E-Mail karger@karger.com Original Paper Neonatology 2015;107:68–75 DOI: 10.1159/000368181 Enhanced Nutrient Supply to Very Low Birth Weight Infants is Associated with Improved White Matter Maturation and Head Growth Kenneth Strømmen   a, b Elin W. Blakstad   b, c Sissel J. Moltu   b, d Astrid N. Almaas   b, c Ane C. Westerberg   b, i Inge K. Amlien   e Arild E. Rønnestad   a Britt Nakstad   c Christian A. Drevon   b Atle Bjørnerud   e, f, g Frederic Courivaud   f Per K. Hol   f Marit B. Veierød   b, h Anders M. Fjell   e Kristine B. Walhovd   e Per O. Iversen   b a  Department of Neonatal Intensive Care, Women and Children’s Division, Oslo University Hospital Rikshospitalet, b  Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, c  Akershus University Hospital and Faculty Division AHUS, Institute for Clinical Medicine, d  Oslo University Hospital Ullevål, e  Research Group for Lifespan Changes in Brain and Cognition, Department of Psychology, f  The Intervention Centre, Oslo University Hospital Rikshospitalet, g  Department of Physics, and h  Department of Biostatistics, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, and i  Department of Nutrition, Atlantis Medical University College, Oslo, Norway ity, head circumference growth and decreased mean diffu- sivity (MD) in cerebral white matter (WM) areas, suggesting improved cerebral maturation among infants on the en- hanced nutrient supply. Methods: In this randomized con- trolled trial, infants on the enhanced nutrient supply re- ceived increased amounts of energy, protein, fat, essential fatty acids and vitamin A until discharge. DTI was performed close to term equivalent age. Outcomes were growth veloc- ity, head circumference growth and WM mean diffusivity. Results: Among the 50 included infants, 14 in the interven- tion group and 11 controls underwent a successful DTI. In- fants on the enhanced diet achieved improved growth ve- locity (16.5 vs. 13.8 g/kg/day, p = 0.01) and increased head circumference (Δz score: 0.24 vs. –0.12, p = 0.15). A signifi- cantly lower MD was seen in a large WM area such as the su- perior longitudinal fasciculi (1.19 × 10 –3 vs. 1.24 × 10 –3 mm 2 /s, Key Words Premature infants · Growth and nutrition · Brain imaging · Brain maturation · Diffusion tensor imaging · Mean diffusivity Abstract Background: Extrauterine growth restriction is common among very low birth weight infants (VLBW, BW <1,500 g). Optimal postnatal nutrient supply is essential to limit growth restriction and ensure adequate growth and neurodevelop- ment. Objectives: We compared an enhanced postnatal nu- trient supply to a standard supply and evaluated the effects on growth velocity, head circumference growth and cerebral maturation – the latter by magnetic resonance diffusion ten- sor imaging (DTI). We hypothesized increased growth veloc- Received: May 15, 2014 Accepted after revision: September 3, 2014 Published online: November 14, 2014 Kenneth Strømmen, MD Department of Neonatal Intensive Care, Women and Children’s Division Oslo University Hospital, Rikshospitalet, P.O. Box 4950 Nydalen NO–0424 Oslo (Norway) E-Mail Kenneth.Strommen  @  medisin.uio.no © 2014 S. Karger AG, Basel 1661–7800/14/1071–0068$39.50/0 www.karger.com/neo Downloaded by: UIO - Universitetsbibl.&#44; i. Oslo 128.39.244.113 - 11/14/2014 5:20:43 PM