Nutrition and the developing brain: the road to optimizing early neurodevelopment: a systematic review

Abstract

BACKGROUND: Neonatal intensive care practices have resulted in marked improvements in the survival of premature infants; however, they remain at significant risk for adverse neurodevelopmental outcomes. The impact of current nutritional practices on brain development following early extra-uterine exposure in premature infants is not well known. METHODS: We performed a systematic review to investigate nutritional effects on postnatal brain development in healthy term and prematurely born infants utilizing advanced magnetic resonance imaging tools. RESULTS: Systematic screen yielded 595 studies for appraisal. Of these, 22 total studies were selected for inclusion in the review, with findings summarized in a qualitative, descriptive fashion. CONCLUSION: Fat and energy intake are associated with improved brain volume and development in premature infants. While breast milk intake and long-chain polyunsaturated fatty acid supplementation has been proven beneficial in term infants, the impact in preterm infants is less well understood.

Relationships between Neonatal Nutrition and Growth to 36 Weeks’ Corrected Age in ELBW Babies–Secondary Cohort Analysis from the Provide Trial

“…Full fortifier or preterm formula was not started during the 4 weeks after birth for 35% of babies (sites 1-8: 92%; 20%; 47%; 13%; 8%; 14%; 13%, and 30%). The median (IQR) age at achievement of full enteral feeds was 14 (11,17) days and this differed by site (Figure 2C). Of the included babies, 49% (n = 212) were boys, 11% (n = 48) were SGA and 22% (n = 94) were twins (Table 2).…”

“…Full fortifier or preterm formula was not started during the 4 weeks after birth for 35% of babies (sites 1-8: 92%; 20%; 47%; 13%; 8%; 14%; 13%, and 30%). The median (IQR) age at achievement of full enteral feeds was 14 (11,17) days and this differed by site (Figure 2C). From birth to 36 weeks' CA, the median (IQR) change in z-score for weight was −0.48 (−1.09, 0.05), for length −1.16 (−1.86, −0.43), and for head circumference −0.82 (−1.51, −0.19) (Figure 3).…”

“…Suboptimal neurodevelopment affects 20-45% of preterm babies and up to 50% of ELBW babies [8]. The current recommendation for growth of ELBW babies is that it should match fetal growth rates [9], although evidence that this improves neurodevelopment is lacking [10,11]. While recent improvements to neonatal care and nutrition have made it possible for some neonatal units to match fetal growth rates [12][13][14][15], worldwide, many ELBW babies continue to have postnatal malnutrition, faltering growth and less than optimal neurodevelopment compared with their term-born peers [8].…”

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

“…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]. Additionally, a recent systematic review showed that nutritional intake is independently associated with brain development [7]. Early cumulative fat and energy intakes were associated with larger brain volumes, improved white matter integrity [3,8], and lower brain injury scores [9].…”

Intravenous Lipid for Preterm Infants: The Right Amount, at the Right Time, of the Right Kind

“…Furthermore, there is increasing evidence that neurodevelopmental outcomes in very preterm infants are enhanced with increased early postnatal and cumulative energy intake over the duration of hospitalization, as well as more enteral feeding, especially of mother's milk, which is relatively rich in lipid composition. 4,5 It is encouraging, therefore, that in this volume of The Journal, Alburaki et al 6 report more positive head circumference growth in preterm infants from a randomized, nonblinded study in which an intervention group of very preterm infants (n = 45, 27.1 weeks mean gestational age) received earlier and higher dosing of intravenous soy-based lipid emulsion (2 g/kg on day 1, then 3 g/kg/day while receiving intravenous feeding) while a control group (n = 38, 27.3 weeks mean gestational age) received 0.5-1.0 g/kg on day 1, advancing to 3 g/kg/day by daily increments of 0.5-1.0 g/kg. The intervention group by design had higher cumulative lipid intake in the first 7 days after birth (+24%, 13.5 AE 4.2 vs 10.9 AE 3.5 g/kg per day, P = .03).…”