Associate Professor of Pediatrics and Neonatologist, Neonatal Research Center, Department of pediatrics, School of Medicine, Shiraz University of Medical Science, Shiraz, Iran.
Assistant Professor of Neonatology, Tehran University of Medical Sciences, Hakim Children Hospital, Tehran, Iran.
J Mother Child. 2023 Jun 27;27(1):21-29. doi: 10.34763/jmotherandchild.20232701.d-22-00072. eCollection 2023 Jun 1.
During NICU admission, extra-uterine growth retardation that can affect the neurodevelopmental outcome is a challenging problem in extremely preterm infants. This trial aimed to determine the effect of additional enteral protein supplementation on the growth velocity of the anthropometric parameters.
In this randomized controlled trial, 77 preterm infants (gestational age ≤33 weeks and birth weight <1500 g) who reached full enteral feeding with either fortified breast milk or preterm formula were included. They were randomized to receive either 4-<5 g/kg/day protein through extra protein supplementation (intervention) or 3-<4 g/kg/day protein. Weight gain, as well as length and head circumference growth, were monitored daily and weekly, respectively. Venous blood gas, blood urea nitrogen (BUN), and albumin levels were checked weekly.
Five out of 77 participants were excluded due to feeding intolerance. Analyses were conducted on 36 neonates with protein intake of 3.66 ± 0.22 gr/kg/day and 36 with extra protein intake. Baseline characteristics were similar between the groups. An additional protein supply of 0.89 gr/kg/day, resulting in an average protein intake of 4.55 ± 0.18 in the intervention group, increased the postnatal weight gain, linear growth, and head circumference growth (7.98 gr/kg/day, 0.347 cm/week, and 0.38 cm/week, respectively). The albumin levels were significantly increased, but the BUN levels were not significantly increased in the intervention group. None of the patients developed necrotizing enterocolitis or significant acidosis.
Protein supplementation significantly improves the growth of the anthropometric parameters. An increase in serum albumin and no increase in serum urea can indicate the anabolic effect of extra protein. Protein supplementation can add to routine feeding protocols of VLBW infants without any short-term adverse effect; however, further study for evaluation of long-term complications is needed.
在新生儿重症监护病房（NICU）住院期间，宫外生长迟缓会影响极早产儿的神经发育结局，这是一个具有挑战性的问题。本试验旨在确定额外肠内蛋白质补充对人体测量参数生长速度的影响。
在这项随机对照试验中，纳入了 77 名胎龄≤33 周且出生体重<1500 g 的早产儿（达到完全肠内喂养，使用强化母乳或早产儿配方奶）。他们被随机分为两组，分别接受 4-<5 g/kg/天或 3-<4 g/kg/天的蛋白质补充。分别每天和每周监测体重增加、长度和头围增长。每周检查静脉血气、血尿素氮（BUN）和白蛋白水平。
由于喂养不耐受，77 名参与者中有 5 名被排除。对 36 名蛋白质摄入量为 3.66 ± 0.22 gr/kg/天和 36 名额外蛋白质摄入量的新生儿进行了分析。两组的基线特征相似。额外提供 0.89 gr/kg/天的蛋白质，使干预组的平均蛋白质摄入量达到 4.55 ± 0.18，增加了出生后的体重增加、线性生长和头围增长（分别为 7.98 gr/kg/天、0.347 cm/周和 0.38 cm/周）。干预组白蛋白水平显著升高，但 BUN 水平无显著升高。没有患者发生坏死性小肠结肠炎或明显酸中毒。
蛋白质补充显著改善了人体测量参数的生长。血清白蛋白增加而血清尿素增加不明显表明额外蛋白质具有合成代谢作用。蛋白质补充可添加到极低出生体重儿的常规喂养方案中，无任何短期不良影响；然而，需要进一步研究以评估长期并发症。
