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Parenteral nutrition after preterm birth compromises brain development (137.3)

Parenteral nutrition (PN) is essential for preterm infants intolerant of enteral nutrition (EN), but is associated with gastrointestinal atrophy and dysfunction, liver pathology, and increased risks of sepsis. We discovered that growth and maturation of the brain after preterm birth is also compromised by PN. Preterm pigs delivered at 92% of gestation (representative of 32 week preterm infants) were provided PN for 24 h before 10 more days of nutritional support provided either by continued PN or conversion to full EN using formula. Fluid volumes, energy, and nutrients were comparable. Providing PN resulted in higher body weight gain, but at necropsy brain mass was 13% lower compared with EN pigs (P<0.01).Assessments of activity revealed a rapid divergence between PN and EN pigs (P<0.01) and neurocognitive skills of PN pigs after 10 days were diminished (P<0.02). The delayed development of motor skills corresponded with a smaller cerebellum. Diffusion tensor imaging revealed myelination of major CNS nerve tracts was reduced among PN pigs. The compromised brain development caused by PN is a novel finding, though the roles of specific nutrients are uncertain. Advances in PN for preterm infants are hindered by a poor understanding of nutrient requirements and a reliance on clinical trials with preterm infants. The preterm pig is a translational animal model for screening PN solutions, accelerating advances in nutrition support, and providing insights for the design of clinical protocols to evaluate improved PN solutions.