Integration of parenteral nutrition with galactose may improve neurodevelopmental outcomes for preterm newborns

• Premature newborns may not be considered as though they had not yet been born. • Parenteral nutrition should add galactose to glucose to mirror maternal milk. • Breast milk-like parenteral nutrition may improve premature newborn neurodevelopment. Although 90 % of premature babies survive, there is still a need for interventions to improve motor and cognitive neurodevelopmental outcomes. Breast milk is the universally preferred nutrition for the newborn human infant for its numerous benefits. However, premature newborns, especially extremely preterm (below 28 weeks gestational age), do not have access to milk. Those infants often experience severe illness due to the immaturity of multiple systems, needing parenteral nutrition for the first days in the neonatal intensive care unit. Notably, premature breast milk adjusts to the changing needs of the premature for the lactose and protein content. For those babies that cannot be fed maternal milk due to the prematurity of multiple systems, parenteral nutrition is tailored to mimic a pre-birth condition in that it only delivers dextrose as the carbohydrate source. This paper challenges the notion that premature newborns should be considered as though they had not yet been born. It proposes the hypothesis that early supplementation of parenteral nutrition with galactose—emulating the composition of maternal milk—may help mitigate complications associated with premature brain development. Galactose plays a pivotal role in myelination linked to cognitive development. Controlled clinical and animal model trials are proposed to support the hypothesis that the use of breast milk-like parenteral nutrition can prevent neonatal hypoglycemia while improving neurodevelopment in extremely premature newborns.