Impact of early protein and energy intakes on neurodevelopment at 2 years of corrected age in very low birth weight infants: A single-center observational study

Abstract

Introduction Aggressive nutritional strategy, particularly enhancing early provision of energy and protein, has appeared to reduce postnatal growth failure and improve later developmental outcomes. But the amount of macronutrients required remains unclear. The aim of this study was to investigate the impact of protein and energy intakes during the first two weeks after birth on neurodevelopmental outcomes. Methods This retrospective cohort study of very low birth weight infants born between January 2012 and December 2015 was conducted at one tertiary neonatal intensive care unit. The primary outcome was a neurodevelopmental impairment (NDI) at 2 years corrected age defined by a cerebral palsy or a 24 month Ages and Stages Questionnaires score on any of the five domains lower than 2 standard deviation below the mean score. Multivariable logistic regression analysis was used to adjust for perinatal and postnatal confounders. Results Among 245 (73%) infants discharged home alive, 159 (65%) had follow-up at 2 years. Infants with NDI (55/159, 35%) were more likely male gender (67.3% versus 46.2%, P = 0.02) and experienced more patent ductus arteriosus (PDA) ligation (20% versus 5.8%, P = 0.01) than control. After adjusting for confounders, first-week protein intake (OR: 2.27 [CI: 1.07–5.14]; P < 0.05), second-week non-protein energy intake (OR: 1.03 [CI: 1.01–1.05]; P < 0.01) and PDA ligation (OR: 6.81 [1.80–28.46]; P < 0.01) had significant independent association with higher likelihood of NDI at 2 years. Conclusion Providing nutrition above the optimal level may not be beneficial and may even be harmful. These results confirm the recent recommendation to decrease amino acid intakes published in the latest ESPGHAN guidelines.

Early protein intake predicts functional connectivity and neurocognition in preterm born children

“…Protein intakes in our study cohort were largely within this range. In contrast to these findings, another report noted that high protein intake (4 g/kg/day) was associated with neurodevelopmental impairments at 2 years in very low birth weight children 38 . These findings suggest that adequate early protein intake is essential for optimal brain growth, although adverse effects of protein overfeeding cannot be excluded.…”

Nutritional Intake, White Matter Integrity, and Neurodevelopment in Extremely Preterm Born Infants

“…In preterm infants, early parenteral protein intake has been associated with lower M-ABC scores [46], higher odds on cerebral palsy [46], and lower cognitive scores [47]. Additionally, increased early total protein intake was associated with higher odds on neurodevelopmental impairments [14]. On the contrary, several studies show positive associations between total protein intake [3,12] or enteral protein intake [46,48,49] and NDO [15].…”

“…Despite promising associations between nutrient intake and brain development, nutritional effects on NDO remain inconclusive [3,[11][12][13][14][15]. A meta-analysis revealed that increased early enteral nutrition in preterm infants may support survival without neurodevelopmental impairment [16].…”

Targeted Breast Milk Fortification for Very Low Birth Weight (VLBW) Infants: Nutritional Intake, Growth Outcome and Body Composition

“…Preterm infants experience high rates of postnatal growth restriction [1], with a particular need for protein supply for growth and improved neurodevelopmental outcomes [2,3]. Human milk (HM) use is very well tolerated and is acknowledged as ideal nutritional support for improving the survival and long-term outcomes of neonates [4].…”