Related Experiment Videos
Choline supply of preterm infants: assessment of dietary intake and pathophysiological considerations
Wolfgang Bernhard1, Anna Full, Jörg Arand
1Department of Neonatology, Faculty of Medicine, Eberhard-Karls-University, Calwer Strasse 7, 72076, Tübingen, Germany. wolfgang.bernhard@med.uni-tuebingen.de
Insights
Preterm infants often receive insufficient choline, crucial for brain development, especially in the first ten days of life. Further research is needed to understand the impact of adequate choline intake on neurodevelopment in very low birth weight infants.
Area of Science:
- Nutritional Science
- Neonatology
- Developmental Pediatrics
Background:
- Choline is a vital nutrient, forming cell membranes and supporting brain development.
- Its importance in preterm infant nutrition is under-recognized despite its essential role.
Purpose of the Study:
- To estimate the adequate choline intake for preterm infants.
- To assess choline nutritional intake in extremely low birth weight (ELBW) infants.
Main Methods:
- Choline requirements were estimated using international recommendations.
- Retrospective analysis of nutrient intake in 93 ELBW infants (born <1000g or <28 weeks gestation) admitted in 2006-2007.
Main Results:
- Estimated adequate choline intake varied by body weight, with smaller infants needing more (e.g., 31.4 mg/kg/day for 290g infants).
- Median choline supply plateaued at day 11 and was frequently below recommended levels, particularly in the first 10 postnatal days.
- Less than 2% of infants achieved the median adequate intake.
Conclusions:
- Preterm infants, especially ELBW infants, frequently experience inadequate choline nutrition, particularly during the early postnatal period.
- Given choline's role in brain development, further studies are essential to evaluate the long-term neurodevelopmental outcomes of optimizing choline intake in this vulnerable population.
Background:
Choline forms the head group of phosphatidylcholines, comprising 40-50 % of cellular membranes and 70-95 % of phospholipids in surfactant, bile, and lipoproteins. Moreover, choline serves as the precursor of acetylcholine and is important for brain differentiation and function. While accepted as essential for fetal and neonatal development, its role in preterm infant nutrition has not yet gained much attention.
Methods:
The adequate intake of choline of preterm infants was estimated from international recommendations for infants, children, and adults. Choline intake relative to other nutrients was determined retrospectively in all inborn infants below 1,000 g (extremely low birth weight) or below 28 weeks gestational age, admitted to our department in 2006 and 2007 (N = 93).
Results:
Estimation of adequate intake showed that children with 290 g body weight need more choline than those with 1,200 g (31.4 and 25.2 mg/kg/day, respectively). Day-by-day variability was high for all nutrient intakes including choline. In contrast to the continuous intrauterine choline delivery, median supply reached a plateau at d11 (21.7 mg/kg/day; 25th/75th percentile: 19.6; 23.9). Individual choline supply at d0-d1 and d2-d3 was <10 mg/kg/day in 100 and 69 % of infants, respectively. Furthermore, intakes <10 mg/kg/day were frequently observed beyond day 11. Median adequate intakes (27.4 mg/kg/day at 735 g body weight) were achieved in <2 %.
Conclusions:
Nutritional intake of choline in this cohort of preterm infants was frequently less than the estimated adequate intake, with particular shortage until postnatal d10. Because choline is important for brain development, future studies are needed to investigate the effects of adequate nutritional choline intake on long-term neurodevelopment in VLBW infants.