Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, 3584 EA Utrecht, The Netherlands.
University Medical Center Utrecht Brain Center, Utrecht University, 3584 CG Utrecht, The Netherlands.
Nutrients. 2021 Sep 27;13(10):3409. doi: 10.3390/nu13103409.
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.
Two retrospective cohorts of extremely preterm infants (gestational age < 28 weeks) were included. Cohort B ( = 79) received a new nutritional regimen, with more rapidly increased, higher protein intake compared to cohort A ( = 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).
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, = 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.
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.
确定极低出生体重儿的最佳营养方案仍然具有挑战性。本研究旨在评估一种新的营养方案和个体宏量营养素摄入对脑白质完整性和神经发育结局的影响。
纳入了两批极低出生体重儿（胎龄 < 28 周）的回顾性队列。队列 B（n=79）接受了一种新的营养方案，与队列 A（n=99）相比，蛋白质摄入量增加更快，更高。计算了前 28 天的个体蛋白质、脂肪和热量摄入量。在胎龄校正年龄（CA）（Bayley-III-NL）和 5.9 岁时（WPPSI-III-NL、MABC-2-NL）进行了弥散张量成像，并评估了认知和运动发育。
与队列 A 相比，队列 B 的婴儿蛋白质摄入量显著更高（3.4 g/kg/d vs. 2.7 g/kg/d），并且在多个脑白质束中具有更高的各向异性分数（FA），但在 2 岁 CA 时运动评分更低（均值（SD）：103（12）vs. 109（12））。更高的蛋白质摄入量与 2 岁 CA 时更高的 FA 和更低的运动评分相关（B=-6.7，p=0.001）。然而，2 岁 CA 时的运动评分仍在正常范围内，差异在 5.9 岁时并不持续。蛋白质、脂肪或热量摄入与认知或运动发育无显著关联。
在极低出生体重儿中，出生后蛋白质摄入似乎对脑白质发育很重要，但不一定能改善长期认知和运动发育。
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