Massey Documents by Type
Permanent URI for this communityhttps://mro.massey.ac.nz/handle/10179/294
Browse
7 results
Search Results
Item An exploration of body composition in healthy early and full term infants using air displacement plethysmography shortly after birth : a thesis presented in partial fulfilment of the requirements for the degree of Masters of Science in Nutrition and Dietetics at Massey University, Albany, New Zealand(Massey University, 2018) Beauchamp, Annaliese HelenaBackground: The Developmental Origin of Health and Disease theory suggests environmental factors during gestation are important early predictors of later disease. There is a wealth of evidence identifying an association between low and extreme birth weights and an increased risk of adverse health outcomes in later life. The importance of growth in early life led to standardised monitoring of body weight, length and head circumference at birth and throughout infancy. Evidence now suggests body composition, specifically adiposity, in early life to be a better marker of poor health outcomes in later life. Gestation is a continuum and during each week of gestation the foetus continues to accrue fat mass (FM) and fat free mass (FFM), which are not routinely measured at birth. Development of air displacement plethysmography (ADP) presents a valid and reliable technique to measure FM and FFM of infants at birth. Majority of infants are born at term gestation (37 to <42 weeks). Early term infants (37 to <39 weeks) have a higher risk of developing adverse clinical outcomes and later health issues compared to full term infants (39 to <42 weeks). It is currently unknown whether there are differences in FM and FFM between infants born early versus full term. Aim: To investigate the FM and FFM of healthy early and full term New Zealand (NZ) infants within three days of birth. Methods: Healthy term infants were recruited from Auckland City Hospital (ACH), NZ as part of this cross-sectional observation study. Weight, length and waist circumference were measured using standardised techniques. ADP was used to measure FM and FFM of infants. Infants were grouped into early or full term categories. Waist circumference was divided by length to give the waist to length ratio (WLR). Two indices of length-normalised body composition were calculated: a FM index (FMI) and FFM index (FFMI) derived by dividing FM and FFM values (kg) by length2 (m2). Independent 2-tailed t-tests were used to compare the body composition measurements between early and full term infants and between genders. Results: 255 healthy term infants were recruited. There were no differences in the percentage of FM and FFM between early term and full term infants (10.2±4.0% vs 11.1±4.1%, P=0.109 and 90.0±4.0% vs 89.0±4.1%, P=0.110). Full term infants had significantly higher FMI and FFMI compared to early term infants (1.44±0.6 vs 1.26±0.06, P=0.02 and 11.3±1.0 vs 10.8±0.96, P<0.001). Early term males had significantly heavier body weights (P=0.04), FFM (2793.1±332.9g vs 2619.7±315.4g, P=0.003), FFM % (90.8±3.8% vs 88.7±4.0%, P=0.009), FMI (1.15±0.55 vs 1.38±0.56, P=0.039) and lower FM % (9.2±3.8% vs 11.3±4.0%, P=0.009) than female early term infants. No gender differences within full term infants were noted in FM (g), FFM (g), FM %, FFM %, FMI or FFMI. Conclusion: The results of this study suggest full term infants continue to gain FM and FFM along the same trajectories as that at early term gestation although they have greater FMI and FFMI than early term infants. While there were gender differences in body composition noted between early term infants, they were no longer apparent within the full term infants. This study identified the need to investigate the body composition changes of healthy early and full term infants at different time periods following birth. This will allow observation of factors which influence body composition in early life.Item A study to explore mothers' and fathers' shared and individual experiences of premature birth : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Psychology at Massey University, Albany, New Zealand(Massey University, 2005) Lomas, MicheleThis qualitative research project using some of the methodologies of Grounded Theory looked at five couples' experiences of premature birth, in particular comparing and contrasting the experiences of mothers and fathers. Significant themes that were identified were: helplessness, related to parents' belief that they were unable to alter outcomes for their baby; issues of control around the care of the newborn baby; communication and relationships with healthcare staff and the impact on parents' perceptions of inclusiveness in the care of their infants; and for fathers in particular, feeling that they missed out on aspects of the parenting of their newborn. The conclusions were that, due to a number of factors within the NICU environment in conjunction with gender specific methods of coping, fathers tend to be marginalised and excluded from the care of their babies. As a result of this, fathers then distance themselves from contact with their newborns, leading to the cyclic exacerbation of the issues of control and helplessness, which further reinforces their disengagement from the situation. Mothers struggled with the same issues, but not to the extent that they withdrew emotionally and physically from the care of their babies.Item Exploring the fat mass and fat free mass of term and moderate to late preterm infants : an observational study : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Nutrition and Dietetics at Massey University, Albany, New Zealand(Massey University, 2015) Van Dorp, Louise MaryBackground: Moderate to late preterm infants (32-36+6 weeks’ gestation) make up 83% of preterm births in New Zealand. Preterm birth is associated with having a higher risk of obesity, diabetes and cardiovascular disease in later life. Preterm infants demonstrate postnatal growth restriction followed by a period of accelerated growth. When compared to term infants at equivalent ages, preterm infants have been found to have a higher % fat mass. Nutrition is a modifiable factor contributing to the growth of preterm infants. While the goal is for these infants to be breast-fed, this is often not possible in early postnatal life due to delayed maternal milk supply and immaturity of the infant. Evidence is limited for the optimal feeding strategy for these infants until full breast-feeds can be established and there is great variability in practice. Aims: To measure the % fat mass and fat free mass of moderate to late preterm infants and term infants after birth at Auckland City Hospital; to explore the relationship between feeding strategies currently used within Auckland City Hospital and the acquisition of fat and fat free mass in moderate to late preterm infants after birth. Methods: Moderate to late preterm infants and term infants were recruited from Auckland City Hospital. Air displacement plethysmography (ADP) was used to measure the fat mass and fat free mass of the infants. Preterm infants were measured once they were medically stable and term infants were measured within 72 hr of birth. Eleven preterm infants were measured a second time prior to discharge from hospital. Information regarding what the preterm infants were fed within the first five days after birth was collected from their medical notes and the infants were prospectively grouped according to which feeding strategy they predominantly received, either: breast-milk, infant formula, 10% dextrose, or parenteral nutrition. Statistical analysis was performed using independent t-tests, Pearson’s Chi square tests, Mann-Whitney tests, paired sample t-tests, one-way ANOVA, and Kruskal-Wallis tests. Results: Forty seven preterm moderate to late preterm infants and sixty nine term infants were recruited. Term infants had a mean ± SD % FM of 10.9 ± 4.2%, when broken down by sex males had 9.4 ± 3.5% and females had 12.2 ± 4.8% (P = 0.018). Preterm infants measured within the first week of birth (n = 25) had a mean ± SD % FM of 8.7 ± 4.4% and those measured within the second week of birth (n = 19) had a mean ± SD % FM of 8.1 ± 2.9% (P = 0.6). Twenty two preterm infants were measured at ≥ 36 weeks’ postmenstrual age and had a mean ± SD % FM of 10.9 ± 5.0%, which did not differ from the % FM of term infants measured after birth (P = 0.98). Eleven preterm infants were measured twice during their hospital admission and their mean ± SD % FM increased from 8.5 ± 3.5% to 15.0 ± 4.2% (P <0.001). The median [25th-75th quartiles] % increase in FM for infants with two measurements was 98.9 [70.1, 114.9] %. One-way ANOVA revealed significant differences in FFM (P = 0.004), weight (P = 0.013), and length (P = 0.036) between the feeding groups. Post hoc analysis showed that infants in the parenteral nutrition group had significantly less FFM than infants in the formula group (P = 0.008) and were lighter and shorter than the breast-milk group (P = 0.013, P = 0.036). Conclusions: Moderate to late preterm infants experience a rapid increase in FM during hospital admission and reach the % FM of a term infant before term corrected age. Moderate to late preterm infants in the parenteral nutrition group were the lightest, shortest and had the least FFM. This study also highlights considerations to be made for future research using ADP in the Newborn Intensive Care Unit at Auckland City Hospital.Item Feeding practices and growth of preterm infants discharged from the Neonatal Intensive Care Unit at Auckland City Hospital until twelve months corrected age : a thesis presented in partial fulfilment of the requirements for the degree of Masters in Science in Nutrition and Dietetics at Massey University, Albany, New Zealand(Massey University, 2014) Vitali, Jennifer Angela-JaneBackground: Preterm infants are unique in their physiological, developmental and nutritional needs. Previous research regarding the preterm infant has focused on interventions within the hospital setting. Recently the lack of research in the post discharge period has been highlighted. The period after discharge poses a vulnerable period as previous intensive care, growth and nutritional monitoring of the infant are no longer readily available. The aim of this study was to identify current breastfeeding, complementary feeding, feeding practices and growth of preterm infants after hospital discharge from the Neonatal Intensive Care Unit (NICU) at Auckland City Hospital until twelve months corrected age. Method: Infants who were born preterm (<37 weeks’ gestation) were recruited from Auckland City Hospital NICU, a tertiary care level hospital. Homes visits were undertaken at four months after discharge and at twelve months corrected age to collect anthropometric measurements. Online surveys were administered at four months post discharge and at six, nine and twelve months corrected age. Data collected included demographic information at birth, mode of feeding, age of introduction of complementary foods and types of foods introduced to infants. Data were analysed using descriptive statistics. Group comparisons were made using Pearson’s chi-square (2), Fishers Exact test and paired T- tests. Differences were considered significant at P< 0.05. Results: Sixty-eight preterm infants were recruited from the NICU at Auckland City Hospital of whom the majority (76%) were born moderate to late preterm. The median (range) age of babies was 34 weeks (24+2 - 36+6 weeks) and their mean (± SD) birth weight was 2.03 ± 0.65 kg. At hospital discharge 73% of the infants were exclusively breastfed. By four months after discharge this had decreased to 46%, and by 12 months corrected age, only 21% of babies continued to be breastfed. The mean chronological age of complementary food introduction was 23 ± 4.4 weeks (range 12 - 34 weeks). The majority of the babies (84%) started complementary feeding within the recommended age range. The most common first food was baby rice (45%) and infants showed increasing variation in their diet from six until twelve months corrected age. Z-scores for weight, length and head circumference were calculated using UK-WHO data. There was a significant decrease in mean Z-scores for weight, length and head circumference between birth and hospital discharge. The majority of infants regained this deficit by four months and twelve months corrected age. Although, there were a few infants found to be at risk of growth faltering. Conclusion: This study shows that the majority of preterm infants discharged from the NICU are breastfed at discharge, although, breastfeeding declines significantly by four months after discharge and thereafter. The majority of infants are introduced to complementary feeding appropriately although the choices of early complementary foods need to be addressed to include high energy nutrient dense foods. Lastly, growth in the post discharge period of these infants was adequate to support and maintain growth for the majority of infants, more research is needed to determine the feeding practices over this time which impacted on growth.Item A retrospective study of feeding practices and growth of preterm infants admitted to the Special Care Baby Unit at Whangarei Hospital : a thesis presented in partial fulfilment of requirements for the degree of Masters in Science in Nutrition and Dietetics at Massey University, Albany, New Zealand(Massey University, 2014) Share, Ashleigh NicoleIntroduction: Being born preterm places an infant at increased risk of post- natal growth faltering. The immature development of the gastro-intestinal system often in conjunction with feeding difficulties can result in inadequate nutritional intake. Therefore, close monitoring of feeding and growth during hospital admission in preterm infants is important to enable the provision of adequate nutrition support, with early interventions recommended to support optimal growth. Aim: To investigate feeding practices, monitoring and growth outcomes of preterm infants admitted to the Special Care Baby Unit (SCBU) at Whangarei Hospital, New Zealand. Methods: Retrospective data on feeding and growth outcomes was collected from medical notes of preterm infants admitted to SCBU for a minimum of 3 days between January 2013 and March 2014. Data collection on feeding practices included mode, type and duration of feeding during admission and upon discharge. Growth outcomes included body weight, length, and head circumference which are expressed as Z-scores using UK-WHO data. Days to regain birth weight was a further measure of growth outcomes. Data was collected on the monitoring of feeding practices and growth parameters as well as any referrals to paediatric dietetic services during admission. Results: One hundred infants were recruited, 57 of whom were male. The median age of the infants was 35 weeks (range 25-36 weeks). Fourteen infants were born extremely premature and 86 were of moderate to late prematurity. Median length of SCBU admission was 14 days. Breastfeeding was initiated by 83% of the mothers. Seventy-six infants received enteral feeding with 45 infants commenced on expressed breast milk. On a median day of 9, 54 infants reached full enteral feeding volumes. Of the 79 infants discharged home, 47 regained birth weight prior to discharge. The mean change in z-score between birth and discharge was -0.49±0.16 with 19 infants decreasing by >1 z-score. During admission only 6/100 infants were referred to dietetic services. On discharge, 73.1% were receiving some breast milk with 67.1% exclusively breastfeeding. Conclusions: Preterm infants admitted to SCBU had high rates of breast feeding initiation and nearly 3 out 4 infants were receiving some milk on discharge. However, prior to discharge nearly 20% could be identified at risk of growth faltering. This suggests that improvements could be made to the monitoring of feeding and growth of these infants prior to discharge and more referrals to dietetic services may be warranted.Item Iron status of preterm infants after hospital discharge : a thesis presented in partial fulfilment of the requirements for the degree of Masters in Science in Nutrition and Dietetics at Massey University, Albany, New Zealand(Massey University, 2013) Moor, Charlotte FelicityBackground: Preterm infants are at an increased risk of developing iron deficiency (defined in paeditaric populations as a ferritin value <12 μg/L or a serum transferrin receptor concentration >2.4 mg/L) after discharge due to their shortened gestational length, increased requirements for rapid growth, and excessive blood losses through phlebotomy. Optimising preterm infant iron status after discharge is important as poor iron status has been associated with negative health and neurodevelopmental outcomes later in life. Only preterm infants born before 32 weeks gestation or with a birth weight less than 1800 g currently receive routine iron supplementation after discharge from Auckland City Hospital; however there is paucity of evidence to determine whether this is best practice. Objective: To investigate the iron status of preterm infants in Auckland, New Zealand at four months after discharge from hospital. Methods: Sixty one preterm infants were recruited through Auckland City Hospital. At four months after discharge infant haemoglobin, serum ferritin and soluble transferrin receptor (sTfR) concentrations were measured to assess iron status. Weight, length and head circumference were also measured. Information about iron supplementation and mode of feeding was collected using an online questionnaire. Statistical analysis using independent t-tests, Mann-Whitney tests and bivariate correlations were performed. Results: 16.4% of preterm infants had iron deficiency anaemia (defined in paediatric populations as a haemoglobin less than 110 g/L in conjunction with low iron stores) at four months after discharge, with an additional 6.6% of preterm infants classified as having iron deficiency. No infant had iron overload. Iron supplementation was associated with significantly higher haemoglobin (P<0.001) and serum ferritin (P<0.001) concentrations along with lower sTfR concentrations (P=0.005) at four months after discharge. Iron supplementation was also protective against suboptimal iron status at four months after discharge (P=0.018). Mode of feeding, introduction of solids, intrauterine growth restriction, and maternal iron status had no effect on infant iron status at four months after discharge. There was also no relationship between growth and iron supplementation or iron status at four months after discharge. Conclusion: Preterm infants who did not receive iron supplements after discharge had an increased risk of developing iron deficiency and iron deficiency anaemia at four months after discharge. Routine iron supplementation for all preterm infants combined with screening for iron deficiency anaemia after discharge appears to be a safe and effective way to reduce the risk of iron deficiency and iron deficiency anaemia at four months after discharge.Item Vitamin D status of preterm infants at 4 months past hospital discharge : a thesis presented in partial fulfilment of the requirements for the degree of Masters of Science in Nutrition and Dietetics, Massey University, Albany, New Zealand(Massey University, 2013) Emmett, Briar KellyPreterm birth and survival rates are increasing in New Zealand and around the world. Preterm infants are subject to shorter gestational lengths and subsequently suffer from decreased nutrient accretion in utero. Vitamin D is one nutrient that is accrued in the final stages of gestation. At birth preterm infants rely on an exogenous source of this nutrient to achieve and maintain adequate stores. The vitamin D status of preterm infants after hospital discharge in New Zealand was previously unknown. The aim of this study was to investigate the serum 25-hydroxyvitamin D (25(OH)D) status of preterm infants at 4 months post hospital discharge, and describe the factors affecting these concentrations. An observational study of 49 preterm infants (<37 weeks gestation) at 4 months post hospital discharge was undertaken. A capillary blood sample was obtained from infants. Serum 25(OH)D was analysed using ADIVA Centaur Vitamin D Total immunoassay. Questionnaires were used to assess sun exposure behaviours and feeding and supplement use. In this sample of 49 preterm infants, 28.6% were classified as having insufficient vitamin D status (25(OH)D ≤50 nmol/L), of these 8.2% were further classified as having mild to moderate vitamin D deficiency (25(OH)D ≤25 nmol/L). The mean 25(OH)D concentration was 73.8 nmol/L, the range was 16 nmol/L – 314 nmol/L. Vitadol C supplementation had the most significant effect on infant 25(OH)D concentrations. All (n=14) exclusively breastfed infants who did not receive Vitadol C supplements were vitamin D insufficient or deficient on analysis. All infants who received Vitadol C or infant formula were vitamin D sufficient. Vitamin D deficiency is prevalent in exclusively breastfed preterm infants not receiving vitamin D supplements. Vitamin D supplementation should be considered for all preterm infants as part of New Zealand’s child health policy.