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. 2021 Sep 27;13(10):3409.
doi: 10.3390/nu13103409.

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

Lisa M Hortensius  1   2 , Els Janson  1   2 , Pauline E van Beek  3 , Floris Groenendaal  1   2 , Nathalie H P Claessens  1   2 , Henriette F N Swanenburg de Veye  4 , Maria J C Eijsermans  1   5 , Corine Koopman-Esseboom  1 , Jeroen Dudink  1   2 , Ruurd M van Elburg  1   6 , Manon J N L Benders  1   2 , Maria Luisa Tataranno  1   2 , Niek E van der Aa  1   2
Affiliations

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

Lisa M Hortensius et al. Nutrients. .

Abstract

Background: Determining optimal nutritional regimens in extremely preterm infants remains challenging. This study aimed to evaluate the effect of a new nutritional regimen and individual macronutrient intake on white matter integrity and neurodevelopmental outcome.

Methods: Two retrospective cohorts of extremely preterm infants (gestational age < 28 weeks) were included. Cohort B (n = 79) received a new nutritional regimen, with more rapidly increased, higher protein intake compared to cohort A (n = 99). Individual protein, lipid, and caloric intakes were calculated for the first 28 postnatal days. Diffusion tensor imaging was performed at term-equivalent age, and cognitive and motor development were evaluated at 2 years corrected age (CA) (Bayley-III-NL) and 5.9 years chronological age (WPPSI-III-NL, MABC-2-NL).

Results: Compared to cohort A, infants in cohort B had significantly higher protein intake (3.4 g/kg/day vs. 2.7 g/kg/day) and higher fractional anisotropy (FA) in several white matter tracts but lower motor scores at 2 years CA (mean (SD) 103 (12) vs. 109 (12)). Higher protein intake was associated with higher FA and lower motor scores at 2 years CA (B = -6.7, p = 0.001). However, motor scores at 2 years CA were still within the normal range and differences were not sustained at 5.9 years. There were no significant associations with lipid or caloric intake.

Conclusion: In extremely preterm born infants, postnatal protein intake seems important for white matter development but does not necessarily improve long-term cognitive and motor development.

Keywords: diffusion tensor imaging; extremely preterm infant; neurodevelopmental outcome; nutrition; white matter.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of inclusion. DTI = diffusion tensor imaging; FU = follow-up; CA = corrected age; ChA = chronological age. * >3 standard deviations from the mean enteral and parenteral intake that caused significance.
Figure 2
Figure 2
The introduction of the new nutrition protocol was associated with higher FA in several white matter tracts (A). Independent of the nutrition protocol, total protein intake was also associated with higher FA (B). Significant voxels (red-yellow; color bar indicates p-value) are presented on top of the mean FA skeleton (green) and are viewed from a sagittal (left), coronal (middle), and axial (right) perspective.
Figure 3
Figure 3
Cognitive (A,C) and motor (B,D) outcome at both follow-up ages for cohort A and B. Each data point represents a score of an individual infant. Lines represent the median with interquartile range. ** p < 0.01. Bayley: Bayley Scales of Infant and Toddler-Development, assessed at 2 years corrected age. WPPSI: Wechsler Preschool and Primary Scale of Intelligence, assessed at 5.9 years chronological age. M-ABC: Movement Assessment Battery for Children, assessed at 5.9 years chronological age.
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