Preterm Nutrition and Brain Development

Author: Janice Man  

Editors: Dr Jenneffer Tibaes, Dr Ramya Rajaram, Sarah Anderson, Sarah Armes 

Acknowledgements: NNEdPro Global Institute for Food, Nutrition and Health; International Academy of Nutrition Educators (IANE); BMJ Nutrition, Prevention & Health; Authors of the Article – Chiara Nava, Enrica Lupo, Gianluca Lista.

Premature birth is associated with long-term brain development challenges, as the preterm brain is very vulnerable during the early postnatal period. Proper nutrition, especially from breast milk, plays a critical role in promoting brain development and may improve cognitive outcomes later in life. However,  because breast milk alone does not fully meet the nutritional needs of preterm infants, specialised formulas and fortifiers are often used. The effects of these interventions on brain development remain unclear. Ongoing research investigates the effect of specific dietary components, such as prebiotics, fats, and vitamins, on brain development and long-term neurological health. 

This study by Nava et al. (2024) examines the impact of prematurity on brain development, focusing on the risks of short-term injuries and long-term neurodevelopmental impairments, particularly in infants born before 28 weeks of gestation. It emphasises the crucial role of nutrition during the "first thousand days" (from conception to age 2), a critical period for brain growth. The study highlights how undernutrition, especially in infants with very low birth weight, can hinder brain development and lead to delays in brain maturation. The goal is to review recent research on how early nutrition influences the development and long-term outcomes of the preterm brain. 

Key Findings 

Human Milk (HM): HM is the gold standard for infant nutrition and is linked to better brain development and cognitive outcomes in term infants. These benefits are attributed to both its nutrient content and the mother-child interaction it promotes. HM intake during NICU hospitalisation is associated with better brain development among preterm infants, as shown on MRI scans. However, findings are inconsistent across studies due to methodological issues. 

HM Fortification: Since HM alone does not fulfil the nutritional requirements of most preterm infants, cow’s milk-based fortifiers are commonly used and help support growth (weight, length, head size). However, current evidence does not confirm their effect on long-term brain development, highlighting the need for better-designed studies. 

Preterm Formula: Nutrient-enriched formulas for preterm infants (with added nutrients like LCPUFAs, choline, and sphingolipids) have been linked to improved brain structure, growth, and cognitive outcomes in early studies. However, more recent trials have shown mixed or no significant effects, likely due to differences in timing, nutrient composition, and study populations. 

Key Nutrients (e.g., DHA, HMOs): Certain nutrients, such as DHA, show promise in improving white matter development and reducing brain injuries when given early, while others, like HMOs, have shown benefits on growth and immune health but lack direct clinical evidence of cognitive benefits. More research is needed to clarify their roles in neurodevelopment. 

Nutritional intake – Implications  

Recent research suggests that higher caloric and fat intake during the first two weeks of life in preterm infants is associated with reduced brain damage and improved brain development. This early nutritional support is linked to healthier brain structure and better overall development by 18 months of age. For infants who already have brain injuries, a diet rich in energy and protein may help support their growth and recovery. Overall, early nutrition is crucial for both preventing and addressing neurological complications in preterm infants. 

Conclusion 

As advancements in neonatology have improved the survival rates of premature infants, there is a growing focus on preventing long-term neurological issues, particularly through early nutrition. Breast milk is the ideal source of nutrition, promoting brain development and better cognitive outcomes in childhood. In cases where breast milk is unavailable, specially formulated preterm formulas enriched with essential nutrients may offer benefits. Ongoing research is needed to fully understand how specific nutrients affect the development of preterm infants' brains and their long-term health. 

For more details, read the full study here.  

References 

Nava, C., Lupo, E., & Lista, G. (2025). Preterm nutrition and brain development. BMJ Nutrition, Prevention & Health. https://doi.org/10.1136/bmjnph-2023-000749