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Does more protein in the first week of life change outcomes for very low birthweight babies?

Barbara E Cormack1, Frank H Bloomfield, Anne Dezoete

  • 1National Women's Health, Auckland City Hospital, Auckland, New Zealand. BCormack@adhb.govt.nz

Journal of Paediatrics and Child Health
|June 11, 2011
PubMed

Insights

Revised intravenous nutrition (IVN) in premature infants did not significantly impact growth or neurodevelopment. Early enteral protein intake, however, showed a positive association with improved neurodevelopmental outcomes in these vulnerable infants.

Area of Science:

  • Neonatology
  • Nutritional Science
  • Pediatric Neurodevelopment

Background:

  • Revised nutrient intake recommendations for premature infants (<1500g) prompted reformulation of intravenous nutrition (IVN) solutions.
  • The goal was to deliver recommended nutrient intakes (RNI) in a restricted volume, minimizing non-nutritional fluid administration.
  • An audit was conducted to evaluate the impact of these IVN changes on nutritional delivery, growth, and clinical and neurodevelopmental outcomes.

Purpose of the Study:

  • To assess if reformulated IVN solutions achieved revised RNI in infants <1500g.
  • To determine the influence of these IVN changes on infant growth, clinical status, and neurodevelopmental outcomes at 18 months corrected age.
  • To explore the relationship between early nutritional intake and long-term neurodevelopmental results.

Main Methods:

  • A comparative study of two cohorts (n=40 each) of infants <1500g, categorized as 'before' and 'after' IVN reformulation.
  • Data collected included nutritional intake (first 30 days), growth parameters, and clinical outcomes.
  • Neurodevelopmental assessment utilized the Bayley III at 18 months corrected age.

Main Results:

  • Infants receiving the reformulated IVN ('after' group) had significantly lower fluid intake (105 vs. 132 mL/kg/day) but higher protein intake (3.2 vs. 2.4 g/kg/day) in the first week.
  • No significant differences were observed in clinical outcomes, growth z-scores at 4 weeks, or neurodevelopmental scores at 18 months corrected age between the groups.
  • Higher enteral protein intake in the first two weeks was positively correlated with cognitive (r=0.13) and motor (r=0.27) neurodevelopmental scores.

Conclusions:

  • The reformulated IVN regimen successfully delivered nutrient intakes closer to RNI but did not lead to significant improvements in growth or neurodevelopmental outcomes at 18 months corrected age.
  • Early enteral protein intake in the first two weeks of life emerged as a significant positive predictor of neurodevelopmental outcomes.
  • These findings underscore the importance of early enteral nutrition, particularly protein, for optimizing brain development in premature infants.
Abstract

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