Energy-enhanced parenteral nutrition and neurodevelopment of preterm newborns: a cohort study

Objectives Preterm births are higher risk of neurodevelopment (NDV) disabilities. To limit long-term consequences, guidelines recommend aggressive Parenteral Nutrition (PN) soon after birth. Our purpose was to study the effects of an energy-enhanced PN in the first week of life on long-term NDV in preterm neonates. Methods We compared two Cohorts (A energy-enhanced PN and B energy-standard PN) of newborns with different energy intake in the first 7 days of life (DOL) given by PN but with the same protein amount, to study the influences of an energy-enhanced PN on NDV at 24 months of life evaluating with Bayley Scale of Infants Development - III edition Results We analyzed 51 newborns (A 24 vs. B 27). The two Cohorts were similar for baseline characteristics (gestational age A 29, 95 % CI 28 to 30 weeks vs. B 29, 95 % CI 28 to 30 weeks; birth weight A 1214, 95 % CI 1062 to 1365 grams vs. B 1215, 1068 to 1363 grams; male gender A 62.5% vs. B 55.6%). Infants in Cohort B showed significantly (p<0.05) best gross motor, total scaled and total composite motor scores (A 8 (1) vs. B 9 (2); A 17 (4) vs. B 19 (5); A 91 (12) vs. B 97 (15); respectively). Cohort A showed a higher percentage of infants with delayed socio-emotional competence (A 30.4% vs. B 7.7%, p<0.05). No differences were found in growth parameters at 24 months of life. Linear regression analysis showed that socio-emotional competence and motor score were negatively associated with energy intake of the first 7 DOL given by PN Conclusions A more aggressive PN strategy results in lower motor score ad socio-emotional competences performance at 24 months of life. More caution might be advocated for an energy-enhanced PN protocol, particularly in neonates with lower birth weight, for long-term NDV in preterm neonates.