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Neurodevelopment in children born small for gestational age: a randomized trial of nutrient-enriched versus standard
Ruth Morley1, Mary S Fewtrell, Rebecca A Abbott
1Medical Research Council Childhood Nutrition Research Centre, Institute of Child Health, London, United Kingdom. morleyr@unimelb.edu.au
Insights
Nutrient-enriched formula did not improve neurodevelopment in small for gestational age (SGA) infants. Enriched formula showed a developmental disadvantage in girls at 9 months, and breastfeeding was linked to better neurodevelopmental outcomes in SGA infants.
Area of Science:
- Pediatric Nutrition
- Neurodevelopmental Pediatrics
- Growth and Development
Background:
- Children born small for gestational age (SGA) often face neurodevelopmental challenges.
- Previous research indicated nutrient enrichment of formula improved growth in term SGA infants.
- This study investigated if enriched formula also enhances neurodevelopmental outcomes.
Purpose of the Study:
- To evaluate the effect of nutrient-enriched formula on the neurodevelopmental outcomes of term SGA infants.
- To compare neurodevelopmental scores between infants receiving standard formula, enriched formula, and breast milk.
Main Methods:
- A randomized controlled trial involving term SGA infants.
- Infants were fed either standard formula (n=147) or nutrient-enriched formula (n=152) for 9 months.
- A reference group of 175 breastfed SGA infants was included for comparison.
Main Results:
- No significant difference in Bayley Mental Development Index (MDI) or Psychomotor Development Index (PDI) scores at 18 months between formula groups.
- Enriched formula group showed a lower developmental quotient at 9 months, particularly in girls.
- Breastfed SGA infants exhibited significantly higher MDI and PDI scores at 18 months compared to formula-fed infants.
Conclusions:
- Nutrient enrichment of formula did not confer a neurodevelopmental advantage in term SGA infants, despite improved linear growth.
- A temporary developmental disadvantage was observed in girls fed enriched formula at 9 months.
- Breastfeeding appears to be particularly beneficial for neurodevelopment in SGA infants; promotion of enriched formula for this population is not recommended at this time.
Objective:
Many studies have shown that children born small for gestational age (SGA) are at a neurodevelopmental disadvantage. We have shown that nutrient enrichment of formula fed to term SGA infants improves their growth and hypothesized that it also would improve their neurodevelopmental outcome.
Design:
A randomized, controlled trial of standard term-infant (n = 147) or nutrient-enriched (n = 152) formula for the first 9 months. A reference group of 175 breastfed SGA infants was also recruited.
Setting:
Subjects were recruited in 5 maternity hospitals in Cambridge, Nottingham, and Leicester, all in the United Kingdom.
Participants:
Healthy, term infants (gestation: > or =37 weeks) with birth weight <10th centile.
Outcome Measures:
Bayley mental and psychomotor scores at 18 months (primary) and developmental scores from Knobloch, Pasamanick, and Sherrard's developmental screening inventory at 9 months (secondary).
Results:
There was no significant intergroup difference in Bayley Mental Development Index (MDI) or Psychomotor Development Index (PDI) scores at 18 months. However, at 9 months, children fed the enriched formula had a significantly lower developmental quotient (99.5 vs 102.0; 95% confidence interval [CI] for difference: -4.6, -0.4). A significant disadvantage was seen in girls (-5.1; 95% CI: -7.8, -2.4) but not in boys (0.9; 95% CI: -2.4, 4.2). Breastfed infants had significantly higher MDI and PDI scores at 18 months than formula-fed infants. Confounding factors accounted for approximately 34% of the observed association between breastfeeding and MDI score and none of the association between breastfeeding and PDI score.
Conclusions:
The previously reported enhanced linear growth in SGA children fed enriched formula was not matched by a neurodevelopmental advantage. At 9 months, girls fed the enriched formula had a significant developmental disadvantage, although this was not seen at 18 months. Later follow-up will determine any long-term effects on health or development. Meanwhile, use of enriched formula for term SGA children should not be promoted. It seems that breastfeeding may be especially beneficial for neurodevelopment in children born SGA.
