Open AccessRelationships Between Early Neonatal Nutrition and Neurodevelopment at School Age in Children Born Very Preterm
Author(s) -
Tottman Anna C.,
Alsweiler Jane M.,
Bloomfield Frank H.,
Gamble Greg D.,
Jiang Yannan,
Leung Myra,
Poppe Tanya,
Thompson Benjamin,
Wouldes Trecia A.,
Harding Jane E.
Publication year - 2020
Publication title -
journal of pediatric gastroenterology and nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.206
H-Index - 131
eISSN - 1536-4801
pISSN - 0277-2116
DOI - 10.1097/mpg.0000000000002471
Subject(s) - medicine , pediatrics , cerebral palsy , odds ratio , wechsler preschool and primary scale of intelligence , gestational age , cohort , confidence interval , incidence (geometry) , birth weight , gestation , cohort study , retrospective cohort study , wechsler intelligence scale for children , pregnancy , intelligence quotient , physical therapy , physics , cognition , psychiatry , biology , optics , genetics
Objectives: The aim of this study was to determine whether a new nutrition protocol designed to increase early protein intakes while reducing fluid volume in infants born very preterm was associated with altered neurodevelopment and growth in childhood. Methods: A retrospective, observational cohort study of children born <30 weeks’ gestation or <1500 g and admitted to the neonatal unit, National Women's Hospital, Auckland, New Zealand, before and after a change in nutrition protocol. The primary outcome was neurodevelopmental impairment at 7 years (any of Wechsler Intelligence Scale for Children full scale IQ < 85, Movement Assessment Battery for Children‐2 total score ⩽5th centile, cerebral palsy, blind, or deaf requiring aids). Outcomes were compared between groups and for the overall cohort using generalized linear regression, adjusted for sex and birth weight z score. Results: Of 201 eligible children, 128 (64%) were assessed (55/89 [62%] exposed to the old nutrition protocol, 73 of 112 [65%] to the new protocol). Children who experienced the new protocol received more protein, less energy, and less carbohydrate in postnatal days 1 to 7. Neurodevelopmental impairment was similar at 7 years (30/73 [41%] vs 25/55 [45%], adjusted odds ratio [AOR] [95% confidence interval] 0.78 [0.35–1.70], P = 0.55), as was the incidence of cerebral palsy (AOR 7.36 [0.88–61.40], P = 0.07). Growth and body composition were also similar between groups. An extra 1 g/kg parenteral protein intake in postnatal days 1 to 7 was associated with a 27% increased odds of cerebral palsy (AOR 1.27 [1.03–1.57], P = 0.006). Conclusions: Higher early protein intakes do not change overall rates of neurodevelopmental impairment or growth at 7 years. Further research is needed to determine the effects of higher early parenteral protein intake on motor development.