Intraventricular Hemorrhage in Extremely Preterm Infants with Low Plasma Choline

Choline is recognized as an essential nutrient overall and for neurodevelopment. Through the development of sphingomyelin and phosphatidylcholine, choline is used in the development of cell membranes and the neurovascular unit. Choline deficiency is common amongst pregnant women and is not currently adequately supplied to preterm infants. The aim of this study was to determine whether there is an association between plasma choline concentrations in preterm infants and intraventricular hemorrhage, a frequent complication of prematurity. This retrospective cohort study involved preterm infants born at Rainbow Babies and Children's Hospital at a gestational age of 24-28 weeks. Discarded patient blood samples from the first 2 h of life were collected and assayed for choline. A Mann Whitney U test was performed in SigmaPlot. 36 infants were enrolled. We found that infants with severe IVH (grade III- IV) had significantly lower concentrations of choline in the first 2 h of life than infants without IVH (14.7 µmol/L (9.6 µmol/L, 18.3 µmol/L) vs 22.0 µmol/L (16.8 µmol/L, 35.1 µmol/L), p = 0.037). We conclude that low choline concentrations may have an impact on development of IVH in premature infants. IMPACT: Extremely preterm infants with low plasma choline may be more likely to experience intraventricular hemorrhage.