Preemies Need More Protein

Preemies Need More Protein

Arslanoglu S, Moro GE, and Ziegler EE. Preterm infants fed fortified human milk receive less protein than they need. J Perinatol (July 2009); 29: 489–492. Full Text | PDF

Objective: The aim of this study was to compare the actual nutrient intakes observed in a previously reported study with assumed nutrient intakes based on the customary assumptions about the composition of human milk.

Study Design: Fortified human milk is assumed to provide adequate amounts of nutrients for premature infants. This assumption holds if milk has the composition of milk expressed by mothers of premature infants during weeks 2 to 3 of lactation. The assumption does not necessarily hold for milk expressed after 2 to 3 weeks lactation. It also does not hold for donor milk, which is typically provided by mothers of term infants. The size of the disparity between assumed and actual nutrient intakes is not known. Actual nutrient intakes were available for 32 preterm infants participating in the study. Assumed nutrient intakes were calculated for these infants by substituting assumed nutrient concentrations for observed nutrient concentrations. Data were compared separately for each of the 3 study weeks.

Result: Actual protein intakes were significantly and consistently lower than assumed protein intakes during each study week. The differences in mean intakes were large, ranging from 0.5 to 0.8 g kg^-1 per day. Differences in energy intake were small and not consistently significant.

Conclusion: Actual intakes of protein by preterm infants fed fortified human milk are substantially lower than assumed intakes. The discrepancy may in part explain why preterm infants frequently show postnatal growth failure.

Comments: Avoiding Extrauterine Growth Retardation has become one of the major challenges in 21^st century neonatology. This study shows that the amount of protein supplied by fortified human milk is much less than we thought, and probably inadequate to support optimal growth. The authors recommend the practice of “adjustable fortification of milk”, increasing or decreasing the amount of fortifier or protein supplement twice weekly to keep the baby’s BUN in the range of 9-14. While this makes sense, the safety or efficacy of this approach has yet to be proven. ABK.

Additional Comments:

Date: 05 Jul 2009
Time: 09:41:48

I Agree with Andy this article will definitely help us avoid the "Extrauterine Growth retardation" Additionally I follow and practice these basic nutrition principles: 1.Calories needed for growth approx. 110-120 Calories/kg/day. 2."Specific Dynamic Action" during PO consumption - requires at least 10% of calories provided. So provide at least 10% more calories than what is needed per day for growth. 3.Give at least 165 Cc/kg/day of fluids PO, will provide provide 132 Cal/kg/day (using a 24 Cal/0z of FBM/formula). 4.Restrict fluids in PDA ONLY if it is Hemodynamically significant - on ventilator, or major oxygen requirement or CO2 retention etc.

UserName: Ravi Agarwal, MD
Institution: Sheridian Healthcare
telephone: 8504960855
email: neodoc1@yahoo.com

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