Optimal Growth and Lower Fat Mass in Preterm Infants Fed a Protein-enriched Postdischarge Formula Randomized outcome trial of nutrient-enriched formula and neurodevelopment outcome in preterm infants Infant growth and later body composition: evidence from the 4-component model. Posthospital discharge feeding for preterm infants: effects of standard compared with enriched milk formula on growth, bone mass, and body composition. Bone mineralization and growth are enhanced in preterm infants fed an isocaloric, nutrient-enriched preterm formula through term. Effects of human milk or formula feeding on the growth, behavior, and protein status of preterm infants discharged from the newborn intensive care unit. Feeding of very-low-birth-weight infants with special formula--continued use beyond 2000 g and effects on growth to 1 year. Randomized trial of nutrient-enriched formula versus standard formula for postdischarge preterm infants. Feeding with premature or infant formula in premature infants after discharge: comparison of growth and nutrition status. Feeding Preterm Infants after Hospital Discharge: Growth and Development at 18 Months of Age Increased bone mineral content of preterm infants fed with a nutrient enriched formula after discharge from hospital. High-Energy and -Protein Diet Increases Brain and Corticospinal Tract Growth in Term and Preterm Infants After Perinatal Brain Injury Growth and Fat-Free Mass Gain in Preterm Infants After Discharge: A Randomized Controlled Trial Neuroimaging, a new tool for investigating the effects of early diet on cognitive and brain development Randomised trial of nutrition for preterm infants after discharge. Feeding Preterm Infants after Hospital Discharge: Effect of Dietary Manipulation on Nutrient Intake and Growth Post‐discharge nutrition of the very low‐birthweight infant: interim results of the multicentric GAMMA study Small for gestational age preterm infants: nutritional strategies and quality of growth after discharge Enriched post-discharge formula versus term formula for bone strength in very low birth weight infants: a longitudinal pilot study Growth and bone mineralization in preterm infants fed preterm formula or standard term formula after discharge. Growth of Preterm Infants Fed Nutrient-Enriched or Term Formula After Hospital Discharge Feeding the premature infant after hospital discharge: growth and biochemical responses. Body composition in preterm infants fed standard term or enriched formula after hospital discharge Growth and body composition in infants with bronchopulmonary dysplasia up to 3 months corrected age: a randomized trial of a high-energy nutrient-enriched formula fed after hospital discharge. Postnatal malnutrition and growth retardation: an inevitable consequence of current recommendations in preterm infants? Preterm infants fed nutrient-enriched formula until 6 months show improved growth and development. Effect of a calcium and phosphorus-enriched formula on bone mineralization and bone growth in preterm infants after discharge from hospital.
Background and Objectives : Postdischarge formulas with extra energy and protein improve short-term growth but may also influence long-term body composition in an unwanted manner . Energy- and protein-enriched formulas with an increased protein-to-energy ratio improves gain of lean mass . The objective of the study was to investigate whether feeding a nutrient-enriched formula without extra energy after term , usually 3 to 4 weeks after discharge , would influence growth and body composition in infancy . Methods : In this r and omized controlled trial preterm infants were fed fortified human milk or preterm formula until term . At term , 102 infants were r and omized to a nutrient-enriched formula without extra energy or st and ard formula until 6 months corrected age . Twenty-six infants received unfortified human milk after term . At term and 6 months corrected age , anthropometry and a dual-energy x-ray absorptiometry ( DEXA ) scan were performed . Lean and fat mass ( FM ) were corrected for height . Results : There were no differences in growth or body size between the feeding groups . Infants fed the enriched formula gained less FM and had lower FM corrected for body size at 6 months corrected age than infants fed st and ard formula . Infants fed human milk had lower lean mass and higher FM corrected for body size at 6 months corrected age than formula-fed infants . Conclusions : Feeding nutrient-enriched formula without extra energy after term does not change quantity of growth but does influence type of weight gain and body composition of preterm infants . Infants fed the nutrient-enriched formula had lower FM corrected for body size at 6 months corrected age than infants fed st and ard formula or human milk Background Preterm infants are at risk for adverse neurodevelopment . Furthermore , nutrition may play a key role in supporting neurodevelopment . The aim of this study was to evaluate whether a nutrient-enriched formula fed to preterm infants after hospital discharge could improve their neurodevelopment at 24 months ( term-corrected age ) . Methods We conducted an observer-blinded , single-center , r and omized controlled trial in infants admitted to the Fondazione IRCCS Cà Gr and a Ospedale Maggiore Policlinico , University of Milan , Italy between 2009 and 2011 . Inclusion criteria were gestational age < 32 weeks and /or birth weight < 1500 g , and being fed human milk for < 20 % of the total milk intake . Exclusion criteria were congenital malformations or conditions that could interfere with growth or body composition . Included infants were r and omized to  receive a st and ard full-term formula or a nutrient-enriched formula  up until 6 months of corrected age , using two computer-generated r and omization lists ; one appropriate for gestational age ( AGA ) and one for small for gestational age ( SGA ) infants . We assessed neurodevelopment at 24 months of corrected age using the Griffiths Mental Development Scale and related subscales ( locomotor , personal-social , hearing and speech , h and and eye coordination , and performance ) . Results Of the 207 r and omized infants , 181 completed the study . 52 AGA and 35 SGA infants were fed a nutrient-enriched formula , whereas 56 AGA and 38 SGA infants were fed a st and ard full-term formula . The general quotient at 24 months of corrected age was not significantly different between infants r and omized to receive a nutrient-enriched formula compared with a st and ard term formula up until 6 months of corrected age ( AGA infants : 93.8 ± 12.6 vs. 92.4 ± 10.4 , respectively ; SGA infants : 96.1 ± 9.9 vs. 98.2 ± 9 , respectively ) . The scores of related subscales were also similar among groups . Conclusions This study found that feeding preterm infants a nutrient-enriched formula after discharge does not affect neurodevelopment at 24 months of corrected age , in either AGA or SGA infants , free from major comorbidities . Trial registration Current Controlled Trials ( http://www.controlled-trials.com/IS RCT N30189842 ) London , UK BACKGROUND Rapid weight gain in infancy is associated with higher body mass index in later life , but its relation with individual body-composition components remains unclear . OBJECTIVE We aim ed to investigate associations between weight gain during different periods in infancy and later fat mass ( FM ) and fat-free mass ( FFM ) . DESIGN Body composition was assessed by using the 4-component model , dual-energy X-ray absorptiometry , and anthropometry in 234 healthy UK children and adolescents ( 105 boys ; x + /- SD age : 11.4 + /- 3.8 y ) . Early growth measurements were prospect i ve in 52 subjects and retrospective in 182 .  Relative weight gain was calculated as change in SD score ( SDS ) during different periods . RESULTS Relative weight gain from 0 to 3 mo and from 3 to 6 mo showed positive relations with childhood FM , waist circumference , and trunk FM that were equivalent to increases in FMI ( FM/height(2 ) ) of 0.24 SDS ( 95 % CI : 0.04 , 0.44 ) and 0.50 SDS ( 0.25 , 0.75 ) per 1-SDS increase in early weight and that were comparable to the effect of current obesity risk factors . Relative weight gain from 0 to 3 mo was also positively associated with later FFMI ( FFM/height(2 ) ) . Relative weight gain from 6 to 12 mo was not associated with later body composition . Associations were independent of birth weight , sex , puberty , physical activity , socioeconomic class , ethnicity , and parental body mass index . CONCLUSIONS In this Western population , greater relative weight gain during early infancy was positively associated with later FM and central fat distribution and with FFM . Rapid weight gain in infancy may be a risk factor for later adiposity . Early infancy may provide an opportunity for interventions aim ed at reducing later obesity risk BACKGROUND Despite the theoretical benefits of nutrient-enriched formula given to preterm infants after hospital discharge , its role in reversing growth deficits after hospital discharge remains poorly defined . OBJECTIVE The aim was to determine the effect of different formulas on the growth , bone mass , and body composition of preterm infants after hospital discharge . DESIGN This was a r and omized , double blind comparison of a nutrient-enriched formula ( EF ) and a formula for term infants ( TF ) given for 1 y after hospital discharge . Compared with the TF , the EF had a higher energy density and higher contents of protein , calcium , and phosphorus ( by 10 % , 21 % , 44 % , and 11 % , respectively ) and higher contents of almost all other nutrients ( by > or=10 % ) . RESULTS  Birth weights of the infants were 630 - 1620 g ( median : 1250 g ) and gestational ages were 24 - 34 wk ( median : 29 wk ) . TF result ed in significantly greater weight , length , head circumference measurements , and their respective z scores on the basis of age- and sex-specific norms . At the end of the study , the mean z scores for the corrected age of infants in the TF group were -0.37 for weight , 0.001 for length , and 0.50 for head circumference . The TF group also had significantly greater dual-energy X-ray absorptiometry measured bone and lean and fat mass than did the EF group ( P < 0.05 for all comparisons ) . CONCLUSIONS The use of EF for preterm infants after hospital discharge shows no advantage over TF in growth , bone mineralization , and body composition . More studies are needed to determine the optimal postdischarge nutrition support for preterm infants BACKGROUND Because recent data on the effects of mineral concentrations in preterm infant formula on bone mineralization are lacking , recommendations for the mineral content of preterm infant formula differ greatly between committees . OBJECTIVE The goal of the study was to assess the effects of an isocaloric , nutrient-enriched preterm formula , which was fed from the age when full enteral feedings were tolerated through expected term , on bone mineralization in preterm infants . DESIGN We conducted a prospect i ve , r and omized , double-blind study in healthy , preterm infants ( gestational age of 28 - 32 wk ) who were fed either a control preterm formula ( n=20 ) or an isocaloric , nutrient-enriched preterm formula ( n=21 ) until 3 mo of age ( ie , approximate expected term ) .  Serum calcium indexes were taken throughout the study , and bone mass was determined by using dual-energy X-ray absorptiometry at hospital discharge and expected term . RESULTS A total of 37 infants ( experimental formula , n=19 ; control formula , n=18 ) completed the study . Compared with control subjects , infants fed the experimental formula had 25 % and 40 % higher intakes of calcium and phosphorus , respectively . Serum calcium , phosphorus , osteocalcin , and alkaline phosphatase concentrations and urinary collagen type I cross-linked N-telopetide concentrations were not significantly different between the groups at any time point . The bone mineral content of infants fed the experimental formula was 23 % ( P=0.039 ) and 35 % ( P=0.002 ) higher at hospital discharge and expected term , respectively . CONCLUSIONS Bone mineralization at hospital discharge and expected term was significantly higher in preterm infants fed the isocaloric , nutrient-enriched formula than in those fed control formula . Continuation of the experimental formula beyond hospital discharge , through expected term , further improved bone mineralization The growth , behavior , and protein status of 59 healthy preterm ( mean gestational age 30 wk ) infants fed either human milk or one of three infant formulas were studied post-discharge from the hospital . Formula-fed infants received either a st and ard term formula , a st and ard preterm formula , or an experimental preterm formula from discharge to 8 wk of age . From 8 to 16 wk , all formula-fed infants received the st and ard term formula . At 2 , 8 , and 16 wk , anthropometric , dietary intake , blood biochemistry , amino acid , and Brazelton Neonatal Behavioral Assessment measurements were evaluated . Weights , lengths , and head circumferences were similar for all feeding groups at discharge . After discharge all formula-fed infants were heavier than human milk-fed infants . Length and head circumference values and plasma urea nitrogen and retinol-binding protein concentrations were not different among dietary groups . Formula-fed infants had higher plasma concentrations of numerous amino acids compared with those of human milk-fed infants during the first 8 wk but not at 16 wk . There were no differences among the feeding groups in the Brazelton assessment . This study found little effect on the growth or behavioral or protein status of preterm infants discharged from the hospital who were fed either human milk or formulas design ed for term or preterm infants Ten very-low-birth-weight ( VLBW ) infants fed a premature formula up to a weight of 2 000 g were r and omized either to continue on the premature formula for a further 8 weeks or to change to a st and ard infant formula .  Four infants in each group completed the 8-week study period , while growth and biochemical data were available on the other 2 infants for half the study period . No significant differences were seen at the end of the study . Infants on the premature formula showed a trend towards more rapid growth during the 8-week period , but this was no longer evident at a corrected age of 3 months . All infants were followed up to a corrected age of 1 year , during which time growth curves were similar to those previously described for VLBW infants . No long-term tendency towards obesity was evident in these infants , who had gained weight up to 2 000 g at a rate equivalent to the intra-uterine rate OBJECTIVES Preterm infants are frequently discharged from the hospital growth retarded and show reduced growth throughout childhood . In a large efficacy and safety trial , we tested the hypothesis that nutritional intervention in the first 9 months postterm would reverse postdischarge growth deficits and improve neurodevelopment without adverse safety outcomes . PARTICIPANTS AND INTERVENTION Two hundred eighty-four infants ( mean gestation : 30.9 weeks ) were studied ; 229 were r and omly assigned a  protein , energy , mineral , and micronutrient-enriched postdischarge formula ( PDF ; N = 113 ) or st and ard term formula  ( TF ; N = 116 ) from discharge ( mean 36.5 weeks ' postmenstrual age ) . A reference group ( N = 65 ) was  breastfed until at least 6 weeks ' postterm . Outcome measures . Anthropometry was performed at 6 weeks and 3 , 6 , 9 , and 18 months . Development was measured at 9 months ( Knobloch , Passamanick , and Sherrard 's developmental screening inventory ) and 18 months ( Bayley Scales of Infant Development II ; primary outcome ) postterm . RESULTS At 9 months , compared with the TF group , those fed PDF were heavier ( difference 370 g ; 95 % confidence interval [ CI ] : 84 - 660 ) and longer ( difference 1.1 cm ; 95 % CI : 0.3 - 1.9 ) ; the difference in length persisted at 18 months ( difference 0.82 cm ; 95 % CI : -0.04 - 1.7 ) . There was no effect on head circumference . The effect of diet was greatest in males ; at 9 months length deficit with TF was 1.5 cm ( 95 % CI : 0.3 - 2.7 ) , and this remained at 18 months ( 1.5 cm [ 95 % CI : 0.3 - 2.7 ] ) . There was no significant difference in developmental scores at 9 or 18 months , although PDF infants had a 2.8 ( -1.3 - 6.8 ) point advantage in Bayley motor score scales . At 6 weeks ' postterm , exclusively breastfed infants were already 513 g ( 95 % CI : 310 - 715 ) lighter and 1.6 cm ( 95 % CI : 0.8 - 2.3 ) shorter than the PDF group , and they remained smaller up to 9 months ' postterm . CONCLUSIONS 1 ) Improving postdischarge nutrition in the first 9 months may " reset " subsequent growth-at least until 18 months for body length . We intend to follow-up the children at older ages . The observed efficacy of PDF was not associated with adverse safety outcomes . 2 ) We can not reject the hypothesis that postdischarge nutrition benefits motor development and this requires additional study . 3 ) Our data raise the possibility that breastfed postdischarge preterm infants may require nutritional supplementation , currently under investigation We design ed this prospect i ve r and omized controlled study to evaluate the effects of  premature and st and ard term formula on growth , nutrient intake and biochemical response in premature infants from hospital discharge to 6 months of corrected age . Premature infants with a gestational age of < or = 35 weeks and a birth weight < or = 1850 gm were assigned to receive  premature infant formula ( n = 19  ) or a st and ard term infant formula  ( n = 15 ) . No differences were found between the two groups in weight , length , or head circumference at baseline or on follow-up . Infants fed premature formula had higher blood urea nitrogen and phosphorus at 3 months of corrected age . Those on the premature formula also had higher energy intake at 1 month of corrected age . We suggest that premature infants , especially very low birth weight infants , fed preterm infant formula after discharge until 6 months of corrected age tolerate the formula well and may benefit over those st and ard term formula We have shown that preterm infants fed a preterm formula grow better than those fed a st and ard term infant formula after hospital discharge . The purpose of this follow-up study was to determine whether improved early growth was associated with later growth and development . Preterm infants ( ≤1750 g birth weight , ≤34 wk gestation ) were r and omized to be fed either a preterm infant formula ( discharge to 6 mo corrected age ) , or a term formula ( discharge to 6 mo ) , or the preterm ( discharge to term ) and the term formula  ( term to 6 mo ) . Anthropometry was performed at 12 wk and 6 , 12 , and 18 mo . Mental and psychomotor development were assessed using the Bayley Scales of Infant Development II at 18 mo . Differences in growth observed at 12 wk were maintained at 18 mo . At 18 mo , boys fed the preterm formula were 1.0 kg heavier , 2 cm longer , and had a 1.0 cm greater occipitofrontal circumference than boys fed the term formula . Boys fed the preterm formula were also 600 g heavier and 2 cm longer than girls fed the preterm formula . However , no differences were noted in MDI or PDI between boys fed the preterm formula and boys fed the term formula or between the boys fed preterm formula and girls fed the preterm formula . Overall , boys had significantly lower MDI than girls ( mean difference , 6.0;p < 0.01 ) , primarily reflecting lower scores in boys fed the term formula . Thus , early diet has long-term effects on growth but not development at 18 mo of age . Sex remains an important confounding variable when assessing growth and developmental outcome in these high-risk infants Bone disease with persistent reduced bone mineralisation is common in premature infants . To test the hypothesis that enhancement of nutritional intake after discharge from hospital improves bone mineralisation , 31 formula fed preterm infants were r and omly assigned to receive st and ard or multinutrient enriched milk from the time of discharge . The calcium and phosphorus contents of the enriched milk were 70 and 35 mg/100 ml v 35 and 29 mg/100 ml for the st and ard formula . Bone mineral content was measured before discharge from hospital in 21 of the infants ; there was no difference in the bone mineral content between the groups at that time ( 35 mg/cm for the two groups ) . There was a significant increase in bone mineral content for those infants receiving the enriched v st and ard formula at 3 and 9 months corrected postnatal age : at 3 months the bone mineral content was 83 v 63 mg/cm and at 9 months 115 v 95 mg/cm . The difference between the groups was thus maintained although not increased at a corrected age of 9 months , when the bone mineral content of infants fed the enriched but not the st and ard formula was no longer significantly different from that of normal infants after adjusting for body size . The difference was not explained by the larger body size in infants fed the enriched formula . The results suggest that the use of a special nutrient enriched postdischarge formula has a significant positive effect on bone growth and mineralisation during a period of rapid skeletal development OBJECTIVE . Our hypothesis was that infants with perinatal brain injury fail to thrive in the first postnatal year because of increased energy and protein requirements from deficits that accumulated during neonatal intensive care . Our aim was to assess whether dietary energy and protein input was a rate-limiting factor in brain and body growth in the first year after birth . METHODS . We conducted a prospect i ve , double-blind and r and omized , 2-stage group sequential study and controlled for gestation , gender , and brain lesion . Neonates with perinatal brain damage were r and omly allocated to receive either a high- ( 120 % recommended average intake ) or average ( 100 % recommended average intake ) energy and protein diet . The study began at term and continued for 12 months . Three-day dietary diaries estimated energy and protein intake . The primary outcome measure was growth of occipitofrontal circumference . Other measures were growth of axonal diameters in the corticospinal tract , which were estimated by using transcranial magnetic stimulation , weight gain , and length . RESULTS . The study was terminated at the first analysis when the 16 subjects had completed the protocol , because the predetermined stopping criterion of > 1 SD difference in occipitofrontal circumference at 12 months ’ corrected age in those receiving the higher-energy and -protein diet had been demonstrated . Axonal diameters in the corticospinal tract , length , and weight were also significantly increased . CONCLUSIONS . These data support our hypothesis that infants with significant perinatal brain damage have increased nutritional requirements in the first postnatal year and suggest that decreased postnatal brain growth may exacerbate their impairment . There are no measures of cognitive ability at 12 months of age , and whether there will be any improvement in the status of these children , therefore , remains to be shown OBJECTIVE : To investigate whether the consumption of a nutrient-enriched formula after hospital discharge determines different growth and weight gain composition in preterm infants according to intra- and extrauterine growth pattern . METHODS : Two hundred seven preterm infants were r and omized at term-corrected age to receive treatment A ( term formula ) or B ( nutrient-enriched formula )  up to 6 months of corrected age , using 2 computer-generated r and omization lists , 1 for adequate for gestational age ( AGA ) and 1 for small for gestational age ( SGA ) infants . Infants were weaned according to our clinical practice after 6 months ’ corrected age . Anthropometric parameters and body composition by an air displacement plethysmography system were assessed at term and 1 , 3 , and 6 months ’ corrected age . Anthropometric parameters were also assessed at 12 months . RESULTS : Protein intakes were higher in infants receiving treatment B than in infants receiving treatment A at each study point . There were no differences between the feeding groups in weight and length SD scores in either the AGA and SGA group through the study . The mean head circumference values were higher in AGA infants receiving treatment B than in AGA infants receiving treatment A at 6 and 12 months , whereas at 6 months , the percentage of fat mass was lower . No difference in body composition was detected among SGA infants through the study . CONCLUSIONS : This r and omized controlled trial demonstrates the beneficial effect of the consumption of a nutrient-enriched formula after hospital discharge by AGA infants both in terms of head circumference growth and fat-free mass gain Nutrition is crucial to the initial development of the central nervous system ( CNS ) , and then to its maintenance , because both depend on dietary intake to supply the elements required to develop and fuel the system . Diet in early life is often seen in the context of “ programming ” where a stimulus occurring during a vulnerable period can have long-lasting or even lifetime effects on some aspect of the organism 's structure or function . Nutrition was first shown to be a programming stimulus for growth , and then for cognitive behavior , in animal studies that were able to employ methods that allowed the demonstration of neural effects of early nutrition . Such research raised the question of whether nutrition could also programme cognition/brain structure in humans . Initial studies of cognitive effects were observational , usually conducted in developing countries where the presence of confounding factors made it difficult to interpret the role of nutrition in the cognitive deficits that were seen . Attributing causality to nutrition required r and omized controlled trials ( RCTs ) and these , often in developed countries , started to appear around 30 years ago . Most demonstrated convincingly that early nutrition could affect subsequent cognition . Until the advent of neuroimaging techniques that allowed in vivo examination of the brain , however , we could determine very little about the neural effects of early diet in humans . The combination of well- design ed trials with neuroimaging tools means that we are now able to pose and answer questions that would have seemed impossible only recently . This review discusses various  neuroimaging methods that are suitable for use in nutrition studies , while pointing out some of the limitations that they may have . The existing literature is small , but examples of studies that have used these methods are presented . Finally , some considerations that have arisen from previous studies , as well as suggestions for future research , are discussed In a r and omised double blind trial , the effect on growth and clinical status of a nutrient enriched ' post-discharge ' milk formula versus a st and ard term formula , was compared in 32 exclusively bottle fed preterm infants . The formulas were used as the sole milk intake up to a postnatal age of 9 months . Significant increases in linear growth and weight gain were observed in the infants who received the enriched diet . There were no differences in vomiting , posseting , or bowel habit between the groups . Formula volumes ingested were similar between diet groups , indicating that the difference in formula composition did not affect the infants ' regulation of intake . These preliminary data suggest that there is a role for specially design ed formulas for preterm infants after discharge from hospital The objective of this study was to compare  formula intake , the time of weaning , and growth in preterm infants ( ≤1750-g birth weight , ≤34-wk gestation ) fed a st and ard term or preterm infant formula after initial hospital discharge . Infants were r and omized at hospital discharge to be fed a  preterm infant formula from discharge to 6 mo corrected age  ( group A ) , a term formula from discharge to 6 mo ( group B ) , or the preterm formula ( discharge to term ) and the term formula ( term to 6 mo ( group C ) . Infants were seen biweekly(discharge to term ) and monthly ( term to 6 mo ) , when intake was measured and anthropometry and blood sampling were performed . The results were analyzed using ANOVA . Although nutrient intake was similar , at 6 mo girls were lighter(6829 versus 7280 g ) and shorter ( 64.4 versus 66.0 cm ) than boys ( p < 0.05 ) . Patient characteristics were similar between the treatment groups . Although the volume of intake differed ( B > C > A ; p < 0.001 ) , energy intake was similar in the groups . Because of differences in formula composition , protein , calcium , and phosphorus intakes differed ( B < C < A ; p < 0.001 ) . Lower protein intakes were related to lower blood urea nitrogen levels ( B < C < A ; p < 0.001 ) . At 6 mo , infant boys in B and C were lighter(6933 , 6660 < 7949 g ) , shorter ( 65.3 , 64.9 < 67.1 cm ) , and had a smaller head circumference ( 43.7 , 43.7 < 44.8 cm ; p < 0.05 ) than infants in group A. Preterm infants were found to increase their volume of intake to compensate for differences in energy density between formulas . After hospital discharge , infant boys fed a preterm formula grew faster than infant girls fed a preterm formula or infant boys fed a term formula This report presents the interim results up to 12 mo corrected age ( c.a . ) of a multicentric , prospect i ve , controlled study on very low‐birthweight infants , r and omized at 40 wk post‐conception in two different groups of formula feeding : 80 Kcal/dL ( group A ) vs 70 Kcal/dL ( group B ) up to 55 wk of postconceptional age . Subsequently , all the babies were fed with a follow‐on formula , with the introduction of solid foods at 6 mo c.a . Weight , length , head circumference and neurological conditions with psychomotor development ( evaluated by the Griffiths’Developmental Scale ) were measured at regular intervals and all of these parameters were satisfactory in both groups . For growth , in group A there was a greater increase in weight in boys at 55 wk and at 6 mo c.a . , and small for gestational age ( SGA ) babies had a greater increase in length at 1 y of age , while head circumference caught up on growth from week 40 to week 55 . Measured by the Griffiths’Developmental Scale , the SGA group fed 80 Kcal/dL had a better score at 6 mo ; similarly boys fed 80 Kcal/dL had a better score at 6 and at 9 mo Infants born preterm are at high risk for poor growth achievement . Small for gestational age ( SGA ( birth weight below the 10th percentile ) preterm infants are even more prone to develop postnatal growth retardation in the early neonatal period , as they do not have a large storage of protein/energy . Both SGA and appropriate for gestational age ( AGA : birth weight between the 10th and 90th percentiles ) infants show persistent postnatal growth failure after discharge . Although the available data clearly demonstrate that preterm infants , especially if born SGA , exhibit postnatal growth retardation at the time of hospital discharge , the importance of the nutritional post discharge management has not been sufficiently taken into account . We have recently conducted a r and omized controlled trial to assess whether infants born SGA may benefit from an enriched post discharge formula . This study suggests that the growth pattern in SGA preterm infants is not affected by the consumption of an enriched post discharge formula . The ponderal and linear growth of these infants does not accelerate to achieve early catch up growth . However , as far as the quality of growth is concerned , the fat mass accretion after term decelerates , so that an increase of fat free mass accretion takes place . Future research effort should be directed toward longer follow up and personalized nutrition management Abstract Aim : To initiate a longitudinal pilot study comparing the effect of nutrient-enriched post-discharge formula ( PDF ) with st and ard term formula ( TF ) on bone strength of very low birth weight ( VLBW ) infants in the first six months post-term . Methods : Two matched groups of VLBW infants were r and omly assigned to enriched PDF ( n=10 ) or TF ( n=10 ) at corrected age of 40 weeks . Anthropometric measurements of growth and measurements of bone speed of sound ( SOS ) indicating bone strength and bone turnover markers ( bone-specific alkaline phosphatase and cross-linked carboxy terminal telopeptide of type I collagen ) were taken at term and at three and six months corrected age . Results : The anthropometric measurements of infants fed PDF and TF were comparable at three and six months corrected age . Bone SOS of the PDF group increased from 2760±113 m/s at term to 2877±90 m/s and 3032±60 m/s at three and six months corrected age , respectively ( P<0.001 ) . Likewise , bone SOS of the TF group increased from 2695±116 m/s at term to 2846±72 and 2978±83 m/s at three and six months , respectively ( P<0.001 ) . No statistically significant difference was found between the groups in terms of growth and bone SOS measurements . The levels of both bone turnover markers decreased significantly during the study period ( P<0.001 for both groups ) . Conclusion : Feeding with PDF after term had no short-term beneficial effect on bone strength and bone turn-over of VLBW infants OBJECTIVE To evaluate growth and bone mineralization in very low birth weight ( VLBW ) infants fed preterm formula ( PF ) or term formula ( TF ) . STUDY DESIGN In a double-blind prospect i ve study , 49 preterm infants of gestational age 33 weeks or less were r and omly fed  PF or TF  for 2 months after discharge , then all of the infants were fed TF for the next 2 months . Anthropometric and dual-energy x-ray absorptiometry data were collected at discharge and at 2 months and 4 months after discharge . Anthropometric data also were collected at 12 months postterm . RESULTS Four months after discharge , both body weight ( 6139 + /- 1254 g vs 5540 + /- 863 g ; P = .03 ) and bone mineral content ( 104.4 + /- 29.2 g vs 87.5 + /- 17.1 g ; P = .01 ) were significantly higher in the PF group compared with the TF group . At 12 months postterm , mean body weight , length , and head circumference remained higher in the PF group than in the TF group , and body mass index was similar and within the normal range in the 2 groups . CONCLUSIONS At 4 months after discharge , growth and mineralization were better in the VLBW infants who were fed PF during the first 2 months after discharge compared with those who were fed TF , suggesting that PF may be particularly valuable at this early stage of development Objective . At hospital discharge , preterm infants may have low body stores of nutrients , deficient bone mineralization , and an accumulated energy deficit . This double-blind , r and omized study evaluated the growth of premature infants with birth weights < 1800 g who were fed a 22 kcal/fl oz nutrient-enriched postdischarge formula ( PDF ) or a 20 kcal/fl oz term-infant formula ( TF )  from hospital discharge to 12 months ' corrected age ( CA ) . Methods . Infants were r and omized to PDF or TF a few days before hospital discharge with stratification by gender and birth weight ( < 1250 g or ≥1250 g ) . The formulas were fed to 12 months ' CA . Growth was evaluated using analysis of variance controlling for site , feeding , gender , and birth weight group . Interaction effects were also assessed . Secondary analyses included a repeated measures analysis and growth modeling . Results . One hundred twenty-five infants were r and omized ; 74 completed to 6 months ' CA and 53 to 12 months ' CA . PDF-fed infants weighed more than TF-fed infants at 1 and 2 months ' CA , gained more weight from study day 1 to 1 and 2 months ' CA , and were longer at 3 months ' CA . There were significant interactions between feeding and birth weight group — among infants with birth weights < 1250 g , those fed PDF weighed more at 6 months ' CA , were longer at 6 months ' CA , had larger head circumferences at term 1 , 3 , 6 , and 12 months ' CA , and gained more in head circumference from study day 1 to term and to 1 month CA . The repeated measures and growth modeling analyses confirmed the analysis of variance results . The PDF formula seemed to be of particular benefit for the growth of male infants . Infants fed the PDF consumed less formula and had higher protein intakes at several time points . Energy intakes , however , were not different . Conclusions . Growth was improved in preterm infants fed a nutrient-enriched postdischarge formula after hospital discharge to 12 months ' CA . Beneficial effects were most evident among infants with birth weights < 1250 g , particularly for head circumference measurements We conducted a double-blinded , r and omized trial in premature infants after hospital discharge to test the hypotheses that growth and biochemical responses in those fed a formula with a reduced protein content ( 1.3 gm/dl ) would be similar to those in infants fed a  st and ard infant formula ( protein 1.5 gm/dl ) . Twenty low birth weight infants were followed for 16 weeks from the time of hospital discharge . Growth ( weight , length , and head circumference ) and biochemical responses ( total protein , prealbumin , retinol-binding protein , and blood urea nitrogen values ) were similar in the two groups of infants . Plasma amino acids reflected the differences in protein intakes and were similar to previously reported values for premature infants fed human milk or formula . These results demonstrate similar growth and biochemical responses in preterm infants fed a st and ard infant formula  and a formula with a protein content closer to that of human milk Summary . Background : Most preterm infants are still preterm and have a low birth weight when they are discharged from the hospital . An important issue is whether the long-term consequences of early growth restriction can be diminished by nutritional intervention in preterm infants after discharge from the hospital . Aim : To evaluate differences in growth and in weight gain composition of preterm infants fed st and ard term formula ( SF ) or enriched formula ( PDF ) after discharge from hospital during the first 2 months of life . Methods : Thirty-three healthy preterm infants , birth weight < 1750 g at gestational age < 35 weeks , were r and omised to SF or PDF at the time of discharge from hospital . Anthropometric variables were studied longitudinally and body composition was measured using dual energy x-ray absorptiometry ( DEXA ) twice , before hospital discharge and two months later . Weight gain composition was calculated as the difference between the two determinations . Results : Seventeen infants were fed SF and 16 PDF .  Anthropometric variables and whole body composition were similar at birth , at the start of the nutritional study ( mean age 45 days ) , and at the end of the study 2 months later . Over the whole study period , weight gain and weight gain composition were similar in the two groups . Sex did not appear to influence weight gain and weight gain composition . In infants with growth restriction at discharge there was a significant reduction of weight gain , fat mass gain , and bone mineral content deposition independently of the formula provided . Conclusions : There is no immediate effect on preterm infants of a nutrient enriched formula compared with a st and ard formula on growth , weight gain , or weight gain composition OBJECTIVES ( 1 ) To determine whether nutrient malabsorption or inadequate nutrient intake were involved in the cause of growth delay in patients with bronchopulmonary dysplasia , and ( 2 ) to determine whether a nutrient-enriched formula given to infants with bronchopulmonary dysplasia to 3 months corrected age improves the rate of growth with greater lean and bone mass accretion when compared with infants fed an isoenergetic st and ard infant formula . STUDY DESIGN A blinded , nutrition intervention trial of 60 preterm infants with bronchopulmonary dysplasia ( birth weight , 866 + /- 169 g , gestational age , 26 + /- 1.5 weeks ) r and omized to either nutrient-enriched formula or st and ard formula .  Growth , body composition , and nutrient retention were compared between groups by Student 's t tests and analysis of covariance . RESULTS Infants fed the enriched formula had significantly greater nitrogen and mineral retention at 38 weeks ' postmenstrual age , and only the infants fed enriched formula had zinc retention similar to the intrauterine accretion . At 3 months corrected age infants fed enriched formula attained greater length ( P < .05 ) , greater radial bone mineral content ( P < .01 ) , and greater lean mass ( P < .01 ) . The male infants in the enriched formula group had greater whole body bone mineral content than did male infants in the st and ard formula group ( P = .02 ) . CONCLUSIONS Greater linear growth and lean and bone mass in the enriched formula group suggests that infants with bronchopulmonary dysplasia attain faster " catch-up " growth when fed higher intakes of protein , calcium , phosphorus , and zinc than provided in st and ard proprietary formulas BACKGROUND Nutrient intakes meeting recommended dietary intakes ( RDIs ) take time to establish and once established are rarely maintained throughout hospital stay in preterm infants . A nutrient deficit , therefore , accrues . RDI are based on needs for maintenance and growth , with no provision to replace this deficit . We , therefore , hypothesized that postnatal malnutrition and growth retardation were inevitable in infants fed current RDI . METHODOLOGY Dietary intakes were prospect ively collected , by a single observer ( N.P. ) , on a daily basis in a group of preterm infants ( n = 105 ; birth weight < /=1750 g ; gestational age < /=34 weeks ) admitted to neonatal intensive care unit over a 6-month period . Actual was subtracted from recommended energy ( 120 kcal/kg/day ) and protein ( 3 g/kg/day ) intakes and nutritional deficits calculated . Infants were weighed on admission and throughout hospital stay . The data were analyzed using a combination of repeated measures analysis of variance and stepwise regression analysis . RESULTS Nutrient intakes meeting current RDIs were rarely achieved during early life . By the end of the first week , cumulative energy and protein deficits were 406 + /- 92 and 335 + /- 86 kcal/kg and 14 + /- 3 and 12 + /- 4 g/kg in infants < /=30 and those at > /=31 weeks . By the end of the fifth week , cumulative energy and protein deficits were 813 + /- 542 and 382 + /- 263 kcal/kg and 23 + /- 12 and 13 + /- 15 g/kg and the z scores were -1.14 + /-.6 and -.82 + /-.5 for infants at < /=30 and > /=31 weeks . Stepwise regression analysis indicated that variation in dietary intake accounted for 45 % of the variation in changes in z score . CONCLUSIONS Preterm infants inevitably accumulate a significant nutrient deficit in the first few weeks of life that will not be replaced when current RDIs are fed . This deficit can be directly related to subsequent postnatal growth retardation.postnatal growth retardation , preterm infants BACKGROUND The purpose of the present study was to determine the effect of feeding nutrient-enriched preterm formula to preterm infants until 6 months ' corrected age ( CA ) on growth and development in the first 18 months of life . METHODS Very low-birthweight preterm infants were fed preterm formula until term ( 40 weeks CA ) . Infants were then assigned to one of three groups and were fed term formula until 6 months ' CA ( group 1 , n= 29 ) ; preterm formula to 3 months ' CA and then term formula to 6 months ' CA ( group 2 , n= 30 ) ; or preterm formula until 6 months ' CA ( group 3 , n= 31 ) . Anthropometry was performed at term , 3 , 6 , 9 , 12 , 15 , and at s18 months ' CA . Mental and psychomotor development were assessed using the Bayley Scales of Infant Development II at 18 months ' CA . RESULTS Although body weight , length , head circumference and z score for CA at term in group 3 were significantly lower than those of groups 1 and 2 , growth rates of these parameters were significantly higher in group 3 up to 18 months CA ' , as compared to groups 1 and 2 . The mental developmental index and psychomotor developmental index of the Bayley test were not significantly different between the three groups . CONCLUSIONS Very low-birthweight preterm infants fed nutrient-enriched preterm formula until 6 months ' CA demonstrated significantly improved growth rates for bodyweight , length and head circumference , and comparable mental and psychomotor development throughout the first 18 months of life At discharge from hospital , 36 preterm infants ( birthweight < 1,800 g ) were r and omized to be given either a st and ard formula or an identical formula enriched with calcium ( 47 vs. 80 mg/100 ml ) and phosphorus ( 30 vs. 45 mg/100 ml ) exclusively until they reached a corrected age of 3 months , thereafter beikost and other formulas were introduced into the diet . Weight , head circumference and radial and body length were measured and radial bone mineral content ( BMC ) and bone width ( BW ) determined by single photon absorptiometry at discharge , at 3 and at 6 months of corrected age . Additionally , an X-ray of the wrist was taken and serum alkaline phosphatase activity determined at discharge , and the latter repeated at 3 months . Bone mineral content , bone width , and the individual increments of both parameters were significantly higher in infants fed the enriched formula at 3 months of age , but these differences were less pronounced at 6 months
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 .