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

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.