Role of the neonatal registered dietitian nutritionist in Canada: A description of staffing and a comparison to practices in the United States.

Background: Neonatal registered dietitian nutritionists (RDNs) are critical members of the neonatal intensive care unit (NICU) team. Ideal RDN staffing levels are unknown. Current staffing levels of neonatal RDNs in Canadian NICUs have not been recently reported.

US neonatal intensive care unit registered dietitian nutritionists salary description and correlates: results of a survey.

Background: This survey described the compensation of neonatal intensive care unit (NICU) registered dietitian nutritionists (RDNs) in the United States and examined correlates of higher salaries within this group.

Methods: A cross-sectional online survey was completed in 2021 by 143 NICU RDNs from 127 US hospitals who reported hourly wage in US dollars (USD). We used initial bivariate analyses to assess the relationship of selected institution-level and individual-level variables to hourly wage; the rank-sum test for binary variables; bivariate regression and Pearson correlation coefficients for continuous variables; the Kruskal-Wallis test for categorical variables.

The Role of the Neonatal Registered Dietitian Nutritionist: Past, Present, and Future.

Neonatal registered dietitian nutritionists (RDNs) are critical members of the neonatal intensive care unit (NICU) team due to their unique skillset of growth assessment, nutrition evaluation, and implementation of nutrition best practices. There is a paucity of data on appropriate staffing of neonatal RDNs in NICUs to promote improved patient outcomes. Here, the authors describe current neonatal RDN staffing and responsibilities in the US NICUs.

An equitable, community-engaged translational framework for science in human lactation and infant feeding-a report from "Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN)" Working Group 5.

Human milk is the ideal source of nutrition for most infants, but significant gaps remain in our understanding of human milk biology. As part of addressing these gaps, the Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN) Project Working Groups 1-4 interrogated the state of knowledge regarding the infant-human milk-lactating parent triad. However, to optimize the impact of newly generated knowledge across all stages of human milk research, the need remained for a translational research framework specific to the field.

Targeted fortification with human milk analysis: An opportunity for innovation.

Human milk's variable macronutrient composition is a necessary consideration when caring for very low birthweight infants. Targeted fortification is the practice of fortifying human milk using its known composition from human milk analysis, rather than its assumed macronutrient values. Utilization of human milk analyzers to measure the protein, fat, lactose, and energy composition within human milk samples has allowed the translation of this practice into the clinical setting.

Enhancing Interpretation of One-Time Body Composition Measurement at Near-Term Gestation in Preterm Infants: An Exploratory Study.

In preterm infants, longitudinal growth patterns have a stronger association with clinical outcomes than cross-sectional metrics. For qualitative growth, a one-time body composition measurement at near term is common, and here we explore the potential use of a novel estimated longitudinal body composition metric (adjusted fat-free mass deficit) using birth anthropometrics. KEY POINTS: · Longitudinal growth patterns are better linked with clinical outcomes in preterm infants.

Parenteral Nutrition.

Prematurity and other complications at birth are nutritional emergencies. Parenteral nutrition is a bridge to enteral nutrition for a few days or months, and sometimes the sole source of nutrition for life. Parenteral nutrition regimens are constructed to provide adequate and balanced energy, macronutrients, and micronutrients to support growth and prevent deficiencies.

Exclusive Maternal Milk Compared With Exclusive Formula on Growth and Health Outcomes in Very-Low-Birthweight Preterm Infants: Phase II of the Pre-B Project and an Evidence Analysis Center Systematic Review.

Unlabelled: As part of the Pre-B Project, a systematic review was conducted to evaluate associations between exclusive maternal milk (≥75%) intake and exclusive formula intake and growth and health outcomes in very-low-birthweight (VLBW) preterm infants. The protocols from the Academy of Nutrition and Dietetics' Evidence Analysis Center and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist were followed. Thirteen observational studies were included; 11 studies reported data that could be synthesized in a pooled analysis.

Effect of parenteral nutrition duration on patterns of growth and body composition in very low-birth-weight premature infants.

Background: Parenteral nutrition (PN) is essential to support premature infants' growth and varies with enteral nutrition (EN) advancement rates. Data on PN duration's impact on premature infants' growth are limited. The aim of this multicenter observational study was to determine the effect of early PN duration on body composition at term corrected gestational age (CGA) in very low-birth-weight (VLBW) premature infants.

Exploring Innovations in Human Milk Analysis in the Neonatal Intensive Care Unit: A Survey of the United States.

Human milk (HM) is the ideal enteral feeding for nearly all infants and offers unique benefits to the very low birthweight (VLBW) infant population. It is a challenge to meet the high nutrient requirements of VLBW infants due to the known variability of HM composition. Human milk analysis (HMA) assesses the composition of HM and allows for individualized fortification.

Infant body composition assessment in the neonatal intensive care unit (NICU) using air displacement plethysmography: Strategies for implementation into clinical workflow.

Nutritional management is integral to infant care in the neonatal intensive care unit (NICU). Recent research on body composition that specifically evaluated fat and fat-free mass has improved our understanding of infant growth and nutritional requirements. The need for body composition monitoring in infants is increasingly recognized as changes in fat mass and fat-free mass associated with early growth can impact clinical outcomes.

Effects of Implementation of Infant-Driven Oral Feeding Guideline on Preterm Infants' Abilities to Achieve Oral Feeding Milestones, in a Tertiary Neonatal Intensive Care Unit.

Objective: This study examines the hypothesis that infant-driven oral feeding leads to earlier achievement of oral feeding and reduces the length of hospital stay compared with provider-driven oral feeding in premature infants METHODS: We used a retrospective chart review to compare 2 groups of premature infants born at ≤35 weeks of gestation. The control group (CG) received the Provider-Driven Oral Feeding model and the intervention group (IG) received the Infant-Driven Oral Feeding model. Postmenstrual age (PMA) upon achieving full oral feeding, PMA at first oral feeding, discharge weight, and length of hospital stay were compared between the groups.

Effect of Enteral Protein Amount on Growth and Health Outcomes in Very-Low-Birth-Weight Preterm Infants: Phase II of the Pre-B Project and an Evidence Analysis Center Systematic Review.

Adequate protein intake by very-low-birth-weight preterm infants (≤1,500 g at birth) is essential to optimize growth and development. The estimated needs for this population are the highest of all humans, however, the recommended intake has varied greatly over the past several years. A literature search was conducted in PubMed, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Cochrane Central databases to identify randomized controlled trials evaluating the effect of prescribed protein intake and identified outcomes.

Association of Protein and Vitamin D Intake With Biochemical Markers in Premature Osteopenic Infants: A Case-Control Study.

Osteopenia in preterm infants (OP) remains an important challenge and is largely dependent on nutritional post-natal intake of factors influencing bone mineralization. We conducted a prospective case-control study to evaluate the importance of protein and vitamin D intake in OP among neonates with birth weight <1,250 g. Simultaneous serum parathyroid hormone (PTH), alkaline phosphatase (ALP), calcium (Ca), phosphorus (P), vitamin D and protein levels were measured during the first six post-natal weeks.

Reliability of routine anthropometric measurements to estimate body composition in term infants.

Background: Birth weight percentiles provide limited information on qualitative infant growth. Body composition provides estimates of fat mass, fat-free mass, and body fat percentage (adiposity). We sought to implement assessment of body composition at birth into clinical practice using a validated anthropometric equation and to evaluate measurement reliability.

Lactose-free infant formula does not change outcomes of neonatal abstinence syndrome (NAS): a randomized clinical trial.

Objective: To determine if lactose-free formula, compared to lactose-containing formula, decreases the cumulative morphine dose required to treat neonatal abstinence syndrome (NAS).

Study Design: In a double-blind clinical trial, we randomized 74 infants (36-42 weeks gestation) at risk for developing NAS due to in-utero exposure to opioids to receive either lactose-free (Similac Sensitive®) or lactose-containing (Similac Advance®) infant formula. The primary outcome measure was the cumulative dose of morphine used for the treatment of NAS during the first 14 days of life.

Burden of prematurity-associated recurrent wheezing: caregiver missed work in the D-Wheeze trial.

Objective: This study describes the burden of prematurity-associated wheezing in black infants with respect to caregiver missed work.

Study Design: We analyzed data from the D-Wheeze trial (ClinicalTrials.gov identifier NCT01601847).

Prevalence of Vitamin D Deficiency in a Large Newborn Cohort from Northern United States and Effect of Intrauterine Drug Exposure.

Vitamin D is not only a vital element in bone health but is also a prohormone. Data regarding distribution of vitamin D status among preterm and term neonates in the United States are limited. There are no data on the effect of intrauterine drug exposure on vitamin D status.

Risk of Iodine Deficiency in Extremely Low Gestational Age Newborns on Parenteral Nutrition.

is an essential component of thyroid hormones, which play a critical role in neurodevelopment. The iodine status of pregnant women and their newborns is not checked routinely. Extremely Low Gestational Age Newborns do not receive Iodine supplementation while on parenteral nutrition (PN).

Targeted Breast Milk Fortification for Very Low Birth Weight (VLBW) Infants: Nutritional Intake, Growth Outcome and Body Composition.

Despite improvements in nutritional management, preterm infants continue to face high rates of postnatal growth restriction. Because variability in breast milk composition may result in protein and energy deficits, targeted fortification has been advocated. We conducted an interventional study to compare body composition and growth outcomes of very low birth weight infants fed targeted protein-fortified human milk (HM) with those fed standard fortified HM.

"Extrauterine growth restriction" and "postnatal growth failure" are misnomers for preterm infants.

Preterm infants are increasingly diagnosed as having "extrauterine growth restriction" (EUGR) or "postnatal growth failure" (PGF). Usually EUGR/PGF is diagnosed when weight is <10th percentile at either discharge or 36-40 weeks postmenstrual age. The reasons why the phrases EUGR/PGF are unhelpful include, they: (i) are not predictive of adverse outcome; (ii) are based only on weight without any consideration of head or length growth, proportionality, body composition, or genetic potential; (iii) ignore normal postnatal weight loss; (iv) are usually assessed prior to growth slowing of the reference fetus, around 36-40 weeks, and (v) are usually based on an arbitrary statistical growth percentile cut-off.

Low caloric intake and high fluid intake during the first week of life are associated with the severity of bronchopulmonary dysplasia in extremely low birth weight infants.

Objective: To study whether there is an association between nutritional intake during the first week of life and severity of bronchopulmonary dysplasia (BPD) in extremely low birth weight (ELBW) infants.

Methods: In a retrospective cohort study, medical records of all ELBW infants admitted to our Neonatal Intensive Care Unit (2010-2017) were reviewed for infants' demographics, clinical characteristics, nutritional intake during their first week of life, and BPD risk factors.

Results: During the study period 226 infants were identified of whom 67% (151/226) had moderate-severe BPD and the rest served as controls.

Accuracy of preterm infant weight gain velocity calculations vary depending on method used and infant age at time of measurement.

Background: We examined preterm infants' weight gain velocity (WGV) to determine how much calculation methods influences actual WGV during the first 28 days of life.

Methods: WGV methods (Average 2-point, Exponential 2-point, Early 1-point, and Daily) were calculated weekly and for various start times (birth, nadir, regain, day 3 and day 7) to 28 days of age for 103 preterm < 1500 gram infants, with daily weights.

Results: Range of WGV estimates decreased 10-22 g/kg/day to 15.