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Breastmilk fortifier and growth of HIV-exposed and HIV-unexposed preterm infants at Tygerberg Hospital, Western Cape
Thesis (MNutr)--Stellenbosch University, 2022.
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| Format: | Thesis |
| Language: | English |
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Stellenbosch : Stellenbosch University
2022
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| _version_ | 1867614120347435008 |
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| access_status_str | Open Access |
| author | Byrne, Jessica |
| author2 | Van Niekerk, Evette |
| author_browse | Byrne, Jessica Van Niekerk, Evette |
| author_facet | Van Niekerk, Evette Byrne, Jessica |
| author_sort | Byrne, Jessica |
| collection | Thesis |
| dc_rights_str_mv | Stellenbosch University |
| description | Thesis (MNutr)--Stellenbosch University, 2022. |
| format | Thesis |
| id | oai:scholar.sun.ac.za:10019.1/125093 |
| institution | Stellenbosch University (South Africa) |
| language | English |
| last_indexed | 2026-06-10T12:46:59.291Z |
| license_str | Other — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from SUNScholar — Stellenbosch University Repository |
| publishDate | 2022 |
| publishDateRange | 2022 |
| publishDateSort | 2022 |
| publisher | Stellenbosch : Stellenbosch University |
| publisherStr | Stellenbosch : Stellenbosch University |
| record_format | dspace |
| source_str | SUNScholar — Stellenbosch University Repository |
| spelling | oai:scholar.sun.ac.za:10019.1/125093 Breastmilk fortifier and growth of HIV-exposed and HIV-unexposed preterm infants at Tygerberg Hospital, Western Cape Byrne, Jessica Van Niekerk, Evette Du Plessis, Lisanne Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Division of Human Nutrition. Infants, Premature -- Nutrition -- Western Cape HIV infections -- Transmission -- Western Cape HIV-positive persons -- Family relationships -- Western Cape HIV infections -- Pregnancy -- Western Cape Breastfeeding -- Western Cape UCTD Thesis (MNutr)--Stellenbosch University, 2022. ENGLISH SUMMARY: Background: Preterm infants frequently experience poor postnatal growth, where inadequate nutrition, particularly inadequate protein intake, is one of the contributing factors. HIV-exposed uninfected (HEU) infants are currently an under-studied population, yet are at risk for preterm birth, intrauterine growth restriction and poor postnatal growth. Fortified breastmilk is recommended as the feed of choice for preterm very low birth weight (VLBW) and extremely low birth weight (ELBW) infants. The only commercially available breastmilk fortifier in South Africa was recently reformulated to increase the protein content, among other changes. Objectives: The primary objective of this study was to evaluate and compare growth outcomes in HEU and HIV-unexposed uninfected (HUU) preterm, ELBW/VLBW infants who received different nutritional formulations of a breastmilk fortifier. Methods: This retrospective study was conducted using data on VLBW/ELBW preterm infants (gestational age [GA] < 37 weeks) who were either HEU or HUU, born at different time periods in Tygerberg Hospital. Data was extracted retrospectively from medical records of eligible infants fed exclusively breastmilk (mother’s own milk [MOM] or donor expressed breastmilk [DEBM]), who received the original fortifier (OF: April – September 2016) or the reformulated fortifier (RF: April – September 2017), from birth until discharge. Maternal and infant demographic and clinical information, weekly length and head circumference measurements, and daily weight, nutritional intake and outputs were collected. Nutritional intake was calculated using nutrient values for preterm MOM and DEBM with either the original or reformulated fortifier. Results: The total study sample consisted of 230 infants. In the OF group, 115 infants (GA: 30 [IQR: 28 – 31] weeks; birth weight [BW]: 1 193.83 ± 200.35 g) received the OF for a median of 14 days (IQR: 9 – 21 days). In the RF group, 115 infants (GA: 30 [IQR: 28-32] weeks; BW: 1 194.66 ± 202.45 g) received the RF for a median of 13 days (IQR: 5 – 22 days). Significantly more infants in the OF group than in the RF group were HEU (29.6% vs. 18.3%; p = 0.044). Weight growth rates were below recommendations in both fortifier groups (OF: 9.99 ± 5.15 g/kg/day vs. RF: 9.74 ± 6.23 g/kg/day; p = 0.744). Length and head circumference gains were also not significantly different between the fortifier groups. Weight-for-age z-scores decreased from birth to discharge by 1.08 SD in the OF group and 1.12 SD in the RF group (p > 0.05). Extrauterine growth restriction was similarly prevalent in both fortifier groups. No differences in growth were found for HIV-exposure status in either fortifier group. The RF group had a higher total protein intake (OF: 3.01 ± 0.88 g/kg/day vs. RF: 3.42 ± 1.13 g/kg/day; p = 0.003) and a higher protein-to-energy ratio (OF: 2.83 g/100 kcal vs. RF: 3.26 g/100 kcal), but no significant difference in energy intake (OF: 126.04 ± 30.90 kcal/kg/day vs. RF: 121.40 ± 31.10 kcal/kg/day). Conclusions: The use of the RF resulted in a higher protein intake and protein-to-energy ratio. Despite this, HEU and HUU VLBW/ELBW preterm infants who received the RF did not experience better growth outcomes compared to those receiving the OF. AFRIKAANSE OPSOMMING: Agtergrond: Premature babas ervaar gereeld swak postnatale groei. Onvoldoende voeding, veral onvoldoende proteien-inname, is een van die bydraende faktore. MIV-blootgestelde nie-geinfekteerde (MBN) babas is huidiglik ‘n onder-bestudeerde populasie, maar loop die risiko van premature geboorte, intra-uteriene groeibeperking en swak postnatale groei. Gefortifiseerde borsmelk word aanbeveel as die gekose voeding vir premature baie lae geboorte massa (BLGM) en uiters lae geboorte massa (ULGM) babas. Die enigste borsmelk fortifiseerder wat kommersieel beskikbaar is in Suid-Afrika het onlangs herformulering ondergaan om, onder andere, die proteien inhoud te verhoog. Doelwitte: Die hoofdoelwit was om groei-uitkomste in MBN en MIV-nie-blootgestelde nie-geinfekteerde (MNN) premature, BLGM/ULGM babas wat verskillende borsmelk fortifiseerders ontvang het, te evalueer en vergelyk. Metodes: Hierdie retrospektiewe studie was uitgevoer met die gebruik van data oor BLGM/ULGM premature babas [gestasie ouderdom (GO) < 37 weke] wat MBN of MNN ontvang het en op verskillende tye in Tygerberg Hospitaal gebore is. Data was terugwerkend ontrek vanuit mediese rekords van geskikte babas wat eksklusief borsmelk [moeder se eie melk (MEM) of skenker borsmelk (SM)] ontvang het, wie die oorspronklike fortifiseerder (OF April – September 2016) of die her-geformuleerde fortifiseerder (HF: April – September 2017) ontvang het, vanaf geboorte tot ontslag. Moeder en baba se demografiese en kliniese inligting, weeklikse lengte en kop-omtrek metings en daaglikse gewig, voedingsinname en uitskeidings is ingevorder. Voedingsinname was uitgewerk met die gebruik van voedingswaardes vir premature MEM en SM met die oorspronklike of die her-geformuleerde fortifiseerder. Resultate: Die totale studie steekproef het bestaan uit 230 babas. In die OF groep, het 115 babas [GO:30 (IQR: 28 – 31) weke; geboortegewig (GG): 1 193.83 ± 200.35 g] die OF vir ‘n mediaan van 14 dae ontvang (IQR: 9 – 21 dae). In die HF groep, het 115 babas [GO: 30 (IQR: 28 – 32) weke; GG: 1 194.66 ± 202.45 g] die HF ontvang vir ‘n mediaan van 13 dae (IQR: 5 – 22 dae). Daar was aansienlik meer babas in die OF groep as die HF groep wat MBN was (29.6% vs. 18.3%; p = 0.044). Gewigstoename was laer as die aanbevelings in beide fortifiserings-groepe (OF: 9.99 ± 5.15 g/kg/dag vs. HF: 9.74 ± 6.23 g/kg/dag; p = 0.744). Lengte en kop-omtrek toename was ook nie betekenisvol verskillend tussen die fortifiserings-groepe nie. Gewig-vir-ouderdom-z-tellings het afgeneem vanaf geboorte tot ontslag met 1.08 SD in die OF groep en 1.12 SD in die HF groep (p > 0.05). Ekstra-uteriene groeibeperking was soortgelyk in beide fortifiserings-groepe. Geen verskille in groei was gevind vir MIV-blootstelling status in enige van die groepe nie. Die HF groep het ‘n hoer totale proteieninname (OF: 3.01 ± 0.88 g/kg/dag vs. HF: 3.42 ± 1.13 g/kg/dag; p = 0.003) en ‘n hoer proteien-tot-energie verhouding gehad (OF: 2.83 g/100 kcal vs. HF: 3.26 g/100 kcal), maar geen opvallende verskille in energie-inname nie (OF: 126.04 ± 30.90 kcal/kg/dag vs. HF: 121.40 ± 31.10 kcal/kg/dag). Gevolgtrekkings: Die gebruik van die HF het gelei tot ‘n hoer proteieninname en proteien-tot-energie verhouding. Ten spyte hiervan, het MBN en MNN BLGM/ULGM premature babas wat die HF ontvang het, nie beter groei uitkomste getoon in vergelyking met die babas wat die OF ontvang het nie. Masters 2022-03-01T11:30:00Z 2022-04-29T12:53:40Z 2022-03-01T11:30:00Z 2022-03-01 Thesis http://hdl.handle.net/10019.1/125093 en Stellenbosch University xv, 111 pages : illustrations, includes annexures application/pdf Stellenbosch : Stellenbosch University |
| spellingShingle | Infants, Premature -- Nutrition -- Western Cape HIV infections -- Transmission -- Western Cape HIV-positive persons -- Family relationships -- Western Cape HIV infections -- Pregnancy -- Western Cape Breastfeeding -- Western Cape UCTD Byrne, Jessica Breastmilk fortifier and growth of HIV-exposed and HIV-unexposed preterm infants at Tygerberg Hospital, Western Cape |
| title | Breastmilk fortifier and growth of HIV-exposed and HIV-unexposed preterm infants at Tygerberg Hospital, Western Cape |
| title_full | Breastmilk fortifier and growth of HIV-exposed and HIV-unexposed preterm infants at Tygerberg Hospital, Western Cape |
| title_fullStr | Breastmilk fortifier and growth of HIV-exposed and HIV-unexposed preterm infants at Tygerberg Hospital, Western Cape |
| title_full_unstemmed | Breastmilk fortifier and growth of HIV-exposed and HIV-unexposed preterm infants at Tygerberg Hospital, Western Cape |
| title_short | Breastmilk fortifier and growth of HIV-exposed and HIV-unexposed preterm infants at Tygerberg Hospital, Western Cape |
| title_sort | breastmilk fortifier and growth of hiv exposed and hiv unexposed preterm infants at tygerberg hospital western cape |
| topic | Infants, Premature -- Nutrition -- Western Cape HIV infections -- Transmission -- Western Cape HIV-positive persons -- Family relationships -- Western Cape HIV infections -- Pregnancy -- Western Cape Breastfeeding -- Western Cape UCTD |
| url | http://hdl.handle.net/10019.1/125093 |
| work_keys_str_mv | AT byrnejessica breastmilkfortifierandgrowthofhivexposedandhivunexposedpreterminfantsattygerberghospitalwesterncape |