Publications
65 results found
Uthaya S, Liu X, Modi N, 2016, Nutritional Evaluation and Optimisation in Neonates trial: is the protein-to-energy ratio important? Reply, AMERICAN JOURNAL OF CLINICAL NUTRITION, Vol: 104, Pages: 1721-1722, ISSN: 0002-9165
Uthaya SN, Liu X, Babalis D, et al., 2016, Nutritional Evaluation and Optimisation in Neonates (NEON): a randomised double-blind controlled trial of amino-acid regimen and intravenous lipid composition in preterm parenteral nutrition, American Journal of Clinical Nutrition, Vol: 103, Pages: 1443-1452, ISSN: 1938-3207
BackgroundParenteral nutrition is central to the care of very immature infants. Current international recommendations favour higher amino-acid intakes and fish oil-containing lipid emulsions. ObjectiveThe aim of this two-by-two factorial, double-blind multicentre randomised controlled trial was to compare the effect of high (immediate Recommended Daily Intake: Imm-RDI) versus low (incremental introduction: Inc-AA) parenteral amino-acid delivery, commenced within 24 hours of birth, on body composition, and a multi-component lipid emulsion containing 30% soy bean oil, 30% medium chain triglycerides, 25% olive oil and 15% fish oil (SMOF) versus soybean oil based lipid emulsion (SO) on Intra-Hepato-Cellular Lipid (IHCL) content. ResultsWe randomised 168 infants born <31 weeks gestation. We evaluated outcomes at term in 133 infants. There were no significant differences between Imm-RDI and Inc-AA groups for non-adipose mass (adjusted mean difference (95% CI): 1.0g (-108, 111) p=0.98) or between SMOF and SO groups for IHCL (adjusted mean ratio SMOF:SO (95% CI): 1.1 (0.8, 1.6) p=0.58). SMOF does not affect IHCL content. There was a significant interaction (p=0.05) between the two interventions for non-adipose mass. There were no significant interactions between group differences for either primary outcome measure after adjusting for additional confounders. Imm-RDI infants were more likely than Inc-AA infants to have blood urea nitrogen levels greater than 7mmol/l or 10mmol/l respectively (75% vs 49%; p<0.01 and 49% vs 18%; p<0.01). Head circumference at term was smaller in the Imm-RDI group (mean difference (95% CI): -0.8cm (-1.5, -0.1) p= 0.02). There were no significant differences in any pre-specified secondary outcomes including adiposity, liver function tests, incidence of conjugated hyperbilirubinaemia, weight, length, mortality and brain volumes. ConclusionsImmediate delivery of Recommended Daily Intake of parenteral amino-acids does not benefit body compo
Uthaya S, Liu X, Babalis D, et al., 2016, Nutritional Evaluation and Optimisation in Neonates (NEON) trial of amino acid regimen and intravenous lipid composition in preterm parenteral nutrition: a randomised double-blind controlled trial, Efficacy and Mechanism Evaluation, Vol: 3, ISSN: 2050-4365
BackgroundParenteral nutrition (PN) is central to the care of very immature infants. Early intakes of higher amounts of amino acids and the use of lipid emulsions containing fish oils are recommended by current international recommendations.ObjectiveTo confirm the safety and demonstrate efficacy of the immediate introduction of the recommended daily intake of amino acids (Imm-RDI) and soya bean oil, medium-chain triglycerides, olive oil and fish oil lipid in PN to increase non-adipose (lean) body mass and decrease intrahepatocellular lipid (IHCL) content.DesignMulticentre, double-blind, 2 × 2 factorial and randomised controlled trial (RCT).SettingNeonatal units in London and south-east England, UK.ParticipantsExtremely preterm infants born before 31 weeks of gestation without major congenital or life-threatening abnormalities who could to be randomised to receive PN within 24 hours of birth.InterventionsInfants were randomised within 24 hours of birth to receive PN containing either high [RDI of amino acids (Imm-RDI)] or low [incremental amino acids (Inc-AA) control] levels of amino acids. In addition, infants were randomised to receive either 20% SMOFlipid® (Fresenius Kabi AG, Richmond Hill, ON, Canada) or 20% Intralipid® (Fresenius Kabi AG, Richmond Hill, ON, Canada) (control). This resulted in four groups: (1) Inc-AA/Intralipid, (2) Inc-AA/SMOFlipid, (3) Imm-RDI/Intralipid and (4) Imm-RDI/SMOFlipid. The intervention was continued until infants were receiving 150 ml/kg/day of enteral feeds for 24 hours.Primary outcome measureFor the amino acid intervention, this was non-adipose or lean body mass measured by magnetic resonance imaging. For the lipid composition intervention, this was IHCL content as measured by hepatic magnetic resonance spectroscopy. Primary outcomes were measured at term age equivalent, between 37 and 44 weeks postmenstrual age.ResultsWe randomised 168 infants born before 31 weeks of gestation. We evaluated outc
Raban S, Santhakumaran S, Keraan Q, et al., 2016, A randomised controlled trial of high vs low volume initiation and rapid vs slow advancement of milk feeds in infants with birthweights 1000 g in a resource-limited setting, Paediatrics and International Child Health, Vol: 36, Pages: 288-295, ISSN: 2046-9047
Background: Optimal feeding regimens for infants ≤ 1000 g have not been established and are a global healthcare concern.Aims and objectives: A controlled trial to establish the safety and efficacy of high vs low volume initiation and rapid vs slow advancement of milk feeds in a resource-limited setting was undertaken.Methods: Infants ≤ 1000 g birthweight were randomised to one of four arms, either low (4 ml/kg/day) or high (24 ml/kg/day) initiation and either slow (24 ml/kg/day) or rapid (36 ml/kg/day) advancement of exclusive feeds of human milk (mother’s or donor) until a weight of 1200 g was reached. After this point, formula was used to supplement insufficient mother’s milk. The primary outcome was time to reach 1500 g.Results: infants were recruited (51: low/slow; 47: low/rapid; 52: high/slow; 50: high/rapid). Infants on rapid advancement regimens reached 1500 g most rapidly (hazard ratio 1.48, 95% CI 1.05–2.09, P=0.03). The rapid advancement groups also regained birthweight more rapidly (hazard ratio 1.77, 95% CI 1.26–2.50, P=0.001). There was no apparent effect of high vs low initiation volumes but there was some evidence of interaction between interventions. There were no significant differences in other secondary outcomes, including necrotising enterocolitis, feed intolerance and late-onset sepsis.Conclusions: In this small pilot study, higher initiation feed volumes and larger daily increments appeared to be well tolerated and resulted in more rapid early weight gain. These data provide justification for a larger study in resource-limited settings to address mortality, necrotising enterocolitis and other important outcomes.
Gale C, Logan KM, Jeffries S, et al., 2015, Sexual dimorphism in relation to adipose tissue and intrahepatocellular lipid deposition in early infancy, International Journal of Obesity, Vol: 39, Pages: 629-632, ISSN: 1476-5497
Sharma S, Varley J, Bell V, et al., 2015, Development of a smartphone app for new mums: an innovative information tool in a responsive maternity unit, Publisher: WILEY-BLACKWELL, Pages: 374-375, ISSN: 1470-0328
Sharma S, Varley J, Bell V, et al., 2015, Development of a smartphone app for new mums: an innovative information tool in a responsive maternity unit, Publisher: WILEY-BLACKWELL, Pages: 14-14, ISSN: 1470-0328
Uthaya S, Modi N, 2014, Practical preterm parenteral nutrition: Systematic literature review and recommendations for practice, EARLY HUMAN DEVELOPMENT, Vol: 90, Pages: 747-753, ISSN: 0378-3782
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- Citations: 13
Gale C, Thomas EL, Jeffries S, et al., 2014, Adiposity and hepatic lipid in healthy full-term, breastfed, and formula-fed human infants: a prospective short-term longitudinal cohort study (vol 99, pg 1034, 2014), AMERICAN JOURNAL OF CLINICAL NUTRITION, Vol: 100, Pages: 1213-1213, ISSN: 0002-9165
Uthaya S, Mancini A, Beardsley C, et al., 2014, Managing palliation in the neonatal unit, ARCHIVES OF DISEASE IN CHILDHOOD-FETAL AND NEONATAL EDITION, Vol: 99, Pages: F349-F352, ISSN: 1359-2998
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- Citations: 11
Gale C, Thomas EL, Jeffries S, et al., 2014, Adiposity and hepatic lipid in healthy full-term, breastfed, and formula-fed human infants: a prospective short-term longitudinal cohort study, American Journal of Clinical Nutrition, Vol: 99, Pages: 1034-1040, ISSN: 0002-9165
Background: The effect of mode of infant feeding on adiposity deposition is not fully understood.Objective: The objective was to test the hypothesis that differences in total and regional adipose tissue content and intrahepatocellular lipid (IHCL) arise in early infancy between breast- and formula-fed infants and to describe longitudinal changes.Design: This prospective longitudinal cohort study was performed in 2 hospitals in the United Kingdom. Healthy, full-term, appropriate weight-for-gestational age infants were recruited; adipose tissue volume and distribution were directly quantified by using whole-body magnetic resonance imaging; IHCL was assessed by in vivo proton magnetic resonance spectroscopy. Measurements were performed after birth (median age: 13 d) and at 6–12 wk of age. Method of infant feeding was recorded prospectively by using maternally completed feeding diaries. Breastfed was defined as >80% of feeds consisting of breast milk at both points; formula-fed was defined as >80% of feeds consisting of formula milk at both points.Results: Longitudinal results were obtained from 70 infants (36 breastfed, 9 mixed-fed, and 25 formula-fed). No differences were found in total or regional adipose tissue or IHCL between breastfed and formula-fed infants. In pooled analyses including all feeding groups, IHCL and total adipose tissue approximately doubled between birth and 6–12 wk: IHCL after birth (median: 0.949; IQR: 0.521–1.711) and at 6–12 wk (1.828; 1.376–2.697; P < 0.001) and total adipose tissue after birth (0.749 L; 0.620–0.928 L) and at 6–12 wk (1.547 L; 1.332–1.790 L; P < 0.001). Increasing adiposity was characterized by greater relative increases in subcutaneous than in internal adipose tissue depots.Conclusions: No differences were detectable in adipose tissue or IHCL accretion between breastfed and formula-fed infants up to 2 mo. The substantial increase in IHCL seen over this period in bo
Roberts I, Alford K, Hall G, et al., 2013, <i>GATA1</i>-mutant clones are frequent and often unsuspected in babies with Down syndrome: identification of a population at risk of leukemia, BLOOD, Vol: 122, Pages: 3908-3917, ISSN: 0006-4971
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- Citations: 114
Gale C, Jeffries S, Logan KM, et al., 2013, Avoiding sedation in research MRI and spectroscopy in infants: our approach, success rate and prevalence of incidental findings, ARCHIVES OF DISEASE IN CHILDHOOD-FETAL AND NEONATAL EDITION, Vol: 98, Pages: F267-F268, ISSN: 1359-2998
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- Citations: 28
De Lucia Rolfe E, Modi N, Uthaya S, et al., 2013, Ultrasound estimates of visceral and subcutaneous-abdominal adipose tissues in infancy., J Obes, Vol: 2013
Other imaging techniques to quantify internal-abdominal adiposity (IA-AT) and subcutaneous-abdominal adiposity (SCA-AT) are frequently impractical in infants. The aim of this study was twofold: (a) to validate ultrasound (US) visceral and subcutaneous-abdominal depths in assessing IA-AT and SCA-AT from MRI as the reference method in infants and (b) to analyze the association between US abdominal adiposity and anthropometric measures at ages 3 months and 12 months. Twenty-two infants underwent MRI and US measures of abdominal adiposity. Abdominal US parameters and anthropometric variables were assessed in the Cambridge Baby Growth Study (CBGS), n = 487 infants (23 girls) at age 3 months and n = 495 infants (237 girls) at 12 months. US visceral and subcutaneous-abdominal depths correlated with MRI quantified IA-AT (r = 0.48, P < 0.05) and SCA-AT (r = 0.71, P < 0.001) volumes, respectively. In CBGS, mean US-visceral depths increased by ~20 % between ages 3 and 12 months (P < 0.0001) and at both ages were lower in infants breast-fed at 3 months than in other infants. US-visceral depths at both 3 and 12 months were inversely related to skinfold thickness at birth (P = 0.03 and P = 0.009 at 3 and 12 months, resp.; adjusted for current skinfold thickness). In contrast, US-subcutaneous-abdominal depth at 3 months was positively related to skinfold thickness at birth (P = 0.004). US measures can rank infants with higher or lower IA-AT and SCA-AT. Contrasting patterns of association with visceral and subcutaneous-abdominal adiposities indicate that they may be differentially regulated in infancy.
Winckworth LC, Chonat S, Uthaya S, 2012, CUTANEOUS LESIONS IN TRANSIENT ABNORMAL MYELOPOIESIS, JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Vol: 48, ISSN: 1034-4810
Omar A, Kuchai R, Heywood R, 2012, CUTANEOUS LESIONS IN TRANSIENT ABNORMAL MYELOPOIESIS, JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Vol: 48, Pages: 184-185, ISSN: 1034-4810
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- Citations: 2
Thomas EL, Uthaya S, Vasu V, 2010, Neonatal intrahepatocellular lipid (vol 93, pg F382, 2008), ARCHIVES OF DISEASE IN CHILDHOOD, Vol: 95, Pages: 1071-1071, ISSN: 0003-9888
Modi N, Uthaya S, Fell J, et al., 2010, A Randomized, Double-Blind, Controlled Trial of the Effect of Prebiotic Oligosaccharides on Enteral Tolerance in Preterm Infants (ISRCTN77444690), PEDIATRIC RESEARCH, Vol: 68, Pages: 440-445, ISSN: 0031-3998
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- Citations: 27
Vasu V, Thomas EL, Durighel G, et al., 2009, LEAN BODY MASS IS REDUCED IN PRETERM INFANTS AT TERM AGE, ACTA PAEDIATRICA, Vol: 98, Pages: 63-63, ISSN: 0803-5253
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- Citations: 2
Doolan A, Thomas L, Uthaya S, et al., 2009, ADIPOSE TISSUE DISTRIBUTION OF YOUNG ADULTS BORN BELOW 33 WEEKS GESTATION, ACTA PAEDIATRICA, Vol: 98, Pages: 122-122, ISSN: 0803-5253
Modi N, Thomas EL, Uthaya SN, et al., 2009, Whole Body Magnetic Resonance Imaging of Healthy Newborn Infants Demonstrates Increased Central Adiposity in Asian Indians, PEDIATRIC RESEARCH, Vol: 65, Pages: 584-587, ISSN: 0031-3998
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- Citations: 77
Thomas EL, Uthaya S, Vasu V, et al., 2008, Neonatal intrahepatocellular lipid, ARCHIVES OF DISEASE IN CHILDHOOD-FETAL AND NEONATAL EDITION, Vol: 93, Pages: F382-F383, ISSN: 1359-2998
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- Citations: 18
Thomas L, Uthaya S, Vasu V, et al., 2008, Neonatal intrahepatocellular lipid., Arch Dis Child, ISSN: 1468-2044
There is increasing evidence that preterm birth is a risk factor for the development of adiposity associated disease though the pathophysiological basis in unclear. <BR>We have previously shown that preterm infants have increased internal abdominal (visceral) adiposity by term. In adults increased internal adiposity is associated with elevated intrahepatocellular lipid (IHCL). <BR>We measured IHCL using 1H NMR spectroscopy in 26 infants (8 healthy preterm-at-term and 18 term-born) and compared values with a reference group of 32 adults.<BR> There was no significant difference between adult and term-born IHCL values. In preterm-at-term infants IHCL was significantly elevated when compared with term-born infants and with adults (IHCL CH2/water median (interquartile range): preterm 1.69 (1.04, 3.529), term 0.21 (0, 0.535) and adult 0.55 (0.08, 1.57).
Uthaya S, Buckley E, McEwan P, et al., 2007, Exploratory, randomised, double-blind, controlled trial of breast milk fortifier containing long chain polyunsaturated fatty acids (LCPUFA) in pre term (PT) infants: effects on term body composition, ACTA PAEDIATRICA, Vol: 96, Pages: 91-91, ISSN: 0803-5253
Yajnik C, Umranikar S, Lubree H, et al., 2007, Increased abdominal and visceral adiposity is manifest in Indian babies at birth, EARLY HUMAN DEVELOPMENT, Vol: 83, Pages: S66-S67, ISSN: 0378-3782
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- Citations: 1
McEwan P, Uthaya S, Thomas L, et al., 2006, Are ethnic differences in body composition present at birth?, EARLY HUMAN DEVELOPMENT, Vol: 82, Pages: 618-618, ISSN: 0378-3782
Modi N, Thomas L, Harrington TAM, et al., 2006, Determinants of adiposity during preweaning postnatal growth in appropriately grown and growth-restricted term infants, PEDIATRIC RESEARCH, Vol: 60, Pages: 345-348, ISSN: 0031-3998
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- Citations: 55
Cockerill J, Uthaya S, Dore CJ, et al., 2006, Accelerated postnatal head growth follows preterm birth, ARCHIVES OF DISEASE IN CHILDHOOD-FETAL AND NEONATAL EDITION, Vol: 91, Pages: F184-F187, ISSN: 1359-2998
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- Citations: 31
Uthaya S, Thomas EL, Hamilton G, et al., 2005, Preterm infants at term show increased intrahepatocellular lipid content on proton magnetic resonance spectroscopy, 46th Annual Meeting of the European-Society-for-Paediatric-Research, Publisher: INT PEDIATRIC RESEARCH FOUNDATION, INC, Pages: 420-420, ISSN: 0031-3998
Uthaya S, Thomas L, Bell J, et al., 2005, Adipose tissue quantity and distribution in healthy term infants using magnetic resonance imaging, 46th Annual Meeting of the European-Society-for-Paediatric-Research, Publisher: INT PEDIATRIC RESEARCH FOUNDATION, INC, Pages: 420-420, ISSN: 0031-3998
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