Early lipid supply and neurological development at one year in very low birth weight (VLBW) preterm infants.

BACKGROUND: The rapid growth of the developing brain during early post-natal life makes it particularly vulnerable to a nutritional deficit. The neurological development of the very low birth weight preterm infant could be related to early lipid supply. AIMS: To evaluate in preterm infants of gestational age ≤ 28 weeks of amenorrhea (WA) the relations between the neurological development determined at a corrected age of one year using the test of Brunet-Lézine and 1) the cumulative intakes of proteins, carbohydrates, lipids and energy during the first 28 days of life and 2) the weight gain in the first 28 days of life. MATERIALS AND METHODS: Study of a mono-centric cohort of 48 premature infants of gestational age ≤ 28 WA consecutively hospitalized and followed longitudinally up to a corrected age of one year. RESULTS: In simple univariate analysis, there was a significant correlation between the developmental quotient (DQ) at a corrected age of one year and the cumulative intake of energy and lipids at 14 days of life (p=0.02, p=0.01, respectively), the number of days to reach the minimum weight (p=0.02) and the weight gain from birth to D28 of life (p=0.04). There was no correlation between the DQ and early intake of proteins or carbohydrates. In multivariate analysis, only the association between the DQ at one year of corrected age and the cumulative lipid intake at 14 days of life remained statistically significant (p=0.04). CONCLUSION: Our study demonstrates the importance of early lipid supply during the first two weeks of life for the neurological development at a corrected age of one year of very low birth weight preterm infants.

Effect of ibuprofen on bilirubin-albumin binding during the treatment of patent ductus arteriosus in preterm infant.

Ibuprofen carries the theoretical risk of increasing bilirubin encephalopathy by displacing bilirubin from albumin binding sites. Indeed, ibuprofen displaces bilirubin from albumin binding site at high concentrations in vitro. The first results in vivo seem to demonstrate no displacement of bilirubin in preterm infants treated by the current recommended doses of 10-5-5 mg/kg/day and when total bilirubin levels are below 10 mg/dL. However, this study does not provide information about possible risks of ibuprofen (IBU) use, when the bilirubin levels are higher than 10 mg/dL or if higher IBU doses are used.

Rapid cortical oscillations and early motor activity in premature human neonate.

Delta-brush is the dominant pattern of rapid oscillatory activity (8-25 Hz) in the human cortex during the third trimester of gestation. Here, we studied the relationship between delta-brushes in the somatosensory cortex and spontaneous movements of premature human neonates of 29-31 weeks postconceptional age using a combination of scalp electroencephalography and monitoring of motor activity. We found that sporadic hand and foot movements heralded the appearance of delta-brushes in the corresponding areas of the cortex (lateral and medial regions of the contralateral central cortex, respectively). Direct hand and foot stimulation also reliably evoked delta-brushes in the same areas. These results suggest that sensory feedback from spontaneous fetal movements triggers delta-brush oscillations in the central cortex in a somatotopic manner. We propose that in the human fetus in utero, before the brain starts to receive elaborated sensory input from the external world, spontaneous fetal movements provide sensory stimulation and drive delta-brush oscillations in the developing somatosensory cortex contributing to the formation of cortical body maps.