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Enteral and parenteral energy intake and neurodevelopment in preterm infants: A systematic review
Maria Chiara De Nardo1, Chiara Di Mario1, Gianluigi Laccetta1
1Department of Maternal and Child Health Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
Insights
Energy intake in preterm infants impacts neurodevelopment (NDV) and brain growth, but optimal strategies remain unclear. Enteral nutrition (EN) shows a positive effect on NDV, while parenteral nutrition requires a cautious approach.
Area of Science:
- Neonatology
- Pediatric Nutrition
- Neurodevelopmental Pediatrics
Background:
- Preterm infants require careful nutritional management for optimal neurodevelopment (NDV) and cerebral growth.
- The specific effects of enteral nutrition (EN) versus parenteral nutrition on these outcomes are not fully elucidated.
Purpose of the Study:
- To systematically review the impact of enteral and parenteral energy intake on neurodevelopment and cerebral growth in preterm infants.
- To evaluate evidence from various study designs, including randomized controlled trials and cohort studies.
Main Methods:
- Systematic review of MEDLINE, Scopus, and ISI Web of Knowledge databases.
- Inclusion of studies examining different energy intakes via parenteral and/or enteral nutrition in early life.
- Data collection and analysis focused on neurodevelopmental outcomes and cerebral growth metrics.
Main Results:
- Thirty-five studies were included; results on NDV were mixed, with some showing no significant difference and others a positive effect of EN.
- Enhanced nutrition, particularly EN, was associated with greater head circumference (HC) in some studies.
- Magnetic resonance imaging results for cerebral growth were inconclusive; EN showed positive effects on specific brain regions.
Conclusions:
- The overall impact of early life energy intake on neurodevelopment in preterm infants remains undefined.
- Enteral nutrition appears to positively influence brain development, supporting recommended intake levels.
- A cautious approach to enhanced parenteral nutrition strategies is suggested, with a need for further research into optimal interventions.
Objectives:
We performed a systematic review to study the effect of enteral and parenteral energy intakes on neurodevelopment (NDV) and cerebral growth in preterm infants, evaluated by NDV scales, magnetic resonance imaging, and head circumference (HC).
Methods:
The MEDLINE, Scopus, and ISI Web of Knowledge databases were searched, using the following medical subject headings and terms: "Premature infants," "nutrition," "brain," "nervous system/growth," and "development." A manual search of the reference lists of all eligible articles was conducted. Studies in which the intervention applied was different energy intakes in parenteral nutrition and/or enteral nutrition (EN) during the first weeks of life and NDV was investigated were included. Data regarding nutrition and NDV were collected and analyzed.
Results:
Thirty-five studies were included, of which 12 were randomized controlled trials (RCTs) and 23 were cohort studies. Eight RCTs and 15 cohort studies investigated NDV using NDV scales. Of these studies, two RTCs and five cohort studies found no significant difference in NDV evaluated with the Bayley scale between neonates fed high-caloric nutrition and those who received lower energy intakes during early life. In one RCT and two cohort studies was observed a positive effect of EN on NDV. Conversely, in one cohort study, a negative correlation between parenteral energy intake and NDV was described. The analysis of the data from RCTs and cohort studies showed greater HC in the groups receiving aggressive parenteral and total enhanced nutrition, respectively. However, two RCTs and one cohort study did not report any differences in terms of HC. Inconclusive results were reported by studies that investigated cerebral growth by magnetic resonance imaging. The studies observing a positive effect of enhanced nutrition on cerebral and basal ganglia growth, caudate nucleus, cerebellum, and thalami volume investigated only the influence of EN.
Conclusions:
The impact of energy intake during early life on NDV remains undefined. A positive impact on brain development encourages the administration of recommended energy intake, mainly by EN, and suggests a more cautious approach to enhanced nutritional strategies by the parenteral route. Further studies are advocated to elucidate the optimal nutritional intervention for preterm infants to improve NDV.
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