Application Series 5
CARE OF 'BABY' BABIES
SIR profiles the Children's Nutritional Center of Texas Children's Hospital in United
States of America where the care and development of premature babies is a major research
project
Background
Medical advances in the field of neonatology have led to rapid increases in the survival and
eventual thriving of very premature, very low birth weight infants. One of the major centers
for neonatology research and the care of premature infants is at Texas Children's Hospital,
Houston Texas. Infants born as young as 22 weeks gestation, and weighing as little as 500
grams are cared for at Texas Children's Neonatal Intensive Care Ward.
The nutrition strategies necessary for the survival of these low weight babies is the concern
of Dr. Richard Schanler and his associates at the USDA's Children's Nutrition Research
Center in Houston. Ken Fraley, a systems programmer at the Center, gave SIR (Americas)
an insight into the work that the Center undertakes.
SIR's Contribution
"Using the Texas Children's premature infants as study subjects", Ken said, "a SIR database
has been active for the past 8 years establishing norms of growth and nutrition. SIR is also
used to analyze smaller samples of infants whom are chosen to participate in more controlled
dietary studies". There are currently over 1500 infants in the Database. SIR's portability has
been an important feature of the study. Ken told us that this database has been migrated
across 3 different machines over this time.
Longitudinal Analysis
Data from growing infants is by definition longitudinal, requiring calculations of growth and
changes in nutritional status over time. SIR's record structure and ability to link such
longitudinal records has been of great help. "A novel use of SIR PQL has been the
development of a program to generate the least squares regression slopes for each
individual's measures over time" Ken pointed out. He has made use of this technique for
summarizing longitudinal data collected at different rates. For example gramsbodyweight
per day can be calculated and tested between samples of infants on different feeding
regimens.
Nutrition Analysed
In addition to the research aspect, clinical care is facilitated by the database in providing a
nutrient analysis based on the formula or intravenous fluid code and volume that an infant
receives during the day. A nutrient content table of all formulas in use is called up by a SIR
PQL procedure, Ken emphasised that "Dieticians and nurses can access the complete
nutrient analysis for that infant; everything from Calories to Zinc."
Ken said "Users have the ability to add new formulas to the nutrient file, or update existing
formula values".
Knowing what nutrients are being fed to the infant is only part of the story. As with many
other organ systems, the digestive tract of the premature infant is often not fully developed.
Absorption and retention of nutrients can become a problem. Ken observed "To study this
problem, nutrient balance studies are performed on qualifying premises". The essence of a
balance study is to carefully measure what goes into the baby in the form of formula and
other nutrient fluids, and measure what comes out; the residual nutrients excreted in urine
and faeces. The difference between a nutrient consumed and that nutrient in the stool is
what is absorbed. Subtracting the nutrient excreted in the urine gives what is actually
retained in the infant to be used for growth and energy. Ken feels that SIR's ability to retrieve
data files used by statistical software facilitated the analysis of this data.
Aid to Mothers
Many mother's wish to eventually breastfeed their premature babies. However, the suckling
reflex is underdeveloped in these very small babies. Also, mother's breastmilk is designed
for nutrition of a full term baby, and may not have the necessary nutrient components for a
baby that should be receiving sustenance in the womb. The solution is to allow mothers to
express milk with a breast pump, and fortify the milk with missing ingredients. "This allows
the baby to receive the immunologic factors from mother's milk, and sustain lactation to
enable mom to eventually initiate normal breastfeeding" said Ken. "The nutrient balance
studies have helped determine what is the right combination of nutrients needed to fortify
human milk for premature babies."
Project a success
Ken is very pleased with what SIR has contributed to his project. "SIR's combination of
dynamic database restructuring and updating, combined with screen data entry with FORMS
has greatly facilitated the viability of this database as a research tool" he said. He has also
complimented the powerful PQL programming language and statistical software interfaces
"these have given the Children's Nutritional Center the ability to perform the sophisticated
data analysis necessary to the understanding of these complex
questions".
For further information on Childrens Nutritional Research Center's use of SIR, please contact:
Ken Fraley
Systems Programmer
Children's Nutritional Research
Center
1100 Bates St
Houston , TX 77030
USA
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