By Scott Baltic NEW YORK (Reuters Health) Jan 22 - Results of a randomized, prospective study examining the effect of diet on the growth of infants who sustained perinatal brain injury shows that a high-energy, high-protein diet can significantly enhance brain growth in the first year. The study findings, reported in the January issue of Pediatrics by British researchers, are so decisive that the trial was terminated during the first-stage analysis. The researchers cautioned, however, that all of the infants in the study had serious brain damage, with most of them likely to still have significant neurological sequelae. It remains to be seen whether the higher-energy/protein diet will result in a long-term improvement in the children's cognitive status. Participants, recruited from a neonatal intensive-care unit, had either severe neonatal encephalopathy or a gestational age of 32 weeks or less with white matter disease. Dr. Janet A. Eyre of the University of Newcastle upon Tyne told Reuters that the brain injuries were either from birth asphyxia or from complications of premature birth. Half of the 16 infants in the study (the average-energy group) received a diet providing 100% of the estimated average requirement based on age and birth weight centile. The other 8 infants (the high-energy group) received a diet providing 120% of the estimated average requirement. Nineteen similar neonates without parental consent were also followed and constituted a "no consent" group. For both groups, the diet was ensured through parental training, food diaries and home visits by dietitians. Gastrotomy feeding was not used in any instance. Two measures for brain growth were used: occipitofrontal circumference and axon diameter growth in the corticospinal tract, the latter measured by transcranial magnetic stimulation. At 12 months, the high-energy group had significantly greater occipitofrontal circumference z scores. In contrast, the average-diet group showed a decline in these scores, and the no-consent group showed a more rapid decline. The high-energy group also showed the greatest growth in axonal diameters. One of the questions for the group's ongoing research, Dr. Eyre told Reuters, is whether such infants need more energy because the injured brain can't control the energy supplied to the body efficiently. Pediatrics 208;121:148-156.
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