Neonatal Morbidity Count Is Associated With a Reduced Likelihood of Achieving Recommendations for Protein, Lipid, and Energy in Very Low Birth Weight Infants: A Prospective Cohort Study

Ng, Dawn V Y; Unger, Sharon; Asbury, Michelle R.; Kiss, Alex; Bishara, Rosine; Bando, Nicole; Tomlinson, Christopher; Gibbins, Sharyn; O'Connor, Deborah L

doi:10.1177/0148607117710441

Cited by 15 publications

(23 citation statements)

References 51 publications

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“…Weekly macronutrient and energy estimates were instead calculated based on known changes in milk composition over time. 32 Thirdly, TBSS confines the analysis to the FA skeleton (thought to reflect the centre of major white matter tracts) and is thus not representative of the entire white matter tract, including poor coverage of the cerebellum. While this attempts to exclude voxels with partial volumes and improve alignment between images, we acknowledge this as potential limitation and encourage replication of findings using other analytical methods.…”

Section: Discussionmentioning

confidence: 99%

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Early nutrition and white matter microstructure in children born very low birth weight

Sato

Vandewouw

Bando

et al. 2021

Brain Communications

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Infants born at very low birth weight (<1500 g) are vulnerable to nutritional deficits during their first postnatal month, which are associated with poor neurodevelopmental outcomes. Despite this knowledge, the impact of early postnatal nutrition on white matter microstructure in children born very low birth weight has not been investigated. In this prospective cohort study, we employed a whole-brain approach to investigate associations between precise estimates of nutrient intake within the first postnatal month with white matter microstructure at 5 years of age. Detailed information about breastmilk, macronutrient and energy intakes during this period were prospectively recorded for all participants. Multi-shell diffusion and T1-weighted MRIs were acquired in 41 children (21 males; mean scan age: 5.75 ± 0.22 years; mean birth weight: 1028.6 ± 256.8 g.). The diffusion tensor imaging and neurite orientation dispersion and density imaging models were used to obtain maps of fractional anisotropy, radial diffusivity, orientation dispersion and neurite density indices. Tract-Based Spatial Statistics was used to test associations between metrics of white matter microstructure with breastmilk, macronutrient (protein, lipids and carbohydrate) and energy intake. Associations between white matter microstructure and cognitive outcomes were also examined. Compared to children who did not meet enteral feeding recommendations, those who achieved enteral protein, lipid and energy recommendations during the first postnatal month showed improved white matter maturation at 5 years. Thus, among the macronutrients, greater protein intake contributed to the beneficial effect of nutrition, showing widespread increases in fractional anisotropy and reductions in radial diffusivity. No significant associations were found between white matter metrics with breastmilk or carbohydrate intake. Voxel-wise analyses with cognitive outcomes revealed significant associations between higher fractional anisotropy and neurite density index with higher processing speed scores. Lower radial diffusivity and orientation dispersion index were also associated with improved processing speed. Our findings support the long-term impacts of early nutrition on white matter microstructure, which in turn is related to cognitive outcomes. These results provide strong support for early postnatal nutritional intervention as a promising strategy to improve long-term cognitive outcomes of infants born at very low birth weight.

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Section: Discussionmentioning

confidence: 99%

“…These details have been previously published. 29 , 32 , 34 Briefly, daily volumes and compositions of the parenteral and enteral nutrition provided were collected for each infant. Mother’s breastmilk intake was calculated as the percentage of total enteral feeds in-hospital.…”

Section: Methodsmentioning

confidence: 99%

Early nutrition and white matter microstructure in children born very low birth weight

Sato

Vandewouw

Bando

et al. 2021

Brain Communications

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“…In a prospective cohort study, Ng et al proposed "nutritional bundles" including guidelines regarding feeding strategies through illness [33]. Despite high rates of morbidity among EPT infants, these "nutritional bundles" may facilitate meeting estimated nutritional needs.…”

Section: Discussionmentioning

confidence: 99%

Perioperative nutrition in extremely preterm infants undergoing surgery for patent ductus arteriosus

Westin

Vanpée

Norman

et al. 2020

Clinical Nutrition Experimental

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fluid intakes during the perioperative week, as well as median parenteral contents of energy and protein, varied significantly between hospitals. Conclusions: Current recommended nutritional goals for extremely preterm infants were not met in the studied neonatal intensive care units. Suboptimal nutrition may have implications for short and long-term outcomes. Improved adherence to nutritional guidelines is warranted for these patients.

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“…Detailed information regarding the study protocol, in-hospital nutrient intakes and growth, and neurodevelopmental outcomes at 18 months' CGA by feeding assignment have been published. 2,3,9,10 To assess how nutrient intakes were associated with growth and neurodevelopment in this present analysis, only infants who survived and had available nutrient intake and weight data for a minimum of 28 days postnatally during the GTA-DoMINO trial were included. Nutrient intake and weight data were included from birth to 90 days postnatally or 36 +0 weeks' CGA, whichever came first.…”

Section: Study Participantsmentioning

confidence: 99%

“…1 However, this is challenging, particularly among infants who are predominantly fed human milk, owing to variability in milk composition, or those who have a major morbidity such as patent ductus arteriosus (PDA), late-onset sepsis, necrotizing enterocolitis (NEC), or chronic lung disease (CLD). 2,3 Systematic reviews and meta-analyses of randomized control trials (RCTs) demonstrate that multinutrient fortification of human milk or provision of nutrient-enriched vs standard term formula results in greater in-hospital weight and head-circumference gains in preterm infants. 4,5 Given the high incidence of suboptimal neurodevelopment among VLBW infants and the rapid rate of brain volume expansion and maturation, optimization of early nutrition and growth is thought to be a promising strategy to diminish the adverse developmental consequences of preterm birth.…”

Section: Introductionmentioning

confidence: 99%

Higher Energy, Lipid, and Carbohydrate Provision to Very Low‐Birth‐Weight Infants Is Differentially Associated With Neurodevelopment at 18 Months, Despite Consistent Improvements in Weight Gain

Bishara

Asbury

et al. 2021

J Parenter Enteral Nutr

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Background:The impact of suboptimal intakes on neurodevelopment of very low-birth-weight (VLBW, <1500 g) infants, particularly those born small for gestational age, <26 weeks, <1000 g, or with morbidities is not well defined. We investigated how macronutrient/energy intakes are associated with growth and neurodevelopment among VLBW infants, adjusted for the aforementioned vulnerabilities. Our hypothesis was that higher nutrient intakes would be positively associated with weight gain and neurodevelopment. Methods: Daily macronutrient/energy intakes and weekly weights from birth until 36 +0 weeks were collected prospectively from VLBW infants (n = 302) enrolled in a previous trial (ISRCTN35317141). Neurodevelopment was assessed by the Bayley-III at 18 months' corrected gestational age. Relationships between quartiles of macronutrient/energy intakes, growth, and neurodevelopment were assessed. Results: Infants born <1000 g, <26 weeks, or with morbidities had lower nutrient intakes and slower growth than infants born ≥1000 g, ≥26 weeks, or with no morbidities, respectively (P < 0.05). Higher quartiles of energy, lipid, and carbohydrate intakes were positively associated with growth velocity (P = <0.0001-0.007); no association was observed for protein intake. Energy, protein-to-energy ratio and lipid intakes were associated with cognitive scores (P = 0.001-0.004); however, intakes within the second and third quartiles were generally associated with the highest cognitive scores. No nutrient intakes were associated with language or motor scores across the entire study period. Conclusion: Smaller, more immature VLBW infants and those with morbidity have the greatest risk of poor nutrition and growth. Increasing macronutrient/energy intakes are generally associated with improved weight gain, but not necessarily improved neurodevelopment.

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Neonatal Morbidity Count Is Associated With a Reduced Likelihood of Achieving Recommendations for Protein, Lipid, and Energy in Very Low Birth Weight Infants: A Prospective Cohort Study

Abstract: Morbidity is associated with a decreased likelihood of achieving lipid and consequently energy recommendations. This and the decline in protein intakes after the early neonatal period require further investigation to ensure optimal nutrition in this vulnerable population.

Cited by 15 publications

References 51 publications

Early nutrition and white matter microstructure in children born very low birth weight

Early nutrition and white matter microstructure in children born very low birth weight

Perioperative nutrition in extremely preterm infants undergoing surgery for patent ductus arteriosus

Higher Energy, Lipid, and Carbohydrate Provision to Very Low‐Birth‐Weight Infants Is Differentially Associated With Neurodevelopment at 18 Months, Despite Consistent Improvements in Weight Gain

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