Neonatal hypoglycemia algorithms improve hospital outcomes.

OBJECTIVE: Neonatal hypoglycemia is a common diagnosis for which management strategies vary. Our goal was to implement hypoglycemia algorithms (HGA) to streamline management of neonatal hypoglycemia within our hospital system and improve outcomes related to promoting the mother-infant dyad and decreasing hospital costs. PATIENTS AND METHODS: A retrospective cohort study analyzed data on 4,666 asymptomatic infants at risk for hypoglycemia and born at two, large, community hospitals between 2010 and 2016. The first algorithm (HGA1) was created in 2012 and subsequently updated (HGA2) in 2014 to include the use of dextrose gel. Infants were separated into three groups by epoch: pre-HGA (2010-2011), HGA1 (2012-2013), and HGA2 (2014-2016). Outcomes between groups were then analyzed. Cost savings were calculated using linear regression. RESULTS: Compared with the pre-HGA group, the HGA1 group had decreased intravenous dextrose use (3.9 vs. 2.5%, p < .001). Compared with the HGA1 group, the HGA2 group had decreased intravenous dextrose use (2.5 vs. 1.0%, p < .001) and increased breastfeeding rates (88.4% vs. 86.7%, p = .003). Neonatal intensive care unit admission rates decreased when comparing the pre-HGA group with the HGA2 group (10.6% vs 9.4%, p = .03). Length of stay was overall unchanged. Total cost savings were approximately $222 per case. CONCLUSIONS: By implementing HGA1 and providing resources to unify care for asymptomatic infants at risk for hypoglycemia, short-term outcomes in our hospital system improved. By updating HGA2 to include the use of dextrose gel, the advantages gained by HGA1 were maintained and further enhanced. Overall cost of care was reduced.

Body composition and cognition in preschool-age children with congenital gastrointestinal anomalies.

BACKGROUND: Children with congenital gastrointestinal anomalies (CGIAs) experience multiple stressors while hospitalized in neonatal intensive care units during an essential time of growth and development. Early stress and inadequate nutrition are linked to altered growth patterns and later neurodevelopmental delays. In other at-risk populations, improved fat-free mass (FFM) accretion is associated with improved cognitive outcomes. OBJECTIVE: To determine if body composition is associated with cognitive function in preschool-age children with CGIAs. STUDY DESIGN: An observational study examined body composition and cognition in 34 preschool-age children with CGIAs. Anthropometric measurements and body composition testing via air displacement plethysmography were obtained. Measurements were compared with a reference group of healthy, term-born children. Cognition was measured with the NIH Toolbox Early Childhood Cognition Battery. Linear regression was used to test the association of body composition with cognitive function. RESULTS: Compared with the reference group, children with CGIAs had similar anthropometric measurements (weight, height, and body mass index z-scores) and body composition at preschool-age. Processing speed scores were lower than standardized means (p = 0.001). Increased FFM was associated with higher receptive vocabulary scores (p = 0.001), cognitive flexibility scores (p = 0.005), and general cognitive function scores (p = 0.05). CONCLUSIONS: At preschool-age, children with CGIAs have similar growth and body composition to their peers. In children with CGIAs, higher FFM was associated with higher cognitive scores. Closer tracking of body composition and interventions aimed at increasing FFM may improve long-term outcomes in this population.

Body Composition Changes from Infancy to 4 Years and Associations with Early Childhood Cognition in Preterm and Full-Term Children.

BACKGROUND: Infants born prematurely are at risk for neurodevelopmental complications. Early growth is associated with improved later cognition. The relationship of early proportionality and body composition with later cognition is not well established. OBJECTIVES: To assess differences in fat-free mass and adiposity (fat mass, percent body fat) changes in preterm and full-term infants through preschool age and examine associations with early childhood cognition. METHODS: This is a prospective, observational study in an appropriate for gestational age cohort of 71 patients (20 preterm and 51 full-term) from infancy through preschool age. Anthropometric and body composition measurements via air displacement plethysmography were obtained during infancy at term and 3-4 months (preterm corrected ages), and at 4 years. Cognitive testing occurred at 4 years. Associations of body composition changes between visits with cognitive function were tested using linear regression. RESULTS: In the preterm group, higher term to 4-month corrected age percent body fat gains were associated with lower working memory performance (p = 0.01), and higher 4-month corrected age to 4-year fat-free mass gains were associated with higher full-scale IQ (p = 0.03) and speed of processing performance (p ≤ 0.02). In the full-term group, higher 4-month to 4-year fat mass gains were associated with lower full-scale IQ (p = 0.03). CONCLUSIONS: Body composition gains during different time periods are associated with varying areas of cognitive function. These findings may inform interventions aimed at optimal growth.