One Extra Gram of Protein to Preterm Infants From Birth to 1800 g: A Single-Blinded Randomized Clinical Trial

Objective: The aim of the study was to evaluate the effect on growth and neurodevelopment of increasing amino acid (AA) during parenteral nutrition and protein intake during enteral nutrition in extremely low birth-weight infants starting from birth to day of reaching 1800 g body weight. Methods : We randomized preterm infants with birth weight 500 to 1249 g either to a high AA/protein intake (HiP [high protein]: parenteral nutrition = 3.5 AA, enteral nutrition = 4.6 protein g.kg(-1).day(-1)) or to a standard of care group (StP [standard protein]: parenteral nutrition = 2.5 AA, enteral nutrition = 3.6 protein g.kg(-1).day(-1)). The primary outcome was weight gain from birth to 1800 g. Results: Two: hundred twenty-six patients were screened, 164 completed the study and were analyzed (82 StP and 82 HiP). Cumulative AA/protein intake from birth to 1800 g was 178 +/- 42 versus 223 +/- 45 g/kg in the StP versus HiP group respectively, P < 0.0001. Blood urea was higher in HiP than in StP group both during parenteral and enteral nutrition (P = 0.004). Weight gain from birth to 1800 g was 12.3 +/- 1.6 in StP and 12.6 +/- 1.7 g.kg(-1).day(-1) in HiP group (P = 0.294). We found no difference in any growth parameters neither during hospital stay nor at 2 years corrected age. Bayley III score at 24 months corrected age was 93.8 +/- 12.9 in StP group and 94.0 +/- 13.9 in the HiP group, P = 0.92. Conclusions: Increasing AA/protein intake both during parenteral and enteral nutrition does not improve growth and neurodevelopment of small preterm infants 500 to 1249 g birth weight.