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Clinician-to-Clinician Update
To schedule a consultation, referral or appointment:
24/7 Neonatal Transport or Neonatologist Physician Consultation Line:
NICU Follow-Up Care
Pediatric Specialty Care Explorer Clinic
2450 Riverside Ave., East Building
Minneapolis 55454

To learn about NICU locations in Burnsville, Maple Grove, Minneapolis, and Woodbury, visit mhealth.org/childrens-NICU

Neuropsychology
Pediatric Specialty Care - Voyager Clinic
2512 Building
2512 S 7th St., Suite R103
Minneapolis, MN 55454

To find neuropsychology locations in Burnsville, Minneapolis, and Woodbury, visit mhealth.org/childrens-neuropsych

Supporting Neurodevelopment in Preterm Infants: A New Focus on Nutrition

Meeting the nutritional needs of infants born before 37 weeks of gestational age can set the trajectory for neurodevelopment in childhood and throughout the child’s lifetime. Addressing  preterm infants’ low body weight remains central to enhancing development. New evidence, however, suggests that a focus on infant body composition in very early nutrition plans is critical. 

Neonatal intensive care unit (NICU)
Neonatlogist Erin Stepka, MD, stands at an incubator in the
University of Minnesota Masonic Children’s Hospital NICU.
Dr. Stepka is Medical Director of Neonatal Program Development
and Clinical Services/Regional Medical Director of Neonatology.
(No patient pictured)
The most active period of neurodevelopment occurs within the prenatal period and the first 2 postnatal years.1 Genetic factors and environmental factors such as stress, poor environmental enrichment, and poor nutrition during this time exert lasting effects on health and neurodevelopment.1,2,3 Very preterm infants have a greater risk of hypertension, altered growth, and deficits in neurodevelopment, as measured in speed of cognitive processing.4 Of external factors affecting healthy development, nutrition is among the most susceptible to effective intervention by pediatricians.2 

Although early gains in growth are associated with improvements in later neurodevelopment, not all weight gain has been correlated with optimal growth. Tracking preterm infant body composition is important to the assessment of preterm infant nutritional status.4,5 A body composition higher in fat free mass has been associated with improved neurodevelopment outcomes. In preterm infants, fat-free mass is lower and fat mass is higher.5 

The latest evidence suggests that percentages of fat-free to fat body mass can predict a preterm infant’s neurodevelopment in childhood. In a study of 20 preterm infants (born before 35 weeks of gestational age) and 51 full-term infants, researchers assessed weight gain and body composition in relation to later measures of cognition. The infants were tracked from birth to 4 years of age. Body composition and anthropometric measurements were taken during infancy at term, at 3-4 months (preterm corrected ages), and at 4 years. Cognitive testing was taken at 4 years. Among the preterm infants, higher percent gains in fat-free mass from age 4 months corrected to 4 years were associated with higher IQ and processing-speed scores. Higher percent gains in fat mass from term to 4 months of age corrected were associated with lower working-memory performance.5 Similarly, for the full-term infants, higher gains in fat mass between the ages 4 months to 4 years were associated with lower IQ.5 

Similar observations were made in a 2018 study of 34 very preterm infants born before 32 weeks of gestational age. In that study, gains in fat-free mass before 4 months of age were associated with greater cognitive processing speed and lower blood pressure at 4 years of age, suggesting that very early nutrition is critical to later development.4 A 2016 study also established that gains in fat-free mass in very preterm infants were associated with improvements in neurodevelopment at 1 year of age.6 

While recent reviews of feeding guidelines for preterm and very low birth-weight infants have noted a variation in practices7,8, a consensus is emerging on the role of nutrition and body mass composition in neurodevelopment. Comprehensive clinical practice guidelines for feeding infants and children are planned for inclusion in the 2020 Dietary Guidelines for Americans.7 

Clinical research is ongoing at the University of Minnesota, where pediatricians, nutritionists, and neurologists are working together to provide optimal nutrition for the neurodevelopment of preterm and full-term infants. 

References

  1. Schwarzenberg SJ, Georgieff MK. AAP COMMITTEE ON NUTRITION. Advocacy for improving nutrition in the first 1000 days to support childhood development and adult health. Pediatrics. 2018;141(2):e20173716. 
  2. Georgieff MK, Ramel SE, Cusick SE. Nutritional influences on brain development. Acta Paediatr. 2018;107(8):1310-1321. doi:10.1111/apa.14287 
  3. Fox SE, Levitt P, Nelson CA. How the timing and quality of early experiences influence the development of brain architecture. Child Dev. 2010;8 (1):28-40. doi:10.1111/j.1467-8624.2009.01380.x 
  4. Pfister KM, Zhang L, Miller NC, Ingolfsland EC, Demerath EW, Ramel SE. Early body composition changes are associated with neurodevelopmental and metabolic outcomes at 4 years of age in very preterm infants. Pediatr Res. 2018;84(5):713-718. doi:10.1038/s41390-018-0158-x 
  5. Scheurer J, Zhang L, Plummer EA, Hultgren SB, Demerath EW, Ramel SE. Body composition changes from infancy to 4 years and associations with early childhood cognition in preterm and full-term children. Neonatology. 2018;114(2):169-176. doi:10.1159/000487915 
  6. Ramel SE, Gray HL, Christiansen E, Boys C, Georgieff MK, Demerath EW. Greater early gains in fat-free mass, but not fat mass, are associated with improved neurodevelopment at 1 year corrected age for prematurity in very low birth weight preterm infants. J Pediatrics. 2016;173:108-115. doi.org/10.1016/j.jpeds.2016.03.003 
  7. Raiten DJ, Steiber AL, Hand RK. Executive summary: evaluation of the evidence to support practice guidelines for nutritional care of preterm infants--The Pre-B Project. Am J Clin Nutr. 2016;103(2;Suppl):599S-605S. doi.org/10.3945/ajcn.115.124222 
  8. Dutta S, Singh B, Chessell L, Wilson J, Janes M, McDonald K, et al. Guidelines for feeding very low birth weight infants. Nutrients. 2015;7(1):423-442. doi.org/10.3390/nu7010423

When to Refer

The Neonatal Intensive Care Unit (NICU) at University of Minnesota Masonic Children’s Hospital provides comprehensive care for preterm and full-term infants. Our Level IV NICU provides the highest recognized level of care, and our neonatologists and nurses have extensive experience in caring for sick newborns and their families. Our clinician researchers have served as co-authors of the 2018 policy statement on improving nutrition in the first 1,000 days of life to support childhood development, and they lead the way in nutritional care for infants born early. Because preterm infants often have ongoing health concerns, our neonatologists continue to monitor their development after they leave the hospital, often until they enter their school years. Each child receives an individual plan that works to maximize normal development. We provide follow-up care at our clinic locations in Minneapolis, Burnsville, Maple Grove, and Woodbury. 

Multidisciplinary, Collaborative Care 

Our neonatologists collaborate with pediatric specialty care teams that include cardiologists and cardiovascular surgeons, neurologists, neurosurgeons, gastroenterologists, endocrinologists, nutritionists, genetic counselors, and nurse intensivists. We see referring physicians as an essential link to the baby and their family and work with them to provide uninterrupted care. As a team, we strive to offer family-centered, multidisciplinary care designed to address the unique needs of each baby. 

Neuropsychology Services

The University of Minnesota Health pediatric neuropsychology care team provides behavioral health services for young patients with conditions affecting cognitive and neurobehavioral functioning and development. We evaluate children experiencing the effects of prematurity and developmental delay as well as patients with neurobehavioral disorders and those with neurobehavioral issues relating to illness or injury. We provide assessment, diagnosis, and tailored treatment plans. To learn more, visit mhealth.org/childrens-neuropsych. To find current clinical trials available through University of Minnesota Health providers: studyfinder.umn.edu.

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