In the Journals

Early nutritional intake related to brain growth in preterm neonates

Preterm neonates who received higher nutritional intake and enteral feeding primarily with breast milk during the first 2 weeks of life were more likely to have greater brain growth, according to recently published study results in Pediatrics.

“To our knowledge, this is the first preterm cohort study in which brain growth as measured on 3 serial scans in relation to early nutrition is examined,” Juliane Schneider, MD, of the pediatrics department, University of Toronto and the Hospital for Sick Children, Toronto, and colleagues wrote. “Higher energy intake during the first 2 weeks of life predicted enhanced brain development, with a positive effect on both [gray matter] and [white matter (WM)], as indicated by more robust growth of the subcortical structures, the cerebellum and the total brain and accelerated WM microstructural maturation to term age, with remarkable consistency across brain measures.”

Schneider and colleagues conducted a prospective study of 49 preterm neonates (21 boys, median gestation age, 27.6 weeks) who underwent serial brain MRI between birth and term-equivalent age (TEA) between 2011 and 2013 at a level 3 neonatal ICU in Switzerland. Serial MRI scans were conducted within the first 2 weeks of life, at an intermediate time point of either 3 weeks of life or at 35 to 35 weeks’ postmenstrual age and at TEA.

Volume segmentation with three-dimensional T1-weighted images included the total brain, basal nuclei and cerebellum. Diffusion tension imaging was used to measure fractional anisotropy.

The researchers measured nutritional intake from neonates aged day 1 to 14. Clinical factors were included. Proteins and carbohydrates provided 4 kcal/g and lipids provide 9 kcal/g.

“Greater energy and lipid intake predicted increased total brain and basal nuclei volumes over the course of neonatal care to term-equivalent age,” the researchers wrote.

Lipids made up 36% of average total energy intake, while proteins made up 15% and carbohydrates made up 49% of the total energy intake during the first 2 weeks of life, with breast milk making up 98% of enteral intake during the time.

“The association of ventilation duration with smaller brain volumes was attenuated by higher energy intake,” the researchers wrote.

Psychomotor outcome at 18 months’ corrected age was predicted by brain growth.

“In very preterm neonates, greater energy intake and enteral feeding (mostly with breast milk) during the first 2 weeks of life predicted more robust brain growth, particularly in the subcortical structures and cerebellum and accelerated WM maturation,” the researchers concluded. “Nutrition in the first weeks after preterm birth appears to have long-lasting effects on neurodevelopment, which may be mediated by advanced brain maturation, as suggested by the association between brain growth and psychomotor outcome at 18 months’ [corrected age].” – by Bruce Thiel

Disclosures: The authors report no relevant financial disclosures.

Preterm neonates who received higher nutritional intake and enteral feeding primarily with breast milk during the first 2 weeks of life were more likely to have greater brain growth, according to recently published study results in Pediatrics.

“To our knowledge, this is the first preterm cohort study in which brain growth as measured on 3 serial scans in relation to early nutrition is examined,” Juliane Schneider, MD, of the pediatrics department, University of Toronto and the Hospital for Sick Children, Toronto, and colleagues wrote. “Higher energy intake during the first 2 weeks of life predicted enhanced brain development, with a positive effect on both [gray matter] and [white matter (WM)], as indicated by more robust growth of the subcortical structures, the cerebellum and the total brain and accelerated WM microstructural maturation to term age, with remarkable consistency across brain measures.”

Schneider and colleagues conducted a prospective study of 49 preterm neonates (21 boys, median gestation age, 27.6 weeks) who underwent serial brain MRI between birth and term-equivalent age (TEA) between 2011 and 2013 at a level 3 neonatal ICU in Switzerland. Serial MRI scans were conducted within the first 2 weeks of life, at an intermediate time point of either 3 weeks of life or at 35 to 35 weeks’ postmenstrual age and at TEA.

Volume segmentation with three-dimensional T1-weighted images included the total brain, basal nuclei and cerebellum. Diffusion tension imaging was used to measure fractional anisotropy.

The researchers measured nutritional intake from neonates aged day 1 to 14. Clinical factors were included. Proteins and carbohydrates provided 4 kcal/g and lipids provide 9 kcal/g.

“Greater energy and lipid intake predicted increased total brain and basal nuclei volumes over the course of neonatal care to term-equivalent age,” the researchers wrote.

Lipids made up 36% of average total energy intake, while proteins made up 15% and carbohydrates made up 49% of the total energy intake during the first 2 weeks of life, with breast milk making up 98% of enteral intake during the time.

“The association of ventilation duration with smaller brain volumes was attenuated by higher energy intake,” the researchers wrote.

Psychomotor outcome at 18 months’ corrected age was predicted by brain growth.

“In very preterm neonates, greater energy intake and enteral feeding (mostly with breast milk) during the first 2 weeks of life predicted more robust brain growth, particularly in the subcortical structures and cerebellum and accelerated WM maturation,” the researchers concluded. “Nutrition in the first weeks after preterm birth appears to have long-lasting effects on neurodevelopment, which may be mediated by advanced brain maturation, as suggested by the association between brain growth and psychomotor outcome at 18 months’ [corrected age].” – by Bruce Thiel

Disclosures: The authors report no relevant financial disclosures.