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首页> 外文期刊>BMC Pediatrics >Optimising nutrition to improve growth and reduce neurodisabilities in neonates at risk of neurological impairment, and children with suspected or confirmed cerebral palsy
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Optimising nutrition to improve growth and reduce neurodisabilities in neonates at risk of neurological impairment, and children with suspected or confirmed cerebral palsy

机译：优化营养以改善具有神经功能障碍风险的新生儿以及疑似或确诊为脑瘫的儿童的生长并减少其神经功能障碍

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Background Neurological impairment is a common sequelae of perinatal brain injury. Plasticity of the developing brain is due to a rich substrate of developing neurones, synaptic elements and extracellular matrix. Interventions supporting this inherent capacity for plasticity may improve the developmental outcome of infants following brain injury. Nutritional supplementation with combination docosahexaenoic acid, uridine and choline has been shown to increase synaptic elements, dendritic density and neurotransmitter release in rodents, improving performance on cognitive tests. It remains elusive whether such specific ‘neurotrophic’ supplementation enhances brain plasticity and repair after perinatal brain injury. Methods/Design This is a two year double-blind, randomised placebo controlled study with two cohorts to investigate whether nutritional intervention with a neurotrophic dietary supplement improves growth and neurodevelopmental outcomes in neonates at significant risk of neurological impairment (the D1 cohort), and infants with suspected or confirmed cerebral palsy (the D2 cohort). 120 children will be randomised to receive dietetic and nutritional intervention, and either active supplement or placebo. Eligible D1 neonates are those born +6 weeks gestation with weight th centile, ≤30+6 weeks gestation and Grade II, III or IV Intra-Ventricular Haemorrhage or periventricular white matter injury, or those born at 31-40+28 weeks gestation, with Sarnat grade I or II or III Hypoxic Ischaemic Encephalopathy or neuroimaging changes compatible with perinatal brain injury. Eligible D2 infants are those aged 1-18 months with a suspected or confirmed clinical diagnosis of cerebral palsy. The primary outcome measure is composite cognitive score on the Bayley Scales of Infant and Toddler Development III at 24 months. Secondary outcomes include visuobehavioural and visual neurophysiological assessments, and growth parameters including weight, height, and head circumference. Discussion This is the first study to supplement neonates and infants with perinatal brain injury with the combination of factors required for healthy brain development, throughout the period of maximal brain growth. A further study strength is the comprehensive range of outcome measures employed. If beneficial, supplementation with brain phosphatide precursors could improve the quality of life of thousands of children with perinatal brain injury. Trial registration Current Controlled trials: ISRCTN39264076 (registration assigned 09/11/2012), ISRCTN15239951 (registration assigned 23/04/2010).
机译：背景技术神经功能障碍是围产期脑损伤的常见后遗症。发育中的大脑的可塑性归因于发育中的神经元，突触元件和细胞外基质的丰富底物。支持这种固有的可塑性的干预措施可以改善脑损伤后婴儿的发育结果。营养补充二十二碳六烯酸，尿苷和胆碱的组合已显示可增加啮齿动物的突触元素，树突密度和神经递质释放，从而改善认知测试的性能。围产期脑损伤后，这种特殊的“神经营养性”补充剂是否能增强大脑的可塑性和修复作用还不清楚。方法/设计这项为期两年的双盲，随机安慰剂对照研究，共有两个队列，旨在研究神经营养饮食补充剂的营养干预是否能改善具有严重神经功能障碍风险的新生儿（D1队列）和婴儿的生长和神经发育结局。患有疑似或确诊的脑瘫（D2队列）。 120名儿童将被随机分配接受饮食和营养干预，以及活性补充剂或安慰剂。符合条件的D1新生儿是指妊娠+6 周出生，体重百分位数，≤30 +6 周出生且II，III或IV级脑室出血或室周白色的新生儿。物质损伤，或妊娠31-40 +28 出生的人，萨尔纳特I级或II级或III级缺氧缺血性脑病或神经影像学改变与围生期脑损伤相适应。符合条件的D2婴儿是1-18个月大的可疑或确诊为脑瘫的临床诊断婴儿。主要结局指标是在24个月时采用Bayley婴幼儿发展测验III的综合认知评分。次要结果包括视行为和视觉神经生理学评估，以及包括体重，身高和头围的生长参数。讨论这是第一项研究，旨在在整个大脑最大生长期间，为健康的大脑发育所需的因素组合补充围生期脑损伤的新生儿和婴儿。进一步的研究优势是所采用的结果测量的综合范围。如果有益的话，补充脑磷脂前体可以改善成千上万围产期脑损伤儿童的生活质量。试用注册当前对照试验：ISRCTN39264076（注册分配为2012年11月11日），ISRCTN15239951（注册分配为23/04/2010）。

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