Early Lipid Intake Improves Cerebellar Growth in Very Low‐Birth‐Weight Preterm Infants

Abstract

Background Despite recent advances in nutrition practice in the neonatal intensive care unit, infants remain at high risk for growth restriction following preterm birth. Additionally, optimal values for macronutrient administration, especially lipid intake, have yet to be established for preterm infants in the extrauterine environment. Methods We studied preterm infants born at very low‐birth weight (VLBW, <1500 g) and ≤32 weeks’ gestation. Cumulative macronutrient (carbohydrate, lipid, protein, energy) intake in the first 2 and 4 weeks of life was compared with total and regional brain volumes on magnetic resonance imaging (MRI) obtained at term‐equivalent age. Preterm infants had no structural brain injury on conventional MRI. Results In a cohort of 67 VLBW infants, cumulative lipid intake in the first 2 weeks of life was positively associated with significantly greater cerebellar volume (β = 95.8; P = .01) after adjusting for weight gain, gestational age at birth, and postmenstrual age at MRI. Cumulative lipid (β = 36.1, P = .01) and energy (β = 3.1; P = .02) intake in the first 4 weeks of life were both significantly associated with greater cerebellar volume. No relationship was seen between carbohydrate or protein intake in the first month of life and cerebral volume at term‐equivalent age. Conclusion Early cumulative lipid intake in the first month of life is associated with significantly greater cerebellar volume by term‐equivalent age in very premature infants. Our findings emphasize the importance of early, aggressive nutrition interventions to optimize cerebellar development in VLBW infants.

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

“…Our results linking energy intake and brain size are consistent with several [ 13 , 14 , 15 ]—though not all [ 16 , 17 , 38 ]—prior studies of macronutrient intake and brain development in preterm infants. Among three prior studies that reported positive associations between macronutrient intake and brain volumes [ 13 , 14 , 15 ], all found that energy intake was linked to brain size, but varied in the brain region involved, with the most common regions being the cerebellum [ 13 , 14 , 15 ], basal ganglia [ 13 , 14 ], and total brain volume [ 14 ].…”

“…Our results linking energy intake and brain size are consistent with several [ 13 , 14 , 15 ]—though not all [ 16 , 17 , 38 ]—prior studies of macronutrient intake and brain development in preterm infants. Among three prior studies that reported positive associations between macronutrient intake and brain volumes [ 13 , 14 , 15 ], all found that energy intake was linked to brain size, but varied in the brain region involved, with the most common regions being the cerebellum [ 13 , 14 , 15 ], basal ganglia [ 13 , 14 ], and total brain volume [ 14 ]. In contrast to energy, prior studies are inconsistent with respect to the relationship between protein intake and brain volume; some linked protein intake to the same regions as energy intake [ 13 , 14 ] while others found no relationship between protein intake and brain size [ 15 , 16 , 17 ].…”

“…Among three prior studies that reported positive associations between macronutrient intake and brain volumes [ 13 , 14 , 15 ], all found that energy intake was linked to brain size, but varied in the brain region involved, with the most common regions being the cerebellum [ 13 , 14 , 15 ], basal ganglia [ 13 , 14 ], and total brain volume [ 14 ]. In contrast to energy, prior studies are inconsistent with respect to the relationship between protein intake and brain volume; some linked protein intake to the same regions as energy intake [ 13 , 14 ] while others found no relationship between protein intake and brain size [ 15 , 16 , 17 ]. Our finding that protein and energy intake were associated with cortical gray matter volume is novel is consistent with experimental evidence suggesting that the cortex is particularly sensitive to protein-energy malnutrition [ 39 ].…”

“…However, the relationship between macronutrient intake and brain development among preterm infants in the NICU remains uncertain. Prior studies were limited by using average reference values for milk composition rather than direct milk analysis [ 13 , 14 , 15 , 16 , 17 ], which is a substantial limitation given the extent of true variation in macronutrient composition and intakes [ 18 ].…”

Using Nature to Nurture: Breast Milk Analysis and Fortification to Improve Growth and Neurodevelopmental Outcomes in Preterm Infants

“…Novel quantitative magnetic resonance imaging (MRI) techniquesincluding volumetric segmentation and diffusion tensor imaging-are emerging as noninvasive methods for evaluating the impact of early nutritional interventions on preterm brain development at the microstructural level [12]. Quantitative MRI has already been utilized to demonstrate the effects of early breast milk, macronutrient, and energy intake on preterm brain development by term-equivalent age, and could potentially be utilized as a future tool in determining ideal breast milk fortification practices [12,[82][83][84].…”