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Title: The long-term impact of early nutrition on preterm brain structure and function
Author: Lapidaire, Winok
ISNI:       0000 0004 8500 4421
Awarding Body: UCL (University College London)
Current Institution: University College London (University of London)
Date of Award: 2019
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Background: Preterm birth has been associated with altered brain structure and cognitive impairment. Neonatal nutrition has been shown to play an important role in brain development in preterm infants, but there is a paucity of study on the long-term effects. Methods: A total of 926 preterm infants (< 37 weeks gestation, birthweight < 1850g) were randomised to receive a nutrient enriched preterm formula (PTF), or the standard diet: term formula (TF) or banked donor breast milk (BBM), either as their sole diet or as a supplement to maternal breast milk (MBM). Of those in the original cohort, 768 subsequently completed IQ tests during childhood. For this adult follow- up, 72 preterm born participants from the trial and 72 newly recruited term born controls underwent MRI scans and completed cognitive tests and questionnaires. Results: Preterm born adults had lower grey matter volumes and lower fibre coherence compared to term born controls. Preterm subjects who performed suboptimally on cognitive tests exhibited widespread changes in diffusion parameters. Increased proportion of human milk in the diet was associated with reduced neonatal infection/NEC. Adults who had suffered neonatal infection/NEC demonstrated reduced cognitive performance and changes in diffusion parameters. A high nutrient neonatal diet and increased neonatal weight gain were associated with higher childhood IQ scores, particularly in children born <30 weeks of gestational age, but this was not significant in adulthood. Discussion: The effects of preterm birth on cognitive outcome and brain structure persists into adulthood. While a large proportion of people born preterm perform in the normal range, there are some who perform suboptimally and exhibit widespread changes in the white matter microstructure. Human milk in the neonatal diet has a positive effect on the risk of infection/NEC and outcomes. The benefits of a high nutrient diet and subsequent increased neonatal weight gain on cognition and brain structure may be limited to low birthweight/low GA infants and could not be established in adulthood.
Supervisor: Clark, C. ; Fewtrell, M. ; Clayden, J. Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available