Background and aims Advances in neonatal intensive care and nutrition support have increased survival of preterm infants, but the risk of compromised neurodevelopment is a concern. We evaluated parenteral nutrition (PN) as a heretofore unreported contributing factor to compromised neurodevelopment after preterm birth.
Methods Neurodevelopment of preterm pigs delivered at 92% of gestation (representative of 32 week preterm infants) and provided PN or enteral nutrition (EN) for 10 days was assessed by observations of motor activity, sensory and cognitive skills, brain mass, magnetic resonance imaging, and cerebellar histology. Fluid volumes, energy, and nutrients were comparable.
Results PN pigs grew slightly better than EN pigs, but had smaller brains (28 + 0.5 vs 32 + 0.6; p = 0.009), including the cerebellum, reduced motor activity (p = 0.005) and sensory responses (p < 0.05) that corresponded with underdeveloped myelination (p = 0.004) from diffusion tensor imaging. PN was associated with lower serum lipids (triglycerides, p = 0.05; total cholesterol, p = 0.04; VLDL, p = 0.04; HDL, p = 0.03; and LDL, p = 0.09). Differences were also detected between PN and EN for weights of the kidneys, heart, pancreas, and spleen, but not lungs.
Conclusions PN is essential for many preterm infant, and particularly those delivered earlier in gestation. The neurodevelopment delay caused by total PN independent of confounding variables (disease, inconsistent gestational ages,diverse genetics, different nutritional support and NICU protocols) is a novel and disturbing finding. The preterm pig is a translational animal model for investigating the relationship between nutrition support and neurodevelopment after preterm birth, improving PN solutions, and advancing neonatal intensive care.