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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Associations between neonatal nutrition and visual outcomes in 7-year-old children born very preterm
Mukhit Kulmaganbetov1,2, Myra Leung3,4,5, Jane M Alsweiler6,7
1Centre for Eye and Vision Research (CEVR), 17W Hong Kong Science Park, Hong Kong, Hong Kong.
Insights
Increased neonatal protein intake in preterm infants showed mixed results for visual development. While global motion perception improved, binocular vision and stereoacuity were less favorable in the group receiving higher protein.
Area of Science:
- Neonatal nutrition and neurodevelopmental outcomes
- Ophthalmic and visual development in preterm infants
Background:
- Preterm birth poses risks for neurodevelopmental outcomes, with early nutrition being a critical factor.
- Uncertainty exists regarding the impact of increased neonatal protein intake on long-term visual development in very preterm infants.
Purpose of the Study:
- To assess the effect of a modified neonatal nutrition protocol, aiming for increased protein intake, on ophthalmic and visual development in school-aged children born very preterm.
- To investigate the long-term visual outcomes associated with changes in parenteral nutrition composition during the neonatal period.
Main Methods:
- A cohort of 128 very preterm infants (birthweight <1500g or gestational age <30 weeks) were divided into two groups based on the neonatal nutrition protocol (OldPro vs. NewPro).
- The NewPro group received parenteral nutrition with increased protein during the first postnatal week.
- Clinical and psychophysical vision assessments, including visual acuity, global motion perception, stereoacuity, ocular motility, and ocular health, were conducted at 7 years' corrected age.
Main Results:
- No significant difference was observed in overall favorable visual outcomes between the OldPro and NewPro groups.
- The NewPro group demonstrated significantly better global motion perception (p=0.04).
- Conversely, the OldPro group showed a higher likelihood of favorable binocular visual outcomes (60% vs. 36%, p=0.02) and passing stereoacuity (p=0.02).
Conclusions:
- Early neonatal nutrition, specifically protein intake, has complex and subtle associations with visual development in school-aged children born very preterm.
- The findings suggest that while increased protein intake may benefit certain aspects of visual processing, it could potentially impact other visual functions like binocularity and stereopsis.
Purpose:
There is uncertainty about the effect of increased neonatal protein intake on neurodevelopmental outcomes following preterm birth. The aim of this study was to assess the effect of a change in neonatal nutrition protocol at a major tertiary neonatal intensive care unit intended to increase protein intake on ophthalmic and visual development in school-age children born very preterm.
Methods:
The study cohort comprised children (n = 128) with birthweight <1500 g or gestational age < 30 weeks born at Auckland City Hospital before (OldPro group, n = 55) and after (NewPro group, n = 73) a reformulation of parenteral nutrition that resulted in increased total protein intake during the first postnatal week and decreased carbohydrate, total parenteral fluid and sodium intake. Clinical and psychophysical vision assessments were completed at 7 years' corrected age, including visual acuity, global motion perception (a measure of dorsal stream function), stereoacuity, ocular motility and ocular health. Composite measures of favourable overall visual, binocular and functional visual outcomes along with individual vision measures were compared between the groups using logistic and linear regression models.
Results:
Favourable overall visual outcome did not differ between the two groups. However, global motion perception was better in the NewPro group (p = 0.04), whereas the OldPro group were more likely to have favourable binocular visual outcomes (60% vs. 36%, p = 0.02) and passing stereoacuity (p = 0.02).
Conclusions:
These results indicate subtle but complex associations between early neonatal nutrition after very preterm birth and visual development at school age.
