight. In conclusion, high ARA during gestation associates with IUGR, through placental oxidative stress, with females being more susceptible.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/ijms19123863DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6321355PMC
December 2018

Study on the nutritional status and feeding habits in school-children in Madrid City (Spain) during the economic crisis.

Nutr Hosp 2018 Oct 5;35(5):1054-1058. Epub 2018 Oct 5.

Clínica Universidad de Navarra.

Introduction: the recent economic and financial crisis has affected most Western countries, especially families of low socioeconomic classes. We speculate that worsening of socioeconomic condition associated with the crisis would increase obesity, mainly in disadvantaged families.

Material And Methods: cross-sectional study of the 290,111 children aged three to 12 years old attending public school during the term 2014-2015 in Madrid City, by means of a stratified weighted sample randomly chosen, taking into account age (grade), city district and schools. The questionnaire included weight and height (auto-reported), dietary report (weekly frequency of intake), as well as socioeconomic variables.

Results: 1,208 questionnaires were evaluated from 64 classes. Half of participants were boys; 42% were younger than five years old, 35% werebetween six and eight years old, and 23% older than eight. Undernutrition was present in 5.0%, and excess of weight (overweight + obesity) in 36.7%. Undernutrition was higher in children under the age of six (9.1%). No relationship was found between undernutrition and the characteristics of the families but was slightly higher in families where both parents were unemployed. Excess of weight was higher in children of non-Spaniard parents (44% vs 32%, p < 0.0001), as well as in those families with economic problems (41% vs 31%, p = 0.0005). Only for meat, grains and dairy, the weekly intake was close to the recommendations.

Conclusions: children from lower income households were at a higher risk of being overweight compared with their peers. Participation in a school-based food aid program may reduce food insecurity for children and their families.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.20960/nh.1824DOI Listing
October 2018

Fat Loss in Continuous Enteral Feeding of the Preterm Infant: How Much, What and When Is It Lost?

Nutrients 2018 Jun 23;10(7). Epub 2018 Jun 23.

Neonatology Department, La Paz University Hospital, Autonomous University of Madrid, 28046 Madrid, Spain.

Human milk fat is a concentrated source of energy and provides essential and long chain polyunsaturated fatty acids. According to previous experiments, human milk fat is partially lost during continuous enteral nutrition. However, these experiments were done over relatively short infusion times, and a complete profile of the lost fatty acids was never measured. Whether this loss happens considering longer infusion times or if some fatty acids are lost more than others remain unknown. Pooled breast milk was infused through a feeding tube by a peristaltic pump over a period of 30 min and 4, 12 and 24 h at 2 mL/h. Adsorbed fat was extracted from the tubes, and the fatty acid composition was analyzed by gas chromatography-mass spectrometry. Total fat loss (average fatty acid loss) after 24 h was 0.6 ± 0.1%. Total fat loss after 24 h infusion was 0.6 ± 0.1% of the total fat infused, although the highest losses occur in the first 30 min of infusion (13.0 ± 1.6%). Short-medium chain (0.7%, = 0.15), long chain (0.6%, = 0.56), saturated (0.7%, = 0.4), monounsaturated (0.5%, = 0.15), polyunsaturated fatty (0.7%, = 0.15), linoleic (0.7%, = 0.25), and docosahexaenoic acids (0.6%, = 0.56) were not selectively adsorbed to the tube. However, very long chain fatty (0.9%, = 0.04), alpha-linolenic (1.6%, = 0.02) and arachidonic acids (1%, = 0.02) were selectively adsorbed and, therefore, lost in a greater proportion than other fatty acids. In all cases, the magnitude of the loss was clinically low.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/nu10070809DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6073555PMC
June 2018

How Should We Define Postnatal Growth Restriction in Preterm Infants?

Neonatology 2018 19;114(2):177-180. Epub 2018 Jun 19.

Neonatology Service, University Hospital La Paz, Madrid, Spain.

Background: Postnatal growth restriction is very common among preterm infants. Growth restriction might be associated with neurodevelopment impairment. The definition of postnatal growth restriction varies among studies. It has often been based on statistical parameters, but we lack biological data to support this definition.

Objectives: The aim here was to study the association between neurodevelopment and postnatal growth restriction defined applying 2 different strategies.

Methods: Bayley Scales of Infant Development-II was performed at 2 years corrected age in 168 preterm infants. Postnatal growth restriction was defined as a weight z-score at 36 weeks <-1.5 or treated as a continuous variable (fall in weight z-scores from birth to 36 weeks postmenstrual age).

Results: Weight z-scores fell in almost all patients (98.8%), and 44.1% had z-scores <-1.5 at 36 weeks. After adjusting for gestational age and small for gestational age at birth, every 1-point fall in weight z-score was associated with a 5.6 point (95% CI 1.7 to 9.4) decrease in the Mental Developmental Index. A weight z-score <-1.5 at 36 weeks was not associated with a worse mental or psychomotor result.

Conclusion: A fall in the weight z-score from birth to 36 weeks is a more rational definition of postnatal growth restriction, and it could predict neurodevelopment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000489388DOI Listing
September 2019

Infantile-onset Pompe disease with neonatal debut: A case report and literature review.

Medicine (Baltimore) 2017 Dec;96(51):e9186

Department of Neonatology-Pediatrics Department of Neuropediatrics Department of Pediatric Cardiology Department of Pathology Department of Pediatrics, La Paz University Hospital, Autonomous University of Madrid, Madrid, Spain Diagnosis and Treatment of Congenital Metabolic Diseases Unit, Department of Neonatology-Pediatrics, IDIS, CIBERER, University Hospital Clinic of Santiago de Compostela, Santiago de Compostela, Spain Health Institute Carlos III, Maternal and Child Health and Development Network-SAMID, Madrid, Spain.

Rationale: Infantile-onset Pompe disease, also known as glycogen storage disease type II, is a progressive and fatal disorder without treatment. Enzyme replacement therapy with recombinant human acid alpha-glucosidase (GAA) enhances survival; however, the best outcomes have been achieved with early treatment.

Patient Concerns: We report a case of a newborn with infantile-onset Pompe disease diagnosed in the first days of life who did not undergo universal neonatal screening. The patient was asymptomatic, with a general physical examination revealing only a murmur. The clinical presentation was dominated by the neonatal detection of hypertrophic cardiomyopathy, without hypotonia or macroglossia.

Diagnoses: Pompe disease was confirmed in the first week of life by GAA activity in dried blood spots, and a GAA genetic study showed the homozygous mutation p.Arg854X.

Interventions: Parents initially refused replacement therapy.

Outcomes: The patient experienced recurrent episodes of ventricular fibrillation during central line placement and could not be resuscitated.

Lessons: Although Pompe disease is rare, and universal screening has not been established, neonatologists should be alerted to the diagnosis of Pompe in the presence of hypertrophic cardiomyopathy. Diagnosis is achieved in a few days with the aid of dried blood spots.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MD.0000000000009186DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5758162PMC
December 2017

Methylation changes and pathways affected in preterm birth: a role for SLC6A3 in neurodevelopment.

Epigenomics 2018 01 27;10(1):91-103. Epub 2017 Nov 27.

Department of Nutrition, Food Sciences & Physiology, Universidad de Navarra, Irunlarrea 1, 31008 Pamplona, Spain.

Aim: To analyze whether preterm newborns show differences in methylation patterns in comparison to full-term newborns in white blood cells.

Patients & Methods: Anthropometrical, biochemical features and methylation levels of preterm newborns (n = 24) and full-term newborns (n = 22) recruited in La Paz University Hospital (Spain) were assessed at 12 months of gestational age, whereas Bayley Scale of Infant Development was evaluated at 24/36 months.

Results: From all the statistically significant CpGs, methylation levels of cg00997378 (SLC6A3 gene) showed the highest differences (p < 0.0001), being associated with prematurity risk factors.

Conclusion: SLC6A3 methylation, previously related to attention-deficit/hyperactivity disorder, neuronal function and behavior, might be a potential epigenetic biomarker with value in the early diagnosis and management of neurodevelopmental diseases in newborns.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2217/epi-2017-0082DOI Listing
January 2018

Nutritional practices in very low birth weight infants: a national survey.

Nutr Hosp 2017 10 24;34(5):1067-1072. Epub 2017 Oct 24.

Paediatrics Service. University Rovira i Virgili, Reus.

Background: Significant efforts have been made to improve the nutritional support of very preterm infants. Large surveys may help to know the nutritional practices for preterm infants in neonatal units and identify if they are in line with the current guidelines.

Methods: A multicentre nationwide web-based survey on clinical feeding practices in very low birth weight (VLBW) infants was conducted in tertiary neonatal hospitals that admit infants with a birth weight < 1,500 g and/or a gestational age of < 32 weeks.

Results: The questionnaire was completed by 53 units (response rate, 59%). Over 90% of the units surveyed start amino-acid administration immediately after birth and more than half use novel intravenous fish oil-based lipid emulsions. Enteral nutrition is started within 24 hours of birth in 65% of units and 86% of these are medium-sized or large. Feeding volumes are increased at a rate of 10-30 ml/kg/day in > 90% of units. Monitoring of serum phosphorus was measured more frequently than albumin (p = 0.009) or triglycerides (p = 0.037), but only 28% of centres regularly measure pre-albumin as a nutritional biomarker. Human milk fortification and iron supplementation, starting at four weeks of age, are almost universal. However, only 30% of units administer 800 IU/day of vitamin D. Nearly 50% of the units discharge infants on preterm formula.

Conclusion: Most Spanish neonatology units use early amino-acid supplementation and over half use novel fish oil-based lipid emulsions. Post-discharge nutrition practices and vitamin administration vary greatly.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.20960/nh.1068DOI Listing
October 2017

The impact of intrauterine and extrauterine weight gain in premature infants on later body composition.

Pediatr Res 2017 Oct 5;82(4):658-664. Epub 2017 Jul 5.

Department of Neonatology, Hospital Universitario La Paz, Red de Salud Materno Infantil y Desarrollo - SAMID, Universidad Autónoma de Madrid, Madrid, Spain.

BackgroundThe impact of intrauterine and extrauterine growth on later insulin resistance and fat mass (FM) in very low birth weight (VLBW) infants is not well established. The aim of our study was to evaluate the effects of intrauterine and early/late extrauterine growth on later insulin resistance and body composition in VLBW infants from 6 months' corrected age (CA) to 36 months.MethodsProspective measurements of body composition by dual-energy X-ray absorptiometry and insulin resistance by homeostasis model assessment insulin resistance (HOMA-IR) along with other fasting plasma biochemistries were made in 95 VLBW infants at 6, 12, 18, and 24 months' CA and 36 months' postnatal age. Mixed-effect models were used to evaluate the effects of age, sex, maturation status, and Δweight SD score on percentage FM (PFM), FM index (FMI), fat-free mass index (FFMI), and HOMA-IR.ResultsPFM and FMI were negatively associated with a decrease in weight-SD scores from birth to 36 weeks' postmenstrual age (PMA; P=0.001) and from 36 weeks' PMA to 6 months' CA (P=0.003). PFM and FMI were higher in AGA than in small for gestational age (SGA) infants. HOMA-IR was not associated with the Δweight-SD scores in either period.ConclusionsCatch-down growth in terms of weight is associated with persistently lower adiposity but not insulin resistance up to 36 months of age.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/pr.2017.123DOI Listing
October 2017

Predicting Full Enteral Feeding in the Postoperative Period in Infants with Congenital Diaphragmatic Hernia.

Eur J Pediatr Surg 2017 Oct 12;27(5):431-436. Epub 2017 Jan 12.

Department of Neonatology, Hospital Universitario La Paz, Madrid, Spain.

 The objective of the study is to examine the factors associated with time to achieve full enteral feeding after repair of congenital diaphragmatic hernia.  Demographic, clinical, and therapeutic data were retrospectively assessed, and uni- and multivariate Cox regression were performed to examine factors predictive of achieving full enteral feeding that was defined as time to achieve120 mL/kg/d after surgical repair.  Of 78 infants, 66 underwent intervention before hospital discharge. All infants who survived had reached full enteral feeding at the time of hospital discharge by a median of 22 days (range: 2-119 days) after surgery and 10 days (range: 1-91) after initiation of postoperative enteral feedings. Independent risk factors associated with a longer time to reach full enteral feeding achievement included gastroesophageal reflux and days of antibiotics in the postoperative period. Daily stool passage preoperatively predicted earlier enteral tolerance.  Infants who survive congenital diaphragmatic hernia generally are able to achieve full enteral feedings after surgical repair. A longer time to full feeding is needed in the most severe cases, but some specific characteristics can be used to help identify patients at higher risk. Although some of these characteristics are unavoidable, others including rational antibiotic usage and active gastroesophageal reflux prevention and treatment are feasible and may improve enteral tolerance.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0036-1597655DOI Listing
October 2017

Effects of different arachidonic acid supplementation on psychomotor development in very preterm infants; a randomized controlled trial.

Nutr J 2015 Sep 30;14:101. Epub 2015 Sep 30.

Neonatology Unit, Department of Paediatrics, University Clinical Hospital of Santiago de Compostela. IDIS, CIBERER, Travesia Choupana, 15706, Santiago de Compostela, Spain.

Background & Aims: Nutritional supplementation with polyunsaturated fatty acids is important in preterm infants neurodevelopment, but it is not known if the omega-6/omega-3 ratio affects this process. This study was designed to determine the effects of a balanced contribution of arachidonic acid in very preterm newborns fed with formula milk.

Methods: This was a randomized trial, in which newborns <1500 g and/or <32 weeks gestational age were assigned to one of two groups, based on the milk formula they would receive during the first year of life. Initially, 60 newborns entered the study, but ultimately, group A was composed of 24 newborns, who were given formula milk with an ω-6/ω-3 ratio of 2/1, and Group B was composed of 21 newborns, given formula milk with an ω-6/ω-3 ratio of 1/1. The infants were followed up for two years: growth, visual-evoked potentials, brainstem auditory-evoked potentials, and plasma fatty acids were periodically measured, and psychomotor development was assessed using the Brunet Lézine scale at 24 months corrected age. A control group, for comparison of Brunet Lézine score, was made up of 25 newborns from the SEN1500 project, who were fed exclusively with breast milk.

Results: At 12 months, arachidonic acid values were significantly higher in group A than in group B (6.95 ± 1.55% vs. 4.55 ± 0.78%), as were polyunsaturated fatty acids (41.02 ± 2.09% vs. 38.08 ± 2.32%) achieved a higher average. Group A achieved a higher average Brunet Lézine score at 24 months than group B (99.9 ± 9 vs. 90.8 ± 11, p =0.028). The Brunet Lézine results from group A were compared with the control group results, with very similar scores registered between the two groups (99.9 ± 9 vs. 100.5 ± 7). There were no significant differences in growth or evoked potentials between the two formula groups.

Conclusions: Very preterm infants who received formula with an ω-6/ω-3 ratio of 2/1 had higher blood levels of essential fatty acids during the first year of life, and better psychomotor development, compared with very preterm newborns who consumed formula with an ω-6/ω-3 of 1/1. Therefore, formula milk with an arachidonic acid quantity double that of docosahexaenoic acid should be considered for feeding very preterm infants.

Trial Registration: ClinicalTrials.gov Identifier NCT02503020.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12937-015-0091-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4590272PMC
September 2015