Protein supplementation of human milk for promoting growth in preterm infants

Amissah, Emma A; Brown, Julie; Harding, Jane E

doi:10.1002/14651858.cd000433.pub3

Cited by 19 publications

(20 citation statements)

References 79 publications

(16 reference statements)

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“…2 Recommendations for the type of nutrition (colored horizontal lines) from birth until 6 months corrected age. Vertical dotted lines represent "transition periods" from 32 to 34 weeks postconceptional age to term age when energy intake may be (gradually) lowered to 115 kcal kg −1 day −1 with a protein intake of ≥ 3 g kg −1 day −1 , provided that growth is age appropriate (i.e., 10-15 g kg −1 day −1 for at least 1 week) [45,47] amount of energy from 32-34 weeks postconceptional age onward, high-protein supplies (≥ 3 g kg −1 day −1 ) resulting in a higher protein-to-energy (P:E) ratio must be maintained to meet the requirements for linear growth and brain development [47,68]. Prolongation of human milk fortification with protein until term age or use of a protein-but not energyfortified formula may be considered during this period.…”

Section: Part B: Practical Nutritional Suggestions From 32-34 Weeks Postconceptional Age To Term Agementioning

confidence: 99%

Improving long-term health outcomes of preterm infants: how to implement the findings of nutritional intervention studies into daily clinical practice

et al. 2021

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Preterm-born children are at risk for later neurodevelopmental problems and cardiometabolic diseases; early-life growth restriction and suboptimal neonatal nutrition have been recognized as risk factors. Prevention of these long-term sequelae has been the focus of intervention studies. High supplies of protein and energy during the first weeks of life (i.e., energy > 100 kcal kg−1 day−1 and a protein-to-energy ratio > 3 g/100 kcal) were found to improve both early growth and later neurodevelopmental outcome. Discontinuation of this high-energy diet is advised beyond 32–34 weeks postconceptional age to prevent excess fat mass and possible later cardiometabolic diseases. After discharge, nutrition with a higher protein-to-energy ratio (i.e., > 2.5–3.0 g/100 kcal) may improve growth and body composition in the short term.Conclusion: Preterm infants in their first weeks of life require a high-protein high-energy diet, starting shortly after birth. Subsequent adjustments in nutritional composition, aimed at achieving optimal body composition and minimizing the long-term cardiometabolic risks without jeopardizing the developing brain, should be guided by the growth pattern. The long-term impact of this strategy needs to be studied. What is Known:• Preterm infants are at risk for nutritional deficiencies and extrauterine growth restriction.• Extrauterine growth restriction and suboptimal nutrition are risk factors for neurodevelopmental problems and cardiometabolic disease in later life. What is New:• Postnatally, a shorter duration of high-energy nutrition may prevent excess fat mass accretion and its associated cardiometabolic risks and an early switch to a protein-enriched diet should be considered from 32-34 weeks postconceptional age.• In case of formula feeding, re-evaluate the need for the continuation of a protein-enriched diet, based on the infant’s growth pattern.

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Section: Part B: Practical Nutritional Suggestions From 32-34 Weeks Postconceptional Age To Term Agementioning

confidence: 99%

Improving long-term health outcomes of preterm infants: how to implement the findings of nutritional intervention studies into daily clinical practice

et al. 2021

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“…In total, 160 quantitative primary studies were synthesised in the 17 SRs, all of which were RCTs or quasi-RCTs. Nine SRs (3,(13)(14)(15)(16)(17)(18)(19)(20) were published in the late 3 years (2018-2020), 5 SRs (21)(22)(23)(24)(25) were between year 2016 to year 2017 and only 3 SRs (26-28) were from year 2007, year 2010 and year 2014. , criteria 2 (duplicate study selection and data extraction), criteria 6 (characteristics of the included studies provided), criteria 7 (scienti c quality of the included studies assessed and documented), and criteria 8 (scienti c quality of the included studies used appropriately in formulating conclusions). The least met AMSTAR criteria was criteria 10 (likelihood of publication bias assessed) owing to the small number of the primary quantitative studies included in several SRs (3, 14, 16, 18-22, 27, 28).…”

Section: Characteristic and Quality Assessment Of Included Srsmentioning

confidence: 99%

“…Seven SRs (13,15,17,19,21,23,26) concluded that there were positive effects to health improvement as a result of the extra supplementation in breast milk or formula. They were prebiotics, protein, arginine, vitamin D, and probiotics which were added to the feeding of preterm infants at a particular dose.…”

Section: Positivementioning

confidence: 99%

“…All the synthesised evidence was graded as low quality apart from the rate of fungal sepsis. Amissah et al (19) reported the effect of protein supplementation on the feeding of preterm infants. Although it could promote physical growth in a short time, the extra protein increased the renal workload and extended the duration of hospitalisation.…”

Section: Positivementioning

confidence: 99%

“…Fourteen SRs(3,13,14,16,(18)(19)(20)(21)(22)(24)(25)(26)(27)(28) were Cochrane SRs and 3 SRs(15,17,23) were conventional ones. As for the number of studies included, only 6 SRs (13, 15, 23-26) incorporated more than 10 primary studies with a relatively larger sample size.…”

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confidence: 99%

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Effectiveness of Feeding Supplementation in Preterm Infants: An Overview of Systematic Reviews

Tao

Yang

et al. 2020

Preprint

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BackgroundPreterm infants have higher nutrition needs than term infants. The effectiveness of various feeding supplementation was assessed by the improvement of health outcomes in single specific systematic reviews (SRs). The aim of this review is to summarise these SRs to provide comprehensive evidence on the effectiveness of these interventions for preterm infants. MethodsA literature search was conducted in the PUBMED, EMBASE, Science Direct, Cochrane library, Web of Science, and Wiley online library. SR selection followed clear inclusion and exclusion criteria. Data extraction was performed by using the pre-designed tables and quality assessment was done by the AMSTAR tool. ResultsSeventeen SRs were included in the review. Fifteen kinds of feeding supplementation were reported in the SRs. The effectiveness of the interventions was defined as positive, having no impact, or inconclusive. Lactoferrin, probiotic, prebiotic, vitamin D, protein, and arginine were concluded to be positive; inositol, iodine, fat, glutamine, and long chain polyunsaturated fatty acid (LCPUFA) were concluded to have no impact; results for prebiotic (for prevention of hyperbilirubinaemia), carbohydrate, multi-nutrient, taurine, calcium, and phosphorus were inconclusive. All the SRs included were graded as being of high quality. ConclusionsSupplements with positive effects on health improvement were considerable to add to the feeding of preterm infants. More well-designed large RCTs are still needed to address the unsolved problems in the SRs concluded as having no impact or where the results were inconclusive.

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Higher Energy, Lipid, and Carbohydrate Provision to Very Low‐Birth‐Weight Infants Is Differentially Associated With Neurodevelopment at 18 Months, Despite Consistent Improvements in Weight Gain

Bishara

Asbury

et al. 2021

J Parenter Enteral Nutr

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Background:The impact of suboptimal intakes on neurodevelopment of very low-birth-weight (VLBW, <1500 g) infants, particularly those born small for gestational age, <26 weeks, <1000 g, or with morbidities is not well defined. We investigated how macronutrient/energy intakes are associated with growth and neurodevelopment among VLBW infants, adjusted for the aforementioned vulnerabilities. Our hypothesis was that higher nutrient intakes would be positively associated with weight gain and neurodevelopment. Methods: Daily macronutrient/energy intakes and weekly weights from birth until 36 +0 weeks were collected prospectively from VLBW infants (n = 302) enrolled in a previous trial (ISRCTN35317141). Neurodevelopment was assessed by the Bayley-III at 18 months' corrected gestational age. Relationships between quartiles of macronutrient/energy intakes, growth, and neurodevelopment were assessed. Results: Infants born <1000 g, <26 weeks, or with morbidities had lower nutrient intakes and slower growth than infants born ≥1000 g, ≥26 weeks, or with no morbidities, respectively (P < 0.05). Higher quartiles of energy, lipid, and carbohydrate intakes were positively associated with growth velocity (P = <0.0001-0.007); no association was observed for protein intake. Energy, protein-to-energy ratio and lipid intakes were associated with cognitive scores (P = 0.001-0.004); however, intakes within the second and third quartiles were generally associated with the highest cognitive scores. No nutrient intakes were associated with language or motor scores across the entire study period. Conclusion: Smaller, more immature VLBW infants and those with morbidity have the greatest risk of poor nutrition and growth. Increasing macronutrient/energy intakes are generally associated with improved weight gain, but not necessarily improved neurodevelopment.

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Protein supplementation of human milk for promoting growth in preterm infants

Abstract: Protein supplementation of human milk for promoting growth in preterm infants (Review)

Cited by 19 publications

References 79 publications

Improving long-term health outcomes of preterm infants: how to implement the findings of nutritional intervention studies into daily clinical practice

Improving long-term health outcomes of preterm infants: how to implement the findings of nutritional intervention studies into daily clinical practice

Effectiveness of Feeding Supplementation in Preterm Infants: An Overview of Systematic Reviews

Higher Energy, Lipid, and Carbohydrate Provision to Very Low‐Birth‐Weight Infants Is Differentially Associated With Neurodevelopment at 18 Months, Despite Consistent Improvements in Weight Gain

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