Abstract OBJECTIVE: To study the effect of early protein and energy intake on early growth velocity of premature infants. METHODS: Clinical data on premature infants with a birth weight of less than 1800 g were collected retrospectively, including records of general status, enteral and parenteral nutrition and growth parameters. These premature infants were divided into two groups according to the timing of amino acid administration: early supplementation (the first 24 hrs of life; EAA group; n=112) and late supplementation (after 24 hrs of life; LAA group; n=52). Protein and energy intake, protein/energy ratio and growth velocity during hospital stay were compared between the two groups. Correlation analysis was used to evaluate the association of early protein and energy intake and protein/energy ratio with growth velocity of infants. RESULTS: Compared with the LAA group, the EAA group presented lower weight loss (6.3% vs 8.8%), shorter time to return to birth weight (7 days vs 9 days), and higher head circumference growth (0.79±0.25 cm/week vs 0.55±0.25 cm/week) and weight growth velocity(20±3 g/kg?d vs 17±3 g/kg?d) (P<0.05). The correlation analysis indicated that protein and energy intake and protein/energy ratio on the 3rd and 7th days of life were positively correlated with weight growth velocity. The protein and energy intake per week after returning to birth weight was positively correlated with weight growth velocity (r= 0.709, P<0.01). Significant correlations were found between the protein and energy intake and both head circumference and length growth velocity on the 3rd and the 7th days of life. CONCLUSIONS: Early administration of amino acids can reduce weight loss, shorten the time taken to return to birth weight, and increase weight and head circumference growth velocity in premature infants. An appropriate increase in protein intake can improve weight, circumference and length growth velocity.
[2]Denne SC, Poindexter BB. Evidence supporting early nutritional support with parenteral amino acid infusion[J]. Semin Perinatol, 2007, 31(2): 56-60.
[3]Whitfield JM, Hendrikson H. Prevention of protein deprivation in the extremely low birth weight infant: a nutritional emergency[J]. Proc (Bayl Univ Med Cent), 2006, 19(3): 229-231.
[4]Hay WW, Thureen P. Protein for preterm infants: how much is needed? How much is enough? How much is too much?[J]. Pediatr Neonatol, 2010, 51(4): 198-207.
[5]Valentine CJ, Fernandez S, Rogers LK, Gulati P, Hayes J, Lore P, et al. Early amino-acid administration improves preterm infant weight[J]. J Perinatol, 2009, 29(6): 428-432.
[6]Sauer PJ. Can extrauterine growth approximate intrauterine growth? Should it?[J]. Am J Clin Nutr, 2007, 85(2): 608S-613S.
[7]Ehrenkranz RA, Dusick AM, Vohr BR, Wright LL,Wrage LA,Poole WK. Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants[J]. Pediatrics, 2006, 117(4): 1253-1261.
[8]Stephens BE, Walden RV, Gargus RA, Tucker R, McKinley L, Mance M, et al. First-week protein and energy intakes are associated with 18-month developmental outcomes in extremely low birth weight infants[J]. Pediatrics, 2009, 123(5): 1337-1343.
[9]Keinman RE. Pediatric Nutrition Handbook[M]. 6th ed. American Academy of Pediatrics, 2009: 23-46.
[10]Agostoni C, Buonocore G, Carnielli VP, De Curtis M, Darmaun D, Decsi T, et al. Enteral nutrient supply for preterm infants: commentary from the European Society for Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition[J]. J Pediatr Gastroenterol Nutr, 2010, 50(1): 85-91.
[11]Lucas A. Programming by early nutrition: an experimental approach[J]. J Nutr, 1998, 128(2 Suppl): 401S-406S.
[12]Leunissen RW, Oosterbeek P, Hol LK, Hellingman AA, Stijnen T, HokkenKoelega AC. Fat mass accumulation during childhood determines insulin sensitivity in early adulthood[J]. J Clin Endocrinol Metab, 2008, 93(2): 445-451.