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

Abstract

Objective: To determine if enteral protein and energy supplementation would significantly improve weight gain as compared with energy supplementation alone in p1250 g infants.Study Design: Inclusion criteria were birth weight (BW) p1250 g, postnatal age X14 days, diet of X75% enteral nutrition (fortified human milk or formula) and either failure to regain BW or weight gain<15 g kg À1 per days. Infants were randomized to a multinutrient supplement that provided increased protein and energy (P/E) intake or energy alone (medium chain triglyceride oil, MCT). Growth rates were compared at the end of the 4-week study period.Result: Of 30 eligible infants, 23 were enrolled, 12 received MCT (BW ¼ 862 ± 252 g, mean ± s.d.) and 11 received P/E (BW ¼ 879 ± 241 g). Significantly higher protein intake (P/E ¼ 3.5±0.3 g kg À1 per day, MCT ¼ 3.0±0.5 g kg À1 per day) and better growth (P/E ¼ 17.0 ± 2.4 g kg À1 per day, MCT ¼ 11.5±4.8 g kg À1 per day) were observed in the P/E group.Conclusion: These data are consistent with the importance of providing additional daily protein intake to achieve increased postnatal growth in very low birth weight infants experiencing slow growth.

Growth of very low birth weight infants after increased amino acid and protein administration

“…Costa-Orvay reported that an intake of 4.2 g/kg/day protein and 150 kcal/kg/day energy increased the accretion of fat-free mass in VLBW infants [14]. A higher protein intake of 3.5 g/kg/day was followed by a higher weight gain of 17.0 g/kg/day within 4 weeks [6]. Miller compared two protein intake levels (4.2 vs. 3.6 g/kg/ day) and found no significant difference in growth parameters [24].…”

Aggressive Nutrition of the Preterm Infant

“…A recently developed fortifier, derived from human milk, seems to reduce the risk of NEC [79••]. Overall, feeding preterm infants exclusively human milk for enteral nutrition has more benefit than risk, especially for NEC [80], but the appropriate fortification of donor milk from milk banks remains problematic and requires further research and improved practices [81]. …”

Muttermilch und Frauenmilchspende in der Frühgeborenenernährung

“…Für Körper-und Kopfwachstum ist vor allem eine ausreichende postnatale Eiweißzufuhr und nicht nur die ausreichende Kalorienzufuhr entscheidend (25). Exzessives Catch-up-Wachstum kann zu viszeraler Adipositas, Insulinresistenz und metabolischem Syndrom im Erwachsenenalter führen (26).…”