Brain development using a multicomponent intravenous lipid emulsion in preterm infants

Area of Science:

• Neonatal Nutrition
• Neurodevelopmental Pediatrics
• Medical Imaging

Background:

• Intravenous lipid emulsions are crucial for nutritional support in very preterm infants.
• Transitioning to fish oil-containing multicomponent lipid emulsions is common, but neurodevelopmental effects require further study.

Purpose of the Study:

• To assess extrauterine third trimester brain growth in very preterm infants receiving soybean oil-only versus fish oil-containing multicomponent lipid emulsions.
• To investigate white matter development and neurobehavioral regulation at term-equivalent age.

Main Methods:

• Quantitative brain MRI (volumetric growth, white matter development) and Neonatal Intensive Care Unit Network Neurobehavioral Scale (NBAS) assessments were performed at term-equivalent age.
• Human milk-fed very preterm infants (gestational age ≤ 32 weeks) receiving either soybean oil-only or multicomponent lipid emulsions were included.
• Analyses were adjusted for gestational age at birth, term assessments, and significant clinical covariates.

Main Results:

• Infants receiving soybean oil-only emulsions showed smaller brainstem volumes compared to the multicomponent group.
• Less mature white matter development was observed in the soybean oil-only group, evidenced by differences in mean diffusivity (MD) and fractional anisotropy (FA) in the corpus callosum, internal capsule, and brainstem.
• Lower quality of movement and higher state-related stress were noted in infants receiving soybean oil-only emulsions.

Conclusions:

• Fish oil-containing multicomponent lipid emulsions were associated with improved regional brain growth in very preterm infants.
• Enhanced white matter microstructural organization was observed in infants receiving multicomponent emulsions.
• Improved neurobehavioral regulation at term corrected age was demonstrated with multicomponent lipid emulsions.