A recent retrospective study (PE van Beek et al. J Pediatr 2020; 223: 57-63. Increase in Brain Volumes after Implementation of a Nutrition Regimen in Infants Born Extremely Preterm) with 178 infants (median gestational age 26.6 weeks) found that a modification in the nutritional regimen resulted in improved brain volumes.

Key findings:

• In cohort B (new regimen), mean protein and caloric intake were 3.4 g/kg/d & 109 kcal/kg/day which were significantly  increased compared to Cohort A: 2.7 g/kg/d and 104 kcal/kg/d for first 28 days of life.
• At 30 weeks gestational age, 22 brain regions were significantly large in cohort B compared with cohort A, though at term age equivalence, only the caudate nucleus remained significantly larger.
• key limitation: brain MRI can only be performed in relatively stable neonates; thus, sicker infants may be underrepresented.

My view: Optimizing nutrition as early as possible is likely to help improve cognitive outcomes.

Related blog posts:

• SMOF Neurodevelopmental Data -in 5 Years We Will Know More
• Downside of Lipid Reduction (Nutrition Week Day 1) This study showed that higher lipid intake in a cohort of neonates born at <30 weeks during the first 2 weeks after birth was associated with a lower incidence of brain lesions and dysmaturation when examined by MRI at term equivalent age (TEA).
• Improving Outlook in Neonatal Nutrition (Part 1)
• Neonatal Nutrition Lecture -What We Know Right Now …
• Favorable Fish Oil Outcomes in High Risk Preterm Infants | gutsandgrowth
• Current Mortality from Being Born Premature | gutsandgrowth
• Visual Acuity and LCPUFA | gutsandgrowth
• Weight Gain in Preemies, Neurodevelopmental Outcomes, and Reverse Causation

Other nutrition-related articles in this issue:

DL Harris et al. J Pediatr 2020; 223: 34-41. Glucose Profiles in Healthy Term Infants in the First 5 Days: The Glucose in Well Babies (GLOW) Study

• In term infants, plasma glucose concentrations of 47 mg/dL (2.6 mmol/L) approximated the 10th percentile in the first 48 hours, and 39% of infants had ≥1 episode below this threshold.
•  The mean glucose concentrations increased over the first 18 hours, remained stable to 48 hours (59 ± 11 mg/dL; 3.3 ± 0.6 mmol/L)] before increasing to a new plateau by the fourth day (89 ± 13 mg/dL; 4.6 ± 0.7 mmol/L).

WG Sharp et al. J Pediatr 2020; 223: 73-80. Intensive Multidisciplinary Intervention for Young Children with Feeding Tube Dependence and Chronic Food Refusal: An Electronic Health Record Review  Congratulations to my colleagues at the Marcus Center for this work, particularly Valerie Volkert who has worked with so many of our kids and Barbara McElhanon who has been so helpful.  83 patients with complex medical-behavioral-developmental problems met study criteria.  Key finding:  58 patients (72%) weaned from tube feeding at follow-up.

From Pitt Street Bridge Park, Mount Pleasant, SC