Department of Paediatrics, University of Toronto and The Hospital for Sick Children, Toronto, Canada.
Department of Woman-Mother-Child, Clinic of Neonatology and.
Pediatrics. 2018 Mar;141(3). doi: 10.1542/peds.2017-2169. Epub 2018 Feb 13.
Optimizing early nutritional intake in preterm neonates may promote brain health and neurodevelopment through enhanced brain maturation. Our objectives were (1) to determine the association of energy and macronutrient intake in the first 2 weeks of life with regional and total brain growth and white matter (WM) maturation, assessed by 3 serial MRI scans in preterm neonates; (2) to examine how critical illness modifies this association; and (3) to investigate the relationship with neurodevelopmental outcomes.
Forty-nine preterm neonates (21 boys, median [interquartile range] gestational age: 27.6 [2.3] weeks) were scanned serially at the following median postmenstrual weeks: 29.4, 31.7, and 41. The total brain, basal nuclei, and cerebellum were semiautomatically segmented. Fractional anisotropy was extracted from diffusion tensor imaging data. Nutritional intake from day of life 1 to 14 was monitored and clinical factors were collected.
Greater energy and lipid intake predicted increased total brain and basal nuclei volumes over the course of neonatal care to term-equivalent age. Similarly, energy and lipid intake were significantly associated with fractional anisotropy values in selected WM tracts. The association of ventilation duration with smaller brain volumes was attenuated by higher energy intake. Brain growth predicted psychomotor outcome at 18 months' corrected age.
In preterm neonates, greater energy and enteral feeding during the first 2 weeks of life predicted more robust brain growth and accelerated WM maturation. The long-lasting effect of early nutrition on neurodevelopment may be mediated by enhanced brain growth. Optimizing nutrition in preterm neonates may represent a potential avenue to mitigate the adverse brain health consequences of critical illness.
优化早产儿的早期营养摄入可以通过促进大脑成熟来促进大脑健康和神经发育。我们的目标是：(1) 确定生命的头 2 周内能量和宏量营养素的摄入量与通过 3 次连续 MRI 扫描评估的早产儿的脑区和总脑生长以及白质（WM）成熟的关系；(2) 检查危重病如何改变这种关联；(3) 研究与神经发育结果的关系。
对 49 名早产儿（21 名男孩，中位[四分位间距]胎龄：27.6[2.3]周）进行连续扫描，中位胎龄为 29.4、31.7 和 41.4 周。使用半自动化方法对大脑、基底核和小脑进行分割。从弥散张量成像数据中提取各向异性分数。监测从出生后第 1 天到第 14 天的营养摄入量，并收集临床因素。
能量和脂质摄入量较高，预测新生儿护理至胎龄等效期总脑和基底核体积增加。同样，能量和脂质摄入量与选定的 WM 束的各向异性分数值显著相关。通气时间与较小的脑容量之间的关联，因能量摄入较高而减弱。脑生长预测了 18 个月校正年龄时的精神运动结果。
在早产儿中，生命的头 2 周内摄入更多的能量和肠内喂养，可预测脑生长更健壮和 WM 成熟加速。早期营养对神经发育的持久影响可能是通过增强脑生长来介导的。优化早产儿的营养可能是减轻危重病对大脑健康不良影响的潜在途径。
