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Effects of early energy intake on neonatal cerebral growth of preterm newborn: an observational study
Giovanni Boscarino1, Maria Di Chiara1, Raffaella Cellitti1
1Department of Maternal and Child Health, Sapienza University of Rome-Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy.
Insights
Early high energy nutrition in preterm newborns impacts brain growth differently based on delivery method. Enteral nutrition supports cerebral growth, while parenteral nutrition may hinder it, affecting caudate head and cerebellum development.
Area of Science:
- Neonatalogy
- Pediatric Neurology
- Nutritional Science
Background:
- Current guidelines for preterm newborns emphasize early high energy nutrition to prevent growth retardation.
- However, the long-term effects of this approach, particularly on cerebral growth, remain debated.
- Cerebral development is known to be influenced by protein intake during early life, and high energy intake via parenteral nutrition has shown negative impacts in critically ill patients.
Purpose of the Study:
- To evaluate the impact of energy intake on cerebral growth in preterm neonates within the first 28 days of life.
- To investigate the differential effects of energy administration routes (enteral vs. parenteral nutrition) on brain development.
Main Methods:
- Included preterm newborns with gestational age < 32 weeks or birth weight < 1500 g.
- Cranial ultrasonography (cUS) was used to measure cerebral structures at 3-7 days of life (T0) and 28 days of life (T1).
- Statistical analyses, including correlation and multivariate analysis, were performed to assess the relationship between energy intake and cerebral growth.
Main Results:
- A significant negative correlation was observed between parenteral nutrition energy intake and right caudate head growth (r = -0.243).
- Total energy intake showed a positive correlation with transverse cerebellum diameter (r = 0.254).
- Multivariate analysis indicated that enteral nutrition independently increased growth of the left caudate head and height cerebellar vermis, while parenteral nutrition independently affected caudate head growth and cerebellum transverse diameter negatively.
Conclusions:
- The route of energy administration significantly influences cerebral growth in preterm neonates.
- High energy intake via enteral nutrition appears positively correlated with cerebral growth.
- Conversely, parenteral nutrition energy intake is associated with poorer cerebral growth as assessed by cUS.
Abstract:
Current guidelines for preterm newborns recommend high energy nutrition soon after birth in order to limit growth retardation. However, long-term effects of this nutritional approach are still debated, and it has been demonstrated that cerebral growth depends on protein intake in early life. A negative impact of early high energy intake by parenteral nutrition (PN) has been reported for patients in critically ill conditions, observed in intensive care unit. We aimed at evaluating the impact of energy intake on cerebral growth in preterm neonates early in life. We included preterm newborns with gestational age < 32 weeks or birth weight (BW) < 1500 g. Measurement of cerebral structures was performed by cranial Ultrasonography (cUS) between 3 and 7 days of life (DOL, T0) and at 28 DOL (T1). We evaluated the relation between energy intake and cerebral growth in the first 28 DOL. We observed in 109 preterm newborns a significant (p < 0.05) negative correlation between energy intake received by PN and right caudate head growth (r = - 0.243*) and a positive correlation between total energy intake and transverse cerebellum diameter (r = 0.254*). Multivariate analysis showed that energy intake administered by enteral nutrition (EN), independently increased growth of left caudate head (β = 0.227*) and height cerebellar vermis (β = 0.415*), while PN independently affected growth of both right and left caudate head (β = - 0.164* and β = - 0.228*, respectively) and cerebellum transverse diameter (β = - 0.849*). The route of energy administration may exert different effects on cerebral growth in early life. High energy intake administered through EN seems to be positively correlated to cerebral growth; conversely, PN energy intake results in a poorer cerebral growth evaluated with cUS.
