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Increase in Brain Volumes after Implementation of a Nutrition Regimen in Infants Born Extremely Preterm

Pauline E van Beek1, Nathalie H P Claessens2, Antonios Makropoulos3

  • 1Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, the Netherlands.

The Journal of Pediatrics
|May 12, 2020
PubMed

Insights

Optimizing early nutrition for extremely preterm infants, with increased protein and lipids, led to larger brain volumes at 30 weeks. This effect was temporary, with only the caudate nucleus larger at term-equivalent age.

Area of Science:

  • Neonatalogy
  • Neuroscience
  • Pediatric Nutrition

Background:

  • Early life nutrition is critical for neurodevelopment in extremely preterm infants.
  • Nutritional deficits in this population can impact long-term brain structure and function.
  • Previous regimens may not have provided adequate protein and lipids for optimal growth.

Purpose of the Study:

  • To evaluate the impact of an enhanced nutrition regimen (higher protein and lipid intake) on structural brain development.
  • To compare brain volumes in extremely preterm infants before and after implementing a new nutrition protocol.
  • To assess changes in 42 brain structures at two key time points.

Main Methods:

  • Retrospective analysis of 178 extremely preterm infants (median gestational age 26.6 weeks) divided into two cohorts.
  • Cohort A (n=99) received the old nutrition regimen; Cohort B (n=79) received the new regimen (2011-2015).
  • Brain magnetic resonance imaging (MRI) at 30 weeks postmenstrual age and term-equivalent age; calculation of 42 brain structure volumes.

Main Results:

  • Cohort B demonstrated significantly higher mean protein (3.4 g/kg/day) and caloric intake (109 kcal/kg/day) compared to Cohort A (2.7 g/kg/day, 104 kcal/kg/day).
  • At 30 weeks postmenstrual age, 22 brain regions were significantly larger in Cohort B.
  • At term-equivalent age, only the caudate nucleus remained significantly larger in Cohort B.

Conclusions:

  • An optimized nutrition protocol in the first 28 postnatal days is associated with temporarily improved early life brain volumes.
  • Enhanced protein and lipid intake may promote transient brain growth in extremely preterm infants.
  • Further research is needed to understand the long-term implications of these early nutritional interventions.
Abstract

Keywords:
MRIbrain volumesprotein

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