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Additional nutrition significantly increases brain growth in babies with perinatal brain damage

Presented at the Neonatal Society 2004 Summer Meeting (programme).

Dabydeen L, Thomas JE, Aston TJ, Hartley H, Sinha SK, Eyre JA

Developmental Neuroscience Group, School of Clinical Medical Sciences, University of Newcastle upon Tyne NE1 4LP, UK

Hypothesis: That increased nutrition during the first year in children with significant perinatal brain damage will optimise growth.

Subjects: Babies with severe hypoxic-ischaemic encephalopathy, cystic periventricular leucomalacia or intraventricular haemorrhage with parenchymal extensions, born in the Northern Region.

Methods: The study was approved by the individual institution's ethics committees. At term subjects were randomly allocated into 2 groups, controlling for gestation, sex, postcode and brain lesion. All were followed by a specialist dietician. The intervention group had a dietary intake target of 120% of estimated energy requirements and the control group,100%. Anthropometric measurements and transcranial magnetic stimulation to estimate maximum corticospinal axonal diameter were performed at term and at 3 monthly intervals. Parents and researchers collecting and analysing these measurements (LD and JAE) were blinded to patient allocation.

Results: 16 babies were recruited over a 2 year period; 11 boys and 10 preterm infants. There were no significant differences in sex, weight and head circumference centiles between intervention and control groups at birth and at the start of the intervention (see Fig.). The intervention group had significantly faster rates of weight gain in the first 6 months (Fig A, p<0.05) and by 12 months were significantly longer (Fig B, p<0.05), had larger occipitofrontal circumferences (Fig C, p<0.05) and greater corticospinal axonal diameters than the control group (Fig. D, p<0.01).

Conclusion: This is the first randomised, double blind, prospective study of a nutritional intervention in babies with significant perinatal brain damage. It demonstrates that increased nutrition in the first year had a significant effect on the initial rate of weight gain and on height, head circumference and maximum axonal diameter in the corticospinal tract. These data also suggest that babies with significant perinatal brain damage may have increased nutritional requirements to maintain normal rates of growth in the first 12 months after birth.

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