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What should be the protein target for adjustable Human Milk fortification in premature infants?
Bayram Ali Dorum1, Hilal Ozkan2, Salih Cagri Cakir3
1Bayram Ali Dorum, Medical Doctor, Division of Neonatology, Department of Pediatrics, Uludag University Medical Faculty, Nilufer-Bursa, Turkey.
Insights
The adjustable fortification (ADJ) regimen significantly enhanced physical growth rates in premature infants compared to standard fortification (STD). While higher protein intake is beneficial, some infants still require supplementation to meet growth and blood urea nitrogen (BUN) targets.
Area of Science:
- Neonatal nutrition
- Pediatric growth and development
Background:
- Premature infants require specialized nutritional support for optimal growth.
- Standard fortification (STD) may not always meet the complex nutritional needs of very preterm infants.
- Adjustable fortification (ADJ) offers a tailored approach to nutrient delivery.
Purpose of the Study:
- To evaluate the impact of an adjustable fortification (ADJ) regimen on growth parameters in preterm infants.
- To assess the protein supplementation required to achieve target blood urea nitrogen (BUN) levels with the ADJ regimen.
Main Methods:
- Retrospective study comparing two groups of preterm infants (≤32 weeks gestational age) fed human milk.
- Group I received standard fortification (STD).
- Group II received the adjustable fortification (ADJ) regimen between 2011 and 2016.
Main Results:
- The ADJ group showed significantly higher daily weight gain and weekly head circumference (HC) increase.
- Infants in the ADJ group had higher weight and HC at 40 weeks corrected age.
- At one year corrected age, growth parameters were similar between groups; 63% of ADJ infants needed protein supplementation up to 1.6 g/day.
Conclusions:
- The ADJ regimen improves physical growth rates in preterm infants in the NICU and post-discharge.
- Increased protein supplementation (up to 1.6 g/day) is safe, feasible, and beneficial.
- Targeted growth and BUN levels may not always be achieved despite optimized protein intake.
Objective:
To assess the short- and long-term effects of the adjustable fortification (ADJ) regimen on growth parameters in premature infants and to evaluate the amount of protein supplements given to reach the targeted blood urea nitrogen (BUN) levels.
Methods:
In this retrospective study, preterm babies who were born at ≤32 weeks gestational age and fed with human milk, were evaluated in two groups. Infants in Group-I were fed only standard fortification (STD). Infants in Group-II were fed the ADJ regimen. The study was conducted between 2011 and 2016.
Results:
There were 123 infants in the STD group and 119 in the ADJ group. The mean gestational age of the patients in Group-I was 29.7±1.8 weeks, and mean birth weight was 1266.1±347.1 g. The mean gestational age of the patients in Group-II was 29.5±1.9 weeks, and the mean birth weight was 1217.5±345.5 g. The daily increase in weight and weekly increase in HC were significantly higher in the ADJ group infants. Weight and HC of infants in the ADJ group were significantly higher at 40 weeks. At one year corrected age, weight, length, and HC measurements of both groups were similar. In Group-II, 63% of patients required additional protein supplementation up to 1.6 g/day to achieve the target BUN levels.
Conclusion:
A higher protein intake through the ADJ regimen improves the physical growth rate of premature infants in the NICU and after discharge. However, sometimes, the targeted growth and BUN values cannot be achieved despite the administration of protein at the recommended increased doses. Increasing protein supplementation up to 1.6 g/day is safe, feasible, and beneficial for these infants.
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