Preterm nutrition and the brain.

The brain is the most highly metabolic organ in the preterm neonate and consumes the greatest amount of nutrient resources for its function and growth. As preterm infants survive at greater rates, neurodevelopment has become the primary morbidity outcome of interest. While many factors influence neurodevelopmental outcomes in preterm infants, nutrition is of particular importance because the healthcare team has a great deal of control over its provision. Studies over the past 30 years have emphasized the negative neurodevelopmental consequences of poor nutrition and growth in the preterm infant. While all nutrients are important for brain development, certain ones including glucose, protein, fats (including long-chain polyunsaturated fatty acids), iron, zinc, copper, iodine, folate and choline have particularly large roles in the preterm infant. They affect major brain processes such as neurogenesis, neuronal differentiation, myelination and synaptogenesis, all of which are proceeding at a rapid pace between 22 and 42 weeks' post-conception. At the macronutrient level, weight gain, linear growth (independent of weight gain) and head circumference growth are markers of nutritional status. Each has been associated with long-term neurodevelopment. The relationship of micronutrients to neurodevelopment in preterm infants is understudied in spite of the large effect these nutrients have in other young populations. Nutrients do not function alone to stimulate brain development, but rather in concert with growth factors, which in turn are dependent on adequate nutrient status (e.g. protein, zinc) as well as on physiologic status. Non-nutritional factors such as infection, corticosteroids, and inflammation alter how nutrients are accreted and distributed, and also suppress growth factor synthesis. Thus, nutritional strategies to optimize brain growth and development include assessment of status at birth, aggressive provision of nutrients that are critical in this time period, control of non-nutritional factors that impede brain growth and repletion of nutrient deficits.

[1]  R. Martorell,et al.  Influence of prenatal and postnatal growth on intellectual functioning in school-aged children. , 2012, Archives of pediatrics & adolescent medicine.

[2]  T. Hensch.  Critical period regulation. , 2004, Annual review of neuroscience.

[3]  P. Hüppi,et al.  Cortical Development in the Fetus and the Newborn: Advanced MR Techniques , 2011, Topics in magnetic resonance imaging : TMRI.

[4]  C. Nelson,et al.  Neurobehavioral evidence for working-memory deficits in school-aged children with histories of prematurity. , 1999 .

[5]  E. Ziegler,et al.  Body composition of the reference fetus. , 1976, Growth.

[6]  Ross A. Thompson,et al.  Developmental science and the media. Early brain development. , 2001, The American psychologist.

[7]  N. Kretchmer,et al.  The role of nutrition in the development of normal cognition. , 1996, The American journal of clinical nutrition.

[8]  S. Carlson.  Early determinants of development: a lipid perspective. , 2009, The American journal of clinical nutrition.

[9]  C. Nelson,et al.  Inequality in early childhood: risk and protective factors for early child development , 2011, The Lancet.

[10]  S. Wootton,et al.  Preterm Birth and Body Composition at Term Equivalent Age: A Systematic Review and Meta-analysis , 2012, Pediatrics.

[11]  M. Kron,et al.  Randomized Trial of Early Versus Late Enteral Iron Supplementation in Infants With a Birth Weight of Less Than 1301 Grams: Neurocognitive Development at 5.3 Years' Corrected Age , 2007, Pediatrics.

[12]  B. Vohr,et al.  First-Week Protein and Energy Intakes Are Associated With 18-Month Developmental Outcomes in Extremely Low Birth Weight Infants , 2009, Pediatrics.

[13]  A. Eddins,et al.  In utero iron status and auditory neural maturation in premature infants as evaluated by auditory brainstem response. , 2010, The Journal of pediatrics.

[14]  D. S. Lin,et al.  Biochemical and functional effects of prenatal and postnatal omega 3 fatty acid deficiency on retina and brain in rhesus monkeys. , 1986, Proceedings of the National Academy of Sciences of the United States of America.

[15]  E. Demerath,et al.  The Relationship of Poor Linear Growth Velocity with Neonatal Illness and Two-Year Neurodevelopment in Preterm Infants , 2012, Neonatology.

[16]  C. Craciunescu,et al.  Folic acid deficiency during late gestation decreases progenitor cell proliferation and increases apoptosis in fetal mouse brain. , 2004, The Journal of nutrition.

[17]  L. Wrage,et al.  Growth in the Neonatal Intensive Care Unit Influences Neurodevelopmental and Growth Outcomes of Extremely Low Birth Weight Infants , 2006, Pediatrics.

[18]  S. Zeisel.  Diet-Gene Interactions Underlie Metabolic Individuality and Influence Brain Development: Implications for Clinical Practice Derived from Studies on Choline Metabolism , 2012, Annals of Nutrition and Metabolism.

[19]  V. Fellman,et al.  Inflammation at birth and the insulin‐like growth factor system in very preterm infants , 2007, Acta paediatrica.

[20]  B. Poindexter,et al.  Early provision of parenteral amino acids in extremely low birth weight infants: relation to growth and neurodevelopmental outcome. , 2006, The Journal of pediatrics.

[21]  H. Sandstead.  Zinc: Essentiality for Brain Development and Function , 1984 .

[22]  M. Hall,et al.  TOR Signaling in Growth and Metabolism , 2006, Cell.

[23]  D. Gadian,et al.  The Effect of Early Human Diet on Caudate Volumes and IQ , 2008, Pediatric Research.

[24]  M. Zimmermann.  The effects of iodine deficiency in pregnancy and infancy. , 2012, Paediatric and perinatal epidemiology.

[25]  M. Georgieff,et al.  Iron deficiency and brain development. , 2006, Seminars in pediatric neurology.

[26]  C R Bauer,et al.  Longitudinal Growth of Hospitalized Very Low Birth Weight Infants , 1999, Pediatrics.

[27]  M. Georgieff.  Nutrition and the developing brain: nutrient priorities and measurement. , 2007, The American journal of clinical nutrition.