Early Protein Intake Influences Neonatal Brain Measurements in Preterms: An Observational Study
Gianluca Terrin1, Maria Chiara De Nardo1, Giovanni Boscarino1
1Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy.
Insights
High protein intake is crucial for preterm infant brain development. Enteral nutrition positively impacts cerebral growth, while parenteral nutrition shows negative effects on brain structures.
Area of Science:
- Neonatal Nutrition
- Neurodevelopment
- Pediatric Imaging
Background:
- Current guidelines recommend high protein intake for preterm neonates to prevent extrauterine growth restriction.
- The impact of early high protein intake on brain development in very low birth weight newborns remains controversial.
- Understanding optimal protein delivery methods is critical for neuroprotection in vulnerable infants.
Purpose of the Study:
- To evaluate the effects of early protein intake on cerebral growth in very low birth weight newborns.
- To analyze the correlation between enteral and parenteral protein intake and specific brain structure measurements.
Main Methods:
- Serial cranial ultrasounds (cUS) were performed on very low birth weight newborns at 3-7 and 28 days of life (DOL).
- The study analyzed 100 newborns with a mean gestational age of 29 ± 2 weeks.
- Correlation and multivariate regression analyses assessed the relationship between protein intake routes and cUS-measured cerebral parameters.
Main Results:
- Positive correlations were found between enteral protein intake and measurements of biparietal diameter, occipital-frontal diameter, corpus callosum, caudate head, and cerebellum at 28 DOL.
- Parenteral nutrition protein intake showed significant negative correlations with the same cerebral structures.
- Multivariate analysis confirmed that occipital-frontal diameter, caudate head, and cerebellar vermis measurements depend positively on enteral protein and negatively on parenteral protein intake.
Conclusions:
- Early protein intake is essential for brain development in preterm neonates.
- The route of protein administration significantly influences cerebral structure development.
- Enteral nutrition is encouraged for delivering recommended protein intake to promote positive brain development in preterm infants.
Abstract:
Introduction: To limit extrauterine growth restriction, recent guidelines on nutrition of preterm neonates recommended high protein intake since the first day of life (DOL). The impact of this nutritional strategy on the brain is still controversial. We aimed to evaluate the effects of protein intake on early cerebral growth in very low birth weight newborns. Materials and Methods: We performed serial cranial ultrasound (cUS) scans at 3-7 DOL and at 28 DOL in very low birth weight newborns consecutively observed in the neonatal intensive care unit. We analyzed the relation between protein intake and cerebral measurements at 28 DOL performed by cUS. Results: We enrolled 100 newborns (gestational age 29 ± 2 weeks, birth weight 1,274 ± 363 g). A significant (p < 0.05) positive correlation between enteral protein intake and biparietal diameter (r = 0.490**), occipital-frontal diameter (r = 0.608**), corpus callosum (length r = 0.293*, genu r = 0.301*), caudate head (right r = 0.528**, left r = 0.364**), and cerebellum (transverse diameter r = 0.440**, vermis height r = 0.356**, vermis width r = 0.377**) was observed at 28 DOL. Conversely, we found a significant negative correlation of protein intake given by parenteral nutrition (PN) with biparietal diameter (r = -0.524**), occipital-frontal diameter (r = -0.568**), body of corpus callosum (r = -0.276*), caudate head (right r = -0.613**, left r = -0.444**), and cerebellum (transverse diameter r = -0.403**, vermis height r = -0.274*, vermis width r = -0.462**) at 28 DOL. Multivariate regression analysis showed that measurements of occipital-frontal diameter, caudate head, and cerebellar vermis at 28 DOL depend positively on protein enteral intake (r = 0.402*, r = 0.305*, and r = 0.271*) and negatively by protein parenteral intake (r = -0.278*, r = -0.488*, and r = -0.342*). Conclusion: Brain development in neonatal life depends on early protein intake. High protein intake affects cerebral structures' measurements of preterm newborn when administered by PN. Positive impact on brain development encourages the administration of recommended protein intake mainly by enteral nutrition.
