Development of a brain-specific nutritional status indicator for very preterm infants

PROJECT SUMMARY/ABSTRACT
Each year, over 63,000 U.S. infants are born very preterm, below 32 weeks of gestation. With >90% now
surviving to discharge from the neonatal intensive care unit (NICU), reducing the short- and long-term
morbidities has become the highest priority. Neurodevelopmental impairment is a burdensome long-term
morbidity that affects 50-60% of very preterm infants after NICU discharge. Nutrition is a cornerstone of clinical
care in the NICU and represents a highly modifiable strategy to support healthy brain development during a
critical period, thereby reducing long-term impairments. Previous studies have highlighted nutrient accretion
into tissues as a key driver of healthier brain development and better neurodevelopmental outcomes. A current
gap is in accurate, specific, and feasible strategies to assess and monitor nutrient accretion over time. The
overall aim of this study is to investigate fat-free mass accretion as a dynamic bioindicator of nutritional status
in the NICU. The specific aims involve establishing a new fetal reference for fat-free mass that covers the
entire spectrum of preterm gestational ages, from 23 to 35 weeks, and using this reference to define targets for
fat-free mass accretion that are based on neurodevelopmental outcomes. This study applies the innovative
concept of “growth quality” to NICU nutrition research. Innovative approaches include the application of
bioimpedance analysis to measure body composition in the NICU setting, and the use of quantitative brain
magnetic resonance imaging (MRI) and electroencephalography (EEG) as early biomarkers of
neurodevelopment in this population, in addition to standard behavioral measures. Our overarching goal is to
improve long-term health and developmental outcomes of very preterm infants through pragmatic, evidence-
based innovations in nutritional assessment and care during the NICU hospitalization. The results of this study
will lay the foundation for fat-free mass-driven dietary interventions in the NICU setting. This study has strong
potential to provide an impactful paradigm shift in the approach to the assessment and monitoring of nutritional
status and ultimately the leveraging of nutritional strategies during a critical window in development to improve
outcomes for this vulnerable population.

Grant Number: 5R01HD111016-04
NIH Institute/Center: NIH
Principal Investigator: Mandy Belfort