Protein Requirements in Preterm Infants: Effect of Different Levels of Protein Intake on Growth and Body Composition

Randomized trial of enteral protein and energy supplementation in infants less than or equal to 1250 g at birth

“…Olsen et al 25 showed an association between increased protein intake and improved growth velocity in regression analysis of a cohort consisting infants from six neonatal intensive care units. Embleton and Cooke 16 also found that discharge weight, length and head circumference were significantly related to higher proteincontaining formulas. Furthermore, our observation that the protein intake of 3.5 g kg À1 per day in our P/E group, which was associated with improved postnatal growth, is consistent with the published literature.…”

“…Furthermore, our observation that the protein intake of 3.5 g kg À1 per day in our P/E group, which was associated with improved postnatal growth, is consistent with the published literature. [14][15][16]25,26 Our study was limited by the small number of infants enrolled, but, as significant differences in growth are seen despite the limited number of infants, we believe that this observation is clinically significant. Nevertheless, it is possible with a larger sample size that growth rates would not have differed between groups or that days on steroids would be significantly different between groups.…”

“…18 Our findings of the importance of the type of calories supplied for in-hospital preterm growth have been emphasized by other investigators. [14][15][16][24][25][26][27][28][29][30] In 1998, Carlson and Zeigler 24 published a longitudinal study of 51 preterm infants and their protein intake, energy intake and subsequent growth. Regression analysis suggested that protein intake related positively to growth.…”

“…13 However, several clinical trials examining protein-enriched formulas for low birth weight infants have shown improved growth with higher concentrations of protein. [14][15][16] Therefore, we chose to study the effect of energy supplementation on growth compared with the effect of a multinutrient supplement that provided increased protein and energy intake in smaller infants with birth weights (BWs) p1250 g. We hypothesized that the nutritional intervention of a combined protein and energy supplement would support better in-hospital growth than energy supplementation alone in infants with a BW p1250 g. A randomized non-masked trial including both human-milk-and formula-fed infants was undertaken to assess the nutritional intervention of protein and energy as compared with energy alone for those VLBW infants who were growing below the average intrauterine rate of 15 g kg À1 per day 17 or who had failed to regain BW in the first 2 weeks of life.…”

Dietary proteins and IGF I levels in preterm infants: determinants of growth, body composition, and neurodevelopment

“…Yet there is a need of supportive evidence as to which ratio should be maintained at specific points in time. Several studies found that when preterm infants were on complete enteral nutrition increasing the protein/energy ratio above 3 g protein/100 kcal did not improve fat free mass accretion compared to a ratio of 2.7-2.8 g protein/100 kcal (61,64). To our knowledge studies conducted so far have not assessed the effects on body composition of various protein/energy ratios in the first 2 wk of life.…”