Fernandes Rafael Oliveira, Bernardi Juliana Rombaldi, da Fonseca Júlia Delgado, Gomes da Silva Franciéle, Procianoy Renato Soibelmann, Silveira Rita C
Graduate Program in Child and Adolescent Health (PPGSCA), Medical School of Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.
Graduate Program in Food, Nutrition and Health, Medical School of Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.
Front Nutr. 2022 Oct 20;9:981818. doi: 10.3389/fnut.2022.981818. eCollection 2022.
Early child interventions focused on the family prevented neurodevelopmental and behavioral delays and can provide more knowledge regarding responsive feeding, thus creating learning opportunities to promote better quality nutrition and preventing failure to thrive. The aim is to verify the impact of a continuous program of early home-based intervention on the body composition of preschool infants who were born preterm with very low birth weight (VLBW).
This is a longitudinal analysis from a randomized controlled trial, including VLBW preterm children, born in a tertiary hospital in Southern Brazil and followed up at the high-risk institutional ambulatory clinic. Participants were divided into the intervention group (IG): skin-to-skin care with the mother (kangaroo care), breastfeeding policy, and tactile-kinesthetic stimulation by mothers until hospital discharge. Subsequently, they received a program of early intervention with orientation and a total of 10 home visits, independently from the standard evaluation and care that was performed following the 18 months after birth; conventional group (CG): standard care according to the routine of the newborn intensive care unit (NICU), which includes kangaroo care, and attending to their needs in the follow-up program. Body composition estimation was performed using bioelectrical impedance analyses (BIA), and physical activity and feeding practices questionnaires were evaluated at preschool age, as well as anthropometric measurements and biochemical analysis.
Data of 41 children at 4.6 ± 0.5 years old were evaluated (CG = 21 and IG = 20). Body weight, height, body mass index, waist and arm circumferences, and triceps and subscapular skinfold did not differ between groups. The IG presented higher segmented fat-free mass (FFM) when compared to the CG (right arm FFM: 0.74 vs. 0.65 kg, = 0.040; trunk FFM: 6.86 vs. 6.09 kg, = 0.04; right leg FFM: 1.91 vs. 1.73 kg, = 0.063). Interaction analyses showed that segmented FFM and FFM Index were associated with higher iron content in the IG. In the CG, interaction analyses showed that increased visceral fat area was associated with higher insulin resistance index.
An early intervention protocol from NICU to a home-based program performed by the mothers of VLBW preterm children of low-income families presents a small effect on FFM.
以家庭为重点的早期儿童干预可预防神经发育和行为迟缓，并能提供更多关于响应式喂养的知识，从而创造学习机会以促进更高质量的营养摄入并预防发育迟缓。目的是验证持续的早期家庭干预计划对极低出生体重（VLBW）早产学龄前婴儿身体成分的影响。
这是一项来自随机对照试验的纵向分析，研究对象包括在巴西南部一家三级医院出生的VLBW早产儿童，并在高危机构门诊进行随访。参与者被分为干预组（IG）：与母亲进行皮肤接触护理（袋鼠式护理）、母乳喂养政策，以及母亲在患儿出院前进行触觉 - 动觉刺激。随后，他们接受了一个早期干预计划，包括指导和总共10次家访，独立于出生后18个月后的标准评估和护理；常规组（CG）：根据新生儿重症监护病房（NICU）的常规进行标准护理，包括袋鼠式护理，并在随访计划中满足他们的需求。使用生物电阻抗分析（BIA）进行身体成分估计，并在学龄前评估身体活动和喂养习惯问卷，以及人体测量和生化分析。
对41名4.6±0.5岁儿童的数据进行了评估（CG = 21名，IG = 20名）。两组之间的体重、身高、体重指数、腰围和臂围，以及肱三头肌和肩胛下皮褶厚度没有差异。与CG相比，IG的分段去脂体重（FFM）更高（右臂FFM：0.74 vs. 0.65 kg，P = 0.040；躯干FFM：6.86 vs. 6.09 kg，P = 0.04；右腿FFM：1.91 vs. 1.73 kg，P = 0.063）。交互分析表明，IG中分段FFM和FFM指数与较高的铁含量相关。在CG中，交互分析表明内脏脂肪面积增加与较高的胰岛素抵抗指数相关。
由低收入家庭的VLBW早产儿童母亲执行的从NICU到家庭计划的早期干预方案对FFM有较小影响。
