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World J Methodol. Nov 20, 2021; 11(6): 278-293
Published online Nov 20, 2021. doi: 10.5662/wjm.v11.i6.278
Preterm nutrition and neurodevelopmental outcomes
Alyson Margaret Skinner, Hassib Narchi
Alyson Margaret Skinner, Department of Paediatrics, Manor Hospital, Walsall Healthcare NHS Trust, Walsall WS2 9PS, West Midlands, United Kingdom
Alyson Margaret Skinner, Hassib Narchi, Department of Paediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain PO Box 17666, United Arab Emirates
Author contributions: Both authors contributed to the writing of the manuscript; Narchi H designed the figure.
Conflict-of-interest statement: No conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Alyson Margaret Skinner, BPharm, BSc, FRCP, MBChB, MD, MSc, Doctor, Department of Paediatrics, Manor Hospital, Walsall Healthcare NHS Trust, Moat Road, Walsall WS2 9PS, West Midlands, United Kingdom. alysonskinner8@gmail.com
Received: March 28, 2021
Peer-review started: March 28, 2021
First decision: June 17, 2021
Revised: July 13, 2021
Accepted: September 27, 2021
Article in press: September 27, 2021
Published online: November 20, 2021
Abstract

Survival of preterm infants has been steadily improving in recent years because of many recent advances in perinatal and neonatal medicine. Despite these advances, the growth of survivors does not reach the ideal target level of the normal fetus of the same gestational age. Postnatal weight gain is often not achieved because extrauterine growth has higher energy requirements than intrauterine growth, due to the intensive care environment, illness and inadequate nutrition. Although many other factors influence infant brain development, including family socioeconomic and educational background, the role of nutrition is considerable and fortunately, amenable to intervention. In the preterm neonate, the brain is the most metabolically demanding organ, consuming the largest proportions of energy and nutrient intake for its function and programmed growth and maturation. Weight gain, linear and head circumference growth are all markers of nutritional status and are independently associated with long-term neurodevelopment. Brain development is not only the result of nutrients intake, but in addition, of the interaction with growth factors which depend on adequate nutrient supply and overall health status. This explains why conditions such as sepsis, necrotizing enterocolitis and chronic lung disease alter the distribution and accretion of nutrients thereby suppressing growth factor synthesis. In this review, we will focus on the direct role of nutrition on neurodevelopment, emphasizing why it should be started without delay. The nutritional requirements of the preterm infant will be discussed, followed by the effects of general nutritional interventions and specific nutrients, as well as the role of nutritional supplements on neurodevelopment. The primordial role of human breast milk, breast milk fortifiers and human milk oligosaccharides will be discussed in detail. We will also examine the role of nutrition in preventing neonatal complications which can affect neurodevelopment in their own right.

Keywords: Brain, Nutrition, Preterm infants, Neurodevelopmental outcomes, Newborn, Breast milk

Core Tip: Survival of preterm infants has been steadily improving because of the many recent advances in perinatal and neonatal medicine. However, neither the growth of survivors reaches the ideal target level of the normal foetus of the same gestational age, nor is the optimum postnatal weight gain often achieved. In the preterm neonate, the brain is the most metabolically demanding organ. Growth is a marker of nutritional status and is also independently associated with long-term neurodevelopment. In this review, we will discuss the direct role of nutrition and the effect of general and specific nutritional interventions on neurodevelopment.