To determine whether maternal supplementation with high-dose docosahexaenoic acid (DHA) in breastfed, very preterm neonates improves neurodevelopmental outcomes at 18 to 22 months' corrected age ...(CA).
Planned follow-up of a randomized, double-blind, placebo-controlled, multicenter trial to compare neurodevelopmental outcomes in breastfed, preterm neonates born before 29 weeks' gestational age (GA). Lactating mothers were randomized to receive either DHA-rich algae oil or a placebo within 72 hours of delivery until 36 weeks' postmenstrual age. Neurodevelopmental outcomes were assessed with the Bayley Scales of Infant and Toddler Development third edition (Bayley-III) at 18 to 22 months' CA. Planned subgroup analyses were conducted for GA (<27 vs ≥27 weeks' gestation) and sex.
Among the 528 children enrolled, 457 (86.6%) had outcomes available at 18 to 22 months' CA (DHA, N = 234, placebo, N = 223). The mean differences in Bayley-III between children in the DHA and placebo groups were -0.07 (95% confidence interval CI -3.23 to 3.10, P = .97) for cognitive score, 2.36 (95% CI -1.14 to 5.87, P = .19) for language score, and 1.10 (95% CI -2.01 to 4.20, P = .49) for motor score. The association between treatment and the Bayley-III language score was modified by GA at birth (interaction P = .07). Neonates born <27 weeks' gestation exposed to DHA performed better on the Bayley-III language score, compared with the placebo group (mean difference 5.06, 95% CI 0.08-10.03, P = .05). There was no interaction between treatment group and sex.
Maternal DHA supplementation did not improve neurodevelopmental outcomes at 18 to 22 months' CA in breastfed, preterm neonates, but subgroup analyses suggested a potential benefit for language in preterm neonates born before 27 weeks' GA.
To determine how neonatal growth velocity affects the association between birth weight and neurodevelopmental outcomes in infants born preterm.
This study is a secondary analysis of the Maternal ...Omega-3 Supplementation to Reduce Bronchopulmonary Dysplasia in Very Preterm Infants (MOBYDIck) randomized multicenter trial conducted in breastfed infants born at <29 weeks of gestation, whose mothers were supplemented with docosahexaenoic acid or placebo during the neonatal period. Neurodevelopmental outcomes were assessed at 18-22 months of corrected age using the Bayley-III cognitive and language composite scores. The role of neonatal growth velocity was assessed with causal mediation and linear regression models. Subgroup analyses were stratified by birth weight z-score categories (<25th, ≥25th-≤75th, and >75th percentiles).
Neurodevelopmental outcomes were available for 379 children (mean gestational age, 26.7 ± 1.5 weeks). Growth velocity partially mediated the relationships between birth weight and cognitive (β = −1.1; 95% CI, −2.2 to −0.02; P = .05) and language scores (β = −2.1; 95% CI, −3.3 to −0.8; P = .002). An increase by 1 g/kg/day in growth velocity was associated with an increase by 1.1 point in the cognitive score (95% CI, −0.03 to 2.1; P = .06) and 1.9 point in the language score (95% CI, 0.7 to 3.1; P = .001), after adjustment for birth weight z-score. For children with birth weight <25th percentile, a 1 g/kg/day increase in growth velocity was associated with an increase by 3.3 points in the cognitive score (95% CI, 0.5 to 6.0; P = .02) and 4.1 points in the language score (95% CI, 1.3 to 7.0; P = .004).
Postnatal growth velocity mediated the relationship between birth weight and neurodevelopmental performance, with larger effects for children with lower birth weight.
Clinicaltrials.gov identifier: NCT02371460.
Lymphatic filariasis (LF) is a neglected tropical disease that can cause hydrocele and its associated stigma, loss of economic productivity, and depression. Hydrocele surgery is an essential part of ...LF morbidity management but can be difficult for national programs to implement. To improve access to hydrocele surgeries in Côte d'Ivoire, we provided a WHO-certified surgical training for six surgical teams from five health districts in Côte d'Ivoire. We then evaluated the surgical outcomes and assessed the impact of hydrocele surgery on quality of life of hydrocelectomy patients. Preoperative and operative records were reviewed to describe baseline hydrocele characteristics and operative details. Postoperative interviews were conducted 4 to 6 months after surgical correction using a standardized questionnaire. Seventeen men underwent surgery during the training and were available for an interview at the 6-month visit. At the time of 6-month follow-up, 11/17 (64.7%) reported improvement in activities of daily living and reduction in difficulties with work, 8/17 (47.1%) reported an improved economic situation, 15/17 (88.2%) reported improved social interactions, and 15/16 (93.8%) reported improved sex life after surgical correction. Three patients (17.6%) had minor postoperative complications, but none required hospitalization. All 17 patients who were available for an interview were satisfied with their surgery. Surgical hydrocelectomy training in Côte d'Ivoire was well received and provided life-altering health improvements for participating patients across multiple domains of life. Support to scale up surgical capacity for this neglected problem is needed.
Background
We aim to assess whether the docosahexaenoic acid (DHA)–containing lipid emulsion (LE) SMOFlipid 20% (Fresenius Kabi Canada Ltd) is associated with bronchopulmonary dysplasia (BPD)–free ...survival at 36 weeks' postmenstrual age in very preterm infants.
Methods
This cohort study is nested in the MOBYDIck randomized clinical trial (NCT02371460), which investigated the effect of maternal DHA supplementation on BPD‐free survival in breastfed very preterm infants born between 23 0/7 and 28 6/7 weeks' gestation in 16 Canadian neonatal intensive care units (2015–2018). Parenteral SMOF‐LE was given to the infants according to the sites' routine care protocols. Relative risks (RRs) were estimated using a modified Poisson regression model with generalized estimating equations taking into account recruitment site, multiple birth, DHA supplementation, birth weight, sex, and gestational age.
Results
Among 528 infants (mean gestational age, 26.5 weeks SD, 1.6), 272 received SMOF‐LE. Overall, 56.7% of the infants in the SMOF‐LE group and 59.7% infants in the non–SMOF‐LE group survived without BPD (adjusted RR, 0.94 95% CI, 0.77–1.14; P = 0.51). BPD rates were 39.3% in the SMOF‐LE group vs 34.1% in the non–SMOF‐LE group (adjusted RR, 1.10 95% CI, 0.82–1.47; P = 0.53). Severe BPD rates were 31.8% in the SMOF‐LE group vs 28.8% in the non–SMOF‐LE group (adjusted P = 0.59). Mortality was not significantly different between the SMOF‐LE (6.7%) and non–SMOF‐LE groups (9.5%; adjusted P = 0.40).
Conclusion
In very preterm infants, intravenous DHA‐containing SMOF‐LE during the neonatal period was not associated with BPD‐free survival.
Les enfants nés très prématurément ne profitent pas du transfert en acide docosahexaénoïque (DHA) maternel normalement actif au troisième trimestre de grossesse. De plus, ils ne peuvent en ...synthétiser du fait de leur immaturité enzymatique. Plusieurs études ont documenté l'effet de la supplémentation en DHA sur la croissance postnatale pour améliorer la santé et le neurodéveloppement des prématurés. Cependant, les effets du DHA sur la croissance varient en fonction de plusieurs facteurs dont l'âge gestationnel, la dose administrée et la période d'étude. Évaluer l'effet du DHA sur les indicateurs de croissance en période néonatale (de la naissance à la 36ᵉ semaine d'âge post-menstruel (PMA)) des enfants nés prématurément, pourrait aider à mieux apprécier l'impact du DHA dans le processus de prise en charge nutritionnelle de ces enfants. Notre étude est un objectif secondaire de l'essai clinique randomisé MOBYDIck (Maternal Omega-3 Supplementation to Reduce Bronchopulmonary Dysplasia in Very Preterm Infants), conduit dans 16 unités de soins intensifs néonataux au Canada. Elle rapporte principalement les résultats de l'effet de la supplémentation maternelle en DHA administré à forte dose sur le profil de croissance et la vélocité de poids jusqu'à la 36ᵉ semaine d'âge post menstruel des enfants nés prématurément (avant 29 semaines d'âge gestationnel) et allaités. Les 528 enfants issus de 461 mères qui ont contribué à l'essai MOBYDIck ont constitué notre échantillon. Les analyses ont été réalisées à l'aide d'un modèle de régression linéaire utilisant la méthode d'équations d'estimation généralisées. Les résultats ont montré que les filles du groupe DHA avaient un profil de poids et une vitesse de croissance plus élevés que celles du groupe placebo durant la période néonatale. Inversement, chez les garçons du groupe supplémenté en DHA, le profil de poids jusqu'à la 36ᵉ semaine PMA était plus faible que chez ceux du groupe non supplémenté.
Infants born very prematurely do not benefit from the maternal (DHA) docosahexaenoic acid transfer normally active in the third trimester of pregnancy. Moreover, they cannot synthesize it because of their enzymatic immaturity. Several studies have documented the effect of DHA supplementation on postnatal growth to improve preterm health and neurodevelopment. However, the effects of DHA on growth vary depending on several factors including gestational age, dose administered and study period. To evaluate the effect of DHA on growth indicators in the neonatal period (birth to 36 weeks post-menstrual age (PMA)) of infants born very preterm could help to better appreciate the impact of DHA in the nutritional management process of these infants. Our study is a secondary objective of the MOBYDIck (Maternal Omega-3 Supplementation to Reduce Bronchopulmonary Dysplasia in Very Preterm Infants) randomized clinical trial, conducted in 16 neonatal intensive care units in Canada. It mainly reports the results of the effect of high-dose maternal DHA administered supplementation on the growth profile and weight velocity up to 36 weeks postmenstrual age of infants born prematurely (before 29 weeks gestational age) and breastfed. 528 children from 461 mothers who contributed to the MOBYDIck trial constituted our sample. Analyses were performed using a linear regression model with generalized estimating equations. The results showed that females in the DHA group had a higher weight profile and growth velocity than those in the placebo group during the neonatal period. In contrast, males in the DHA-supplemented group had a lower weight profile through 36 weeks PMA than those in the non-supplemented group.
