Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, IA 52242, USA.
Department of Pediatrics, University of South Dakota, Sioux Falls, SD 57105, USA.
Nutrients. 2023 Apr 19;15(8):1967. doi: 10.3390/nu15081967.
Preterm infants have low circulating levels of leptin, a key trophic hormone that influences growth and development. While the clinical importance of prematurity-associated leptin deficiency is undefined, recent preclinical and clinical investigations have shown that targeted enteral leptin supplementation can normalize neonatal leptin levels. We tested the hypothesis that, independent of growth velocity, prematurity-related neonatal leptin deficiency predicts adverse cardiovascular and neurodevelopmental outcomes. In a planned 2-year longitudinal follow-up of 83 preterm infants born at 22 to 32 weeks' gestation, we obtained blood pressures from 58 children and the Ages & Stages Questionnaire (ASQ-3) for 66 children. Based on univariate analysis, blood pressures correlated with gestational age at birth (R = 0.30, < 0.05) and weight gain since discharge (R = 0.34, < 0.01). ASQ-3 scores were significantly higher in female than male children. Utilizing best subset regression with Mallows' C as the criterion for model selection, higher systolic blood pressure was predicted by rapid postnatal weight gain, later gestation at delivery and male sex (C = 3.0, R = 0.48). Lower ASQ-3 was predicted by lower leptin levels at 35 weeks postmenstrual age, earlier gestation at delivery and male sex (C = 2.9, R = 0.45). Children that had leptin levels above 1500 pg/mL at 35 weeks postmenstrual age had the highest ASQ-3 scores at 2 years. In conclusion, independent of growth velocity, higher leptin levels at 35 weeks' gestation are associated with better developmental assessment scores in early childhood. While longer-term follow-up of a larger cohort is needed, these findings support investigations that have suggested that targeted neonatal leptin supplementation could improve the neurodevelopmental outcomes of preterm infants.
早产儿循环中的瘦素水平较低，瘦素是一种关键的营养激素，可影响生长和发育。虽然与早产相关的瘦素缺乏的临床重要性尚未确定，但最近的临床前和临床研究表明，靶向肠内给予瘦素补充可以使新生儿的瘦素水平正常化。我们检验了以下假设：即与生长速度无关，与早产相关的新生儿瘦素缺乏可预测不良的心血管和神经发育结局。在对 83 名胎龄为 22 至 32 周的早产儿进行的为期 2 年的计划纵向随访中，我们对 58 名儿童进行了血压测量，并对 66 名儿童进行了年龄与发育进程问卷（ASQ-3）评估。基于单变量分析，血压与出生时的胎龄（R = 0.30， < 0.05）和出院后体重增加（R = 0.34， < 0.01）相关。女性儿童的 ASQ-3 评分明显高于男性儿童。利用具有马罗准则的最佳子集回归作为模型选择的标准，发现较高的收缩压与快速的产后体重增加、较晚的分娩胎龄和男性性别有关（C = 3.0，R = 0.48）。较低的 ASQ-3 与孕龄 35 周时较低的瘦素水平、较早的分娩胎龄和男性性别有关（C = 2.9，R = 0.45）。在孕龄 35 周时瘦素水平高于 1500 pg/mL 的儿童，在 2 岁时的 ASQ-3 评分最高。总之，独立于生长速度，孕龄 35 周时较高的瘦素水平与儿童早期的发育评估评分较高有关。虽然需要对更大的队列进行更长期的随访，但这些发现支持了一些研究，这些研究表明，靶向新生儿瘦素补充可能会改善早产儿的神经发育结局。
