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

Hortensius, Lisa M.; Janson, Els; Beek, Pauline E. van; Groenendaal, Floris; Claessens, Nathalie H.P.; Veye, Henriëtte F. N. Swanenburg de; Eijsermans, Maria J.C.; Koopman-Esseboom, Corine; Dudink, Jeroen; Elburg, Ruurd M. van; Benders, Manon J. N. L.; Tataranno, Maria Luisa; Aa, Niek E. van der

doi:10.3390/nu13103409

Cited by 16 publications

(16 citation statements)

References 51 publications

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“…In our study protein intake did not have any relationship with either MDI or PDI scores and its intake was lower than recommended for extremely low birth weight infants, using standard fortification. Results from other studies focusing on protein intake are inconclusive-some authors report positive effect of protein on neurodevelopment [30,44], others report the opposite findings [50]. The latter study found that higher total protein intake resulted in lower motor scores at 2 years of CGA in ELBW infants, despite improved white matter integrity; however, the duration of parenteral nutrition in this study was longer than ours and parenteral protein may have played a role.…”

Section: Early Nutrient Intake and Neurodevelopmentcontrasting

confidence: 83%

Impact of Early Nutrient Intake and First Year Growth on Neurodevelopment of Very Low Birth Weight Newborns

et al. 2022

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Optimal nutrient intake ensuring better neurodevelopment for very low birth weight (VLBW) infants remains unknown. The aim of this study was to assess the relationship between early (first 28 days) nutritional intake, first year growth, and neurodevelopment. In total, 120 VLBW infants were included into the study. A group of 95 infants completed follow-up to 12 months of corrected gestational age (CGA). Nutrient intake was assessed, and weight, length, and head circumference (HC) were measured weekly until discharge and at 3, 6, 9, and 12 months of CGA. Neurodevelopment was assessed at 12 months of CGA. Two groups—extremely preterm (EP) and very/moderately preterm (VP)—were compared. Growth before discharge was slower in the EP group than the VP group. At 12 months, there was no difference in anthropometric characteristics or neurodevelopmental scores between the groups. Higher carbohydrate intake during the first 28 days was the single significant predictor for better cognitive scores only in the EP group (βs = 0.60, p = 0.017). Other nutrients and growth before discharge were not significant for cognitive and motor scores in either group in multivariable models, whereas post-discharge HC growth was associated with both cognitive and motor scores in the VP group. Monitoring intake of all nutrients and both pre-discharge and post-discharge growth is essential for gaining knowledge about individualized nutrition for optimal neurodevelopment.

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Section: Early Nutrient Intake and Neurodevelopmentcontrasting

confidence: 83%

Impact of Early Nutrient Intake and First Year Growth on Neurodevelopment of Very Low Birth Weight Newborns

et al. 2022

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“…Human milk is not the only milk supplied nor breast feeding the only delivery method. Cow’s milk and enriched milk products are also utilized but human milk has many health inductive properties that make it more that nutritional and indeed more medicinal in nature [ 25 , 26 , 27 , 28 ]. Breastfeeding releases antioxidant and anti-inflammatory substances to the infant [ 29 ], helps establish the gut microbiome and the immune system [ 30 , 31 ] while promoting neurological development [ 32 ].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Non-Pharmacological Methods, Such as Breastfeeding, to Mitigate Pain in NICU Infants

et al. 2022

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Neonates do experience pain and its management is necessary in order to prevent long-term, as well as, short-term effects. The most common source of pain in the neonatal intensive care unit (NICU) is caused by medically invasive procedures. NICU patients have to endure trauma, medical adhesive related skin injuries, heel lance, venipuncture and intramuscular injection as well as nasogastric catheterization besides surgery. A cornerstone in pain assessment is the use of scales such as COMFORT, PIPP-R, NIPS and N-PASS. This narrative review provides an up to date account of neonate pain management used in NICUs worldwide focusing on non-pharmacological methods. Non-steroidal anti-inflammatory drugs have well established adverse side effects and opioids are addictive thus pharmacological methods should be avoided if possible at least for mild pain management. Non-pharmacological interventions, particularly breastfeeding and non-nutritive sucking as primary strategies for pain management in neonates are useful strategies to consider. The best non-pharmacological methods are breastfeeding followed by non-nutritive sucking coupled with sucrose sucking. Regrettably most parents used only physical methods and should be trained and involved for best results. Further research in NICU is essential as the developmental knowledge changes and neonate physiology is further uncovered together with its connection to pain.

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“…Two small studies found positive associations of cumulative fat and energy intake with fractional anisotropy, but conflicted regarding the tract impacted; one found positive associations with the PLIC [ 13 ], while the other found associations with five white matter tracts (posterior corona radiata, thalamic radiations, superior longitudinal fasciculus, corticospinal tract, and superior corona radiata) but not the PLIC [ 14 ]. In addition, one study in extremely preterm infants found a positive association between higher protein—rather than fat—intake in the first week of life and FA in many of the same tracts as above, including portions of the corona radiata, thalamic radiations, superior longitudinal fasciculus, and internal capsule, plus the corpus callosum [ 40 ]. In contrast, we studied many of the same white matter tracts but found no association between macronutrient or energy intake and FA in any of the 15 tracts assessed.…”

Section: Discussionmentioning

confidence: 99%

Associations of Macronutrient Intake Determined by Point-of-Care Human Milk Analysis with Brain Development among very Preterm Infants

et al. 2022

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Point-of-care human milk analysis is now feasible in the neonatal intensive care unit (NICU) and allows accurate measurement of macronutrient delivery. Higher macronutrient intakes over this period may promote brain growth and development. In a prospective, observational study of 55 infants born at <32 weeks’ gestation, we used a mid-infrared spectroscopy-based human milk analyzer to measure the macronutrient content in repeated samples of human milk over the NICU hospitalization. We calculated daily nutrient intakes from unfortified milk and assigned infants to quintiles based on median intakes over the hospitalization. Infants underwent brain magnetic resonance imaging at term equivalent age to quantify total and regional brain volumes and fractional anisotropy of white matter tracts. Infants in the highest quintile of energy intake from milk, as compared with the lower four quintiles, had larger total brain volume (31 cc, 95% confidence interval [CI]: 5, 56), cortical gray matter (15 cc, 95%CI: 1, 30), and white matter volume (23 cc, 95%CI: 12, 33). Higher protein intake was associated with larger total brain (36 cc, 95%CI: 7, 65), cortical gray matter (22 cc, 95%CI: 6, 38) and deep gray matter (1 cc, 95%CI: 0.1, 3) volumes. These findings suggest innovative strategies to close nutrient delivery gaps in the NICU may promote brain growth for preterm infants.

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

Cited by 16 publications

References 51 publications

Impact of Early Nutrient Intake and First Year Growth on Neurodevelopment of Very Low Birth Weight Newborns

Impact of Early Nutrient Intake and First Year Growth on Neurodevelopment of Very Low Birth Weight Newborns

Effectiveness of Non-Pharmacological Methods, Such as Breastfeeding, to Mitigate Pain in NICU Infants

Associations of Macronutrient Intake Determined by Point-of-Care Human Milk Analysis with Brain Development among very Preterm Infants

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