Infant Health Outcomes

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Accuracy of Methods for Calculating Postnatal Growth Velocity for Extremely Low Birth Weight Infants

Citation: Patel A.L., Engstrom J.L., Meier P.P., Kimura R.E. Accuracy of Methods for Calculating Postnatal Growth Velocity for Extremely Low Birth Weight Infants. Pediatrics Vol. 116 No. 6,  2005: 1466-1473

Objective. No uniform method for calculating growth velocity (GV) (grams per kilogram per day) among extremely low birth weight (ELBW) infants has been reported. Because the calculation of actual GV is so labor intensive, investigators have estimated GV with varying approaches, making comparisons across studies difficult. This study compares the accuracy of 3 mathematical methods used for estimating average GV, namely, 2-point models using the difference between weights at 2 time points divided by time and weight (either birth weight [BW] or average weight), linear regression models that are normalized for either BW or average weight, and an exponential model. The accuracy of all models was compared with actual GVs calculated from daily weight measures for a group of ELBW infants.
Methods. Actual GVs were calculated from daily weights for 83 ELBW infants admitted to the special care nursery and were compared with estimated GVs from each of the 5 models for the same infants.
Results. The exponential model, using weights from 2 time points, ie, GV = [1000 x ln(Wn/W1)]/(Dn - D1), was extremely accurate, with mean absolute errors of 0.02% to 0.10%. The 2-point and linear models were highly inaccurate when BW was used in the denominator, with mean absolute errors of 50.3% to 96.4%. The 2-point and linear models were fairly accurate when average weight was used in the denominator, with mean absolute errors of 0.1% to 8.97%. Additional analyses showed that the accuracy of the 2-point and linear model estimates was affected significantly by the combination of BW, length of stay, and chronic lung disease, whereas the exponential model was not affected by these combined factors.
Conclusions. GV estimates calculated with 3 commonly used models varied widely, compared with actual GVs; however, the exponential model estimates were extremely accurate. The exponential model provides the accuracy and ease of use that are lacking in current methods applied to infant growth research.

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Cost of Morbidities in Very Low Birth Weight Infants
Citation: AL Patel, TJ Johnson, JL Engstrom, LF Fogg, BJ Jegier, HER Bigger and PP Meier

Objective: To study the incidence of sepsis and neonatal intensive care unit (NICU) costs as a function of the human milk (HM) dose received during the first 28 days post birth for very low birth weight (VLBW) infants.

Design: Prospective cohort study of 175 VLBW infants. The average daily dose of HM (ADDHM) was calculated from daily nutritional data for the first 28 days post birth (ADDHM-Days 1–28). Other covariates associated with sepsis were used to create a propensity score, combining multiple risk factors into a single metric.

Results: The mean gestational age and birth weight were 28.1±2.4 weeks and 1087±252 g, respectively. The mean ADDHM-Days 1–28 was 54±39 ml kg1 day1 (range 0–135). Binary logistic regression analysis controlling for propensity score revealed that increasing ADDHM-Days 1–28 was associated with lower odds of sepsis (odds ratio 0.981, 95% confidence interval 0.967–0.995, P¼0.008). Increasing ADDHM-Days 1–28 was associated with significantly lower NICU costs.

Conclusion: A dose–response relationship was demonstrated between ADDHM-Days 1–28 and a reduction in the odds of sepsis and associated NICU costs after controlling for propensity score. For every HM dose increase of 10 ml kg1 day1, the odds of sepsis decreased by 19%. NICU costs were lowest in the VLBW infants who received the highest ADDHM-Days 1–28.

Journal of Perinatology advance online publication, 31 January 2013; doi:10.1038/jp.2013.2

Keywords: premature infant; breast milk; infection; economics; health-care costs return to top

The meaning of milk for mothers of very low birth weight infants hospitalized in the neonatal intensive care unit
Citation: Rossman, B., Kratovil, A. L., Greene, M. M., Engstrom, J. L., & Meier, P. P. (2013). “I have faith in my milk”: The meaning of milk for mothers of very low birth weight infants hospitalized in the neonatal intensive care unit. Journal of Human Lactation, 29, 359-365.   return to top

Health, nutrition and cost outcomes of human milk feedings for very low birthweight infants.
Citation: Meier, P. P., & Bode, L.  (2013). Health, nutrition and cost outcomes of human milk feedings for very low birthweight infants.  Advances in Nutrition, 4, 670-671.

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The rewards outweigh the efforts: Breastfeeding outcomes for mothers of preterm infants
Citation: Kavanaugh, K., Meier, P., Zimmermann, B., & Mead, L. (1997). The rewards outweigh the efforts: Breastfeeding outcomes for mothers of preterm infants. Journal of Human Lactation, 13(1), 15-21. return to top

Bottle and breastfeeding: Effects on transcutaneous oxygen pressure and temperature in small preterm infants
Citation: Meier, P. P. (1988). Bottle and breastfeeding: Effects on transcutaneous oxygen pressure and temperature in small preterm infants. Nursing Research, 37, 36-41. return to top