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The influence of nutrition on white matter development in preterm infants: a scoping review

Pediatric Research (2023)Cite this article

Abstract

White matter (WM) injury is the most common type of brain injury in preterm infants and is associated with impaired neurodevelopmental outcome (NDO). Currently, there are no treatments for WM injury, but optimal nutrition during early preterm life may support WM development. The main aim of this scoping review was to assess the influence of early postnatal nutrition on WM development in preterm infants. Searches were performed in PubMed, EMBASE, and COCHRANE on September 2022. Inclusion criteria were assessment of preterm infants, nutritional intake before 1 month corrected age, and WM outcome. Methods were congruent with the PRISMA-ScR checklist. Thirty-two articles were included. Negative associations were found between longer parenteral feeding duration and WM development, although likely confounded by illness. Positive associations between macronutrient, energy, and human milk intake and WM development were common, especially when fed enterally. Results on fatty acid and glutamine supplementation remained inconclusive. Significant associations were most often detected at the microstructural level using diffusion magnetic resonance imaging. Optimizing postnatal nutrition can positively influence WM development and subsequent NDO in preterm infants, but more controlled intervention studies using quantitative neuroimaging are needed.

Impact

  • White matter brain injury is common in preterm infants and associated with impaired neurodevelopmental outcome.

  • Optimizing postnatal nutrition can positively influence white matter development and subsequent neurodevelopmental outcome in preterm infants.

  • More studies are needed, using quantitative neuroimaging techniques and interventional designs controlling for confounders, to define optimal nutritional intakes in preterm infants.

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Acknowledgements

We thank the following staff at the University Library Utrecht for their help in drafting the initial search strategy and assistance in updating the initial search: Paulien Wiersma and Dr Marie-Louise S. Goudeau.

Funding

E.J. and M.J.N.L.B. are funded by the Athena Grant “Utrecht Center for Food and Health – research program specialized nutrition,” subsidy from the Dutch Ministry of Economic Affairs, Utrecht Province and the municipality of Utrecht. E.J., N.E. and M.J.N.L.B. are also funded by a Health-Holland-TKI grant, LSHM19087.

Author information

Authors and Affiliations

  1. Department of Neonatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands

    Els Janson, Marle F. Willemsen, Jeroen Dudink, Ruurd M. Van Elburg, Lisa M. Hortensius, Manon J. N. L. Benders & Niek E. van der Aa

  2. University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands

    Els Janson, Jeroen Dudink, Lisa M. Hortensius, Manon J. N. L. Benders & Niek E. van der Aa

  3. Faculty of Medicine, Utrecht University, Utrecht, The Netherlands

    Marle F. Willemsen

  4. Department of Neonatology, Máxima Medical Center, Veldhoven, The Netherlands

    Pauline E. Van Beek

  5. Department of Pediatrics, Emma Children’s Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands

    Ruurd M. Van Elburg

  6. Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

    Emily W. Y. Tam

  7. Neonatology, Instituto de Investigación Sanitaria, La Paz University Hospital-IdiPAZ (Universidad Autonoma), Madrid, Spain

    Miguel Saenz de Pipaon & Miguel Sáenz de Pipaón

  8. Department of Neonatology, Necker-Enfants Malades Hospital, University of Paris, Paris, France

    Alexandre Lapillonne

  9. Department for Developmental Origins of Disease, University Medical Center Utrecht Brain Center and Wilhelmina Children’s Hospital, Utrecht University, 3508 AB, Utrecht, The Netherlands

    Caroline G. M. de Theije

  10. Division of Paediatric and Adolescent Medicine, Department of Neonatal Intensive Care, Ullevål, Oslo University Hospital, Oslo, Norway

    Sissel J. Moltu

  11. Hans Christian Andersen Children’s Hospital, Department of Neonatology, Odense University Hospital, 5000, Odense, Denmark

    Gitte Zachariassen

  12. Department of Clinical Research, University of Southern, 5000, Odense, Denmark

    Gitte Zachariassen

  13. Department of Neonatal Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK

    Mark J. Johnson

  14. NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK

    Mark J. Johnson

  15. Department of Pediatrics, McMaster University, Hamilton, ON, Canada

    Christoph Fusch

  16. Department of Pediatrics, Nuremberg General Hospital, Paracelsus Medical School, Nuremberg, Germany

    Christoph Fusch

  17. Department of Neonatal Intensive Care, CHU La Réunion, Saint Pierre, France

    Silvia Iacobelli

Authors
  1. Els Janson
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  2. Marle F. Willemsen
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  3. Pauline E. Van Beek
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  4. Jeroen Dudink
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  5. Ruurd M. Van Elburg
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  6. Lisa M. Hortensius
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  7. Emily W. Y. Tam
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  8. Miguel Saenz de Pipaon
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  9. Alexandre Lapillonne
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  10. Caroline G. M. de Theije
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  11. Manon J. N. L. Benders
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  12. Niek E. van der Aa
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Consortia

on behalf of ESPR Nutrition council members

  • Miguel Sáenz de Pipaón
  • , Alexandre Lapillonne
  • , Sissel J. Moltu
  • , Gitte Zachariassen
  • , Mark J. Johnson
  • , Christoph Fusch
  •  & Silvia Iacobelli

Contributions

E.J., M.F.W., P.E.v.B., J.D., R.M.v.E., and N.E.v.d.A. made substantial contributions to the conception and design, acquisition of data, or analysis and interpretation of data. E.J., P.E.v.B., J.D., R.M.v.E., L.M.H., E.W.Y.T., M.S.d.P., A.L., C.G.M.d.T., and N.E.v.d.A. contributed to drafting the article or revising it critically for important intellectual content. E.J., M.F.W., P.E.v.B., J.D., R.M.v.E., L.M.H., E.W.Y.T., M.S.d.P., A.L., C.G.M.d.T., M.J.N.L.B., N.E.v.d.A., S.J.M., G.Z., M.J.J. C.F., and S.I. contributed to final approval of the version to be published.

Corresponding author

Correspondence to Niek E. van der Aa.

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Janson, E., Willemsen, M.F., Van Beek, P.E. et al. The influence of nutrition on white matter development in preterm infants: a scoping review. Pediatr Res (2023). https://doi.org/10.1038/s41390-023-02622-1

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  • DOI: https://doi.org/10.1038/s41390-023-02622-1

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