Preterm Infants Need Optimized Nutrition For Maximal Brain Growth Interview with:
Katherine Ottolini MD, lead study author

Children’s National Health System and

Catherine Limperopoulos, Ph.D., senior study author

Dr. Limperopoulos

Catherine Limperopoulos, Ph.D., senior study author and
Director of Developing Brain Research Laboratory
Children’s National Health System What is the background for this study? What are the main findings?

Response: Nutrition is an important modifiable factor for brain development in premature infants, however few studies have evaluated the impact of nutritional interventions in the neonatal intensive care unit (NICU) on structural brain development in very premature infants using advanced, quantitative MRI techniques.

The goal of this study was to utilize quantitative MRI to evaluate the impact of macronutrient (carbohydrate, protein, fat) and energy intake throughout the duration of the NICU stay on brain volumes and white matter development in very premature infants at term-equivalent age (TEA).

We prospectively enrolled 68 very low birthweight infants (< 1500g) admitted to Children’s NICU within the first 7 days of life. We found significant negative associations between cumulative macronutrient and energy intake on both the brain’s white matter microstructural development (in the superior cerebellar peduncle, corpus callosum) and regional brain volumetric growth (cortical gray matter and cerebellum).

In contrast, when evaluating average nutritional intake, we found significant associations between lipid and energy intake and regional brain volumes in the cortical gray matter, brainstem and cerebellum. What should readers take away from your report?

 Response: Our study highlights the significant impact of ex-utero nutritional support on brain development in preterm infants. We demonstrate that macronutrient and energy intake significantly contribute to brain growth & development using advanced MRI techniques at term-equivalent age. The negative association between cumulative nutrient intake and brain volumetric growth and white matter development may reflect a longer dependence on ex-utero nutritional support in the NICU and could be a surrogate marker of disease severity (i.e., how sick or critically ill the premature infant is).

The positive relationship we showed between average lipid and energy intake and regional brain growth will support future modifications to current nutritional practices in the NICU to better support the developing preterm brain. Increasing lipid intake could potentially have a positive neurodevelopmental effect due to lipids’ high energy content, which likely plays a critical role in the development of neuronal cell membranes and myelin formation in the brain’s white matter.

Collectively, our findings suggest that nutritional practices in the NICU can be modified to enhance brain development during this sensitive period of third trimester brain development in premature infants that occurs in the extra-uterine NICU environment What recommendations do you have for future research as a result of this work?

Response: The goal of our research is to optimize nutritional interventions for the preterm neonate that best support brain development and mimic in utero growth and development. To this end, we plan to carefully study preterm infant nutritional intake at different time points throughout their neonatal intensive care, to determine whether there is an ideal threshold of macronutrient intake or critical window of time for which interventions will be most effective in supporting optimal brain growth and development during this vital period of neurodevelopment.

No disclosures 


 Pediatric Academic Societies 2018 abstract:

“Impact of early nutrition on microstructural brain development in very low birth weight infants.”
4:15 p.m. to 4:30 p.m. (ET)
Katherine Ottolini; Nickie Andescavage, M.D., Attending, Children’s Neonatal-Perinatal Medicine; Kushal Kapse; Catherine Limperopoulos, Ph.D., director, Children’s Developing Brain Research Laboratory




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Last Updated on May 18, 2018 by Marie Benz MD FAAD