Increasing Early Protein Intake Is Associated With a Reduction in Insulin‐Treated Hyperglycemia in Very Preterm Infants

Mahaveer, Ajit; Grime, Christopher; Morgan, Colin

doi:10.1177/0884533612438730

Cited by 28 publications

(20 citation statements)

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“…Standardizing and concentrating neonatal PN is particularly effective at optimizing early protein intake. 20 Previous RCTs 14,18 investigating early neonatal PN failed to achieve optimal nutritional intakes. This may explain why the improved neurodevelopmental outcomes seen in large cohort studies 37 were not reproduced.…”

Section: Discussionmentioning

confidence: 99%

“…It has been shown to be effective in optimizing actual protein and energy intake in the PN-dependent period of VPIs. 5,20 .We modified our original standardized concentrated neonatal PN regimen (the control regimen) by increasing the macronutrient (protein, lipid, and glucose) content by ∼30% and so created the Standardized, Concentrated With Added Macronutrients Parenteral (SCAMP) nutrition regimen. 21 We hypothesized that the SCAMP nutrition regimen would improve early head growth.…”

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confidence: 99%

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Postnatal Head Growth in Preterm Infants: A Randomized Controlled Parenteral Nutrition Study

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: Preterm infants dependent on parenteral nutrition are vulnerable to deficits in early postnatal nutritional intake. This coincides with a period of suboptimal head growth. Observational studies indicate that poor nutritional intake is associated with suboptimal head growth and neurodevelopmental outcome. WHAT THIS STUDY ADDS:This study provides randomized controlled trial evidence that head growth failure in the first 4 weeks of life can be ameliorated with early nutritional intervention. Early macronutrient intake can be enhanced by optimizing a standardized, concentrated neonatal parenteral nutrition regimen. abstract BACKGROUND: Early postnatal head growth failure is well recognized in very preterm infants (VPIs). This coincides with the characteristic nutritional deficits that occur in these parenteral nutrition (PN) dependent infants in the first month of life. Head circumference (HC) is correlated with brain volume and later neurodevelopmental outcome. We hypothesized that a Standardized, Concentrated With Added Macronutrients Parenteral (SCAMP) nutrition regimen would improve early head growth. The aim was to compare the change in HC (DHC) and HC SD score (DSDS) achieved at day 28 in VPIs randomly assigned to receive SCAMP nutrition or a control standardized, concentrated PN regimen. METHODS:Control PN (10% glucose, 2.8 g/kg per day protein/lipid) was started within 6 hours of birth. VPIs (birth weight ,1200 g; gestation ,29 weeks) were randomly assigned to either start SCAMP (12% glucose, 3.8 g/kg per day protein/lipid) or remain on the control regimen. HC was measured weekly. Actual daily nutritional intake data were collected for days 1 to 28.RESULTS: There were no differences in demographic data between SCAMP (n = 74) and control (n = 76) groups. Comparing cumulative 28-day intakes, the SCAMP group received 11% more protein and 7% more energy. The SCAMP group had a greater DHC at 28 days (P , .001). The difference between the means (95% confidence interval) for DHC was 5 mm (2 to 8), and DSDS was 0.37 (0.17 to 0.58). HC differences are still apparent at 36 weeks' corrected gestational age. Dr Morgan developed the original concept and designed the study, ensured regulatory approvals, performed some study measurements, data collection and collation, coordinated data analysis, and drafted the initial manuscript; Mr McGowan performed most of the study measurements, data collection, and collation, contributed to data analysis and made study design modifications; Mr Herwitker was involved with study design and regulatory approval, overseeing study PN manufacture, and some data collation; Ms Hart provided the medical statistical support at the design, monitoring, and analytical stages of the study; Dr Turner was involved in study design and data analysis; and all authors approved the final manuscript as submitted. CONCLUSIONS:This trial has been registered with the ISRCTN Register (http:// isrctn.org) (identifier ISRCTN76597892 Improved survival of very preterm infants (VPIs) ha...

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Section: Discussionmentioning

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Postnatal Head Growth in Preterm Infants: A Randomized Controlled Parenteral Nutrition Study

et al. 2014

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“…Hyperkalemia often is reduced, and insulin secretion, known to be stimulated by such amino acids as leucine and arginine, is increased, producing higher plasma insulin concentrations, which are associated with a lower incidence of hyperglycemia and lower time-averaged glucose concentrations [12, 40•, 56–58]. Furthermore, acidosis is much more likely to be the result of abnormal renal function and fluid balance.…”

Section: Aggressive Parenteral Nutrition Of Preterm Infantsmentioning

confidence: 99%

Aggressive Nutrition of the Preterm Infant

2013

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Nutrition of preterm infants should result in growth similar to that of normally growing fetuses of the same gestational age. Unfortunately, most preterm infants are not fed enough to achieve this objective; as a result they are growth restricted by term gestation. Recent studies have demonstrated that early and enhanced “aggressive” nutrition of preterm infants can reduce postnatal growth failure and improve longer-term outcomes, particularly for the brain and its cognitive functions. When preterm infants are fed more aggressively (earlier onset of intravenous and enteral feeding, earlier achievement of full enteral feeding) cumulative energy and protein deficits are reduced and they consistently regain birth weight sooner, the incidence of necrotizing enterocolitis and late-onset sepsis is unchanged or reduced, and they achieve discharge criteria and go home sooner, with overall shorter hospital stays, and have improved anthropometrics by term gestation. More research is needed, however, to determine optimum feeding of preterm infants, particularly during periods of illness and physiological instability.

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“…16 Also, the plasma concentrations of all essential AAs and most nonessential AAs increased with early AA administration and were more in concordance with reference ranges from healthy fetuses or breast fed infants. 16 In addition, early parenteral AA intake is associated with a reduction in insulin-treated hyperglycemia 17 and better long-term neurodevelopmental outcomes. 18 Thus, early PN containing AA supplementation in 24 hours of life has become part of the standard care for VLBW infants.…”

Section: Discussionmentioning

confidence: 99%

Stopping Parenteral Nutrition for 3 Hours Reduces False Positives in Newborn Screening

Tim‐Aroon

Harmon

Nock

et al. 2015

The Journal of Pediatrics

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Increasing Early Protein Intake Is Associated With a Reduction in Insulin‐Treated Hyperglycemia in Very Preterm Infants

Abstract: Increasing early protein intake is associated with a reduction in insulin-treated hyperglycemia in infants <29 weeks' gestation.

Cited by 28 publications

References 42 publications

Postnatal Head Growth in Preterm Infants: A Randomized Controlled Parenteral Nutrition Study

Postnatal Head Growth in Preterm Infants: A Randomized Controlled Parenteral Nutrition Study

Aggressive Nutrition of the Preterm Infant

Stopping Parenteral Nutrition for 3 Hours Reduces False Positives in Newborn Screening

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