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Habits that might seriously damage preterm infants’ kidneys

Pediatric Research (2024)Cite this article

We write to stress that persistent barriers to achieving high-quality neonatal feeding might have been remedied earlier, with statements by clinical scientists from centers of high credibility based on knowledge at the time. Lapillonne et al. 1 recently highlighted that all scientific societies support the practice of feeding human milk (HM) to preterm infants. Unfortunately, these recommendations have not had the desired impact on neonatal care. There continues to be a wide global variability among neonatologists regarding the ideal enteral feed for preterm infants. Recent surveys show that 33% of Chinese neonatal intensive care units have access to banked milk, but only 22% use it; similarly, 45% of Japanese neonatologists refrain from using it.2

Hence, we started to read the recent review by Iacobelli et al. 3 which aimed to compile clinical evidence on the effects of postnatal nutrition on renal outcomes of preterm infants, with great excitement. We thought this article would leave us better than found. After reading the entire article, our view is that this study focuses on the link between postnatal renal development and the isolated intake of nutrients rather than on the type of food in which these nutrients are offered to the preterm infant. A key concern in this respect is that one should recognize that infant feeding type or methods impact energy expenditure, substrate oxidation, overall nutrient utilization, and body composition.4 Specifically, regarding protein utilization, preterm newborns can break down proteins from HM, with proteases playing a little role in protein digestion;5 in parallel, HM-fed infants benefit from lower protein oxidation rates for energy purposes than formula-fed infants.4 This advantage may help HM-fed preterm newborns restore their body composition by promoting fat-tissue growth and a higher nitrogen balance as opposed to formula-fed infants.6

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References

  1. Lapillonne, A., Lembo, C. & Iacobelli, S. Breast milk feeding in premature infants with persistent ductus arteriosus. Pediatr. Res. https://doi.org/10.1038/s41390-024-03048-z (2024).

  2. Wada, Y. S. et al. Survey of enteral feeding of preterm infants and the human milk bank in Japan. Pediatr. Int. 65, e15527 (2023).

    Article  PubMed  Google Scholar 

  3. Iacobelli, S., Lapillonne, A., Boubred, F. & ESPR Nutrition council members. Early postnatal nutrition and renal consequences in preterm infants. Pediatr. Res. https://doi.org/10.1038/s41390-024-03080-z (2024).

  4. Perrone, M. et al. Energy Expenditure, Protein Oxidation and Body Composition in a Cohort of Very Low Birth Weight Infants. Nutrients 6, 3962 (2021).

    Article  Google Scholar 

  5. Gianni, M. L., Roggero, P. & Mosca, F. Human milk protein vs. formula protein and their use in preterm infants. Curr. Opin. Clin. Nutr. Metab. Care. 22, 76–81 (2019).

    Article  CAS  PubMed  Google Scholar 

  6. Morlacchi, L. et al. Protein use and weight-gain quality in very-low-birth-weight preterm infants fed human milk or formula. Am. J. Clin. Nutr. 107, 195–200 (2018).

    Article  PubMed  Google Scholar 

  7. Kalhoff, H., Manz, F., Kiwul, P. & Kiwull-Schöne, H. Food Composition and Acid-Base Balance: Alimentary Acid Load and Clinical Implications in Neonates. Open. Nutr. J. 2, 5–8 (2006).

    Article  Google Scholar 

  8. McCance, R. A. The role of the developing kidney in the maintenance of internal stability. J. R. Coll. Physicians Lond. 6, 235–245 (1972).

    CAS  PubMed  Google Scholar 

  9. Gross, S. J. Growth and biochemical response of preterm infants fed human milk or modified infant formula. N. Engl. J. Med. 308, 237–241 (1983).

    Article  CAS  PubMed  Google Scholar 

  10. Janas, L. M., Picciano, M. F. & Hatch, T. F. Indices of protein metabolism in term infants fed human milk, whey-predominant formula, or cow’s milk formula. Pediatrics 75, 775–784 (1985).

    Article  CAS  PubMed  Google Scholar 

  11. Wu, T.-Z. et al. Differences in serum biochemistry between breast-fed and formula-fed infants. J. Chin. Med. Assoc. 74, 511–515 (2011).

    Article  CAS  PubMed  Google Scholar 

  12. Schanler, R. J., Shulman, R. J. & Lau, C. Feeding strategies for pre- mature infants: beneficial outcomes of feeding fortified human milk versus preterm formula. Pediatrics 103, 1150–1157 (1999).

    Article  CAS  PubMed  Google Scholar 

  13. Verd, S. et al. Blood biochemical profile of very preterm infants before and after trophic feeding with exclusive human milk or with formula milk. Clin. Biochem. 47, 584–587 (2014).

    Article  CAS  PubMed  Google Scholar 

  14. Miliku, K. et al. Infant Breastfeeding and Kidney Function in School-Aged Children. Am. J. Kidney Dis. 66, 421–428 (2015).

    Article  PubMed  Google Scholar 

  15. Ginovart, G., Gich, I. & Verd, S. Formula Feeding Is Independently Associated With Acute Kidney Injury in Very Low Birth Weight Infants. J. Hum. Lact. 32, NP111–NP115 (2016).

    Article  PubMed  Google Scholar 

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Acknowledgements

We dedicate this paper to our patients and their families. Our special thank is addressed to our local librarians of Bibliosalut.

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Authors and Affiliations

  1. Majorcan Department of Primary Care, Pediatric Division, La Vileta surgery, 07013, Palma de Mallorca, Spain

    Sergio Verd

  2. Balearic Health Research Institute (IdISBa), 07120, Palma de Mallorca, Spain

    Sergio Verd

  3. Neonatal Intensive Care Unit, Department of Pediatrics, Hospital Germans Trias i Pujol, 08916, Badalona, Spain

    Roser Porta & Gemma Ginovart

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  1. Sergio Verd
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Roser Porta and Gemma Ginovart have equally contributed to this manuscript. Sergio Verd wrote the final draft. All authors reviewed and approved the final manuscript. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

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Correspondence to Sergio Verd.

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Verd, S., Porta, R. & Ginovart, G. Habits that might seriously damage preterm infants’ kidneys. Pediatr Res (2024). https://doi.org/10.1038/s41390-024-03229-w

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