Department of Maternal and Child Health Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
Department of Maternal and Child Health Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
Nutrition. 2022 May;97:111572. doi: 10.1016/j.nut.2021.111572. Epub 2021 Dec 22.
We performed a systematic review to study the effect of enteral and parenteral energy intakes on neurodevelopment (NDV) and cerebral growth in preterm infants, evaluated by NDV scales, magnetic resonance imaging, and head circumference (HC).
The MEDLINE, Scopus, and ISI Web of Knowledge databases were searched, using the following medical subject headings and terms: "Premature infants," "nutrition," "brain," "nervous system/growth," and "development." A manual search of the reference lists of all eligible articles was conducted. Studies in which the intervention applied was different energy intakes in parenteral nutrition and/or enteral nutrition (EN) during the first weeks of life and NDV was investigated were included. Data regarding nutrition and NDV were collected and analyzed.
Thirty-five studies were included, of which 12 were randomized controlled trials (RCTs) and 23 were cohort studies. Eight RCTs and 15 cohort studies investigated NDV using NDV scales. Of these studies, two RTCs and five cohort studies found no significant difference in NDV evaluated with the Bayley scale between neonates fed high-caloric nutrition and those who received lower energy intakes during early life. In one RCT and two cohort studies was observed a positive effect of EN on NDV. Conversely, in one cohort study, a negative correlation between parenteral energy intake and NDV was described. The analysis of the data from RCTs and cohort studies showed greater HC in the groups receiving aggressive parenteral and total enhanced nutrition, respectively. However, two RCTs and one cohort study did not report any differences in terms of HC. Inconclusive results were reported by studies that investigated cerebral growth by magnetic resonance imaging. The studies observing a positive effect of enhanced nutrition on cerebral and basal ganglia growth, caudate nucleus, cerebellum, and thalami volume investigated only the influence of EN.
The impact of energy intake during early life on NDV remains undefined. A positive impact on brain development encourages the administration of recommended energy intake, mainly by EN, and suggests a more cautious approach to enhanced nutritional strategies by the parenteral route. Further studies are advocated to elucidate the optimal nutritional intervention for preterm infants to improve NDV.
我们进行了一项系统评价，以研究肠内和肠外能量摄入对早产儿神经发育（NDV）和大脑生长的影响，通过 NDV 量表、磁共振成像和头围（HC）进行评估。
检索 MEDLINE、Scopus 和 ISI Web of Knowledge 数据库，使用以下医学主题词和术语：“早产儿”、“营养”、“脑”、“神经系统/生长”和“发育”。对所有合格文章的参考文献进行了手工检索。纳入的研究中，干预措施为生命早期肠外营养和/或肠内营养（EN）中的不同能量摄入，且研究了 NDV。收集和分析了营养和 NDV 相关数据。
共纳入 35 项研究，其中 12 项为随机对照试验（RCT），23 项为队列研究。8 项 RCT 和 15 项队列研究使用 NDV 量表评估 NDV。其中，2 项 RCT 和 5 项队列研究发现，接受高能量营养的新生儿与生命早期接受低能量摄入的新生儿之间，贝利量表评估的 NDV 无显著差异。1 项 RCT 和 2 项队列研究发现，EN 对 NDV 有积极影响。相反，在 1 项队列研究中，描述了肠外能量摄入与 NDV 之间的负相关。对 RCT 和队列研究数据的分析显示，接受积极肠外和总增强营养的组 HC 更大。然而，2 项 RCT 和 1 项队列研究在 HC 方面没有报告任何差异。通过磁共振成像研究脑生长的研究报告了不确定的结果。观察到增强营养对脑和基底节生长、尾状核、小脑和丘脑体积有积极影响的研究仅调查了 EN 的影响。
生命早期能量摄入对 NDV 的影响仍不明确。对大脑发育的积极影响鼓励给予推荐的能量摄入，主要通过 EN，并建议对通过肠外途径的增强营养策略采取更为谨慎的方法。提倡进一步研究，以阐明最佳营养干预措施，以改善早产儿的 NDV。
