Am J Perinatol 2024; 41(S 01): e1813-e1819
DOI: 10.1055/a-2077-2551
Original Article

Effects of a Multicomponent Lipid Emulsion on Brain Volumes in Extremely Low Birth Weight Infants

Simonetta Costa   *
1   Unit of Neonatology, Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
,
Carmen Cocca    *
1   Unit of Neonatology, Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
,
Gabriella D'Apolito
2   Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology, Diagnostic Imaging Area, Rome, Italy
,
Antonietta De Gisi
1   Unit of Neonatology, Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
,
Simona Fattore
1   Unit of Neonatology, Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
,
Maria L. Tataranno
4   Unit of Neonatology, Wilhemina Children's Hospital University Medical Center, Utrecht, The Netherlands
,
Manon Benders
4   Unit of Neonatology, Wilhemina Children's Hospital University Medical Center, Utrecht, The Netherlands
,
Roberta Pastorino
5   Department of Woman and Child Health and Public Health, Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
6   Section of Hygiene, University Department of Life Sciences and Public Health, Catholic University of Sacred Heart, Rome, Italy
,
Cesare Colosimo
2   Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology, Diagnostic Imaging Area, Rome, Italy
3   Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
,
Giovanni Vento
1   Unit of Neonatology, Department of Woman and Child Health and Public Health, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
› Institutsangaben Funding None.
› Weitere Informationen
Auch verfügbar auf
   Lizenzen und Reprints

Abstract

Objective During the early weeks of life optimization of nutrition in extremely preterm infants presents a critical opportunity to attenuate the adverse neurological consequences of prematurity and potentially improve neurodevelopmental outcome. We hypothesized that the use of multicomponent lipid emulsion (MLE) in parenteral nutrition (PN) would be related to larger volume of the cerebellum on brain magnetic resonance at term of equivalent age (TEA) in extremely low birth weight (ELBW) infants.

Study Design We analyzed the brain magnetic resonance imaging (MRI) at TEA of a cohort of preterm infants with gestational age ≤28 weeks and/or birth weight <1,000 g randomly assigned in our previous trial to receive an MLE or soybean-based lipid emulsion (SLE). The primary outcome of the study was the cerebellar volume (CeV), valued on MRI acquired at TEA. Secondary outcomes included total brain volume (TBV), supratentorial volume, brainstem volume, and CeV corrected for TBV evaluated on MRI acquired at TEA.

Results MRIs at TEA of 34 infants were then analyzed: 17 in the MLE group and 17 in the SLE group. The postmenstrual age (PMA) at which MRIs were performed were comparable between the two study groups. The CeV as well as the PMA-corrected CeV were significantly higher in the MLE group than in the SLE group. No difference was found among the other brain volumes considered.

Conclusion Our results suggest that the use of MLE in PN could promote CeV growth in ELBW infants, valued with MRI at TEA.

Key Points

  • Optimization of nutrition in extremely low birthweight infants.

  • Use of multicomponent lipid emulsions in parenteral nutrition.

  • Larger cerebellar volume with use of multicomponent lipid emulsion.

Keywords

brain volume - multicomponent lipid emulsion - magnetic resonance imaging - preterm infants

Authors' Contributions

All authors contributed to the study conception and design. All authors read and approved the final manuscript.


* These authors contributed equally to this work and act as first author.




Publikationsverlauf

Eingereicht: 27. Dezember 2022

Angenommen: 14. April 2023

Accepted Manuscript online:
19. April 2023

Artikel online veröffentlicht:
19. Mai 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Ehrenkranz RA, Dusick AM, Vohr BR, Wright LL, Wrage LA, Poole WK. Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants. Pediatrics 2006; 117 (04) 1253-1261
    CrossrefPubMedGoogle Scholar
  • 2 Lodygensky GA, Vasung L, Sizonenko SV, Hüppi PS. Neuroimaging of cortical development and brain connectivity in human newborns and animal models. J Anat 2010; 217 (04) 418-428
    CrossrefPubMedGoogle Scholar
  • 3 Ottolini KM, Andescavage N, Keller S, Limperopoulos C. Nutrition and the developing brain: the road to optimizing early neurodevelopment: a systematic review. Pediatr Res 2020; 87 (02) 194-201
    CrossrefPubMedGoogle Scholar
  • 4 Bin-Nun A, Kassirer Y, Mimouni FB, Shchors I, Hammerman C. Head circumference growth is enhanced by SMOFlipid in preterm neonates. Am J Perinatol 2020; 37 (11) 1130-1133
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 5 Hill NS, Cormack BE, Little BS, Bloomfield FH. Growth and clinical outcome in very low-birth-weight infants after the introduction of a multicomponent intravenous lipid emulsion. JPEN J Parenter Enteral Nutr 2020; 44 (07) 1318-1327
    CrossrefPubMedGoogle Scholar
  • 6 Torgalkar R, Dave S, Shah J. et al. Multi-component lipid emulsion vs soy-based lipid emulsion for very low birth weight preterm neonates: a pre-post comparative study. J Perinatol 2019; 39 (08) 1118-1124
    CrossrefPubMedGoogle Scholar
  • 7 Gharami K, Das M, Das S. Essential role of docosahexaenoic acid towards development of a smarter brain. Neurochem Int 2015; 89: 51-62
    CrossrefPubMedGoogle Scholar
  • 8 Costa S, Cocca C, Barone G. et al. Growth of head circumference and body length in preterm infants receiving a multicomponent vs a soybean-based lipid emulsion: a randomized controlled trial. JPEN J Parenter Enteral Nutr 2021; 45 (01) 94-101
    CrossrefPubMedGoogle Scholar
  • 9 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 (04) 529-534
    CrossrefPubMedGoogle Scholar
  • 10 de Vries LS, Eken P, Dubowitz LM. The spectrum of leukomalacia using cranial ultrasound. Behav Brain Res 1992; 49 (01) 1-6
    CrossrefPubMedGoogle Scholar
  • 11 Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163 (07) 1723-1729
    CrossrefPubMedGoogle Scholar
  • 12 Bell MJ, Ternberg JL, Feigin RD. et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978; 187 (01) 1-7
    CrossrefPubMedGoogle Scholar
  • 13 International Committee for the Classification of Retinopathy of Prematurity. The International Classification of Retinopathy of Prematurity revisited. Arch Ophthalmol 2005; 123 (07) 991-999
    CrossrefPubMedGoogle Scholar
  • 14 Vatansever D, Kyriakopoulou V, Allsop JM. et al. Multidimensional analysis of fetal posterior fossa in health and disease. Cerebellum 2013; 12 (05) 632-644
    CrossrefPubMedGoogle Scholar
  • 15 Calandrelli R, D'Apolito G, Marco P, Zampino G, Tartaglione T, Colosimo C. Costello syndrome: analysis of the posterior cranial fossa in children with posterior fossa crowding. Neuroradiol J 2015; 28 (03) 254-258
    CrossrefPubMedGoogle Scholar
  • 16 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 (11) 2208-2214
    CrossrefPubMedGoogle Scholar
  • 17 Jeong HJ, Shim SY, Cho HJ, Cho SJ, Son DW, Park EA. Cerebellar development in preterm infants at term-equivalent age is impaired after low-grade intraventricular hemorrhage. J Pediatr 2016; 175: 86-92.e2
    CrossrefPubMedGoogle Scholar
  • 18 Comparing two means – sample size. Accessed May 5, 2023 at: https://select-statistics.co.uk/calculators/sample-size-calculator-two-means/
    PubMed
  • 19 Harris WS, Baack ML. Beyond building better brains: bridging the docosahexaenoic acid (DHA) gap of prematurity. J Perinatol 2015; 35 (01) 1-7
    CrossrefPubMedGoogle Scholar
  • 20 Lauritzen L, Brambilla P, Mazzocchi A, Harsløf LB, Ciappolino V, Agostoni C. DHA effects in brain development and function. Nutrients 2016; 8 (01) 6
    CrossrefPubMedGoogle Scholar
  • 21 De Rooy L, Hamdallah H, Dyall SC. Extremely preterm infants receiving standard care receive very low levels of arachidonic and docosahexaenoic acids. Clin Nutr 2017; 36 (06) 1593-1600
    CrossrefPubMedGoogle Scholar
  • 22 Lapillonne A, Eleni dit Trolli S, Kermorvant-Duchemin E. Postnatal docosahexaenoic acid deficiency is an inevitable consequence of current recommendations and practice in preterm infants. Neonatology 2010; 98 (04) 397-403
    CrossrefPubMedGoogle Scholar
  • 23 Hortensius LM, Hellström W, Sävman K. et al. Serum docosahexaenoic acid levels are associated with brain volumes in extremely preterm born infants. Pediatr Res 2021; 90 (06) 1177-1185
    CrossrefPubMedGoogle Scholar
  • 24 Schneider J, Fischer Fumeaux CJ, Duerden EG. et al. Nutrient intake in the first two weeks of life and brain growth in preterm neonates. Pediatrics 2018; 141 (03) e20172169
    CrossrefPubMedGoogle Scholar
  • 25 Coviello C, Keunen K, Kersbergen KJ. et al. Effects of early nutrition and growth on brain volumes, white matter microstructure, and neurodevelopmental outcome in preterm newborns. Pediatr Res 2018; 83 (1–1): 102-110
    CrossrefPubMedGoogle Scholar
  • 26 Ottolini KM, Andescavage N, Kapse K. et al. Early lipid intake improves cerebellar growth in very low-birth-weight preterm infants. JPEN J Parenter Enteral Nutr 2021; 45 (03) 587-595
    CrossrefPubMedGoogle Scholar
  • 27 Clouchoux C, Guizard N, Evans AC, du Plessis AJ, Limperopoulos C. Normative fetal brain growth by quantitative in vivo magnetic resonance imaging. Am J Obstet Gynecol 2012; 206 (02) 173.e1-173.e8
    CrossrefPubMedGoogle Scholar
  • 28 Andescavage NN, du Plessis A, McCarter R. et al. Complex trajectories of brain development in the healthy human fetus. Cereb Cortex 2017; 27 (11) 5274-5283
    PubMedGoogle Scholar
  • 29 Caligiore D, Pezzulo G, Baldassarre G. et al. Consensus Paper: towards a systems-level view of cerebellar function: the interplay between cerebellum, basal ganglia, and cortex. Cerebellum 2017; 16 (01) 203-229
    CrossrefPubMedGoogle Scholar
  • 30 Schmahmann JD. The cerebellum and cognition. Neurosci Lett 2019; 688: 62-75
    CrossrefPubMedGoogle Scholar
  • 31 van Goudoever JB, Vlaardingerbroek H. The present challenges of parenteral nutrition in preterm infants and children. J Nutr 2013; 143 (12) 2059S-2060S
    CrossrefPubMedGoogle Scholar
  • 32 Georgieff MK. Nutrition and the developing brain: nutrient priorities and measurement. Am J Clin Nutr 2007; 85 (02) 614S-620S
    PubMedGoogle Scholar
  • 33 Ramel SE, Georgieff MK. Preterm nutrition and the brain. World Rev Nutr Diet 2014; 110 (110): 190-200
    CrossrefPubMedGoogle Scholar
  • 34 Innis SM. Dietary omega 3 fatty acids and the developing brain. Brain Res 2008; 1237 (1237): 35-43
    CrossrefPubMedGoogle Scholar
  • 35 Stephens BE, Walden RV, Gargus RA. et al. First-week protein and energy intakes are associated with 18-month developmental outcomes in extremely low birth weight infants. Pediatrics 2009; 123 (05) 1337-1343
    CrossrefPubMedGoogle Scholar