van Beek PE, Claessens NHP, Makropoulos A, Groenendaal F et al. .Increase in Brain Volumes after Implementation of a Nutrition Regimen in Infants Born Extremely Preterm. J Pediatr. 2020 May 7. pii: S0022-3476(20)30567-9. doi: 10.1016/j.jpeds.2020.04.063.

OBJECTIVE: To assess the effect of early life nutrition on structural brain development in two cohorts of extremely preterm infants, before and after implementation of a nutrition regimen containing more protein and lipid.

STUDY DESIGN: 178 infants were retrospectively included (median gestational age 26.6 wks, IQR 25.9 – 27.3), of whom 99 received the old nutrition regimen (cohort A, 2011-2013) and 79 the new nutrition regimen (cohort B, 2013-2015). Intake of protein, lipids and calories was calculated for the first 28 postnatal days. Brain MRI was performed at 30 weeks post-menstrual age (PMA) (IQR 30.3-31.4) and term-equivalent age (TEA) (IQR 40.9-41.4). Volumes of 42 (left + right) brain structures were calculated.

RESULTS: Mean protein and caloric intake in cohort B (3.4 g/kg/day; p<0.001 and 109 kCal/kg/day; P = .038) were higher than in cohort A (2.7 g/kg/day; 104 kCal/kg/day). At 30 weeks, 22 regions were significantly larger in cohort B compared with cohort A, whereas at TEA, only the caudate nucleus was significantly larger in cohort B compared with cohort A.

CONCLUSIONS: An optimized nutrition protocol in the first 28 days of life is associated with temporarily improved early life brain volumes.