Nutritional Interventions to Improve Brain Outcomes in Preterm Infants

The last 20 years have seen dramatic improvements in survival for preterm infants in both high- and low-income settings. Survival rates of over 50% in infants born 16 weeks early (24 weeks' gestation) are now commonplace in well-resourced neonatal intensive care units. However, ensuring adequate nutrient intakes especially in the first few days and weeks is challenging, and many infants show poor growth and nutritional status. Good nutritional management should be seen as the cornerstone of good neonatal care and is key to improving a range of important outcomes including reduced rates of retinopathy of prematurity, chronic lung disease, necrotizing enterocolitis (NEC), and sepsis. Equally importantly, is that good nutritional status is essential to optimize brain growth and differentiation. There are multiple potential mechanisms that link nutrition to brain outcomes in preterm infants including needs for tissue accretion, energy supply, signaling roles, functional components in human milk, epigenetic regulation, prevention of NEC and disease, and impacts on the gut brain axes. This article will review data in support of different mechanistic links for the impact of nutrition on brain outcomes in preterm infants.