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Brain development using a multicomponent intravenous lipid emulsion in preterm infants.

Katherine M Ottolini1,2,3, Julius Ngwa1,3, Sudeepta K Basu1,2,3

  • 1Developing Brain Institute, Children's National Hospital, 111 Michigan Avenue, NW, Washington, DC, USA.

BMC Pediatrics
|December 30, 2024
PubMed
Summary

Fish oil-containing lipid emulsions improved brain growth and white matter development in very preterm infants compared to soybean oil-only emulsions. This nutritional support enhanced neurobehavioral regulation at term corrected age.

Keywords:
LipidsMRINeurodevelopmentNutritionPreterm

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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.