A recent study published in Pediatric Research examined the role of early nutrition in brain development and cognitive function in very preterm (VPT) infants. The research, which focused on infants born at less than 32 weeks gestational age (GA), suggests that while nutrition plays a role in neurodevelopment, individual variations in macronutrient intake may not significantly impact brain growth or cognitive outcomes.
The Importance of Nutrition in Neurodevelopment
Neurodevelopment is a critical health outcome for preterm infants, with environmental factors like nutrition, oxidative stress, and infection influencing brain differentiation and growth. Though largely preprogrammed, the brain’s development is sensitive to various modifiable factors, particularly during the later stages of gestation, when brain growth is at its peak. Preterm infants are especially vulnerable to disruptions in brain maturation, as much of their neurogenesis occurs outside the womb. This results in smaller brain volumes and cognitive impairments compared to full-term infants.
Extremely preterm (EPT) infants, defined as those born between 22 and 27 weeks gestation, face an even higher risk of postnatal malnutrition due to poor enteral nutrient uptake, limited nutrient reserves, and feeding intolerance. Despite the acknowledged importance of nutrition for shaping brain structure, the exact effects of macronutrients on brain volume remain unclear, with previous studies yielding conflicting results.
Study Design and Methodology
The study analyzed data from 170 VPT infants born at a children’s hospital between July 2011 and December 2014. Of the 150 surviving infants, 118 underwent brain MRI scans, and 72 infants met the criteria for inclusion after exclusion due to missing nutritional data, lack of parental consent, or unavailable MRI scans. The study team gathered a variety of data, including GA, birth weight, delivery mode, sex, and Apgar scores, and tracked morbidities such as mechanical ventilation, sepsis, and necrotizing enterocolitis.
Nutritional intake was meticulously monitored, with human milk provided starting two hours after birth and fortification introduced once enteral intake reached 100 mL/kg/day. The protocol followed European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) guidelines. MRIs were performed at term (40 weeks post-menstrual age), and neurodevelopmental assessments were conducted at age 2 using the Bayley Scales of Infant and Toddler Development (BSID). Neurodevelopmental impairment (NDI) was defined by a cerebral palsy diagnosis or a BSID score below 85.
Key Findings
The mean GA of the study infants was 28.1 weeks, with an average birth weight of 1,190 grams. The cohort included both VPT (GA 28–31 weeks) and EPT (GA 22–27 weeks) infants. Although MRI scans revealed no significant differences in brain volume or structure between VPT and EPT infants, a numerical reduction in white matter volume was observed in EPT infants, though it was not statistically significant after adjusting for covariates.
The study also found no significant differences in neurodevelopmental outcomes between the two groups at age 2. Eleven infants had NDI, with no significant subgroup differences. Initial correlation analyses suggested positive associations between white matter volume and various macronutrients (such as protein, fat, and carbohydrates) and fluid intake. However, these associations disappeared after adjusting for covariates, indicating that variations in nutrient intake did not directly affect brain growth or neurodevelopment.
Conclusion and Implications
The findings of this study suggest that within a cohort receiving standardized nutrition, individual variations in macronutrient intake do not significantly influence brain morphology, growth, or cognitive development in preterm infants. The study emphasizes that larger nutritional deficits, which were not present in this cohort, may still pose risks to brain development. Additionally, the study’s limitations—such as its small sample size, retrospective design, and lack of post-discharge nutritional data—could have influenced long-term neurodevelopmental outcomes. The strict adherence to clinical nutritional guidelines likely minimized observable differences in brain development.
While the research did not find strong evidence to support the idea that small variations in postnatal nutrition impact neurodevelopment, it highlights the importance of adequate nutrition in ensuring optimal brain growth in preterm infants, particularly those at higher risk for malnutrition. Future studies with larger sample sizes and more comprehensive long-term follow-up could provide further insights into the role of nutrition in shaping brain development in this vulnerable population.
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