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Bando N, Sato J, Vandewouw MM, Taylor MJ, Tomlinson C, Unger S, Asbury MR, Law N, Branson HM, O'Connor DL. Early nutritional influences on brain regions related to processing speed in children born preterm: A secondary analysis of a randomized trial. JPEN J Parenter Enteral Nutr 2024. [PMID: 39007723 DOI: 10.1002/jpen.2669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 06/01/2024] [Accepted: 06/16/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Processing speed is a foundational skill supporting intelligence and executive function, areas often delayed in preterm-born children. The impact of early-life nutrition on gray matter facilitating processing speed for this vulnerable population is unknown. METHODS Magnetic resonance imaging and the Wechsler Preschool and Primary Scale of Intelligence-IV Processing Speed Index were acquired in forty 5-year-old children born preterm with very low birth weight. Macronutrient (grams per kilogram per day) and mother's milk (percentage of feeds) intakes were prospectively collected in the first postnatal month and associations between early-life nutrition and the primary outcome of brain regions supporting processing speed were investigated. RESULTS Children had a mean (SD) gestational age of 27.8 (1.8) weeks and 45% were male. Macronutrient intakes were unrelated, but mother's milk was positively related, to greater volumes in brain regions, including total cortical gray matter, cingulate gyri, and occipital gyri. CONCLUSION First postnatal month macronutrient intakes showed no association, but mother's milk was positively associated, with volumetric measures of total and regional cortical gray matter related to processing speed in preterm-born children. This exploratory analysis suggests early-life mother's milk supports processing speed by impacting structural underpinnings. Further research is needed on this potential strategy to improve preterm outcomes.
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Affiliation(s)
- Nicole Bando
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Julie Sato
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
- Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
- Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Marlee M Vandewouw
- Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
- Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Autism Research Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Margot J Taylor
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
- Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
- Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Christopher Tomlinson
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sharon Unger
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, Sinai Health, Toronto, Ontario, Canada
| | - Michelle R Asbury
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nicole Law
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Helen M Branson
- Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Deborah L O'Connor
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, Sinai Health, Toronto, Ontario, Canada
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Bando N, Sato J, Taylor MJ, Tomlinson C, Unger S, Asbury MR, Law N, O'Connor DL. Early-life nutrition is associated with processing speed at age 5 in children born preterm with very low birth weight. J Pediatr Gastroenterol Nutr 2024; 79:140-147. [PMID: 38698666 DOI: 10.1002/jpn3.12232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/27/2024] [Accepted: 04/10/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVE Processing speed is suboptimal among preterm-born children which is of concern as it is a foundational skill supporting higher-level cognitive functions. The study objective was to evaluate associations between early-life nutrition and processing speed in childhood. METHODS Macronutrient and human milk (mother's own, donor) intakes from 137 children born preterm with very low birth weight enrolled in a nutrition feeding trial were included. Processing speed was evaluated at age 5 using the Wechsler Preschool and Primary Scale of Intelligence-fourth edition Processing Speed Index. Associations between early-life nutrition and processing speed were explored through linear regression. RESULTS Children had a mean (standard deviation [SD]) birth gestational age of 28.1 (2.5) weeks, weight of 1036 (260) g and 52% were male. The mean (SD) assessment age was 5.7 (0.2) years. Sex-dependent relationships were identified between first postnatal month protein, lipid and energy intakes and processing speed at 5 years. For females, lower protein (per 0.1 g/kg/d: -0.88, 95% confidence interval [CI]: -1.53, -0.23; p = 0.01) and energy (per 10 kcal/kg/d: -2.38, 95% CI: -4.70, -0.05; p = 0.03) intakes were related to higher processing speed scores. Mother's milk provision was positively associated (per 10% increase: 0.80, 95% CI: 0.22, 1.37; p = 0.01) and donor milk was negatively associated (per 10% increase: -1.15, 95% CI: -2.22, -0.08; p = 0.04) with processing speed scores; no sex differences were observed. CONCLUSIONS First postnatal month nutrition was related to processing speed at age 5 in children born preterm with very low birth weight. Early-life nutrition that supports processing speed may be leveraged to improve later cognitive outcomes for this vulnerable population.
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Affiliation(s)
- Nicole Bando
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Julie Sato
- Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
- Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Margot J Taylor
- Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
- Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Christopher Tomlinson
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sharon Unger
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, Sinai Health, Toronto, Ontario, Canada
| | - Michelle R Asbury
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nicole Law
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Deborah L O'Connor
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, Sinai Health, Toronto, Ontario, Canada
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Moltu SJ, Nordvik T, Rossholt ME, Wendel K, Chawla M, Server A, Gunnarsdottir G, Pripp AH, Domellöf M, Bratlie M, Aas M, Hüppi PS, Lapillonne A, Beyer MK, Stiris T, Maximov II, Geier O, Pfeiffer H. Arachidonic and docosahexaenoic acid supplementation and brain maturation in preterm infants; a double blind RCT. Clin Nutr 2024; 43:176-186. [PMID: 38061271 DOI: 10.1016/j.clnu.2023.11.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/24/2023] [Accepted: 11/26/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Arachidonic acid (ARA) and docosahexaenoic acid (DHA) are important structural components of neural cellular membranes and possess anti-inflammatory properties. Very preterm infants are deprived of the enhanced placental supply of these fatty acids, but the benefit of postnatal supplementation on brain development is uncertain. The aim of this study was to test the hypothesis that early enteral supplementation with ARA and DHA in preterm infants improves white matter (WM) microstructure assessed by diffusion-weighted MRI at term equivalent age. METHODS In this double-blind, randomized controlled trial, infants born before 29 weeks gestational age were allocated to either 100 mg/kg ARA and 50 mg/kg DHA (ARA:DHA group) or medium chain triglycerides (control). Supplements were started on the second day of life and provided until 36 weeks postmenstrual age. The primary outcome was brain maturation assessed by diffusion tensor imaging (DTI) using Tract-Based Spatial Statistics (TBSS) analysis. RESULTS We included 120 infants (60 per group) in the trial; mean (range) gestational age was 26+3 (22+6 - 28+6) weeks and postmenstrual age at scan was 41+3 (39+1 - 47+0) weeks. Ninety-two infants underwent MRI imaging, and of these, 90 had successful T1/T2 weighted MR images and 74 had DTI data of acceptable quality. TBSS did not show significant differences in mean or axial diffusivity between the groups, but demonstrated significantly higher fractional anisotropy in several large WM tracts in the ARA:DHA group, including corpus callosum, the anterior and posterior limb of the internal capsula, inferior occipitofrontal fasciculus, uncinate fasciculus, and the inferior longitudinal fasciculus. Radial diffusivity was also significantly lower in several of the same WM tracts in the ARA:DHA group. CONCLUSION This study suggests that supplementation with ARA and DHA at doses matching estimated fetal accretion rates improves WM maturation compared to control treatment, but further studies are needed to ascertain any functional benefit. CLINICAL TRIAL REGISTRATION www. CLINICALTRIALS gov; ID:NCT03555019.
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Affiliation(s)
- Sissel J Moltu
- Department of Neonatal Intensive Care, Oslo University Hospital, 0424 Oslo, Norway.
| | - Tone Nordvik
- Department of Neonatal Intensive Care, Oslo University Hospital, 0424 Oslo, Norway
| | - Madelaine E Rossholt
- Department of Pediatrics and Adolescence Medicine, Oslo University Hospital, 0424 Oslo, Norway
| | - Kristina Wendel
- Department of Neonatal Intensive Care, Oslo University Hospital, 0424 Oslo, Norway
| | - Maninder Chawla
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, 0424 Oslo, Norway
| | - Andres Server
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, 0424 Oslo, Norway
| | | | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, 0424 Oslo, Norway
| | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, 90185 Umeå, Sweden
| | - Marianne Bratlie
- Department of Pediatrics and Adolescence Medicine, Oslo University Hospital, 0424 Oslo, Norway
| | - Marlen Aas
- Department of Neonatal Intensive Care, Oslo University Hospital, 0424 Oslo, Norway
| | - Petra S Hüppi
- Department of Woman, Child and Adolescent Medicine, University of Geneva, 1211 Geneva, Switzerland
| | - Alexandre Lapillonne
- Department of Neonatal Intensive Care, APHP Necker-Enfants Malades Hospital, Paris University, 75015 Paris, France
| | - Mona K Beyer
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, 0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Tom Stiris
- Department of Neonatal Intensive Care, Oslo University Hospital, 0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ivan I Maximov
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Oliver Geier
- Department of Physics and Computational Radiology, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norwary
| | - Helle Pfeiffer
- Department of Neonatal Intensive Care, Oslo University Hospital, 0424 Oslo, Norway; Department of Pediatric Neurology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
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Bobba PS, Weber CF, Higaki ARA, Mukherjee P, Scheinost D, Constable RT, Ment L, Taylor SN, Payabvash S. Impact of postnatal weight gain on brain white matter maturation in very preterm infants. J Neuroimaging 2023; 33:991-1002. [PMID: 37483073 PMCID: PMC10800683 DOI: 10.1111/jon.13145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/10/2023] [Accepted: 07/14/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND AND PURPOSE Very preterm infants (VPIs, <32 weeks gestational age at birth) are prone to long-term neurological deficits. While the effects of birth weight and postnatal growth on VPIs' neurological outcome are well established, the neurobiological mechanism behind these associations remains elusive. In this study, we utilized diffusion tensor imaging (DTI) to characterize how birth weight and postnatal weight gain influence VPIs' white matter (WM) maturation. METHODS We included VPIs with complete birth and postnatal weight data in their health record, and DTI scan as part of their predischarge Magnetic Resonance Imaging (MRI). We conducted voxel-wise general linear model and tract-based regression analyses to explore the impact of birth weight and postnatal weight gain on WM maturation. RESULTS We included 91 VPIs in our analysis. After controlling for gestational age at birth and time between birth and scan, higher birth weight Z-scores were associated with DTI markers of more mature WM tracts, most prominently in the corpus callosum and sagittal striatum. The postnatal weight Z-score changes over the first 4 weeks of life were also associated with increased maturity in these WM tracts, when controlling for gestational age at birth, birth weight Z-score, and time between birth and scan. CONCLUSIONS In VPIs, birth weight and post-natal weight gain are associated with markers of brain WM maturation, particularly in the corpus callosum, which can be captured on discharge MRI. These neuroimaging metrics can serve as potential biomarkers for the early effects of nutritional interventions on VPIs' brain development.
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Affiliation(s)
- Pratheek S Bobba
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
| | - Clara F Weber
- Social Neuroscience Lab, Department of Psychiatry and Psychotherapy, Lübeck University, Lübeck, Germany
| | - Adrian R Acuna Higaki
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
| | - Pratik Mukherjee
- Department of Radiology and Biomedical Imaging, Bioengineering, University of California, San Francisco, San Francisco, California, USA
| | - Dustin Scheinost
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
| | - R Todd Constable
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
| | - Laura Ment
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sarah N Taylor
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
| | - Seyedmehdi Payabvash
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
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Janson E, Willemsen MF, Van Beek PE, Dudink J, Van Elburg RM, Hortensius LM, Tam EWY, de Pipaon MS, Lapillonne A, de Theije CGM, Benders MJNL, van der Aa NE. The influence of nutrition on white matter development in preterm infants: a scoping review. Pediatr Res 2023:10.1038/s41390-023-02622-1. [PMID: 37147439 DOI: 10.1038/s41390-023-02622-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/16/2023] [Accepted: 03/22/2023] [Indexed: 05/07/2023]
Abstract
White matter (WM) injury is the most common type of brain injury in preterm infants and is associated with impaired neurodevelopmental outcome (NDO). Currently, there are no treatments for WM injury, but optimal nutrition during early preterm life may support WM development. The main aim of this scoping review was to assess the influence of early postnatal nutrition on WM development in preterm infants. Searches were performed in PubMed, EMBASE, and COCHRANE on September 2022. Inclusion criteria were assessment of preterm infants, nutritional intake before 1 month corrected age, and WM outcome. Methods were congruent with the PRISMA-ScR checklist. Thirty-two articles were included. Negative associations were found between longer parenteral feeding duration and WM development, although likely confounded by illness. Positive associations between macronutrient, energy, and human milk intake and WM development were common, especially when fed enterally. Results on fatty acid and glutamine supplementation remained inconclusive. Significant associations were most often detected at the microstructural level using diffusion magnetic resonance imaging. Optimizing postnatal nutrition can positively influence WM development and subsequent NDO in preterm infants, but more controlled intervention studies using quantitative neuroimaging are needed. IMPACT: White matter brain injury is common in preterm infants and associated with impaired neurodevelopmental outcome. Optimizing postnatal nutrition can positively influence white matter development and subsequent neurodevelopmental outcome in preterm infants. More studies are needed, using quantitative neuroimaging techniques and interventional designs controlling for confounders, to define optimal nutritional intakes in preterm infants.
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Affiliation(s)
- Els Janson
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Marle F Willemsen
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Pauline E Van Beek
- Department of Neonatology, Máxima Medical Center, Veldhoven, The Netherlands
| | - Jeroen Dudink
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Ruurd M Van Elburg
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Pediatrics, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Lisa M Hortensius
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Emily W Y Tam
- Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Miguel Saenz de Pipaon
- Neonatology, Instituto de Investigación Sanitaria, La Paz University Hospital-IdiPAZ (Universidad Autonoma), Madrid, Spain
| | - Alexandre Lapillonne
- Department of Neonatology, Necker-Enfants Malades Hospital, University of Paris, Paris, France
| | - Caroline G M de Theije
- Department for Developmental Origins of Disease, University Medical Center Utrecht Brain Center and Wilhelmina Children's Hospital, Utrecht University, 3508 AB, Utrecht, The Netherlands
| | - Manon J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Niek E van der Aa
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
- University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands.
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DiPiero M, Rodrigues PG, Gromala A, Dean DC. Applications of advanced diffusion MRI in early brain development: a comprehensive review. Brain Struct Funct 2023; 228:367-392. [PMID: 36585970 PMCID: PMC9974794 DOI: 10.1007/s00429-022-02605-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/21/2022] [Indexed: 01/01/2023]
Abstract
Brain development follows a protracted developmental timeline with foundational processes of neurodevelopment occurring from the third trimester of gestation into the first decade of life. Defining structural maturational patterns of early brain development is a critical step in detecting divergent developmental trajectories associated with neurodevelopmental and psychiatric disorders that arise later in life. While considerable advancements have already been made in diffusion magnetic resonance imaging (dMRI) for pediatric research over the past three decades, the field of neurodevelopment is still in its infancy with remarkable scientific and clinical potential. This comprehensive review evaluates the application, findings, and limitations of advanced dMRI methods beyond diffusion tensor imaging, including diffusion kurtosis imaging (DKI), constrained spherical deconvolution (CSD), neurite orientation dispersion and density imaging (NODDI) and composite hindered and restricted model of diffusion (CHARMED) to quantify the rapid and dynamic changes supporting the underlying microstructural architectural foundations of the brain in early life.
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Affiliation(s)
- Marissa DiPiero
- Department of Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, 53705, USA
- Waisman Center, University of Wisconsin-Madison, Madison, WI, 53705, USA
| | | | - Alyssa Gromala
- Waisman Center, University of Wisconsin-Madison, Madison, WI, 53705, USA
| | - Douglas C Dean
- Waisman Center, University of Wisconsin-Madison, Madison, WI, 53705, USA.
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, 53705, USA.
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, 53705, USA.
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Zhang Y, Deng Q, Wang J, Wang H, Li Q, Zhu B, Ji C, Xu X, Johnston L. The impact of breast milk feeding on early brain development in preterm infants in China: An observational study. PLoS One 2022; 17:e0272125. [PMID: 36409687 PMCID: PMC9678255 DOI: 10.1371/journal.pone.0272125] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/13/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The prevailing consensus from large epidemiological studies is that breastfeeding is associated with improved IQ and cognitive functioning in later childhood and adolescence. Current research is exploring the association between breastfeeding and early brain development in preterm infants. OBJECTIVE To explore the differences in brain gray matter between breastmilk-fed and formula-fed preterm infants using structural and functional magnetic resonance imaging. METHODS A convenience sample of breastmilk-fed preterm infants(n = 34) and formula-fed infants (n = 22) aged approximately 32 weeks. At near term-equivalent age, MR scanning was performed. Gray matter structural and functional differences between the two groups were assessed using MATLAB software for voxel-based morphometry (VBM) and amplitude of low-frequency fluctuation (ALFF) analysis. RESULTS Maternal and neonatal demographic characteristics showed no significant difference between the two groups. Breastmilk-fed infants had greater regional gray matter volume on MRI than formula-fed infants in multiple brain regions, including the bilateral frontal lobe (BA11, BA46), right temporal lobe (BA37), and left caudate nucleus, at a statistical threshold of p<0.01 (AlphaSim corrected) with a cluster size of >40 voxels. Compared with formula-fed infants, breastmilk-fed infants showed increased brain activation on fMRI in the right superior temporal gyrus (BA41). CONCLUSION Breastmilk-fed infants had greater regional gray matter development and increased regional gray matter function compared with formula-fed infants at near term-equivalent age, suggesting breastmilk feeding in the early period after birth may have some degree of influence on early brain development in preterm infants.
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Affiliation(s)
- Yao Zhang
- Department of Midwifery, School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Qingqi Deng
- Department of Midwifery, School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Jinhua Wang
- Department of Radiology, Children’s Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Hua Wang
- Neonatal Intensive Care Unit, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Qiufang Li
- Neonatal Intensive Care Unit, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Binghua Zhu
- Department of Nursing, The Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Chai Ji
- Department of Radiology, Children’s Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xinfen Xu
- Neonatal Intensive Care Unit, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China,Department of Nursing, Haining Maternal and Child Health Hospital, Haining, Zhejiang, China,* E-mail: (XX); (LJ)
| | - Linda Johnston
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada,* E-mail: (XX); (LJ)
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8
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Xu J, Shin J, McGee M, Unger S, Bando N, Sato J, Vandewouw M, Patel Y, Branson HM, Paus T, Pausova Z, O'Connor DL. Intake of mother's milk by very-low-birth-weight infants and variation in DNA methylation of genes involved in neurodevelopment at 5.5 years of age. Am J Clin Nutr 2022; 116:1038-1048. [PMID: 35977396 PMCID: PMC9535521 DOI: 10.1093/ajcn/nqac221] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 08/09/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Mechanisms responsible for associations between intake of mother's milk in very-low-birth-weight (VLBW, <1500 g) infants and later neurodevelopment are poorly understood. It is proposed that early nutrition may affect neurodevelopmental pathways by altering gene expression through epigenetic modification. Variation in DNA methylation (DNAm) at cytosine-guanine dinucleotides (CpGs) is a commonly studied epigenetic modification. OBJECTIVES We aimed to assess whether early mother's milk intake by VLBW infants is associated with variations in DNAm at 5.5 y, and whether these variations correlate with neurodevelopmental phenotypes. METHODS This cohort study was a 5.5-y follow-up (2016-2018) of VLBW infants born in Ontario, Canada who participated in the Donor Milk for Improved Neurodevelopmental Outcomes trial. We performed an epigenome-wide association study (EWAS) to test whether percentage mother's milk (not including supplemental donor milk) during hospitalization was associated with DNAm in buccal cells during early childhood (n = 143; mean ± SD age: 5.7 ± 0.2 y; birth weight: 1008 ± 517 g). DNAm was assessed with the Illumina Infinium MethylationEPIC array at 814,583 CpGs. In secondary analyses, we tested associations between top-ranked CpGs and measures of early childhood neurodevelopment, e.g., total surface area of the cerebral cortex (n = 41, MRI) and Full-Scale IQ (n = 133, Wechsler Preschool and Primary Scale of Intelligence-IV). RESULTS EWAS analysis demonstrated percentage mother's milk intake by VLBW infants during hospitalization was associated with DNAm at 2 CpGs, cg03744440 [myosin XVB (MYO15B)] and cg00851389 [metallothionein 1A (MT1A)], at 5.5 y (P < 9E-08). Gene set enrichment analysis indicated that top-ranked CpGs (P < 0.001) were annotated to genes enriched in neurodevelopmental biological processes. Corroborating these findings, DNAm at several top identified CpGs from the EWAS was associated with cortical surface area and IQ at 5.5 y (P < 0.05). CONCLUSIONS In-hospital percentage mother's milk intake by VLBW infants was associated with variations in DNAm of neurodevelopmental genes at 5.5 y; some of these DNAm variations are associated with brain structure and IQ.This trial was registered at isrctn.com as ISRCTN35317141 and at clinicaltrials.gov as NCT02759809.
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Affiliation(s)
- Jingxiong Xu
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
| | - Jean Shin
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Meghan McGee
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sharon Unger
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Sinai Health, Toronto, Ontario, Canada
- Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nicole Bando
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Julie Sato
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
- Neuroscience & Mental Health Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Marlee Vandewouw
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
- Neuroscience & Mental Health Program, The Hospital for Sick Children, Toronto, Ontario, Canada
- Autism Research Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Yash Patel
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Helen M Branson
- Division of Neuroradiology, Department of Medical Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Tomas Paus
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine and CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
- Department of Neuroscience, Faculty of Medicine and CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
| | - Zdenka Pausova
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Deborah L O'Connor
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Sinai Health, Toronto, Ontario, Canada
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9
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Sato J, Vandewouw MM, Safar K, Ng DVY, Bando N, O’Connor DL, Unger SL, Pang E, Taylor MJ. Social-Cognitive Network Connectivity in Preterm Children and Relations With Early Nutrition and Developmental Outcomes. Front Syst Neurosci 2022; 16:812111. [PMID: 35465192 PMCID: PMC9022474 DOI: 10.3389/fnsys.2022.812111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/18/2022] [Indexed: 11/13/2022] Open
Abstract
Infants born very low birth weight (VLBW, < 1,500 g) are at a heightened risk for structural brain abnormalities and social-cognitive deficits, which can impair behavioural functioning. Resting-state fMRI, reflecting a baseline level of brain activity and underlying social-cognitive processes, has also been reported to be altered in children born VLBW. Yet very little is known about the functional networks underlying social cognition using magnetoencephalography (MEG) and how it relates to neonatal factors and developmental outcomes. Thus, we investigated functional connectivity at rest in VLBW children and the associations with early nutrition and IQ and behavioural problems. We collected resting-state MEG recordings and measures of IQ and social-cognitive behaviour, as well as macronutrient/energy intakes during initial hospitalisation in 5-year-old children born VLBW (n = 37) compared to full-term (FT; n = 27) controls. We examined resting-state network differences controlling for sex and age at scan. Functional connectivity was estimated using the weighted phase lag index. Associations between functional connectivity with outcome measures and postnatal nutrition were also assessed using regression analyses. We found increased resting-state functional connectivity in VLBW compared to FT children in the gamma frequency band (65–80 Hz). This hyper-connected network was primarily anchored in frontal regions known to underlie social-cognitive functions such as emotional processing. In VLBW children, increased functional connectivity was related to higher IQ scores, while reduced connectivity was related to increased behavioural problems at 5 years of age. These within-group associations were found in the slower frequency bands of theta (4–7 Hz) and alpha (8–12 Hz), frequently linked to higher-order cognitive functions. We also found significant associations between macronutrient (protein and lipid) and energy intakes during the first postnatal month with functional connectivity at preschool-age, highlighting the long-term impacts of postnatal nutrition on preterm brain development. Our findings demonstrate that at preschool-age, VLBW children show altered resting-state connectivity despite IQ and behaviour being in the average range, possibly reflecting functional reorganisation of networks to support social-cognitive and behavioural functioning. Further, our results highlight an important role of early postnatal nutrition in the development of resting-state networks, which in turn may improve neurodevelopmental outcomes in this vulnerable population.
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Affiliation(s)
- Julie Sato
- Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychology, University of Toronto, Toronto, ON, Canada
- Division of Neurosciences and Mental Health, Hospital for Sick Children, Toronto, ON, Canada
- *Correspondence: Julie Sato,
| | - Marlee M. Vandewouw
- Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada
- Division of Neurosciences and Mental Health, Hospital for Sick Children, Toronto, ON, Canada
- Autism Research Centre, Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Kristina Safar
- Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada
- Division of Neurosciences and Mental Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Dawn V. Y. Ng
- Division of Translational Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Nicole Bando
- Division of Translational Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Deborah L. O’Connor
- Division of Translational Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
- Department of Paediatrics, Sinai Health, Toronto, ON, Canada
| | - Sharon L. Unger
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
- Department of Paediatrics, Sinai Health, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Division of Neonatology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Elizabeth Pang
- Division of Neurosciences and Mental Health, Hospital for Sick Children, Toronto, ON, Canada
- Division of Neurology, Hospital for Sick Children, Toronto, ON, Canada
| | - Margot J. Taylor
- Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychology, University of Toronto, Toronto, ON, Canada
- Division of Neurosciences and Mental Health, Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
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10
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Sato J, Vandewouw MM, Bando N, Branson HM, O'Connor DL, Unger SL, Taylor MJ. White matter alterations and cognitive outcomes in children born very low birth weight. Neuroimage Clin 2021; 32:102843. [PMID: 34601309 PMCID: PMC8496319 DOI: 10.1016/j.nicl.2021.102843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 10/25/2022]
Abstract
BACKGROUND Very low birth weight (VLBW) infants are at risk for disrupted white matter maturation, yet little is known about the contributing factors, particularly at preschool-age when cognitive difficulties begin to emerge. We examined white matter microstructure in five-year-old VLBW and full-term (FT) children, and its association with cognitive outcomes and birth weight. METHODS Multi-shell diffusion and MR images were obtained for 41 VLBW (mean birth weight: 1028.6 ± 256.8 g) and 26 FT (3295.4 ± 493.9 g) children. Fractional anisotropy (FA), radial diffusivity (RD), neurite orientation dispersion index (ODI) and density index (NDI) were estimated using diffusion tensor and neurite orientation dispersion and density imaging models. Between-group analyses used a general linear model with group and sex as explanatory variables. Within-group associations between white matter microstructure, cognitive outcomes and birth weight were also investigated. RESULTS VLBW compared to FT children showed lower FA and NDI across widespread white matter regions. Smaller clusters of atypical ODI were also found in VLBW children. Within-group analyses in FT children revealed that lower RD and higher NDI were associated with vocabulary acquisition and working memory. In VLBW children, higher FA and NDI, and lower RD and ODI, were associated with improved processing speed. In both groups, FA was positively associated with birth weight. CONCLUSIONS Our findings demonstrate white matter alterations in young VLBW children, including widespread reductions in axon density that may reflect sustained myelination disruptions. The associations with cognitive outcomes may also highlight which of the VLBW children are at higher risk for later cognitive difficulties.
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Affiliation(s)
- Julie Sato
- Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada; Psychology, University of Toronto, Toronto, Ontario, Canada; Neurosciences & Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Marlee M Vandewouw
- Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada; Neurosciences & Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada; Autism Research Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada; Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Nicole Bando
- Translational Medicine, SickKids Research Institute, Toronto, Ontario, Canada
| | - Helen M Branson
- Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada; Medical Imaging, University of Toronto, Ontario, Canada
| | - Deborah L O'Connor
- Translational Medicine, SickKids Research Institute, Toronto, Ontario, Canada; Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada; Paediatrics, Mount Sinai Health, Toronto, Ontario, Canada
| | - Sharon L Unger
- Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada; Paediatrics, University of Toronto, Toronto, Ontario, Canada; Paediatrics, Mount Sinai Health, Toronto, Ontario, Canada; Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Margot J Taylor
- Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada; Psychology, University of Toronto, Toronto, Ontario, Canada; Neurosciences & Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada; Medical Imaging, University of Toronto, Ontario, Canada; Paediatrics, University of Toronto, Toronto, Ontario, Canada
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11
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McLeod G, Farrent S, Gilroy M, Page D, Oliver CJ, Richmond F, Cormack BE. Variation in Neonatal Nutrition Practice and Implications: A Survey of Australia and New Zealand Neonatal Units. Front Nutr 2021; 8:642474. [PMID: 34409058 PMCID: PMC8365759 DOI: 10.3389/fnut.2021.642474] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 06/24/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Significant global variation exists in neonatal nutrition practice, including in assigned milk composition values, donor milk usage, fortification regimens, probiotic choice and in methods used to calculate and report nutrition and growth outcomes, making it difficult to synthesize data to inform evidence-based, standardized nutritional care that has potential to improve neonatal outcomes. The Australasian Neonatal Dietitians' Network (ANDiN) conducted a survey to determine the degree to which neonatal nutritional care varies across Australia and New Zealand (A&NZ) and to highlight potential implications. Materials and Methods: A two-part electronic neonatal nutritional survey was emailed to each ANDiN member (n = 50). Part-One was designed to examine individual dietetic practice; Part-Two examined site-specific nutrition policies and practices. Descriptive statistics were used to examine the distribution of responses. Results: Survey response rate: 88%. Across 24 NICU sites, maximum fluid targets varied (150–180 mL.kg.d−1); macronutrient composition estimates for mothers' own(MOM) and donor (DM) milk varied (Energy (kcal.dL−1) MOM: 65–72; DM 69–72: Protein (g.dL−1): MOM: 1.0–1.5; DM: 0.8–1.3); pasteurized DM or unpasteurized peer-to-peer DM was not available in all units; milk fortification commenced at different rates and volumes; a range of energy values (kcal.g−1) for protein (3.8–4.0), fat (9.0–10.0), and carbohydrate (3.8–4.0) were used to calculate parenteral and enteral intakes; probiotic choice differed; and at least seven different preterm growth charts were employed to monitor growth. Discussion: Our survey identifies variation in preterm nutrition practice across A&NZ of sufficient magnitude to impact nutrition interventions and neonatal outcomes. This presents an opportunity to use the unique skillset of neonatal dietitians to standardize practice, reduce uncertainty of neonatal care and improve the quality of neonatal research.
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Affiliation(s)
- Gemma McLeod
- Neonatology, Child and Adolescent Health Service, Nedlands, WA, Australia.,Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia.,Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | | | - Melissa Gilroy
- Mater Health Services, Brisbane, QLD, Australia.,Mater Research Institute, University of Queensland, Brisbane, QLD, Australia
| | - Denise Page
- Mater Health Services, Brisbane, QLD, Australia.,Mater Research Institute, University of Queensland, Brisbane, QLD, Australia
| | | | | | - Barbara E Cormack
- Starship Children's Health, Auckland, New Zealand.,Liggins Institute, University of Auckland, Auckland, New Zealand
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