Closing the gap in our tiniest patients

Could a common nutritional supplement, creatine, greatly reduce risks of brain injury in our tiniest patients, saving them from severe lifelong complications?

While more preterm babies are surviving at earlier ages, many have long-term challenges as a result of impaired brain development or brain injury around the time of birth. Sadly, these conditions require lifelong medical care.

Creatine is essential for healthy brain development in humans. During pregnancy, creatine is transferred from mother to developing baby through the placenta and, when a full-term baby is born, he or she must obtain enough creatine through their diet, or generate their own creatine through their kidneys and liver.

Our researchers have evidence to suggest that a preterm infant cannot generate enough creatine needed for a developing brain, and this may contribute to their poor neurological outcomes.

In an observational study, Dr Stacey Ellery will test this theory by measuring creatine levels in preterm infants. The study protocol, called ‘Understanding Creatine for Neurological Health in Babies (UNICORN)’, has been published in the journal, Frontiers in Physiology.

With collaborators at Capital Coast District Hospital Board in Wellington, New Zealand, Dr Ellery will measure creatine and brain energy levels in 80 premature infants, born between 23 and 36 weeks’ gestation.

“If our theory is right and these babies are low in creatine, providing a creatine supplement to preterm babies could greatly improve their outcomes,” Dr Ellery said.

“We would be bridging the gap during a period of significant brain growth and development until preterm babies are able to generate it by themselves.”

What would the treatment be?

If the study shows that preterm babies are equally deficient in creatine, potentially all preterm babies would receive a dietary supplement. However, if a small number of babies have a deficit, preterm infants would be tested before receiving a supplement.

Creatine has already been successfully trialled in preterm babies for a different condition, which means there are no safety concerns in introducing it as a treatment.

“The next step for the team would be safety trials with a view to creatine becoming a standard nutritional management for preterm infants,” said Dr Ellery.

Importance of creatine during pregnancy

Our previous research has shown a baby’s growth during pregnancy may be dependent on a mother’s level of creatine. The finding prompted a world-first study of 250 pregnant women at Monash Health to determine optimum creatine levels during pregnancy.