Arch Dis Child Fetal Neonatal Ed doi:10.1136/archdischild-2012-302868
  • Original article

Increased protein intake decreases postnatal growth faltering in ELBW babies

  1. Frank H Bloomfield2,3
  1. 1Nutrition Services, Auckland City Hospital, Auckland, New Zealand
  2. 2Liggins Institute and Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
  3. 3Newborn Services, National Women's Health, Auckland City Hospital, Auckland, New Zealand
  1. Correspondence to Barbara Elizabeth Cormack, Nutrition Services, Office 2, Level 8. Room 81.038 Support Building, Auckland City Hospital, Private Bag 920 24, Auckland, New Zealand; bcormack{at}
  • Received 21 August 2012
  • Revised 18 November 2012
  • Accepted 18 February 2013
  • Published Online First 13 March 2013


Objective To determine whether purposely designed nutritional guidelines for extremely low birthweight (ELBW; birth weight <1000 g) babies result in protein intakes that meet international consensus recommendations, and whether this results in improved growth from birth to discharge.

Design A prospective cohort study of nutritional intakes and growth in ELBW babies.

Setting A tertiary neonatal intensive care unit in New Zealand.

Patients 100 ELBW babies who survived for the first month of life, 50 before the introduction of the guideline (Lo Pro) and 50 after (Hi Pro).

Intervention Introduction of a nutritional guideline aimed at increasing protein intakes to meet international consensus recommendations.

Main outcome measures Weekly protein intakes over the first month of life and growth until discharge.

Results Hi Pro babies had significantly higher protein intakes in the first month of life than Lo Pro babies (mean (SD), 3.8 (0.3) vs 3.3 (0.4) g/, p<0.0001) and a significantly greater growth velocity (GV) over the first 30 days after regaining birth weight (19.5 (5.0) vs 16.2 (5.4) g/, p<0.002). Hi Pro babies had a significantly lesser Z-score change between birth and discharge than Lo Pro babies for weight (0.0 (1.2) vs −0.9 (1.1), p=0.001), length (−0.8 (0.8) vs −1.2 (1.1), p=0.02) and head circumference (−0.2 (1.1) vs −1.1 (1.6), p<0.001).

Conclusions Simple, standardised nutritional guidelines can result in recommended protein intakes for ELBW babies being achieved and result in increased GV. Downward crossing of centiles between birth and discharge, common in ELBW babies, is significantly reduced for weight, length and head circumference.

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