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Nutritional state, maturational delay on electroencephalogram, and developmental outcome in extremely low birth
Akihisa Okumura1, Masahiro Hayakawa, Makoto Oshiro
1Department of Pediatrics, Juntendo University, School of Medicine, Bunkyo-ku, Tokyo, Japan. okumura@juntendo.ac.jp
Insights
Neonatal undernutrition and persistent immature EEG patterns in extremely low birth weight infants are linked to poorer neurodevelopmental outcomes, including lower IQ and head circumference, at 6-9 years of age.
Area of Science:
- Neonatology
- Neurodevelopmental Pediatrics
- Developmental Neuroscience
Background:
- Extremely low birth weight (ELBW) infants face risks for suboptimal neurodevelopmental outcomes.
- Nutritional status and electroencephalographic (EEG) maturation during the neonatal period are critical factors influencing long-term development.
- Understanding the interplay between early nutrition, brain maturation, and later developmental trajectories is essential for ELBW infant care.
Purpose of the Study:
- To investigate the relationship between neonatal nutritional status, EEG maturational patterns, and neurodevelopmental outcomes at 6-9 years in ELBW infants.
- To determine if undernutrition and persistent dysmature EEG patterns independently or interactively affect cognitive and physical development.
Main Methods:
- Longitudinal follow-up of 13 ELBW infants up to 6 or 9 years of age.
- Definition of undernutrition: enteral feeding < 100mL/kg/day at 3 weeks.
- Definition of dysmature patterns: EEG patterns ≥ 2 weeks immature for post-conceptional age.
- Assessment of IQ (full, verbal, performance) and anthropometric measures (height, weight, head circumference).
Main Results:
- Infants experiencing neonatal undernutrition exhibited significantly lower full and verbal IQ scores compared to normally nourished infants.
- Among undernourished infants, those with persistent dysmature EEG patterns showed a trend towards lower full and performance IQ.
- Head circumference was smaller (below 50th percentile) in a majority of undernourished infants compared to normally nourished infants.
Conclusions:
- Neonatal undernutrition is associated with worse neurodevelopmental outcomes in ELBW infants at school age.
- Persistent EEG immaturity in undernourished ELBW infants may further exacerbate negative developmental trajectories.
- Optimizing neonatal nutrition and monitoring brain maturation are crucial for improving long-term outcomes in ELBW infants.
Abstract:
The aim of this study is to clarify the relation among developmental outcome, nutritional state during the neonatal period, maturational electroencephalographic changes. Thirteen extremely low birth weight infants who completed 6- or 9-year follow-up were a subject of this study. Undernutrition was defined as enteral feeding below 100mL/kg/day at 3 weeks of age. Dysmature patterns were defined as the persistence of EEG patterns 2 weeks or more immature for post-conceptional age. IQ was examined at 6 and 9 years of age. Body height and weight, and head circumference at 6 years of age were stratified by the percentile grades. Full and verbal IQ was significantly lower in infants with undernutrition than those with normal nutrition. Among infants with undernutrition, those with persistent dysmature patterns tended to have lower full and performance IQ than those without persistent dysmature patterns. Head circumference was 50 percentile or larger in all infants with normal nutrition, whereas it was below 50 percentile in six of eight infants with undernutrition. Extremely low birth weight infants with undernutrition had worse neurodevelopmental outcome at 6 or 9 years of age than those with normal nutrition. Among infants with undernutrition, developmental outcome was relatively worse in those with persistent dysmature patterns than those without.
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