Effects of High versus Standard Early Protein Intake on Growth of Extremely Low Birth Weight Infants

Abstract

Objectives: Early provision of protein has been shown to limit catabolism and could improve growth. Our objective was to determine whether early aggressive protein intake improved growth outcomes of extremely low birth weight (ELBW) infants. Patients and Methods: ELBW infants were included in the study if they had no major congenital anomalies or renal failure and were still hospitalized at 36 weeks postmenstrual age. In 25 infants (HP) the early protein intake was planned to be 20% greater than in 31 historical controls (SP). Results: The 2 groups were similar in the baseline characteristics. The mean protein intake during the first 14 days of life was significantly greater in the HP group (3.1 AE 0.2 vs 2.5 AE 0.2 g/kg/d; P<0.0001). HP group showed lower postnatal weight loss (À3.1%; 95% confidence interval [CI] À5.9, À0.2) and earlier regain of birth weight (À4.1 days; 95% CI À6.6, À1.7). Mean blood urea nitrogen and bicarbonate levels were similar; mean serum glucose level was lower in the HP group (À21,7 mg/dL; 95% CI À41.9,À1.5). HP infants had a reduced fall in weight z score (À0.57; 95% CI À1.01, À0.12) and in length z score (À0.51; 95% CI À0.97, À0.05) from birth to discharge. Conclusion: Early high protein intake was associated with improved weight and length growth outcomes at discharge. These findings highlight the benefits of aggressive protein intake immediately after birth. JPGN 44:124-129, 2007.

Brief Parenteral Nutrition Accelerates Weight Gain, Head Growth Even in Healthy VLBWs

“…[26]. Research focused on providing earlier parenteral nutrition, such as intravenous amino acids, has shown a beneficial impact on growth of VLBW infants [27]. For example, Poindexter reported that early provision of amino acids was associated with significantly better growth at 36 weeks postmenstrual age.…”

“…In the Poindexter study, subjects took on average 32–34 days to reach 110 kcal/kg/day enteral feeding, and were administered parenteral nutrition for on average 32 days [28]. In the Maggio study, subjects took on average 24–27 days to reach 150 ml/kg/day enteral feeding, and were administered parenteral nutrition for 24–27 days [27]. Even the recent studies shown in a meta-analysis by Moyses [9] on the effect of parenteral nutrtion on growth, show that time to full feeds took an average of 15 to 33 days [29]–[33].…”

Aggressive Nutrition of the Preterm Infant

“…This seems to be true immediately after birth [27, 28] and for infants who are physiologically unstable as a result of significant medical and surgical treatment [31]. Principal effects of earlier/higher rates of IV amino acid administration include increased weight gain, increased weight at discharge, and reduced growth restriction at term gestation [32–36]. A recent meta-analysis and other specific studies of early parenteral nutrition revealed that early parenteral nutrition of preterm infants provides a positive benefit for short term growth outcome and does not increase morbidity or mortality [37•, 38, 39].…”

Fatal Effects of a Neonatal High-Protein Diet in Low-Birth-Weight Piglets Used as a Model of Intrauterine Growth Restriction

“…Indeed, special caution is required with regard to the amount of protein-enriched formula given to IUGR infants during the first week of life in view of the risk of metabolic overloading due to the immaturity of most tissue functions, particularly when IUGR is associated with prematurity [31,32] . Recent recommendations include progressive protein increase from the first hours of life to improve nitrogen balance and reduce postnatal growth retardation [33] .…”