Document Detail

Nutritionally regulated hormonal factors in prolonged postnatal growth retardation and its associated adverse neurodevelopmental outcome in extreme prematurity.
MedLine Citation:
PMID:  12890931     Owner:  NLM     Status:  MEDLINE    
Recent published data show that at hospital discharge, most infants born at <30 weeks of gestation would not achieve the median birth weight of the reference fetus at the same postconceptional age, and many would be less than the 10th centile. Estimating from the current recommendations of calorie and protein intakes, these infants accrue large deficits in intakes of protein and calorie during the first weeks of life. Postnatal growth retardation over a prolonged period of time is related to neurodevelopmental delays. While a total energy intake of 120 kcal/kg/day has generally been considered adequate, protein requirement in low gestation infants remains a matter for debate. Increasing the dietary protein:calorie ratio has previously been proposed as a strategy to enhance growth and to achieve a body composition similar to that of the reference fetus. Previous study data reveal that serum insulin-like growth factor I (IGF-I) concentration is positively correlated with protein intake, and nitrogen retention, in turn, is positively correlated with serum IGF-I concentration. Remarkably, elevated serum growth hormone but low serum IGF-I concentrations have been reported in low gestation infants and in infants with intrauterine growth retardation, suggesting IGF-I being a nutritionally regulated hormonal factor in the postnatal growth retardation. As neurodevelopment in extreme prematurity is likely affected by multiple factors, we hypothesize that a combined strategy of the previously proposed hormonal supplement with hydrocortisone and tri-iodothyronine together with increased dietary protein intake (progressively increasing from 1.5 g/kg/day intravenously administered amino acids immediately after birth, then 3.6 g/100 kcal at approximately 125 kcal/kg/day when enterally fed till the infant reaches a body weight of >or=1.8 kg and at >or=50th centile weight of the reference fetus at the same postconceptional age) would likely be synergistic and more effective in improving neurodevelopmental outcome.
Melinda Y Yeung; John P Smyth
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Biology of the neonate     Volume:  84     ISSN:  0006-3126     ISO Abbreviation:  Biol. Neonate     Publication Date:  2003  
Date Detail:
Created Date:  2003-07-31     Completed Date:  2004-03-17     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  0247551     Medline TA:  Biol Neonate     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  1-23     Citation Subset:  IM    
Copyright Information:
Copyright 2003 S. Karger AG, Basel
Department of Pharmacy, Liverpool Hospital, Liverpool, NSW, Australia.
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MeSH Terms
Amino Acids / toxicity
Body Weight
Dietary Proteins / administration & dosage
Embryonic and Fetal Development
Energy Intake
Gestational Age
Growth Disorders*
Hormones / physiology*
Human Growth Hormone / physiology
Infant Nutritional Physiological Phenomena*
Infant, Newborn
Infant, Premature*
Insulin-Like Growth Factor I / analysis
Nervous System / growth & development*
Nutritional Requirements
Reg. No./Substance:
0/Amino Acids; 0/Dietary Proteins; 0/Hormones; 12629-01-5/Human Growth Hormone; 67763-96-6/Insulin-Like Growth Factor I

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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