Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Effects of early parenteral nutrition on the development of premature infants born at 22–23 weeks of gestation: a retrospective cohort study evaluated by brain magnetic resonance imaging

European Journal of Clinical Nutrition (2024)Cite this article

Subjects

Abstract

Background

The effect of early parenteral nutrition (EPN) therapy on brain development in extremely premature infants at a gestational age (GA) of 22–25 weeks remains unknown.

Objectives

This study investigated the effect of EPN therapy on GA 22 to 25 weeks of gestation using magnetic resonance imaging (MRI) global brain abnormality score (GBAS).

Subjects

Forty-six preterm infants born before 26 weeks of gestation were divided into the GA 22–23 weeks (GA 22–23; n = 18) and GA 24–25 weeks (GA 24–25; n = 28) group.

Methods

Each infant received ≥3.0 g/kg/day of amino acids from day 1 of life and ≥1.0 g/kg/day of lipid emulsion the next day. Weight change during hospitalization, GBAS at discharge, and developmental quotient (DQ) until three years old were compared between the groups.

Results

GA 22–23 showed long-term postnatal weight loss, but weight at 41 weeks of postmenstrual age did not differ between the groups. The GBAS score was not significantly different, but the head circumference was smaller in GA 22–23 than in GA 24–25 until 2 years old. The DQ at 1–1.5 years old was lower in GA 22–23 than that of GA 24–25; however, there was no significant difference in DQ after 2 years old between the groups.

Conclusions

The effect of nutritional support with EPN therapy in premature neonates born at <24 weeks of gestation may still be inadequate. GBAS is useful for assessing brain development in very preterm infants, and the importance of nutritional support during the first few weeks of life should continue to be explored.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Schematic illustration of the measurement details of the brain regions.
Fig. 2: Changes in the Z score of the body weight during the course of hospitalization.

Similar content being viewed by others

Data availability

The datasets generated and analyzed in this study are available from the corresponding author upon reasonable request.

References

  1. Whitfield JM, Hendrikson H. Prevention of protein deprivation in the extremely low birth weight infant: a nutritional emergency. Baylor University Medical Center Proceedings. 2006;19:229–31.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Thureen PJ, Hay WW Jr. Early aggressive nutrition in preterm infants. Semin Neonatol. 2001;6:403–15.

    Article  PubMed  CAS  Google Scholar 

  3. Su BH. Optimizing nutrition in preterm infants. Pediatr Neonatol. 2014;55:5–13.

    Article  PubMed  Google Scholar 

  4. Wilson DC, Cairns P, Halliday HL, Reid M, McClure G, Dodge JA. Randomised controlled trial of an aggressive nutritional regimen in sick very low birthweight infants. Arch Dis Child Fetal Neonatal Ed. 1997;77:F4–F11.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  5. Yu VY, James B, Hendry P, MacMahon RA. Total parenteral nutrition in very low birthweight infants: a controlled trial. Arch Dis Child. 1979;54:653–61.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  6. Dinerstein A, Nieto RM, Solana CL, Perez GP, Otheguy LE, Larguia AM. Early and aggressive nutritional strategy (parenteral and enteral) decreases postnatal growth failure in very low birth weight infants. J Perinato. 2006;26:436–42.

    Article  CAS  Google Scholar 

  7. Maggio L, Cota F, Gallini F, Lauriola V, Zecca C, Romagnoli C. Effects of high versus standard early protein intake on growth of extremely low birth weight infants. J Pediatr Gastroenterol Nutr. 2007;44:124–9.

    Article  PubMed  Google Scholar 

  8. Kidokoro H, Neil JJ, Inder TE. New MR imaging assessment tool to define brain abnormalities in very preterm infants at term. AJNR Am J Neuroradiol. 2013;34:2208–14.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  9. Blanc WA. Pathology of the placenta, membranes, and umbilical cord in bacterial, fungal, and viral infections in man. Monographs in pathology. 1981;22:67–132.

    Google Scholar 

  10. Enjoji M, Yanai N. Analytic test for development in infancy and childhood. Pediatr Int. 1961;4:2–6.

    Article  Google Scholar 

  11. Walsh MC, Kliegman RM. Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am. 1986;33:179–201. https://doi.org/10.1016/s0031-3955(16)34975-6.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  12. Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr. 1978;92:529–34. https://doi.org/10.1016/s0022-3476(78)80282-0

    Article  PubMed  CAS  Google Scholar 

  13. International Committee for the Classification of Retinopathy of Prematurity. The international classification of retinopathy of prematurity revisited. Arch Ophthalmol. 2005;123:991–9. https://doi.org/10.1001/archopht.123.7.991.

    Article  Google Scholar 

  14. Clark RH, Thomas P, Peabody J. Extrauterine growth restriction remains a serious problem in prematurely born neonates. Pediatrics. 2003;111:986–90.

    Article  PubMed  Google Scholar 

  15. Thureen PJ. Early aggressive nutrition in very preterm infants. Nestle Nutr Workshop Ser Pediatr Program. 2007;59:193–208.

    PubMed  Google Scholar 

  16. Steward DK, Pridham KF. Growth patterns of extremely low-birth-weight hospitalized preterm infants. J Obstet Gynecol Neonatal Nurs. 2002;31:57–65.

    Article  PubMed  Google Scholar 

  17. Sakurai M, Itabashi K, Sato Y, Hibino S, Mizuno K. Extrauterine growth restriction in preterm infants of gestational age < or =32 weeks. Pediatr Int. 2008;50:70–75.

    Article  PubMed  Google Scholar 

  18. Moyses HE, Johnson MJ, Leaf AA, Cornelius VR. Early parenteral nutrition and growth outcomes in preterm infants: a systematic review and meta-analysis. Am J Clin Nutr. 2013;97:816–26.

    Article  PubMed  CAS  Google Scholar 

  19. Radmacher PG, Looney SW, Rafail ST, Adamkin DH. Prediction of extrauterine growth retardation (EUGR) in VVLBW infants. J Perinatol. 2003;23:392–5.

    Article  PubMed  Google Scholar 

  20. Choi AY, Lee YW, Chang MY. Modification of nutrition strategy for improvement of postnatal growth in very low birth weight infants. Korean J Pediatr. 2016;59:165–73. https://doi.org/10.3345/kjp.2016.59.4.165.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  21. Loui A, Tsalikaki E, Maier K, Walch E, Kamarianakis Y, Obladen M. Growth in high risk infants <1500 g birthweight during the first 5 weeks. Early Hum Dev. 2008;84:645–50. https://doi.org/10.1016/j.earlhumdev.2008.04.005

    Article  PubMed  CAS  Google Scholar 

  22. Kalikkot Thekkeveedu R, Guaman MC, Shivanna B. Bronchopulmonary dysplasia: a review of pathogenesis and pathophysiology. Respir Med. 2017;132:170–7. https://doi.org/10.1016/j.rmed.2017.10.014.

    Article  PubMed  Google Scholar 

  23. Wemhöner A, Ortner D, Tschirch E, Strasak A, Rüdiger M. Nutrition of preterm infants in relation to bronchopulmonary dysplasia. BMC Pulm Med. 2011;11:7. https://doi.org/10.1186/1471-2466-11-7.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  24. New K, Flint A, Bogossian F, East C, Davies MW. Transferring preterm infants from incubators to open cots at 1600 g: a multicentre randomised controlled trial. Arch Dis Child Fetal Neonatal Ed. 2012;97:F88–92. https://doi.org/10.1136/adc.2011.213587.

    Article  PubMed  CAS  Google Scholar 

  25. Shankaran S, Bell EF, Laptook AR, Saha S, Newman NS, Kazzi SNJ, et al. Weaning of moderately preterm infants from the incubator to the crib: a randomized clinical trial. J Pediatr. 2019;204:96–102. https://doi.org/10.1016/j.jpeds.2018.08.079.

    Article  PubMed  Google Scholar 

  26. Cristofalo EA, Schanler RJ, Blanco CL, Sullivan S, Trawoeger R, Kiechl-Kohlendorfer U, et al. Randomized trial of exclusive human milk versus preterm formula diets in extremely premature infants. J Pediatr. 2013;163:1592–5. https://doi.org/10.1016/j.jpeds.2013.07.011.

    Article  PubMed  Google Scholar 

  27. Brown JVE, Walsh V, McGuire W. Formula versus maternal breast milk for feeding preterm or low birth weight infants. Cochrane Database Syst Rev. 2019;8:CD002972. https://doi.org/10.1002/14651858.CD002972.pub3.

    Article  PubMed  Google Scholar 

  28. Stephens BE, Walden RV, Gargus RA, Tucker R, McKinley L, Mance M, et al. First-week protein and energy intakes are associated with 18-month developmental outcomes in extremely low birth weight infants. Pediatrics. 2009;123:1337–43. https://doi.org/10.1542/peds.2008-0211.

    Article  PubMed  Google Scholar 

  29. Ohnishi S, Ichiba H, Tanaka Y, Harada S, Matsumura H, Kan A, et al. Early and intensive nutritional strategy combining parenteral and enteral feeding promotes neurodevelopment and growth at 18 months of corrected age and 3 years of age in extremely low birth weight infants. Early Hum Dev. 2016;100:35–41. https://doi.org/10.1016/j.earlhumdev.2016.03.014.

    Article  PubMed  Google Scholar 

  30. Ernst KD, Radmacher PG, Rafail ST, Adamkin DH. Postnatal malnutrition of extremely low birth-weight infants with catch-up growth post discharge. J Perinatol. 2003;23:477–82.

    Article  PubMed  Google Scholar 

  31. Embleton NE, Pang N, Cooke RJ. Postnatal malnutrition and growth retardation: an inevitable consequence of current recommendations in preterm infants? Pediatrics. 2001;107:270–3.

    Article  PubMed  CAS  Google Scholar 

  32. Balakrishnan M, Tucker R, Stephens BE, Bliss JM. Blood urea nitrogen and serum bicarbonate in extremely low birth weight infants receiving higher protein intake in the first week after birth. J Perinatol. 2011;31:535–9.

    Article  PubMed  CAS  Google Scholar 

  33. Radmacher PG, Lewis SL, Adamkin DH. Early amino acids and the metabolic response of ELBW infants (< or = 1000 g) in three time periods. J Perinatol. 2009;29:433–7.

    Article  PubMed  CAS  Google Scholar 

  34. Imai K, Hara H, Sawada T, Wada M. Comparison of the clinical characteristics of infants with punctate white matter lesions and/or cystic lesions. Neuropediatrics. 2023;54:6–13. https://doi.org/10.1055/s-0042-1759789.

    Article  PubMed  CAS  Google Scholar 

  35. Resch B, Vollaard E, Maurer U, Haas J, Rosegger H, Müller W. Risk factors and determinants of neurodevelopmental outcome in cystic periventricular leucomalacia. Eur J Pediatr. 2000;159:663–70. https://doi.org/10.1007/pl00008403.

    Article  PubMed  CAS  Google Scholar 

  36. Abiramalatha T, Bandyopadhyay T, Ramaswamy VV, Shaik NB, Thanigainathan S, Pullattayil AK, et al. Risk factors for periventricular leukomalacia in preterm infants: a systematic review, meta-analysis, and GRADE-based assessment of certainty of evidence. Pediatr Neurol. 2021;124:51–71. https://doi.org/10.1016/j.pediatrneurol.2021.08.003.

    Article  PubMed  Google Scholar 

  37. Lencki SG, Maciulla MB, Eglinton GS. Maternal and umbilical cord serum interleukin levels in preterm labor with clinical chorioamnionitis. Am J Obstet Gynecol. 1994;170:1345–51. https://doi.org/10.1016/s0002-9378(94)70154-7.

    Article  PubMed  CAS  Google Scholar 

  38. Parodi A, Malova M, Cardiello V, Raffa S, Re M, Calevo MG, et al. Punctate white matter lesions of preterm infants: Risk factor analysis. Eur J Paediatr Neurol. 2019;23:733–9. https://doi.org/10.1016/j.ejpn.2019.06.003.

    Article  PubMed  Google Scholar 

  39. Kinney HC. The near-term (late preterm) human brain and risk for periventricular leukomalacia: a review. Semin Perinatol. 2006;30:81–8. https://doi.org/10.1053/j.semperi.2006.02.006.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank the faculty, staff, and all the participants in this study for their support.

Author information

Authors and Affiliations

  1. Maternity and Perinatal Care Center, University of the Ryukyus Hospital, Okinawa, Japan

    Mayumi Tsukayama, Hideki Goya & Tomohide Yoshida

  2. Department of Child Health and Welfare (Pediatrics), Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan

    Mayumi Tsukayama, Haruna Azuma, Itsuki Oshiro, Tomohide Yoshida & Koichi Nakanishi

Authors
  1. Mayumi Tsukayama
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Haruna Azuma
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Itsuki Oshiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hideki Goya
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tomohide Yoshida
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Koichi Nakanishi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Mayumi Tsukayama, Data curation, Writing–original draft preparation. Haruna Azuma and Itsuki Oshiro contributed equally to the data curation and wrote the original draft preparation. Tomohide Yoshida: Conceptualization, methodology, writing (reviewing and editing), visualization, and investigation. Hideki Goya: Supervision and Reviewing. Koichi Nakanishi: Supervision. Reviewing and editing. Final approval of the submitted version.

Corresponding author

Correspondence to Tomohide Yoshida.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethics approval

This retrospective cohort study was conducted with the approval of the institutional ethics committee of the University of the Ryukyus (No. 1725). Consent of subjects was obtained by opting out to their parents.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tsukayama, M., Azuma, H., Oshiro, I. et al. Effects of early parenteral nutrition on the development of premature infants born at 22–23 weeks of gestation: a retrospective cohort study evaluated by brain magnetic resonance imaging. Eur J Clin Nutr (2024). https://doi.org/10.1038/s41430-024-01504-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1038/s41430-024-01504-x

Search

Advanced search

Quick links