Department of Maternal and Child Health, Sapienza University of Rome-Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy.
Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy.
Sci Rep. 2021 Sep 16;11(1):18457. doi: 10.1038/s41598-021-98088-4.
Current guidelines for preterm newborns recommend high energy nutrition soon after birth in order to limit growth retardation. However, long-term effects of this nutritional approach are still debated, and it has been demonstrated that cerebral growth depends on protein intake in early life. A negative impact of early high energy intake by parenteral nutrition (PN) has been reported for patients in critically ill conditions, observed in intensive care unit. We aimed at evaluating the impact of energy intake on cerebral growth in preterm neonates early in life. We included preterm newborns with gestational age < 32 weeks or birth weight (BW) < 1500 g. Measurement of cerebral structures was performed by cranial Ultrasonography (cUS) between 3 and 7 days of life (DOL, T0) and at 28 DOL (T1). We evaluated the relation between energy intake and cerebral growth in the first 28 DOL. We observed in 109 preterm newborns a significant (p < 0.05) negative correlation between energy intake received by PN and right caudate head growth (r = - 0.243*) and a positive correlation between total energy intake and transverse cerebellum diameter (r = 0.254*). Multivariate analysis showed that energy intake administered by enteral nutrition (EN), independently increased growth of left caudate head (β = 0.227*) and height cerebellar vermis (β = 0.415*), while PN independently affected growth of both right and left caudate head (β = - 0.164* and β = - 0.228*, respectively) and cerebellum transverse diameter (β = - 0.849*). The route of energy administration may exert different effects on cerebral growth in early life. High energy intake administered through EN seems to be positively correlated to cerebral growth; conversely, PN energy intake results in a poorer cerebral growth evaluated with cUS.
目前的早产儿指南建议在出生后尽快给予高能量营养，以限制生长迟缓。然而，这种营养方法的长期效果仍存在争议，并且已经证明脑生长取决于生命早期的蛋白质摄入。在重症监护病房中，已经报道了危重患者通过肠外营养（PN）早期给予高能量摄入的负面影响。我们旨在评估生命早期能量摄入对早产儿脑生长的影响。我们纳入了胎龄<32 周或出生体重<1500 克的早产儿。在出生后 3-7 天（T0）和 28 天（T1）进行头颅超声检查（cUS）以测量脑结构。我们评估了前 28 天内能量摄入与脑生长的关系。我们在 109 例早产儿中观察到，PN 摄入的能量与右侧尾状头生长呈显著负相关（p<0.05，r=-0.243*），总能量摄入与小脑横径呈显著正相关（p<0.05，r=0.254*）。多变量分析表明，肠内营养（EN）给予的能量摄入独立增加了左侧尾状头（β=0.227*）和小脑蚓部高度（β=0.415*）的生长，而 PN 独立影响了右侧和左侧尾状头（β=-0.164和β=-0.228）和小脑横径（β=-0.849*）的生长。能量摄入途径可能对生命早期的脑生长产生不同的影响。通过 EN 给予高能量摄入似乎与脑生长呈正相关；相反，PN 能量摄入会导致 cUS 评估的脑生长较差。
