Nutrient Intake in the First Two Weeks of Life and Brain Growth in Preterm Neonates.

Authors

Juliane Schneider, Department of Paediatrics, University of Toronto and The Hospital for Sick Children, Toronto, Canada & Department of Woman-Mother-Child, Clinic of Neonatology
Céline J Fischer Fumeaux, Department of Woman-Mother-Child, Clinic of Neonatology
Emma G Duerden, Department of Paediatrics, University of Toronto and The Hospital for Sick Children, Toronto, Canada
Ting Guo, Department of Paediatrics, University of Toronto and The Hospital for Sick Children, Toronto, Canada
Justin Foong, Department of Paediatrics, University of Toronto and The Hospital for Sick Children, Toronto, Canada
Myriam Bickle Graz, Department of Woman-Mother-Child, Clinic of Neonatology
Patric Hagmann, Department of Radiology, Clinic of Neuroradiology, University Hospital Center and University of Lausanne, Lausanne, Switzerland
M Mallar Chakravarty, Douglas Mental Health University Institute, Montreal, Canada & Departments of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal, Canada
Petra S Hüppi, Division of Development and Growth, Department of Paediatrics, University Hospital of Geneva, Geneva, Switzerland
Lydie Beauport, Department of Woman-Mother-Child, Clinic of Neonatology
Anita C Truttmann, Department of Woman-Mother-Child, Clinic of Neonatology
Steven P Miller, Department of Paediatrics, University of Toronto and The Hospital for Sick Children, Toronto, CanadaFollow

Document Type

Article

Publication Date

3-1-2018

Journal

Pediatrics

Volume

141

Issue

3

First Page

e20172169

URL with Digital Object Identifier

10.1542/peds.2017-2169

Abstract

BACKGROUND: Optimizing early nutritional intake in preterm neonates may promote brain health and neurodevelopment through enhanced brain maturation. Our objectives were (1) to determine the association of energy and macronutrient intake in the first 2 weeks of life with regional and total brain growth and white matter (WM) maturation, assessed by 3 serial MRI scans in preterm neonates; (2) to examine how critical illness modifies this association; and (3) to investigate the relationship with neurodevelopmental outcomes.

METHODS: Forty-nine preterm neonates (21 boys, median [interquartile range] gestational age: 27.6 [2.3] weeks) were scanned serially at the following median postmenstrual weeks: 29.4, 31.7, and 41. The total brain, basal nuclei, and cerebellum were semiautomatically segmented. Fractional anisotropy was extracted from diffusion tensor imaging data. Nutritional intake from day of life 1 to 14 was monitored and clinical factors were collected.

RESULTS: Greater energy and lipid intake predicted increased total brain and basal nuclei volumes over the course of neonatal care to term-equivalent age. Similarly, energy and lipid intake were significantly associated with fractional anisotropy values in selected WM tracts. The association of ventilation duration with smaller brain volumes was attenuated by higher energy intake. Brain growth predicted psychomotor outcome at 18 months' corrected age.

CONCLUSIONS: In preterm neonates, greater energy and enteral feeding during the first 2 weeks of life predicted more robust brain growth and accelerated WM maturation. The long-lasting effect of early nutrition on neurodevelopment may be mediated by enhanced brain growth. Optimizing nutrition in preterm neonates may represent a potential avenue to mitigate the adverse brain health consequences of critical illness.