Nutritional Intake, White Matter Integrity, and Neurodevelopment in Extremely Preterm Born Infants.

Lisa M Hortensius,Manon J N L Benders,Corine Koopman-Esseboom,Floris Groenendaal,Ruurd M Van Elburg,Jeroen Dudink,Els Janson,Maria J C Eijsermans,Henriette F N Swanenburg De Veye,Nathalie H P Claessens,Maria Luisa Tataranno,Pauline E Van Beek,Niek E Van Der Aa

doi:10.3390/nu13103409

Abstract

Background: Determining optimal nutritional regimens in extremely preterm infants remains challenging. This study aimed to evaluate the effect of a new nutritional regimen and individual macronutrient intake on white matter integrity and neurodevelopmental outcome. Methods: Two retrospective cohorts of extremely preterm infants (gestational age < 28 weeks) were included. Cohort B (n = 79) received a new nutritional regimen, with more rapidly increased, higher protein intake compared to cohort A (n = 99). Individual protein, lipid, and caloric intakes were calculated for the first 28 postnatal days. Diffusion tensor imaging was performed at term-equivalent age, and cognitive and motor development were evaluated at 2 years corrected age (CA) (Bayley-III-NL) and 5.9 years chronological age (WPPSI-III-NL, MABC-2-NL). Results: Compared to cohort A, infants in cohort B had significantly higher protein intake (3.4 g/kg/day vs. 2.7 g/kg/day) and higher fractional anisotropy (FA) in several white matter tracts but lower motor scores at 2 years CA (mean (SD) 103 (12) vs. 109 (12)). Higher protein intake was associated with higher FA and lower motor scores at 2 years CA (B = −6.7, p = 0.001). However, motor scores at 2 years CA were still within the normal range and differences were not sustained at 5.9 years. There were no significant associations with lipid or caloric intake. Conclusion: In extremely preterm born infants, postnatal protein intake seems important for white matter development but does not necessarily improve long-term cognitive and motor development.

Highlights

Adequate nutritional intake in extremely preterm (EP) infants (gestational age (GA) < 28 weeks) is very important to achieve growth similar to fetal growth in utero
We further explored the effect of this new nutritional regimen on (a) white matter integrity at term equivalent age (TEA) and (b) neurodevelopmental outcome (NDO) at 2 years corrected age (CA) and 5.9 years chronological age
We evaluated the effects of individual total, enteral, and parenteral macronutrient intakes during the first 28 postnatal days on (c) white matter integrity at TEA and (d) NDO at 2 years CA and 5.9 years chronological age

Summary

Introduction

Adequate nutritional intake in extremely preterm (EP) infants (gestational age (GA) < 28 weeks) is very important to achieve growth similar to fetal growth in utero. Postnatal growth is positively associated with different measures of brain development, including cortical maturation [1], linear measures of brain size [2], brain volumes [3], and neurodevelopmental outcome (NDO) [4,5,6]. Cumulative fat and energy intakes were associated with larger brain volumes, improved white matter integrity [3,8], and lower brain injury scores [9]. A positive association between cumulative protein intake and total brain volume has been shown [8,10], only enteral protein intake has previously been associated with improved white matter integrity [3,8]. The role of the macronutrient administration route (i.e., enteral or parenteral) has not yet been fully elucidated, but enteral nutrition is suggested to contribute most to brain development [3,8]

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