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Nagano-shi, Japan

Collins C.T.,Womens and Childrens Health Research Institute | Collins C.T.,University of Adelaide | Makrides M.,Womens and Childrens Health Research Institute | Makrides M.,University of Adelaide | And 11 more authors.
British Journal of Nutrition | Year: 2011

The effect of the dietary n-3 long-chain PUFA, DHA (22:6n-3), on the growth of pre-term infants is controversial. We tested the effect of higher-dose DHA (approximately 1% dietary fatty acids) on the growth of pre-term infants to 18 months corrected age compared with standard feeding practice (0•20•3 % DHA) in a randomised controlled trial. Infants born < 33 weeks gestation (n 657) were randomly allocated to receive breast milk and/or formula with higher DHA or standard DHA according to a concealed schedule stratified for sex and birth-weight ( < 1250 and 1250 g). The dietary arachidonic acid content of both diets was constant at approximately 0•4 % total fatty acids. The intervention was from day 2 to 5 of life until the infant's expected date of delivery (EDD). Growth was assessed at EDD, and at 4, 12 and 18 months corrected age. There was no effect of higher DHA on weight or head circumference at any age, but infants fed higher DHA were 0•7 cm (95 % CI 0•1, 1•4 cm; P = 0•02) longer at 18 months corrected age. There was an interaction effect between treatment and birth weight strata for weight (P = 0•01) and length (P = 0•04). Higher DHA resulted in increased length in infants born weighing 1250 g at 4 months corrected age and in both weight and length at 12 and 18 months corrected age. Our data show that DHA up to 1 % total dietary fatty acids does not adversely affect growth. © 2011 The Authors.

Miller J.,Womens and Childrens Health Research Institute | Miller J.,University of Adelaide | Makrides M.,Womens and Childrens Health Research Institute | Makrides M.,University of Adelaide | And 9 more authors.
American Journal of Clinical Nutrition | Year: 2012

Background: Preterm human milk-fed infants often experience suboptimal growth despite the use of human milk fortifier (HMF). The extra protein supplied in fortifiers may be inadequate to meet dietary protein requirements for preterm infants. Objective: We assessed the effect of human milk fortified with a higher-protein HMF on growth in preterm infants. Design: This is a randomized controlled trial in 92 preterm infants born at <31 wk gestation who received maternal breast milk that was fortified with HMF containing 1.4 g protein/100 mL (higher-protein group) or 1.0 g protein/100 mL (current practice) until discharge or estimated due date, whichever came first. The HMFs used were isocaloric and differed only in the amount of protein or carbohydrate. Length, weight, and head-circumference gains were assessed over the study duration. Results: Length gains did not differ between the higher- and standard-protein groups (mean difference: 0.06 cm/wk; 95% CI: -0.01, 0.12 cm/wk; P = 0.08). Infants in the higher-protein group achieved a greater weight at study end (mean difference: 220 g; 95% CI: 23, 419 g; P = 0.03). Secondary analyses showed a significant reduction in the proportion of infants who were less than the 10th percentile for length at the study end in the higher-protein group (risk difference: 0.186; 95% CI: 0.370, 0.003; P = 0.047). Conclusions: A higher protein intake results in less growth faltering in human milk-fed preterm infants. It is possible that a higher-protein fortifier than used in this study is needed. This trial was registered with the Australian New Zealand Clinical Trials Registry (http://www.anzctr.org.au/) as ACTRN12606000525583. © 2012 American Society for Nutrition.

Adelson P.L.,University of Adelaide | Wedlock G.R.,Performance Planning and Outcomes Unit | Wilkinson C.S.,Maternal Fetal Medicine | Howard K.,University of Sydney | And 2 more authors.
Australian Health Review | Year: 2013

Objective To compare the costs of inpatient (usual care) with outpatient (intervention) care for cervical priming for induction of labour in women with healthy, low-risk pregnancies who are being induced for prolonged pregnancies or for social reasons. Methods Data from a randomised controlled trial at two hospitals in South Australia were matched with hospital financial data. A cost analysis comparing women randomised to inpatient care with those randomised to outpatient care was performed, with an additional analysis focusing on those who received the intervention. Results Overall, 48% of women randomised into the trial did not receive the intervention. Women randomised to outpatient care had an overall cost saving of 319 per woman (95% CI -104 to 742) as compared with women randomised to usual care. When restricted to women who actually received the intervention, in-hospital cost savings of 433 (95% CI -282 to 1148) were demonstrated in the outpatient group. However, these savings were partially offset by the cost of an outpatient priming clinic, reducing the overall cost savings to 156 per woman. Conclusions Overall cost savings were not statistically significant in women who were randomised to or received the intervention. However, the trend in cost savings favoured outpatient priming. What is known about the topic? Induction of labour is a common obstetric intervention. For women with low-risk, prolonged pregnancies who require cervical priming there has been increased interest in whether this period of waiting for the cervix to 'ripen' can be achieved at home. Outpatient priming has been reported to reduce hospital costs and improve maternal satisfaction. However, few studies have actually examined the cost of outpatient priming for induction of labour. What does this paper add? This is the first paper in Australia to both assess the full cost of outpatient cervical priming and to compare it with usual (inpatient) care. This is the first costing paper from a randomised controlled trial directly comparing inpatient and outpatient priming with prostaglandin E2. What are the implications for practitioners? For women with prolonged, low-risk pregnancies, a program of outpatient cervical priming can potentially reduce in-hospital costs and free up labour ward beds by avoiding an additional overnight hospitalisation. © 2013 AHHA.

Tamaru S.,Center for Perinatal Medicine | Kikuchi A.,Center for Perinatal Medicine | Takagi K.,Center for Perinatal Medicine | Wakamatsu M.,Center for Perinatal Medicine | And 4 more authors.
Early Human Development | Year: 2011

Background: Very premature infants occasionally have neurodevelopmental disabilities. However, there have been quite limited data on prenatal risk factors associated with their neurodevelopmental outcomes. Aim: To clarify the relationship between prenatal risk factors and neurodevelopmental outcomes of very premature infants. Study design: The study design is a retrospective review. Subjects: One hundred seventy Japanese women with a singleton pregnancy and their infants whose birth weight being less than 1500. g were included. We classified those infants into 118 appropriate for gestational age (AGA) and 52 small for gestational age (SGA) infants. Outcome measures: Infants' neurodevelopmental outcomes at 18. months of corrected age were evaluated by the Kyoto Scale of Psychological Development 2001 (KSPD). We analyzed and compared the infants' outcomes and prenatal risk factors between two groups. Results: Mortality and rate of infants unevaluable by KSPD because of severe impairment were not significantly different between those groups. However, the developmental quotient score of the cognitive-adaptive area in SGA infants born between 25 and 31. weeks of gestation was significantly lower than that in AGA infants randomly selected as gestation-matched controls. More advanced gestational age and heavier birth weight protected against adverse neurodevelopmental outcomes in both groups. Moreover, male infants were related to the excess risk of adverse neurodevelopmental outcomes in the SGA group. Conclusion: In view of the neurodevelopment of the infants, it seems that the most efficient obstetric strategy for improving prognosis of premature infants should be targeted to prolong the pregnancy period as long as the reassuring fetal status and maternal stable health condition are being confirmed. © 2010 Elsevier Ltd.

Imada S.,Center for Perinatal Medicine | Takagi K.,Center for Perinatal Medicine | Kikuchi A.,Center for Perinatal Medicine | Ishikawa K.,Center for Perinatal Medicine | And 3 more authors.
Journal of Obstetrics and Gynaecology Research | Year: 2012

Aim: Although birthweight placental weight ratio (BPR) may be a promising indicator which reflects pathophysiology of fetal growth restriction (FGR), the standard of BPR changes throughout gestation in a Japanese population has not been established as far as we know. Therefore, we first examined BPR of appropriate-fordates (AFD) infants in each gestational week in preterm deliveries. We then compared it with that in a group of light-for-dates (LFD) infants born from mothers with and without pregnancy-induced hypertension (PIH). Material and Methods: Placentas of a singleton pregnancy with 373 AFD and 110 LFD infants delivered from 22 to 36 weeks of gestation in our hospital during the period between September 2000 and December 2008 were included. We examined the placental weight and BPR of each gestational week in AFD and LFD groups. And the mean BPR and placental weight in the three groups (AFD: LFD with PIH: LFD without PIH) were compared according to gestational periods. Results: The placental weight and BPR were significantly correlated to the gestational week both in AFD and LFD groups. We found that although the mean BPR in LFD-PIH(-) group was significantly lower than those both in AFD group and in LFD-PIH(+) group in 22-29 weeks, the mean BPR in 30-36 weeks was not statistically different among these three groups. Conclusion: Our result in the AFD group may be useful as one of the standards of BPR changes throughout gestation in a Japanese population for future studies. We believe that BPR may be a clinically useful indicator which reflects pathophysiology of FGR. © 2011 Japan Society of Obstetrics and Gynecology.

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