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

Bell, Katherine; Cherkerzian, Sara; Drouin, Kaitlin; Matthews, Lillian G.; Inder, Terrie E.; Prohl, Anna K.; Warfield, Simon K.; Belfort, Mandy B.

doi:10.3390/children9070969

Cited by 7 publications

(4 citation statements)

References 52 publications

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“…The benefits of breastfeeding and human milk exposure are well-documented, with studies reporting positive associations between the duration of human milk exposure and total and region-specific brain volumes in infancy and intelligence test scores in early childhood and beyond for those born full-term and preterm [ 11 , 12 , 13 , 14 ]. Although the macronutrient content of human milk has been examined in relation to brain development and neurodevelopmental outcomes [ 15 , 16 ], the composition of human milk is one of the most understudied biological systems in the life sciences. There is also a knowledge gap regarding the mechanisms through which human milk components shape the structural and functional features of the infant brain.…”

Section: Introductionmentioning

confidence: 99%

Human Milk Oligosaccharides and Infant Neurodevelopment: A Narrative Review

et al. 2023

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The objective of this narrative review was to synthesize the literature on human milk oligosaccharides (HMOs) and neurodevelopmental outcomes in human milk-fed infants. We conducted a scoping review of the literature indexed in PubMed reporting observational or interventional studies on HMO exposure in relation to psychometric measures in infants. Studies were characterized based on study design and definitions of HMO exposure and neurodevelopmental outcomes. Six studies were identified; all were observational in design, and five were conducted in full-term infants. Sample sizes ranged from 35–659 infants. HMOs were defined as individual concentrations or relative abundances assessed at 1 and/or 6 months of age. Studies accounted for differences in HMO exposure based on maternal secretor status. Neurodevelopmental outcomes were assessed between 6 and 24 months of age and included four domains. Studies in full-term infants reported that total and individual fucosylated and sialylated HMOs were positively associated with cognitive, language, and motor skill domains between 18 and 24 months of age, while the single study in preterm infants reported no statistically significant findings in the full cohort. The presence of a maternal secretor did not consistently alter the associations between HMO exposure and neurodevelopmental outcomes. Emerging evidence from observational studies suggests that HMO exposure may be beneficial for neurodevelopment in infants.

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Section: Introductionmentioning

confidence: 99%

Human Milk Oligosaccharides and Infant Neurodevelopment: A Narrative Review

et al. 2023

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“…Early fat and caloric intake have been associated with regional brain volumetrics in preterm infants 12 , 13 , while another study found no relationship 59 . Protein and total energy intake via human milk specifically has also been related to greater total and regional brain volumes 60 . Again, these studies have primarily utilized term equivalent age brain imaging.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, we did not prospectively assess nutritional intake, feeding composition, or feeding volumes in the NICU. However, given conflicting evidence, a robust relationship between intake in the NICU and brain growth (as indexed by volumetric analysis of MRI at term equivalent age) is still being established 12 , 13 , 59 , 60 . This could be due to difficulty reliably assessing enteral intake in the NICU, with some investigators finding nutritional intake in their studies failed to meet recommended amounts and others estimating enteral intake based on an assumed composition of maternal breast milk 12 , 13 , 59 , though accurate human milk analysis has been demonstrated to be capably incorporated in these studies 60 .…”

Section: Discussionmentioning

confidence: 99%

Correlation of NICU anthropometry in extremely preterm infants with brain development and language scores at early school age

Fu,

Barnes-Davis,

Fujiwara

et al. 2023

Sci Rep

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Growth in preterm infants in the neonatal intensive care unit (NICU) is associated with increased global and regional brain volumes at term, and increased postnatal linear growth is associated with higher language scores at age 2. It is unknown whether these relationships persist to school age or if an association between growth and cortical metrics exists. Using regression analyses, we investigated relationships between the growth of 42 children born extremely preterm (< 28 weeks gestation) from their NICU hospitalization, standardized neurodevelopmental/language assessments at 2 and 4–6 years, and multiple neuroimaging biomarkers obtained from T1-weighted images at 4–6 years. We found length at birth and 36 weeks post-menstrual age had positive associations with language scores at 2 years in multivariable linear regression. No growth metric correlated with 4–6 year assessments. Weight and head circumference at 36 weeks post-menstrual age positively correlated with total brain volume and negatively with global cortical thickness at 4–6 years of age. Head circumference relationships remained significant after adjusting for age, sex, and socioeconomic status. Right temporal cortical thickness was related to receptive language at 4–6 years in the multivariable model. Results suggest growth in the NICU may have lasting effects on brain development in extremely preterm children.

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“…SWS is a preliminary version of a BE tool available within the Morphologically Adaptive Neonatal Tissue Segmentation (MANTiS) toolbox [42], based on watershed transform. It can be used before the tissue classification pipeline and has been used in several studies [55][56][57][58][59][60][61][62][63][64][65], although it was not used in the validation study of the toolbox (they used BET instead) as it was not available then.…”

Section: Selection Of Automated Brain Extraction Methodsmentioning

confidence: 99%

Brain Extraction Methods in Neonatal Brain MRI and Their Effects on Intracranial Volumes

Vaz,

Canto Moreira,

Hellström-Westas

et al. 2024

Applied Sciences

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Magnetic resonance imaging (MRI) plays an important role in assessing early brain development and injury in neonates. When using an automated volumetric analysis, brain tissue segmentation is necessary, preceded by brain extraction (BE) to remove non-brain tissue. BE remains challenging in neonatal brain MRI, and despite the existence of several methods, manual segmentation is still considered the gold standard. Therefore, the purpose of this study was to assess different BE methods in the MRI of preterm neonates and their effects on the estimation of intracranial volumes (ICVs). This study included twenty-two premature neonates (mean gestational age ± standard deviation: 28.4 ± 2.1 weeks) with MRI brain scans acquired at term, without detectable lesions or congenital conditions. Manual segmentation was performed for T2-weighted scans to establish reference brain masks. Four automated BE methods were used: Brain Extraction Tool (BET2); Simple Watershed Scalping (SWS); HD Brain Extraction Tool (HD-BET); and SynthStrip. Regarding segmentation metrics, HD-BET outperformed the other methods with median improvements of +0.031 (BET2), +0.002 (SWS), and +0.011 (SynthStrip) points for the dice coefficient; and −0.786 (BET2), −0.055 (SWS), and −0.124 (SynthStrip) mm for the mean surface distance. Regarding ICVs, SWS and HD-BET provided acceptable levels of agreement with manual segmentation, with mean differences of −1.42% and 2.59%, respectively.

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

Cited by 7 publications

References 52 publications

Human Milk Oligosaccharides and Infant Neurodevelopment: A Narrative Review

Human Milk Oligosaccharides and Infant Neurodevelopment: A Narrative Review

Correlation of NICU anthropometry in extremely preterm infants with brain development and language scores at early school age

Brain Extraction Methods in Neonatal Brain MRI and Their Effects on Intracranial Volumes

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