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The influence of nutrition on white matter development in preterm infants: a scoping review

Els Janson1,2, Marle F Willemsen1,3, Pauline E Van Beek4

  • 1Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.

Pediatric Research
|May 5, 2023
PubMed

Insights

Optimizing nutrition for preterm infants supports white matter (WM) development and neurodevelopmental outcomes. Early enteral nutrition, especially human milk, shows positive associations with WM development.

Area of Science:

  • Neonatal Neurology
  • Developmental Pediatrics
  • Nutritional Science

Background:

  • White matter (WM) injury is a primary cause of impaired neurodevelopmental outcomes in preterm infants.
  • Currently, no specific treatments exist for WM injury in this vulnerable population.
  • Early postnatal nutrition is a potential modifiable factor to support WM development.

Purpose of the Study:

  • To conduct a scoping review assessing the influence of early postnatal nutrition on white matter development in preterm infants.
  • To synthesize evidence on nutritional interventions and their impact on WM outcomes.
  • To identify gaps in current research regarding optimal nutrition for preterm infants' brain development.

Main Methods:

  • Searches conducted in PubMed, EMBASE, and COCHRANE databases up to September 2022.
  • Inclusion criteria: preterm infants, nutritional intake before 1 month corrected age, and WM outcome assessment.
  • Methods aligned with PRISMA-ScR guidelines, including 32 reviewed articles.

Main Results:

  • Longer parenteral feeding duration showed negative associations with WM development, potentially confounded by illness.
  • Positive associations observed between macronutrient, energy, and human milk intake (especially enteral) and WM development.
  • Fatty acid and glutamine supplementation results were inconclusive; microstructural changes detected via diffusion MRI were most significant.

Conclusions:

  • Optimizing early postnatal nutrition can positively influence white matter development and subsequent neurodevelopmental outcomes in preterm infants.
  • Further controlled intervention studies employing quantitative neuroimaging are necessary.
  • Defining optimal nutritional strategies requires rigorous research controlling for confounding factors.

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