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Randomised trial of early diet in preterm babies and later intelligence quotient
1Medical Research Council Childhood Nutrition Research Centre, Institute of Child Health, London WC1N 1EH, UK. A.Lucas@ich.ucl.ac.uk
Insights
Early nutrition for preterm infants significantly impacts cognitive development, especially in boys. Suboptimal neonatal nutrition may lead to lasting impairments in language-based skills and overall intelligence.
Area of Science:
- Neonatal nutrition and child development
- Pediatric neurodevelopmental outcomes
- Nutritional science and cognitive function
Background:
- Preterm infants are at risk for suboptimal early nutrition.
- Cognitive development in early childhood is crucial for long-term outcomes.
- Neonatal nutritional status can influence brain growth and functional development.
Purpose of the Study:
- To investigate the long-term effects of perinatal nutrition on cognitive function in preterm children.
- To determine if specific nutritional interventions in the neonatal period influence cognitive outcomes at school age.
- To assess the impact of different infant formulas on intelligence quotient (IQ) in preterm survivors.
Main Methods:
- A randomized, blinded nutritional intervention trial was conducted in two neonatal units.
- 424 preterm infants (<1850g birth weight) received either standard or nutrient-enriched preterm formula for approximately one month.
- Cognitive function, including verbal and overall IQ, was assessed at 7.5-8 years using the Weschler intelligence scale for children (revised).
Main Results:
- A significant sex difference was observed: boys fed standard formula showed a disadvantage in verbal IQ compared to those fed preterm formula.
- Higher intakes of trial diets correlated with lower overall and verbal IQ scores in boys.
- Infants fed standard formula had a higher incidence of low verbal IQ (<85), particularly in boys.
Conclusions:
- Preterm infants are vulnerable to suboptimal early nutrition, impacting language-based cognitive skills.
- Neonatal nutrition may permanently affect cognitive function, especially in males.
- Suboptimal nutrition during early brain development could impair functional compensation after brain injury.
Objectives:
To determine whether perinatal nutrition influences cognitive function at 7 1/2 - 8 years in children born preterm.
Design:
Randomised, blinded nutritional intervention trial. Blinded follow up at 7 1/2 - 8 years.
Setting:
Intervention phase in two neonatal units; follow up in a clinic or school setting.
Subjects:
424 preterm infants who weighed under 1850 g at birth; 360 of those who survived were tested at 7 1/2 - 8 years.
Interventions:
Standard infant formula versus nutrient enriched preterm formula randomly assigned as sole diet (trial A) or supplements to maternal milk (trial B) fed for a mean of 1 month.
Main Outcome Measures:
Intelligence quotient (IQ) at 7 1/2 - 8 years with abbreviated Weschler intelligence scale for children (revised).
Results:
There was a major sex difference in the impact of diet. At 7 1/2 - 8 years boys previously fed standard versus preterm formula as sole diet had a 12.2 point disadvantage (95% confidence interval 3.7 to 20.6; P<0.01) in verbal IQ. In those with highest intakes of trial diets corresponding figures were 9.5 point disadvantage and 14.4 point disadvantage in overall IQ (1.2 to 17.7; P<0.05) and verbal IQ (5.7 to 23.2; P<0.01). Consequently, more infants fed term formula had low verbal IQ (<85): 31% versus 14% for both sexes (P=0.02) and 47% versus 13% in boys P=0.009). There was a higher incidence of cerebral palsy in those fed term formula; exclusion of such children did not alter the findings.
Conclusions:
Preterm infants are vulnerable to suboptimal early nutrition in terms of their cognitive performance--notably, language based skills--at 7 1/2 - 8 years, when cognitive scores are highly predictive of adult ones. Our data on cerebral palsy generate a new hypothesis that suboptimal nutritional management during a critical or plastic early period of rapid brain growth could impair functional compensation in those sustaining an earlier brain insult. Cognitive function, notably in males, may be permanently impaired by suboptimal neonatal nutrition.