Peer-reviewed article
Early Optimal Parenteral Nutrition During NICU Stay and Neurodevelopmental Outcomes in Very Preterm Infants: State of the Art.
Francesca Tesser, Marta Meneghelli, Diletta Martino, Luca Pegoraro, Maria Sofia Pelosi et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This systematic review examined how parenteral nutrition (artificial feeding through the veins) given to very premature babies in intensive care relates to their brain development in the first two years of life. The review found that while early amino acids and immediate glucose are important, overly aggressive nutrition may not improve brain development and could cause problems. The evidence suggests a personalized approach to feeding based on each baby's condition and tolerance is needed, with lipids and fish oil requiring further study.
Key points
- 22 studies were included, of which 12 were randomized controlled trials
- Early amino acid supplementation is mandatory and improves short-term growth
- Aggressive parenteral nutrition caloric intakes have uncertain long-term outcomes for neurodevelopment
- Glucose should be provided immediately but strictly monitored to avoid high blood sugar
- A customized nutrition approach based on the patient's clinical state and tolerance may be better than aggressive feeding
Limitations
This is a narrative review of existing studies rather than new research, so it summarizes what is known but cannot establish new causal relationships. The review identifies significant gaps in evidence about whether improved growth from nutrition directly translates to better brain development outcomes.
Abstract
BACKGROUND: Preterm infants (PIs) are more susceptible to neurodevelopmental impairment compared with term newborns. Adequate postnatal growth has been associated with improved neurocognitive outcomes; therefore, optimization of nutrition may positively impact the neurodevelopment of PIs. OBJECTIVE: This study focused on macronutrient parenteral nutrition (PN) intake during the Neonatal Intensive Care Unit stay and their associations with neurodevelopmental outcomes in PIs in the first two years of life. METHODS: The Embase, MEDLINE, and Cochrane Library databases were searched using the following subject headings and terms (MeSH): "premature infants", "parenteral nutrition", "growth", "brain", "neurodevelopment", and "central nervous system diseases". All relevant papers' reference lists were manually searched. PN and neurodevelopment studies concerning the first two years of life were collected and analyzed. RESULTS: 275 potential studies were retrieved, 64 were selected for full-text reading, and 22 were included (12 randomized controlled trials). While glucose intakes should be immediately provided and strictly monitored avoiding hyperglycemia, the long-term outcomes of aggressive PN caloric intakes are uncertain. Early amino acid (AA) supplementation is mandatory and improves short-term growth, though it is questionable whether increased AA and better neurodevelopment are directly related. Lipid infusion should be initiated right after birth, and further investigation will enable us to ascertain the potential impacts of lipid emulsions, particularly fish oil, on PI neurodevelopment. CONCLUSIONS: An aggressive PN and its possible metabolic complication could not favor neurodevelopment; the way forward could be a customized approach, depending on the patient's clinical state and tolerance. Long-term follow-up studies and the search for specific markers of tolerance are warranted.