Post-discharge formula feeding in preterm infants: A systematic review mapping evidence about the role of macronutrient enrichment

Inga C. Teller, Nicholas D. Embleton, Ian J. Griffin, Ruurd M. van Elburg

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background & aims: Preterm infants are a heterogeneous group and many accumulate growth deficits before and after initial hospital discharge. Although this is associated with worse cognitive outcome, recent meta-analyses suggest that nutrient fortification of breast milk, or the use of nutrient and energy rich formulae after discharge exert little effect on growth and neurodevelopment. However, the complexity of study design, inclusion criteria and outcome parameters, combined with differences in formula composition mean that meta-analysis may overlook important effects of differing interventions in sub-groups. Methods: We systematically identified evidence and mapped the information on Participants, Intervention, Comparator, and Outcome (PICO) from 31 published studies illustrating the marked heterogeneity in study design and interventions next to outcomes on (quality of) growth and neurodevelopment. Results: Despite significant heterogeneity in study design, we found that nutrient enriched diets after discharge show no negative effects but frequently improve growth parameters at some point in the course of the study, in particular for boys. The data indicates that when energy requirements are adequate, increased protein results in increased growth and lean mass (LM) accretion; In particular, higher protein to energy ratios lead to increased lean mass accretion, and increased head circumference (HC) at one year. However, improvements in neurodevelopmental outcome were rarely seen. Conclusion: This comprehensive evidence mapping approach to the field provides a broad but detailed overview of the currently available evidence. Furthermore, we identified key gaps in existing knowledge on the role of nutrient enrichment in the post-discharge period.

Original languageEnglish (US)
JournalClinical Nutrition
DOIs
StateAccepted/In press - Feb 3 2015

Fingerprint

Premature Infants
Growth
Food
Meta-Analysis
Human Milk
Proteins
Head
Diet

Keywords

  • Body composition
  • Growth
  • Neurodevelopment
  • Protein:energy ratio
  • Quality of growth

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Nutrition and Dietetics

Cite this

Post-discharge formula feeding in preterm infants : A systematic review mapping evidence about the role of macronutrient enrichment. / Teller, Inga C.; Embleton, Nicholas D.; Griffin, Ian J.; van Elburg, Ruurd M.

In: Clinical Nutrition, 03.02.2015.

Research output: Contribution to journalArticle

@article{bfbee1aa328b4f929585f47ed5b87189,
title = "Post-discharge formula feeding in preterm infants: A systematic review mapping evidence about the role of macronutrient enrichment",
abstract = "Background & aims: Preterm infants are a heterogeneous group and many accumulate growth deficits before and after initial hospital discharge. Although this is associated with worse cognitive outcome, recent meta-analyses suggest that nutrient fortification of breast milk, or the use of nutrient and energy rich formulae after discharge exert little effect on growth and neurodevelopment. However, the complexity of study design, inclusion criteria and outcome parameters, combined with differences in formula composition mean that meta-analysis may overlook important effects of differing interventions in sub-groups. Methods: We systematically identified evidence and mapped the information on Participants, Intervention, Comparator, and Outcome (PICO) from 31 published studies illustrating the marked heterogeneity in study design and interventions next to outcomes on (quality of) growth and neurodevelopment. Results: Despite significant heterogeneity in study design, we found that nutrient enriched diets after discharge show no negative effects but frequently improve growth parameters at some point in the course of the study, in particular for boys. The data indicates that when energy requirements are adequate, increased protein results in increased growth and lean mass (LM) accretion; In particular, higher protein to energy ratios lead to increased lean mass accretion, and increased head circumference (HC) at one year. However, improvements in neurodevelopmental outcome were rarely seen. Conclusion: This comprehensive evidence mapping approach to the field provides a broad but detailed overview of the currently available evidence. Furthermore, we identified key gaps in existing knowledge on the role of nutrient enrichment in the post-discharge period.",
keywords = "Body composition, Growth, Neurodevelopment, Protein:energy ratio, Quality of growth",
author = "Teller, {Inga C.} and Embleton, {Nicholas D.} and Griffin, {Ian J.} and {van Elburg}, {Ruurd M.}",
year = "2015",
month = "2",
day = "3",
doi = "10.1016/j.clnu.2015.08.006",
language = "English (US)",
journal = "Clinical Nutrition",
issn = "0261-5614",
publisher = "Churchill Livingstone",

}

TY - JOUR

T1 - Post-discharge formula feeding in preterm infants

T2 - A systematic review mapping evidence about the role of macronutrient enrichment

AU - Teller, Inga C.

AU - Embleton, Nicholas D.

AU - Griffin, Ian J.

AU - van Elburg, Ruurd M.

PY - 2015/2/3

Y1 - 2015/2/3

N2 - Background & aims: Preterm infants are a heterogeneous group and many accumulate growth deficits before and after initial hospital discharge. Although this is associated with worse cognitive outcome, recent meta-analyses suggest that nutrient fortification of breast milk, or the use of nutrient and energy rich formulae after discharge exert little effect on growth and neurodevelopment. However, the complexity of study design, inclusion criteria and outcome parameters, combined with differences in formula composition mean that meta-analysis may overlook important effects of differing interventions in sub-groups. Methods: We systematically identified evidence and mapped the information on Participants, Intervention, Comparator, and Outcome (PICO) from 31 published studies illustrating the marked heterogeneity in study design and interventions next to outcomes on (quality of) growth and neurodevelopment. Results: Despite significant heterogeneity in study design, we found that nutrient enriched diets after discharge show no negative effects but frequently improve growth parameters at some point in the course of the study, in particular for boys. The data indicates that when energy requirements are adequate, increased protein results in increased growth and lean mass (LM) accretion; In particular, higher protein to energy ratios lead to increased lean mass accretion, and increased head circumference (HC) at one year. However, improvements in neurodevelopmental outcome were rarely seen. Conclusion: This comprehensive evidence mapping approach to the field provides a broad but detailed overview of the currently available evidence. Furthermore, we identified key gaps in existing knowledge on the role of nutrient enrichment in the post-discharge period.

AB - Background & aims: Preterm infants are a heterogeneous group and many accumulate growth deficits before and after initial hospital discharge. Although this is associated with worse cognitive outcome, recent meta-analyses suggest that nutrient fortification of breast milk, or the use of nutrient and energy rich formulae after discharge exert little effect on growth and neurodevelopment. However, the complexity of study design, inclusion criteria and outcome parameters, combined with differences in formula composition mean that meta-analysis may overlook important effects of differing interventions in sub-groups. Methods: We systematically identified evidence and mapped the information on Participants, Intervention, Comparator, and Outcome (PICO) from 31 published studies illustrating the marked heterogeneity in study design and interventions next to outcomes on (quality of) growth and neurodevelopment. Results: Despite significant heterogeneity in study design, we found that nutrient enriched diets after discharge show no negative effects but frequently improve growth parameters at some point in the course of the study, in particular for boys. The data indicates that when energy requirements are adequate, increased protein results in increased growth and lean mass (LM) accretion; In particular, higher protein to energy ratios lead to increased lean mass accretion, and increased head circumference (HC) at one year. However, improvements in neurodevelopmental outcome were rarely seen. Conclusion: This comprehensive evidence mapping approach to the field provides a broad but detailed overview of the currently available evidence. Furthermore, we identified key gaps in existing knowledge on the role of nutrient enrichment in the post-discharge period.

KW - Body composition

KW - Growth

KW - Neurodevelopment

KW - Protein:energy ratio

KW - Quality of growth

UR - http://www.scopus.com/inward/record.url?scp=84950968495&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84950968495&partnerID=8YFLogxK

U2 - 10.1016/j.clnu.2015.08.006

DO - 10.1016/j.clnu.2015.08.006

M3 - Article

AN - SCOPUS:84950968495

JO - Clinical Nutrition

JF - Clinical Nutrition

SN - 0261-5614

ER -