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One Extra Gram of Protein to Preterm Infants From Birth to 1800 g: A Single-Blinded Randomized Clinical Trial
Maria Paola Bellagamba1, Elisabetta Carmenati, Rita D'Ascenzo
1*Division of Neonatology, Department of Mother and Child Health, Ospedale Salesi-Azienda Ospedaliero Universitaria Ospedali Riuniti †Department of Medical Sciences, Polytechnic University of Marche, Ancona, Italy.
Insights
Increasing amino acid (AA) and protein intake in preterm infants did not improve growth or neurodevelopment. This study found no significant differences in weight gain or cognitive scores at 2 years corrected age between high-protein and standard-protein groups.
Area of Science:
- Neonatal nutrition
- Pediatric growth and development
- Neurodevelopmental outcomes
Background:
- Extremely low birth-weight infants require precise nutritional support for optimal growth and development.
- Optimizing amino acid (AA) and protein intake during parenteral and enteral nutrition is crucial for preterm neonates.
- Previous studies suggest potential benefits of higher protein intake, but evidence remains inconclusive.
Purpose of the Study:
- To evaluate the impact of increased amino acid (AA) and protein intake on growth and neurodevelopment in extremely low birth-weight infants.
- To compare high protein (HiP) versus standard protein (StP) feeding regimens in preterm infants from birth to 1800g body weight.
- To assess the long-term effects of early nutritional strategies on neurodevelopmental outcomes at 2 years corrected age.
Main Methods:
- Randomized controlled trial involving preterm infants (500-1249g birth weight) assigned to high AA/protein or standard care groups.
- High protein group received 3.5g AA/kg/day parenteral nutrition and 4.6g protein/kg/day enteral nutrition.
- Standard protein group received 2.5g AA/kg/day parenteral nutrition and 3.6g protein/kg/day enteral nutrition. Primary outcome: weight gain to 1800g.
Main Results:
- Cumulative AA/protein intake was significantly higher in the HiP group (223±45 g/kg) compared to the StP group (178±42 g/kg) (P<0.0001).
- No significant differences were observed in weight gain from birth to 1800g (12.6±1.7 g/kg in HiP vs. 12.3±1.6 g/kg in StP; P=0.294).
- Neurodevelopmental outcomes, assessed by Bayley III scores at 24 months corrected age, showed no significant difference between groups (94.0±13.9 in HiP vs. 93.8±12.9 in StP; P=0.92).
Conclusions:
- Increasing amino acid and protein intake during parenteral and enteral nutrition does not enhance growth in preterm infants.
- Higher protein intake in early life does not lead to improved neurodevelopmental outcomes at 2 years corrected age in this cohort.
- Current findings suggest that standard protein intake is sufficient for growth and neurodevelopment in extremely low birth-weight infants.
Objective:
The aim of the study was to evaluate the effect on growth and neurodevelopment of increasing amino acid (AA) during parenteral nutrition and protein intake during enteral nutrition in extremely low birth-weight infants starting from birth to day of reaching 1800 g body weight.
Methods:
We randomized preterm infants with birth weight 500 to 1249 g either to a high AA/protein intake (HiP [high protein]: parenteral nutrition = 3.5 AA, enteral nutrition = 4.6 protein g · kg · day) or to a standard of care group (StP [standard protein]: parenteral nutrition = 2.5 AA, enteral nutrition = 3.6 protein g · kg · day). The primary outcome was weight gain from birth to 1800 g.
Results:
TWO:: hundred twenty-six patients were screened, 164 completed the study and were analyzed (82 StP and 82 HiP). Cumulative AA/protein intake from birth to 1800 g was 178 ± 42 versus 223 ± 45 g/kg in the StP versus HiP group respectively, P < 0.0001.Blood urea was higher in HiP than in StP group both during parenteral and enteral nutrition (P = 0.004).Weight gain from birth to 1800 g was 12.3 ± 1.6 in StP and 12.6 ± 1.7 g · kg · day in HiP group (P = 0.294). We found no difference in any growth parameters neither during hospital stay nor at 2 years corrected age. Bayley III score at 24 months corrected age was 93.8 ± 12.9 in StP group and 94.0 ± 13.9 in the HiP group, P = 0.92.
Conclusions:
Increasing AA/protein intake both during parenteral and enteral nutrition does not improve growth and neurodevelopment of small preterm infants 500 to 1249 g birth weight.
