Protein and Preterm Infants

  • Protein is a major driving force for growth and, therefore, long-term outcome.1

    — 2014 Global Expert Recommendations

    The nutritional goal for preterm infants is to achieve a postnatal growth rate, tissue composition, and functional outcome that is as close as possible to that of a normal fetus at the same postmenstrual age.1

    • To achieve this, it is important to have an adequate balance of energy to protein in the preterm diet. Both energy and protein are important to promote growth.1

    Neonatal nutrition experts have increased the level of protein they recommend to promote postnatal growth and long term outcomes1-3


    Neonatal nutrition experts have increased the level of protein they recommend to promote postnatal growth and long term outcomes

    Increased protein intake improved linear growth status4

    For example, the difference in a length z-score change of +0.77 for an infant boy 36 0/7 weeks’ postmenstrual age (PMA)4

    Difference in a length z-score change

    • Stoll et al reported that 79% of extreme preterm infants are below the 10th percentile by 36 weeks’ PMA5
    • Data from Olsen et al 2014 suggest an additional 100 grams of protein over 28 days could significantly improve length z-score4

    Linear growth in premature infants is an important factor in neurological development6,7


    Linear growth in premature infants is a key factor


    * Study did not specify brand or product type fed to infants

    BSID=Bayley Scales of Infant Development; CA=corrected age; SD=standard deviation; VLBW=very low birth weight

    Increased protein intake in first week improved neurodevelopmental outcomes in ELBW infants8


    Protein matters as early as week 16


    * Included parenteral and enteral protein intake

    CA=corrected age; ELBW=extremely low birth weight; MDI=Mental Development Index

    References: 1. Koletzko B et al. Nutritional Care of Preterm Infants: Scientific Basis and Practical Guidelines. Basel, Switzerland: Karger; 2014; 1-314. 2. Tsang RC et al. eds. Nutritional of the Preterm Infant: Scientific Basis and Practical Guidelines. 2nd ed. Cincinnati, OH: Digital Educational Publishing, Inc. 2005. 3. Tsang RC et al. eds. Nutritional Needs of the Preterm Infant: Scientific Basis and Practical Guidelines. Pawling, NY: Caduceus Medical Publishers, Inc. 1993. 4. Olsen IE et al. J Pediatr Gastroenterol Nutr. 2014; 58:409-416. 5. Stoll BJ et al. Pediatrics. 2010; 126:443-456. 6. Pfister KM et al. Pediatr Res. 2013; 74:576-583. 7. Ramel SE et al. Neonatology. 2012; 102:19-24. 8. Stephens BE et al. Pediatrics. 2009; 123:1337-1343.

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