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

Objective: To determine if enteral protein and energy supplementation would significantly improve weight gain as compared with energy supplementation alone in <= 1250 g infants. Study Design: Inclusion criteria were birth weight (BW) <= 1250 g, postnatal age >= 14 days, diet of >= 75% enteral nutrition (fortified human milk or formula) and either failure to regain BW or weight gain < 15 g kg(-1) 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 = 862 +/- 252 g, mean +/- s.d.) and 11 received P/E (BW = 879 +/- 241 g). Significantly higher protein intake (P/E = 3.5 +/- 0.3 g kg(-1) per day, MCT = 3.0 +/- 0.5 g kg(-1) per day) and better growth (P/E = 17.0 +/- 2.4 g kg(-1) per day, MCT = 11.5 +/- 4.8 g kg(-1) 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. Journal of Perinatology (2010) 30, 517-521; doi:10.1038/jp.2010.10; published online 4 March 2010