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Published on: November 20, 2015
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.
Insights
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.
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.
Background:
Intravenous lipid emulsions are an essential component of nutritional support for very preterm infants. Many neonatal intensive care units have transitioned from traditional soybean oil-only to fish oil-containing multicomponent lipid emulsions, but the neurodevelopmental implications have not been well-explored. The primary aim of this study was to assess extrauterine third trimester brain growth in very preterm infants supported with soybean oil-only compared to fish-oil containing multicomponent lipid emulsions; white matter development and neurobehavioral regulation at term were also investigated.
Methods:
Human milk-fed very preterm infants (born less than or equal to 32 weeks' gestation) receiving either soybean oil-only (before 2019) or multicomponent (after 2019) lipid emulsions underwent quantitative brain MRI (volumetric growth and white matter development) and neurodevelopmental assessment (Neonatal Intensive Care Unit Network Neurobehavioral Scale) at term-equivalent age. Analyses were adjusted for age at birth and term assessments, as well as clinically significant covariates.
Results:
92 infants (61 soybean, 31 multicomponent) were included (mean [SD] birth gestational age: 27.3 [2.3] weeks). Soybean oil-only infants demonstrated smaller brainstem volumes (β [95% CI] = -0.5 [-0.8,-0.1], p = .007); additionally less mature white matter development (mean diffusivity [MD, mm2/second x10- 3] and fractional anisotropy [FA]) in the corpus callosum (MD genu: β = 0.10 [0.01, 0.20], p = .04; splenium: β = 0.14 [0.04, 0.24], p = .006), posterior limbs of internal capsule (MD right (R): β = 0.05 [0.02, 0.08], p = .004, left (L): β = 0.04 [0.01, 0.08], p = .01; FA R: β = -0.03 [-0.06, -0.00], p = .03), and brainstem (FA R: β = 0.07 [0.04, 0.10], p < .001, L: β = 0.05 [0.02, 0.09], p = .002); and lower quality of movement (β = -0.54 [-0.97, -0.11], p = .02) and higher state-related stress (β = 1.41 [0.14, 2.83], p = .04).
Conclusions:
Very preterm infants supported with a fish-oil containing multicomponent compared to soybean oil-only lipid emulsion demonstrated improved regional brain growth, as well as evidence of enhanced white matter microstructural organization and neurobehavioral regulation, at term corrected age.
Trial Registration:
Clinical trial number: Not applicable.
