Aim To evaluate the impact of an improved nutritional policy for extremely low birthweight (ELBW) infants on nutritional deficits and postnatal growth. Method We compared two groups of 37 ELBW infants, born before and after the introduction of an improved nutritional policy in April 2006. Group A (born 2005 to early 2006) and group B (born 2009) stayed in a French neonatal intensive care unit (NICU) for at least 7weeks. Optimal energy and protein intakes were 120 and 3.5g/kg/day, respectively, and used to calculate cumulative deficits. Delta z-scores for weight, length and head circumference were calculated between birth and 36weeks of postmenstrual age (PMA). The improved nutritional policy focused on earlier and higher parenteral intake of lipids and proteins, earlier and higher human milk fortification and earlier transition to preterm formula. Results The two groups did not differ in gestational age and birthweight. However, protein and energy deficits were significantly reduced in group B. Between birth and 36weeks of PMA, delta z-scores were significantly reduced for length (p=0.012) but not for weight (p=0.09) or head circumference (p=0.83). Conclusion Higher parenteral intake and close attention to enteral feeding reduced nutritional deficits and linear growth restriction in infants admitted to a French NICU.

To evaluate the impact of an improved nutritional policy for extremely low birthweight (ELBW) infants on nutritional deficits and postnatal growth. We compared two groups of 37 ELBW infants, born before and after the introduction of an improved nutritional policy in April 2006. Group A (born 2005 to early 2006) and group B (born 2009) stayed in a French neonatal intensive care unit (NICU) for at least 7 weeks. Optimal energy and protein intakes were 120 and 3.5 g/kg/day, respectively, and used to calculate cumulative deficits. Delta z-scores for weight, length and head circumference were calculated between birth and 36 weeks of postmenstrual age (PMA). The improved nutritional policy focused on earlier and higher parenteral intake of lipids and proteins, earlier and higher human milk fortification and earlier transition to preterm formula. The two groups did not differ in gestational age and birthweight. However, protein and energy deficits were significantly reduced in group B. Between birth and 36 weeks of PMA, delta z-scores were significantly reduced for length (p = 0.012) but not for weight (p = 0.09) or head circumference (p = 0.83). Higher parenteral intake and close attention to enteral feeding reduced nutritional deficits and linear growth restriction in infants admitted to a French NICU.

Most of the published studies evaluating renal prognosis of children born very preterm found asymptomatic abnormalities (blood pressure, glomerular filtration rate GFR, hypercalciuria, decreased renal size, microalbuminuria...) during childhood or early adulthood.The objective of this stuyd was to assess renal function (inulin clearance) in a prospective single-center cohort of children born preterm between 1998 and 2001 (< 30 GW, < 1000 g) and to identify neonatal risk factors for renal abnormalities during childhood. Fifty children were included in the final part of the study. At a mean age of 7.6 years, no patient had arterial hypertension or chronic kidney diseases, but mean centile for diastolic blood pressure was higher than expected and ultrasounds revealed small-sized kidneys compared to controls. The average GFR was 112 ml.min per 1.73 m(2) (91-158). Two children had microalbuminuria, two had hypercalciuria and one had nephrocalcinosis. Children with intra- or extra-uterine growth retardation had an impaired GFR compared to children with appropriate pre- and post-natal growth (107 vs. 110 vs. 125 ml/min per 1.73m(2), p < 0.05). Children with bronchopulmonary dysplasia had a significant higher microalbuminuria.In conclusion, findings of borderline blood pressure and reduced kidney size in children born preterm can be regarded as markers of reduced nephron number. Long term renal follow-up (blood pressure, serum creatinine, urine albumin / creatinine ratio) should be performed in all children born very preterm, with an early referring when abnormalities are highlighted. (C) 2009 Elsevier Masson SAS. All rights reserved.

A single-center prospective cohort study was designed to identify alterations of renal function during childhood in children born prematurely. A cohort of 143 such babies born over a 4-year period (birth weight less than 1000 g and/or less than 30 weeks of gestation) was prospectively included at birth. A mailing was sent to all parents to propose renal evaluation. Among the 50 included children, 23 had intrauterine and 16 had extrauterine growth retardation. When comparing both of these groups to 11 children with appropriate pre- and postnatal growth at a mean follow-up of 7.6 years, both groups of growth-restricted children had slightly but significantly lower glomerular filtration rates, measured by inulin clearance, although both groups were still within the normal range for their ages. There were no differences for other renal parameters, neonatal therapies or complications, except for postnatal corticosteroid exposure. Children with extrauterine growth restriction were found to have significantly lower protein-energy intake during their first week of life than the intrauterine growth-restricted or the normotrophic children. Our study found that children with either intra- or extrauterine growth retardation are at risk of decreased glomerular filtration rates during childhood. Extrauterine growth restriction represents a new risk factor for long-term renal impairment in premature children.

L’objectif de cette etude etait de realiser une analyse cout-efficacite de l’erythropoietine humaine recombinante (Rhu-EPO) versus transfusion sanguine dans le traitement de l’anemie du premature. Un arbre decisionnel a ete construit pour analyser les couts et les consequences du traitement par Rhu-EPO et des transfusions sanguines. Nous avons utilise les pratiques cliniques du service de neonatalogie de l’hopital Debrousse a Lyon et suppose que les enfants recevaient 250 UI/kg de Rhu-EPO trois fois par semaine pendant six semaines. Les probabilites de succes de traitement ont ete obtenues de la litterature medicale. L’analyse a montre que le cout du traitement par Rhu-EPO etait de 2 389 F contre 1 490,45 F pour la transfusion sanguine. Cependant, de nombreux arguments cliniques etaient en faveur du developpement du traitement par Rhu-EPO dans l’anemie du premature.