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First nutritional intervention trial on neurodevelopment in infants with suspected Cerebral Palsy

During pregnancy and in the first two years of life the brain grows rapidly. Adequate nutrient intake is essential for healthy brain development.1,2 In case of brain injury, sufficient nutrition is possibly even more crucial as the developing brain is very plastic and may have the capacity to alter its structure and function in response to injury.3,4,5

There is a need for studies on early nutritional interventions aimed at improved neurodevelopmental outcomes in children with Cerebral Palsy (CP). Nutritional intervention at a time the brain displays much neuroplasticity, could potentially increase the capacity of the brain to modify its connections or rewire itself. This study explores whether a novel early nutritional intervention may improve neurodevelopmental outcomes experienced by children with CP.

First trial

Developmental Medicine and Child Neurology published the results of the ‘Dolphin’ trial; Nutritional intervention and neurodevelopmental outcome in infants with suspected cerebral palsy . The Dolphin study is the first trial looking into the effect of a nutritional intervention on the neurodevelopment of infants with suspected CP. To the best of our knowledge this is the first study with a nutritional intervention period of 2 years in this population.

The study investigated whether a nutritional intervention including DHA, choline, and uridine (phospholipid precursors), as well as other nutrients, improved neurodevelopmental outcomes in infants with suspected CP. The Dolphin trial specifically looked at motor, cognitive and language development.

The Dolphin study was a small double-blind randomized controlled trial that was run independently. Nutricia developed and provided the study product. For this trial, 40 infants aged 1 to 18 months with suspected CP were recruited from child development centers in the UK.

Conclusion

There was no statistically significant neurodevelopmental advantage for the treatment group versus the comparison group. Additionally, the authors of the publication conclude that families of infants with suspected CP found a 2-year nutritional supplementation feasible.

Ana Bonouvrié, Senior Scientist at Danone Nutricia Research: “Despite not reaching statistically significant levels, the authors conclude that if replicated, cognitive and language advantage of the treatment group would be of clinically meaningful magnitude.6 As this was a small pilot study, a larger study is needed to get a better understanding of the effect of an early nutritional intervention on cognitive and language development in infants with suspected or diagnosed cerebral palsy. In the end it is our aim to find the best possible nutrition children with CP to ultimately improve quality of life.”

About Cerebral Palsy

Cerebral palsy is one of the most common childhood disabilities, caused by brain damage around birth. Infants are typically diagnosed with CP between 12 and 24 months of age.7 Infants with CP will likely experience a delay in development and growth milestones, affecting motor skills and muscle. From a nutritional perspective, this may result in prolonged feeding times, reduced macro- and micronutrient intake, and failure to grow without adequate nutritional support.

1.
Rosales, F.J., Reznick, J.S., Zeisel, S.H., Understanding the role of nutrition in the brain and behavioral development of toddlers and preschool children: identifying and addressing methodological barriers. Nutr Neurosci. 2009 Oct;12(5):190-202.
2.
Georgieff, M.K., Brunette, K.E., Tran, P.V. Early life nutrition and neural plasticity. Dev Psychopathol. 2015 May;27(2):411-23.
3.
Andrew MJ, et al. Feeding difficulties in children with cerebral palsy. Arch Dis Child Educ Pract Ed 2012; 97: 222–9.
4.
Lucas A, et al. Randomised trial of early diet in preterm babies and later intelligence quotient. BMJ 1998; 317: 1481–7.
5.
Lucas A, et al. Early diet in preterm babies and developmental status at 18 months. Lancet 1990; 335: 1477–81.
6.
Andrew, M.J., Parr, J.R., Montague-Johnson, C., Laler, K., Qi, C., Baker, B., Sullivan, P.B. Nutritional Intervention Trial in Infants with Suspected CP. Developmental Medicine and Child Neurology (2017).
7.
Novak, I., et al. Early, Accurate Diagnosis and Early Intervention in Cerebral Palsy: Advances in Diagnosis and Treatment. JAMA Pediatr. 2017 Sep 1;171(9):897-907.