Annals of Clinical Nutrition and Metabolism

The impact of nutritional intervention by a nutrition support team on extrauterine growth restriction in very low birth weight infants in Korea: a retrospective cohort study: Seung Yun Lee, Hye Su Hwang, Waonsun Im, Hyojoung Kim, Mi Lim Chung; Ann Clin Nutr Metab 2024;16(3):149-157. Published online December 1, 2024; DOI: https://doi.org/10.15747/ACNM.2024.16.3.149

Abstract PDF ePub: Purpose: Achieving proper weight gain through adequate nutrition is critically important in very low birth weight (VLBW) infants. Despite recent active nutritional interventions, growth restriction is still common in VLBW infants. We aimed to determine whether nutritional intervention by a nutrition support team (NST) mitigated extrauterine growth restriction (EUGR) in VLBW infants.
Methods: We retrospectively reviewed the medical records of VLBW infants admitted to Haeundae Paik Hospital between March 2010 and February 2024. EUGR was defined as a decrease in the weight-for-age-z-score>1.2 from birth to the postconceptional age of 36 weeks, using Fenton growth charts.
Results: Among the 603 enrolled VLBW infants, 434 (72.0%) were diagnosed with EUGR. When comparing the control and nutritional intervention groups, the incidence of EUGR was significantly lower in infants in the intervention group (80.6% vs. 62.8%, P<0.00). Intervention group infants started enteral feeding earlier and reached half and full enteral feeding earlier (P<0.05). In addition, intravenous protein and lipid supply started sooner, increased at a faster rate, and reached peak concentrations sooner in the intervention group (P<0.05).
Conclusion: Nutritional intervention by an NST resulted in a significant decrease in the development of EUGR in VLBW infants.

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Selenium deficiency and supplementation in infants: a narrative review: Ji Young Lee, Min Jung Kang, Hyun Jeong Kim, Sung Yun Suh, Yoon Sook Cho, Sook Hee An; Ann Clin Nutr Metab 2023;15(1):8-14. Published online April 1, 2023; DOI: https://doi.org/10.15747/ACNM.2023.15.1.8

Abstract PDF ePub: Purpose: This review aims to provide an overview of the factors and clinical outcomes associated with selenium deficiency and the guidelines on the optimal selenium supplementation in infants.
Current concept: Selenium is a cofactor required to maintain the activity of glutathione peroxidase and is an essential trace element in the human body. Selenium is involved in many stages of oxidative injury within the human body. In severe cases, selenium deficiency may lead to cardiomyopathy. Particularly in infants, the risk factors for selenium deficiency are preterm birth and long-term parenteral nutrition. Several studies have been conducted on the relationship between selenium deficiency and bronchopulmonary dysplasia, retinopathy of prematurity, and sepsis, all of which are common diseases in preterm infants. In the past, 2–3 mcg/kg/day of intravenous selenium supplementation was recommended in preterm infants with selenium deficiency. However, recent studies have suggested that only 2–3 mcg/kg/day can prevent further decreases of selenium level in the blood of preterm infants, and that higher supplementation of 1.5–4.5 mcg/kg/day or 7 mcg/kg/day is necessary to reach the level of healthy infants at term. The recommended dose of selenium through enteral nutrition for preterm infants is 1.3–4.5 mcg/kg/day or 5–10 mcg/kg/day, depending on the guideline.
Conclusion: Adequate selenium administration is required for adequate nutritional support in infants to prevent selenium deficiency, and more studies should be conducted to establish dosing guidelines considering risk factors in preterm infants.

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Effect of Nutritional Intervention by the Nutrition Support Team on Postnatal Growth in Preterm Infants: So Jin Yoon, Joo Hee Lim, Soon Min Lee, Sun Jung Kim, Sun Kyung Lee, Soo Min Lee; J Clin Nutr 2020;12(2):26-33. Published online December 31, 2020; DOI: https://doi.org/10.15747/jcn.2020.12.2.26

Abstract PDF ePub

Purpose: Nutritional intervention by an interdisciplinary nutrition support team (NST) can potentially improve postnatal growth outcomes in preterm infants. This study aimed to measure the growth impact of a nutritional intervention package performed by an NST in a quality improvement effort in a neonatal intensive care unit (NICU).
Methods: Fifty-two infants born below 2,000 g and admitted to NICU participated in the Quality Improvement (QI) program between March 2016 and February 2017. The nutritional intervention was applied according to newly established nutritional guidelines on parenteral and enteral nutrition, and an NST performed a weekly nutritional assessment. The Z-scores of weight, height, and head circumference were calculated according to the gestational age and sex. The clinical impact on postnatal growth was compared between the QI and pre-QI groups. The pre-QI group included 69 infants admitted in the same NICU between 2014 and 2015.
Results: The time to the initiation of enteral nutrition decreased significantly (P<0.001). Changes in weight (P=0.027), head circumference (P=0.003), Z-scores between birth, and 40 weeks postconceptional age (PCA) were significantly larger in the QI than the pre-QI group. The percentage of infants weighing below the 10th percentile at one month after birth and at 40 weeks PCA was higher in the pre-QI than the QI group.
Conclusion: The implementation of evidence-based best practices for preterm nutrition resulted in significant improvements in the growth outcomes in preterm infants.

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Nutrition Supply and Growth Post Nutrition Support Team Activity in Neonatal Intensive Care Unit
Hye Min Ha, Yu Jin Jung, Yoo Rha Hong, So Yoon Choi
Pediatric Gastroenterology, Hepatology & Nutrition.2024; 27(5): 313. CrossRef

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The Need for Early Screening for Iron Deficiency Anemia in 9- to 12-Month-Old Infants: Yang Hwan Cho, Su Yeong Kim, Dae Yong Yi, Sin Weon Yun, Soo Ahn Chae, In Seok Lim, Na Mi Lee; J Clin Nutr 2019;11(2):52-57. Published online December 31, 2019; DOI: https://doi.org/10.15747/jcn.2019.11.2.52

Abstract PDF ePub: Purpose:
Growth and development of infants can be periodically assessed through health screening, but iron deficiency anemia, which is common in infants, is difficult to detect by conducting only infant health screening. This study evaluated the prevalence of iron deficiency anemia in infants who visited Chung-Ang university hospital between 9 and 12 months of age. The study also determined the difference of anemia between term and preterm infants.
Methods:
The subjects of this study were infants aged 9 to 12 months who visited outpatient clinics of Chung-Ang University Hospital from January 2006 to August 2018 for the purpose of infant health screening and immunizations. We divided the subjects as the term group and the preterm group, and their medical records were retrospectively analyzed.
Results:
One hundred and fifty-two infants were included in the study. There were 51 in the preterm infant group and 101 in the term infant group. Thirteen infants were diagnosed with iron deficiency anemia, and 12 infants of these infants were in the term group and one infant was in the preterm group, which was statistically significant (P<0.001). There are significant differences in the hemoglobin (12.0±1.1 g/dL, 12.6±1.2 g/dL), hematocrit (35.8%±2.7%, 36.7%±3.2%), serum iron (60.8±25.4 μg/dL, 73.5±40.9 μg/dL), and unsaturated iron binding capacity (279.1±67.7 μg/dL, 252.0±47.5 μg/dL) between the term infant group and the preterm infant group, respectively (P<0.05).
Conclusion:
Iron deficiency anemia was significantly more often diagnosed in term infants than that in preterm infants. Preterm infants may have a lower prevalence of iron deficiency anemia than do term infants because the preterm infants are taking iron supplements prophylactically. Therefore, iron deficiency anemia should be prevented in term infants, and it is important to confirm the presence of iron deficiency anemia by conducting blood tests during the first 9 to 12 months of life.

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