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Body composition and nutritional intake of HIV exposed preterm, very- and extremely-low birth weight infants in Tygerberg hospital, Western Cape

dc.contributor.advisorVan Niekerk, Evetteen_ZA
dc.contributor.advisorDhansay, Muhammed Alien_ZA
dc.contributor.authorStrydom, Klaraen_ZA
dc.contributor.otherStellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.en_ZA
dc.date.accessioned2018-11-12T12:34:50Z
dc.date.accessioned2018-12-07T06:51:36Z
dc.date.available2018-11-12T12:34:50Z
dc.date.available2018-12-07T06:51:36Z
dc.date.issued2018-12
dc.identifier.urihttp://hdl.handle.net/10019.1/104941
dc.descriptionThesis (MNutr)--Stellenbosch University, 2018.en_ZA
dc.description.abstractENGLISH SUMMARY : Introduction: The relationship between HIV exposure and body composition (and the quality thereof) of preterm infants is not well researched. Human breast milk (HBM) is considered inadequate in meeting the protein requirements of very low birth weight (VLBW) infants, which could affect the body composition. Objectives: The primary objective of this study was to determine the body composition of HIV-exposed preterm VLBW and extremely low-birth weight (ELBW) infants. Secondary objectives were to evaluate the effect of the treatment duration of maternal highly active antiretroviral therapy (HAART) and the effect HBM has on the body composition of this vulnerable population. Furthermore, the effect of breast milk fortification and days infants were kept nil per os (NPO) has on body composition were also assessed. Methods: A descriptive cross-sectional study was conducted between May and October 2016. HIV-exposed and -unexposed preterm infants (gestational age < 37 weeks) with a birth weight of ≤1 200 g were included. Each infant’s maternal medical background was recorded. Anthropometric and body composition measurements were recorded weekly during the 28-day follow-up period. Nutritional intakes and clinical progress was documented daily. Results: A total of 113 preterm infants were included in this study, of which thirty infants (27%) were HIV-exposed. HIV-exposed infants had significantly (𝑝= 0.01) lower gestational ages than HIV-unexposed infants (25–28 weeks). HIV-exposed infants displayed significantly lower fat mass percentage (FM%) on day 21 and day 28 (0.9% vs. 1.4%, 𝑝= 0.02 and 1.0% vs. 1.5%; 𝑝= 0.03), respectively. HIV-exposed infants whose mothers received HAART for ≥ 20 weeks had higher weights and FM% with lower fat-free mass percentages (FFM%) at birth when compared to infants whose mothers received treatment for shorter durations (≥ 4–< 20 weeks). In this study 110 of 113 preterm infants received HBM, of which 91 infants received fortified HBM. HIV-exposed and unexposed infants receiving fortified HBM displayed differences in (FM%) (0.88% vs. 1.36%; 𝑝=0.01) compared to (0.97% vs.1.49%; 𝑝= 0.03) and FFM% (98.98% vs. 98.68%; 𝑝= 0.03) compared to (99.02% vs. 98.49%; 𝑝= 0.02), on day 21 and 28 respectively. All Infants kept NPO vs. not kept NPO displayed differences in FM% on day 7, 21 and 28 of life (0.9% vs 1.3%; 𝑝= 0.03), (0.99% vs 1.4%; 𝑝= 0.02) and (0.9% vs 1.6%; 𝑝= 0.0004) as well as differences in FFM% (99.1% vs 98.4%; 𝑝= 0.0005) on day 28 of life. Conclusion: Body composition differs between HIV-exposed and HIV-unexposed preterm infants and the duration of maternal HAART affects postnatal infant body composition. There were no significant differences in the body composition of HIV-exposed and HIV-unexposed infants who received HBM or fortified HBM. However, between the HIV-exposed infants significant differences in body composition measurements were found for infants who received fortified HBM and those who did not. Infants who were kept NPO were generally smaller, shorter, and had lower FM% and more FFM%. Key Message: The ward feeding protocols for preterm infants should be re-evaluated, focusing specifically on the HIV-exposed preterm infants, to improve short and long term outcomes of this vulnerable population.en_ZA
dc.description.abstractAFRIKAANSE OPSOMMING : Inleiding: Die verhouding tussen blootstelling aan MIV, liggaamsamestelling (en die kwaliteit daarvan) en premature babas, is nie goed nagevors nie. Menslike borsmelk (HBM) word as onvoldoende beskou om in die proteïenvereistes van babas met 'n baie lae geboortegewig (VLBW) te voorsien. Dit kan 'n effek op liggaamsamestelling hê. Doelwitte: Die primêre doelwit van hierdie studie was om die liggaamsamestelling te bepaal van premature babas met baie lae geboortegewig (VLBW) en dié met uiters lae geboortegewig (ELBW), wat aan MIV blootgestel was. Sekondêre doelwitte was om te evalueer wat die effek was van die tydsduur waartydens die moeder hoogs aktiewe antiretrovirale behandeling (HAART) ontvang het, en ook om te bepaal wat die effek is van menslike borsmelk (HBM) op die liggaamsamestelling van hierdie kwesbare populasie. Hierbenewens, is die effek van borsmelkfortifisering, asook die dae waarop babas nil per os (NPO) ontvang het, op liggaamsamestelling bepaal. Metodes: 'n Beskrywende deursnit-studie is tussen Mei en Oktober 2016 uitgevoer. Premature babas (gestasie-ouderdom < 37 weke) met 'n geboortegewig van ≤ 1 200 g wat aan MIV blootgestel was en nie aan MIV blootgestel was nie, is as populasie ingesluit. Die mediese agtergrond van elke baba se moeder is opgeteken. Antropometriese en liggaamsamestellingsmates is weekliks gedurende die opvolgperiode van 28 dae opgeteken. Voedings-inname en kliniese vooruitgang is daagliks gedokumenteer. Resultate: 'n Totaal van 113 premature babas is by hierdie studie betrek, van wie dertig babas (27%) aan MIV blootgestel was. Babas wat aan MIV blootgestel was, het beduidend (𝑝=0.01) laer gestasie-ouderdomme gehad as dié wat nie aan MIV blootgestel was nie (25–28 weke). Babas wat aan MIV blootgestel was, het ‘n beduidend laer vetmassa-persentasie (FM%) (0.9% vs. 1.4%, 𝑝= 0.02 en 1.0% vs. 1.5%, 𝑝= 0.03) op Dag 21 en 28 getoon. Babas wat aan MIV blootgestel was en wie se moeders HAART vir ≥ 20 weke ontvang het, het by geboorte meer geweeg en hoër FM% gehad, met 'n laer vetvrye massa-persentasie (FFM%) wanneer hulle vergelyk is met babas wie se moeders behandeling vir korter periodes (≥ 4–< 20 weke) ontvang het. In hierdie studie het 110 van die 113 premature babas menslike borsmelk (HBM) ontvang en 91 gefortifiseerde menslike borsmelk (HBM). Babas wat aan MIV blootgestel was en dié wat nie aan MIV blootgestel was nie, en wat gefortifiseerde menslike borsmelk (HBM) ontvang het, het verskille getoon in FM% (0.88% vs. 1.36%; 𝑝= 0.01) teenoor (0.97% vs.1.49%; 𝑝= 0.03) en FFM% (98.98% vs. 98.68%; 𝑝= 0.03) teenoor (99.02% vs. 98.49%; 𝑝= 0.02) op Dag 21 en 28 onderskeidelik. Die babas wat nil per os (NPO) ontvang het vs. babas was nie NPO ontvang het nie, het geen verskille getoon in FM% (0.9%vs. 1.3%; 𝑝= 0.03), (0.99% vs. 1.4%; 𝑝= 0.02) en (0.9% vs. 1.6%; 𝑝= 0.0004) op Dag 7, 21 en 28 van lewe, en ook nie in FFM% (99.1% vs. 98.4%; 𝑝= 0.0005) op Dag 28 van lewe nie. Gevolgtrekking: Die liggaamsamestelling van premature babas wat aan MIV blootgestel was en dié wat nie aan MIV blootgestel was nie, verskil. Daarbenewens beïnvloed die tydsduur waartydens die moeder HAART-behandeling ontvang, die postnatale liggaamsamestelling van 'n baba. Daar was geen beduidende verskille in die liggaamsamestelling van babas wat aan MIV blootgestel was en dié wat nie aan MIV blootgestel was nie, en wat menslike borsmelk (HBM) of gefortifiseerde menslike borsmelk (HBM) ontvang het nie. In terme van die babas wat aan MIV blootgestel was, is daar egter beduidende verskille gevind in die liggaamsamestellingsmates van dié wat gefortifiseerde menslike borsmelk (HBM) ontvang het en dié wat dit nie ontvang het nie. Babas wat nil per os (NPO) ontvang het, was oor die algemeen kleiner, korter en het 'n laer FM% en meer FFM% gehad.en_ZA
dc.format.extentxxix, 146 pages ; illustrations, includes annexures
dc.language.isoen_ZAen_ZA
dc.publisherStellenbosch : Stellenbosch University
dc.subjectPremature infants -- Nutrition -- Tygerberg hospital -- Western Cape (South Africa)en_ZA
dc.subjectHIV-exposed infants -- Nutrition -- Tygerberg hospital -- Western Cape (South Africa)en_ZA
dc.subjectBreast milken_ZA
dc.subjectUCTD
dc.titleBody composition and nutritional intake of HIV exposed preterm, very- and extremely-low birth weight infants in Tygerberg hospital, Western Capeen_ZA
dc.typeThesisen_ZA
dc.rights.holderStellenbosch University


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