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Updated: Apr 17, 2026

Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Do recommended protein intakes improve neurodevelopment in extremely preterm babies?
E A Cester1, F H Bloomfield2, J Taylor3
1Liggins Institute, University of Auckland, Auckland, New Zealand Neonatal Care Unit, University of Turin, Torino, Italy.
Insights
Increasing protein intake for extremely low birthweight (ELBW) babies improved early growth but did not enhance neurodevelopmental outcomes at two years corrected age. Further randomized trials are needed to confirm these findings in ELBW infants.
Area of Science:
- Neonatal nutrition
- Neurodevelopmental outcomes
- Extremely low birthweight (ELBW) infant care
Background:
- Optimal protein intake is crucial for extremely low birthweight (ELBW) infants.
- Improved early growth in ELBW infants may not translate to better long-term neurodevelopmental outcomes.
- Current feeding guidelines aim to meet protein recommendations for enhanced growth.
Purpose of the Study:
- To investigate if meeting recommended protein intakes improves neurodevelopmental outcomes in ELBW infants.
- To assess the association between enhanced protein nutrition, growth, and neurodevelopment.
- To evaluate the impact of a new nutritional policy on ELBW infant outcomes.
Main Methods:
- Prospective cohort study comparing ELBW infants before and after a new nutritional policy.
- Assessment of 45 'before' and 42 'after' infants at 2 years corrected age.
- Utilized Bayley Scales of Infant and Toddler Development (Bayley-III), motor, and sensory impairment evaluations.
Main Results:
- No significant differences in Bayley-III cognitive, motor, or language scores between cohorts.
- Early growth and reduced postnatal faltering were observed with the new policy.
- No differences in visual, hearing, or gross motor impairments (cerebral palsy) were found.
Conclusions:
- Recommended protein intakes in ELBW infants improved early growth but not neurodevelopmental outcomes at 2 years corrected age.
- Randomized controlled trials are necessary to definitively establish the effect of higher early protein intake on neurodevelopment.
- Early nutritional interventions require further investigation for long-term benefits in ELBW populations.
Objective:
To determine whether achieving recommended protein intakes for extremely low birthweight (ELBW; birth weight <1000 g) babies, resulting in better growth, improves neurodevelopmental outcomes.
Design:
A prospective cohort study of ELBW babies before and after the introduction of a new nutritional policy designed to meet international consensus protein recommendations. Forty-five children born 'before' and 42 born 'after' the policy change were assessed at 2 years' corrected age (CA). Associations between nutritional intakes, growth and neurodevelopmental outcome (Bayley Scales of Infant and Toddler Development, Third edition (Bayley-III), motor and sensory impairment) were assessed using univariate and multivariate analyses.
Results:
Bayley-III cognitive (mean (SD) 96 (12) vs 96 (15)), motor (96 (13) vs 95 (15)) or language scores (89 (11) vs 91 (17)) were not different between the 'before' and 'after' cohorts. In the 'before' cohort, motor scores were positively associated with enteral nutrition intakes and growth velocity. Neither were sensory impairments different between groups (visual impairment 4 vs 2, hearing impairment 2 vs 0) nor was the gross motor function classification score (any cerebral palsy 2 vs 1).
Conclusions:
In this prospective cohort study, increasing intravenous and enteral protein intakes to recommended levels in the first month after birth was not associated with improved cognitive, language or motor scores or decreased sensory impairments at 2 years' CA despite significantly improved early growth and reduced postnatal faltering growth. Appropriate randomised controlled trials are needed to answer definitively whether higher early protein intakes improve neurodevelopmental outcome in this population.
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