ABSTRACT
Objective To study the effects of human milk on feeding intolerance, infant growth and development, complications during hospitalization and length of hospital stay in very/extremely low birth weight (VLBW/ELBW) preterm infants. Methods VLBW/ELBW preterm infants admitted to the Division of Neonatology, Children's Medical Center of the Second Xiangya Hospital from May 2015 to April 2018 were enrolled in this retrospective study and were assigned into two groups: human milk group (human milk accounted for at least 50% of total enteral feeding during hospitalization) and formula group (exclusive formula feeding due to breastfeeding contraindication or insufficient human milk supply). Feeding intolerance, neonatal growth, complications and length of hospital stay were compared between the two groups using independent sample t-test, Mann-Whitney U test and Chi-square test (or Fisher's exact probability test). Results A total of 113 VLBW/ELBW infants were enrolled consisting of 52 in the human milk group and 61 in the formula group. The starting time of enteral feeding, duration of minimal enteral feeding and incidence of feeding intolerance were similar between the two groups (all P>0.05). The increasing rate of milk volume was (8.4±1.6) ml/(kg·d) in the human milk group and (7.6±1.4) ml/(kg·d) in the formula group (t=2.853, P<0.05). The length of parenteral nutrition of the human milk group was shorter than that of the formula group [(29.3±7.6) vs (33.0±7.9) d, t=－2.570, P<0.05], so was the time to full enteral feeding [(30.0±7.8) vs (34.9±8.8) d, t=－3.076, P<0.05]. No significant difference was found in the average weight gain, increment in head circumference or body length, the length of regaining birth weight, or the incidence of extrauterine growth restriction between the two groups (all P>0.05). The incidence of neonatal necrotizing enterocolitis (NEC) in the human milk group was lower than that of the formula group [1.9% (1/52) vs 11.5% (7/61), χ2=3.894, P<0.05]. No statistical difference in the incidence of sepsis, cholestasis, anemia, bronchopulmonary dysplasia (BPD), retinopathy of prematurity or periventricular leukomalacia was observed between the two groups (all P>0.05). There were 14 cases (26.9%) of BPD in the human milk group, of which eight were mild and six moderate. While in the formula group, 24 cases (39.3%) had BPD and among them, four, 18 and two infants were mild, moderate and severe BPD, respectively. BPD cases in the human milk group were less severe than those in the formula group (U=－2.645, P<0.05). The length of hospital stay of the human milk group was shorter than that of the formula group [(47.5±14.8) vs (53.9±16.3) d, t= － 2.129, P<0.05)]. Conclusions Human milk for VLBW/ELBW infants may shorten the time to full enteral feeding and the length of hospital stay, reduce the incidence of NEC, decrease the severity of BPD. VLBW/ELBW infants fed with fortified human milk have similar growth rate as those fed with formula milk.
ABSTRACT
Objective: To investigate the expression of gluconeogenic enzymes phosphoenolpyruvate carboxykinase (PEPCK) and G-6-Pase mRNA of hepatic tissue in rats with intrauterine growth retardation (IUGR) and to explore the molecular mechanism of insulin resistance in IUGR rats. Methods: Pregnant rats were randomly divided into 2 groups: a normal group and a model group. hTe normal group were fed with 21% protein forage and the model group with 10% low protein forage to obtain IUGR pup rats. hTe pup rats were introduced to the normal group and the IUGR group prospectively. At 1, 3 and 8 weeks, the body weight, blood glucose, insulin concentration andinsulin resistance index of the pup rats were measured. Expression of PEPCK and G-6-Pase mRNA were detected by RT-PCR. Results: The birth weight of the IUGR group was significantly lower than that of the normal group (P0.05). The hepatic expression of PEPCK and G-6-Pase mRNA in the IUGR group was significantly higher than that of the normal group at 1, 3 and 8 weeks (P<0.01). Conclusion: The significantly increased expression of PEPCK and G-6-Pase mRNA of hepatic tissue in IUGR rats may increase gluconeogenesis, which is probably one of the molecular mechanisms of insulin resistance and diabetes in IUGR.
ABSTRACT
Objective To investigate the changes of serum leptin and bone speed of sound (SOS) with gestational age (GA) and relationship between leptin and bone SOS in appropriate-for-gestational-age (AGA) neonates. Methods A total of 65 AGA neonates were recruited and divided into three groups according to their gestational age:preterm infant (GA 31-34 w, 14 cases), late preterm infant (GA 34-37 w, 13 cases), and full-term infant (GA≥37 w, 38 cases). Anthropometric parameters, including birth weight, length, leg length, skin fold thickness were measured in all the subjects, and the neonatal nutritional status and body fat content were evaluated by Ponderal Index (PI) and Weststrate equation (F%) respectively. Serum leptin concentration and tibial SOS were measured within 7 days after birth. Results There were signiifcant differences in GA (F=140.199, P<0.001), birth weight (F=47.042, P<0.001), birth length (F=46.877, P<0.001), leg length (F=17.543, P<0.001), PI (F=11.898, P<0.001) and F%( F=21.955, P<0.001) among three groups. Serum leptin and tibial SOS were signiifcantly different among these groups ( F=49.724, 20.052 respectively, P<0.001), and both of them were positively correlated with gestational age and birth weight (P<0.01). In addition, leptin was positively correlated with tibial SOS, but the correlation disappeared after adjustment for GA and anthropometry. According to the multivariate forward stepwise regression analysis, tibial SOS was found to be signiifcantly positively associated with gestational age and birth weight in the three groups. Conclusions Both bone SOS and serum leptin are signiifcantly correlated with gestational age and birth weight in AGA neonates, and leptin is related with but not the independent direct predictor of bone SOS.