Optimisingnutritiontoimprovegrowthandreduceneurodisabilitiesinneonatesatriskofneurologicalimpairment,andchildrenwithsuspectedorconfirmedcerebralpalsy
MoragJAndrew,JeremyRParr,Chriontague-Johnson,OliverBraddick,KarenLaler,NicolaWilliams,BonnyBakerandPeterBSullivan.
BMCPediatrics2015,15:22doi:10.1186/s12887-015-0339-2
Published:17March2015
Abstract
Background
Neurologicalimpairmentisacommonsequelaeofperinatalbraininjury.Plasticityofthedevelopingbrainisduetoarichsubstrateofdevelopingneurones,synapticelementsandextracellularmatrix.Interventionssupportingthisinherentcapacityforplasticitymayimprovethedevelopmentaloutcomeofinfantsfollowingbraininjury.Nutritionalsupplementationwithcombinationdocosahexaenoicacid,uridineandcholinehaeenshowntoincreasesynapticelements,dendriticdensityandneurotranitterreleaseinrodents,improvingperformanceoncognitivetests.Itremainselusivewhethersuchspecificneurotrophicsupplementationenhancerainplasticityandrepairafterperinatalbraininjury.
Methods/Design
Thisisatwoyeardouble-blind,randomisedplacebocontrolledstudywithtwocohortstoinvestigatewhethernutritionalinterventionwithaneurotrophicdietarysupplementimprovesgrowthandneurodevelopmentaloutcomesinneonatesatsignificantriskofneurologicalimpairment(theD1cohort),andinfantswithsuspectedorconfirmedcerebralpalsy(theD2cohort).
120childrenwillberandomisedtoreceivedieteticandnutritionalintervention,andeitheractivesupplementorplacebo.EligibleD1neonatesarethoseborn<306weeksgestationwithweight<9thcentile,≤306weeksgestationandGradeII,IIIorIVIntra-VentricularHaemorrhageorperiventricularwhitematterinjury,orthosebornat31-4028weeksgestation,withSarnatgradeIorIIorIIIHypoxicIschaemicEncephalopathyorneuroimagingchangescompatiblewithperinatalbraininjury.EligibleD2infantsarethoseaged1-18monthswithasuspectedorconfirmedclinicaldiagnosisofcerebralpalsy.TheprimaryoutcomemeasureiscompositecognitivescoreontheBayleyScalesofInfantandToddlerDevelopmentIIIat24months.Secondaryoutcomesincludevisuobehaviouralandvisualneurophysiologicalassesents,andgrowthparametersincludingweight,height,andheadcircumference.
Discussion
Thisisthefirststudytosupplementneonatesandinfantswithperinatalbraininjurywiththecombinationoffactorsrequiredforhealthybraindevelopment,throughouttheperiodofmaximalbraingrowth.Afurtherstudystrengthisthecomprehensiverangeofoutcomemeasuresemployed.Ifbeneficial,supplementationwithbrainphosphatideprecursorscouldimprovethequalityoflifeofthousandsofchildrenwithperinatalbraininjury.
