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Postnatal decrease in circulating insulin-like growth factor-I and low brain volumes in very preterm infants
Ingrid Hansen-Pupp1, Holger Hövel, Ann Hellström
1Division of Pediatrics, Department of Clinical Sciences, Lund, Lund University Hospital, 221 85 Lund, Sweden. ingrid.pupp@skane.se
Insights
Postnatal insulin-like growth factor-I (IGF-I) and IGF binding protein-3 (IGFBP-3) levels are linked to larger brain volumes in very preterm infants. Supporting the IGF-I axis may aid normal brain development in this vulnerable population.
Area of Science:
- Neonatal Medicine
- Developmental Neuroscience
- Pediatric Endocrinology
Background:
- Insulin-like growth factor-I (IGF-I) and IGF binding protein-3 (IGFBP-3) are crucial for brain development.
- Understanding their role in very preterm infants is vital for optimizing neurodevelopmental outcomes.
Purpose of the Study:
- To investigate the association between postnatal serum IGF-I and IGFBP-3 concentrations and brain volumes at term-equivalent age.
- To assess the relationship in infants born extremely preterm.
Main Methods:
- Fifty-one very preterm infants (gestational age 26.4 weeks) were studied.
- Weekly blood samples measured IGF-I and IGFBP-3 from birth to 35 weeks gestational age.
- Brain volumes (total brain, cerebellum, gray matter, white matter) were assessed using MRI at 40 weeks gestational age.
Main Results:
- Postnatal IGF-I and IGFBP-3 concentrations positively correlated with total brain, white matter, gray matter, and cerebellar volumes.
- These associations persisted after adjusting for gestational age, nutrition, and other clinical factors.
- Infants small for gestational age exhibited lower IGF-I levels and smaller brain volumes.
Conclusions:
- Postnatal IGF-I and IGFBP-3 levels are significant positive predictors of brain volumes in very preterm infants.
- Interventions aimed at normalizing the IGF-I axis may promote optimal brain development in this population.
Context:
IGF-I and IGF binding protein-3 (IGFBP-3) are essential for growth and maturation of the developing brain.
Objective:
The aim of this study was to evaluate the association between postnatal serum concentrations of IGF-I and IGFBP-3 and brain volumes at term in very preterm infants.
Design:
Fifty-one infants with a mean (sd) gestational age (GA) of 26.4 (1.9) wk and birth weight (BW) of 888 (288) g were studied, with weekly blood sampling of IGF-I and IGFBP-3 from birth until 35 gestational weeks (GW) and daily calculation of protein and caloric intake. Magnetic resonance images obtained at 40 GW were segmented into total brain, cerebellar, cerebrospinal fluid, gray matter, and unmyelinated white matter volumes.
Main Outcome Measures:
We evaluated brain growth by measuring brain volumes using magnetic resonance imaging.
Results:
Mean IGF-I concentrations from birth to 35 GW correlated with total brain volume, unmyelinated white matter volume, gray matter volume, and cerebellar volume [r = 0.55 (P < 0.001); r = 0.55 (P < 0.001); r = 0.44 (P = 0.002); and r = 0.58 (P < 0.001), respectively]. Similar correlations were observed for IGFBP-3 concentrations. Correlations remained after adjustment for GA, mean protein and caloric intakes, gender, severe brain damage, and steroid treatment. Protein and caloric intakes were not related to brain volumes. Infants with BW small for GA had lower mean concentrations of IGF-I (P = 0.006) and smaller brain volumes (P = 0.001-0.013) than infants with BW appropriate for GA.
Conclusion:
Postnatal IGF-I and IGFBP-3 concentrations are positively associated with brain volumes at 40 GW in very preterm infants. Normalization of the IGF-I axis, directly or indirectly, may support normal brain development in very preterm infants.
