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Effects of a Multicomponent Lipid Emulsion on Brain Volumes in Extremely Low Birth Weight Infants
Simonetta Costa1, Carmen Cocca1, Gabriella D'Apolito2
1Unit of Neonatology, Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Insights
Optimizing nutrition with multicomponent lipid emulsion (MLE) in parenteral nutrition (PN) for extremely low birth weight (ELBW) infants supports larger cerebellar volume. This nutritional strategy may improve neurodevelopmental outcomes in preterm infants.
Area of Science:
- Neonatal nutrition
- Neurodevelopmental outcomes
- Pediatric neuroimaging
Background:
- Optimizing nutrition in early life is crucial for extremely preterm infants to mitigate neurological issues and enhance neurodevelopmental outcomes.
- Parenteral nutrition (PN) strategies, including lipid emulsions, are vital for growth and development in extremely low birth weight (ELBW) infants.
Purpose of the Study:
- To investigate the association between multicomponent lipid emulsion (MLE) use in PN and cerebellar volume at term of equivalent age (TEA) in ELBW infants.
- To determine if MLE influences cerebellar growth compared to soybean-based lipid emulsion (SLE) in this vulnerable population.
Main Methods:
- Analysis of brain magnetic resonance imaging (MRI) at TEA in ELBW infants (gestational age ≤28 weeks or birth weight <1,000g) previously randomized to MLE or SLE in PN.
- Primary outcome: cerebellar volume (CeV) measured via MRI at TEA. Secondary outcomes included total brain volume (TBV) and other brain region volumes.
Main Results:
- MRI data from 34 infants (17 per group) showed significantly larger CeV in the MLE group compared to the SLE group.
- PMA-corrected CeV was also significantly higher in the MLE group, indicating a specific effect on cerebellar growth.
- No significant differences were observed in total brain volume or other measured brain volumes between the groups.
Conclusions:
- The use of MLE in PN is associated with enhanced cerebellar growth in ELBW infants, as assessed by MRI at TEA.
- MLE may be a beneficial nutritional intervention for promoting cerebellar development in extremely preterm infants.
- Further research is warranted to explore the long-term neurodevelopmental implications of these findings.
Objective:
During the early weeks of life optimization of nutrition in extremely preterm infants presents a critical opportunity to attenuate the adverse neurological consequences of prematurity and potentially improve neurodevelopmental outcome. We hypothesized that the use of multicomponent lipid emulsion (MLE) in parenteral nutrition (PN) would be related to larger volume of the cerebellum on brain magnetic resonance at term of equivalent age (TEA) in extremely low birth weight (ELBW) infants.
Study Design:
We analyzed the brain magnetic resonance imaging (MRI) at TEA of a cohort of preterm infants with gestational age ≤28 weeks and/or birth weight <1,000 g randomly assigned in our previous trial to receive an MLE or soybean-based lipid emulsion (SLE). The primary outcome of the study was the cerebellar volume (CeV), valued on MRI acquired at TEA. Secondary outcomes included total brain volume (TBV), supratentorial volume, brainstem volume, and CeV corrected for TBV evaluated on MRI acquired at TEA.
Results:
MRIs at TEA of 34 infants were then analyzed: 17 in the MLE group and 17 in the SLE group. The postmenstrual age (PMA) at which MRIs were performed were comparable between the two study groups. The CeV as well as the PMA-corrected CeV were significantly higher in the MLE group than in the SLE group. No difference was found among the other brain volumes considered.
Conclusion:
Our results suggest that the use of MLE in PN could promote CeV growth in ELBW infants, valued with MRI at TEA.
Key Points:
· Optimization of nutrition in extremely low birthweight infants.. · Use of multicomponent lipid emulsions in parenteral nutrition.. · Larger cerebellar volume with use of multicomponent lipid emulsion..
