Related Experiment Videos
[Post-conceptional age. Effect on protein requirements of premature infants]
G Boehm1, H Senger, D M Müller
1Universitäts-Kinderklinik Leipzig.
Insights
Preterm infants at 37 weeks postconception may not need extra protein in human milk. Current protein intake may exceed their requirements, especially with adequate feeding volumes.
Area of Science:
- Neonatal nutrition
- Pediatric metabolism
- Human milk fortification
Context:
- Preterm infants require specialized nutrition for optimal growth and development.
- Assessing nitrogen balance and serum markers is crucial for understanding nutrient utilization in neonates.
- Human milk fortification is common practice for preterm infants, but optimal levels require further investigation.
Purpose:
- To investigate nitrogen metabolism and serum urea/alpha-amino-nitrogen concentrations in preterm infants at different postconceptional ages.
- To evaluate the impact of human milk fortification on nitrogen balance in preterm neonates.
- To determine if current protein intake recommendations are appropriate for preterm infants nearing term.
Summary:
- Serum urea and alpha-amino-nitrogen levels were higher in preterm infants at 36-37 weeks compared to 32 weeks postconception, despite similar protein intake.
- Elevated renal nitrogen excretion, primarily as urea, was observed in older preterm infants.
- No significant differences in studied parameters were found between preterm infants of different gestational ages at 36-37 weeks postconception.
Impact:
- Findings suggest that protein intake of 3.4 g/kg.day may exceed requirements for preterm infants at or beyond 37 weeks postconception.
- Protein supplementation of human milk may not be necessary after 37 weeks postconception if feeding volumes reach 170 ml/kg.day.
- This research can inform updated guidelines for human milk fortification in late preterm and term-eligible infants.
Abstract:
In 12 preterm infants (mean gestational age: 28.9 weeks; mean birthweight: 1230 g) (Group 1) the serum concentrations of urea and alpha-amino-nitrogen were studied during the 32nd and between the 36th and 37th week of post-conceptional age. In 9 preterm infants with a mean gestational age of 34.6 weeks (mean birthweight: 1860 g) (Group 2) the same parameters were estimated during the 36th or 37th week of postconceptional age. In all male infants (group 1: n = 6; group 2: n = 5) the excretion of nitrogen in urine and stools were measured during a 48 h balance period. During the study all infants were fed with human milk enriched with 3 g of a bovine human milk fortifier (Eoprotin, Milupa AG, Germany) per 100 ml human milk (mean protein intake: 3.4 g/kg.day; mean caloric intake: 132.5 kcal/kg.day). Despite the similar protein and energy intakes on all study days the serum concentrations of urea and alpha-amino-nitrogen were significantly higher during the 36th or 37th postconceptional week if compared to those found during the 32nd postconceptional week. This was accompanied by elevated renal excretion of total nitrogen due to an increased excretion of urea in the older infants. The nitrogen excretions in stools were low during both study periods. During the period 36 and 37 weeks of postconceptional age no differences could be found for all parameters studied between the both groups of different gestational ages. The data of the present study suggest that in preterm infants with postconceptional age of 37 weeks or more protein intakes of 3.4 g/kg.day and more may exceed the requirements of these infants. Thus, supplementation of human milk with protein is not necessary after the 37th week of postconceptional age if feeding volumes of 170 ml/kg.day or more are tolerated.