Early nutrition, growth, and neurodevelopment in the preterm infant

Preterm birth brings an increased risk of suboptimal neurodevelopment compared with birth at full-term, particularly for extremely preterm (< 28 weeks) and extremely low birthweight (ELBW; < 1000 g) infants. Optimizing nutrition and growth are promising strategies to mitigate adverse neurodevelopment for children born preterm. However, few randomized controlled trials of preterm nutrition have been of sufficient size to determine neurodevelopmental effects and a lack of consistent reporting of outcomes, and the way in which the same outcome is reported in different trials makes meta-analysis challenging. Observational studies consistently report that higher protein intakes are associated with improved growth, and often with better neurodevelopment, but differences in methodologies, reporting, and nutrition strategies make it difficult to compare the effects of each interventional and observational studies and cannot determine causation. Future research to establish the effects of nutritional intakes on neurodevelopment for preterm infants needs to address the deficiencies of most research to date, with trials powered for important clinical outcomes. Meta-analysis of neonatal nutrition research will be enhanced by the development of core outcome and minimal reporting sets for studies of neonatal nutrition.