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Effect of Differential Enteral Protein on Growth and Neurodevelopment in Infants <1500 g: A Randomized Controlled
Shivani Dogra1, Anup Thakur, Pankaj Garg
1Department of Neonatology, Institute of Child Health, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India.
Insights
Higher protein intake in preterm infants improved head growth and weight gain by 40 weeks postmenstrual age (PMA). However, this enhanced nutrition did not show long-term benefits in growth or neurodevelopment at 12-18 months corrected age.
Area of Science:
- Neonatal nutrition
- Pediatric growth and development
Background:
- Preterm infants (<32 weeks or 1500g) are at risk for growth faltering.
- Optimizing nutrition, particularly protein intake, is crucial for their development.
Purpose of the Study:
- To investigate if higher enteral protein intake improves head growth at 40 weeks postmenstrual age (PMA) in preterm infants.
- To assess the impact of increased protein on weight gain and length in this vulnerable population.
Main Methods:
- A randomized controlled trial involving 120 preterm infants.
- Infants were assigned to receive either higher (Group A) or standard (Group B) enteral protein fortification of expressed breast milk.
- Protein intake was monitored, and head circumference, length, and weight gain were measured up to 40 weeks PMA.
Main Results:
- Group A demonstrated significantly higher weekly occipitofrontal circumference gain (0.66 cm/week vs. 0.60 cm/week) and weight growth velocity (11.95 g/kg/day vs. 10.78 g/kg/day) compared to Group B.
- No significant differences in length gain were observed between the groups.
- Growth indices and neurodevelopmental outcomes at 12-18 months corrected age were similar in both groups.
Conclusions:
- Fortifying expressed human milk with higher protein content enhances head growth and weight gain in preterm infants by 40 weeks PMA.
- These short-term nutritional benefits do not translate into improved long-term growth or neurodevelopmental outcomes at 12-18 months corrected age.
Objective:
The aim of the study was to determine whether higher enteral protein intake leads to improved head growth at 40 weeks postmenstrual age (PMA) in preterm infants <32 weeks or 1500 g.
Methods:
Randomized controlled trial in which 120 infants were assigned to either group A with higher enteral protein intake achieved by fortification with higher protein containing fortifier (1 g/100 mL expressed breast milk) or to group B with lower enteral protein intake where fortification was done with standard available protein fortifier (0.4 g /100 mL expressed breast milk).
Results:
The mean (standard deviation) protein intake was higher in group A as compared to group B; 4.2 (0.47) compared with 3.6 (0.37) g · kg · day, P < 0.001. At 40 weeks PMA, the mean (standard deviation) weekly occipitofrontal circumference gain was significantly higher in group A as compared to group B; 0.66 (0.16) compared with 0.60 (0.15) cm/week (mean difference 0.064, 95% confidence interval [0.004-0.123], [P = 0.04]). Weight growth velocity in group A was 11.95 (2.2) g · kg · day as compared to 10.78 (2.6) g · kg · day in group B (mean difference 1.10, 95% confidence interval [0.25-2.07], [P = 0.01]). No difference was observed in the length between the 2 groups. There was no difference in growth indices and neurodevelopmental outcomes at 12 to 18 months corrected age in the 2 groups.
Conclusions:
Fortification of expressed human milk with fortifier containing higher protein results in better head growth and weight gain at 40 weeks PMA in preterm infants <32 weeks or 1500 g without any benefits on long-term growth and neurodevelopment at 12 to 18 months corrected age (CTRI/2014/06/004661).
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