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

Mayumi Tsukayama; Haruna Azuma; Itsuki Oshiro; Hideki Goya; Tomohide Yoshida; Koichi Nakanishi

doi:10.1038/s41430-024-01504-x

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 Sep 10. doi: 10.1038/s41430-024-01504-x. Online ahead of print.

Authors

Mayumi Tsukayama^{1

2}, Haruna Azuma², Itsuki Oshiro², Hideki Goya¹, Tomohide Yoshida^{3

4}, Koichi Nakanishi²

Affiliations

¹ Maternity and Perinatal Care Center, University of the Ryukyus Hospital, Okinawa, Japan.
² Department of Child Health and Welfare (Pediatrics), Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
³ Maternity and Perinatal Care Center, University of the Ryukyus Hospital, Okinawa, Japan. [email protected].
⁴ Department of Child Health and Welfare (Pediatrics), Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan. [email protected].

PMID: 39251887
DOI: 10.1038/s41430-024-01504-x

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.