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Do recommended protein intakes improve neurodevelopment in extremely preterm babies?
  1. E A Cester1,2,
  2. F H Bloomfield1,3,
  3. J Taylor4,
  4. S Smith4,
  5. B E Cormack1,3
  1. 1Liggins Institute, University of Auckland, Auckland, New Zealand
  2. 2Neonatal Care Unit, University of Turin, Torino, Italy
  3. 3Newborn Services, Auckland City Hospital, Auckland, New Zealand
  4. 4Child Development Unit, Auckland City Hospital, Auckland, New Zealand
  1. Correspondence to B E Cormack, Neonatal Dietitian, Auckland City Hospital, Level 8. Room 81.038 Support Building, Auckland City Hospital, Private Bag, Auckland 920 24, New Zealand; bcormack{at}adhb.govt.nz

Abstract

Objective To determine whether achieving recommended protein intakes for extremely low birthweight (ELBW; birth weight <1000 g) babies, resulting in better growth, improves neurodevelopmental outcomes.

Design A prospective cohort study of ELBW babies before and after the introduction of a new nutritional policy designed to meet international consensus protein recommendations. Forty-five children born ‘before’ and 42 born ‘after’ the policy change were assessed at 2 years’ corrected age (CA). Associations between nutritional intakes, growth and neurodevelopmental outcome (Bayley Scales of Infant and Toddler Development, Third edition (Bayley-III), motor and sensory impairment) were assessed using univariate and multivariate analyses.

Results Bayley-III cognitive (mean (SD) 96 (12) vs 96 (15)), motor (96 (13) vs 95 (15)) or language scores (89 (11) vs 91 (17)) were not different between the ‘before’ and ‘after’ cohorts. In the ‘before’ cohort, motor scores were positively associated with enteral nutrition intakes and growth velocity. Neither were sensory impairments different between groups (visual impairment 4 vs 2, hearing impairment 2 vs 0) nor was the gross motor function classification score (any cerebral palsy 2 vs 1).

Conclusions In this prospective cohort study, increasing intravenous and enteral protein intakes to recommended levels in the first month after birth was not associated with improved cognitive, language or motor scores or decreased sensory impairments at 2 years’ CA despite significantly improved early growth and reduced postnatal faltering growth. Appropriate randomised controlled trials are needed to answer definitively whether higher early protein intakes improve neurodevelopmental outcome in this population.

  • Nutrition
  • Growth
  • Neurodevelopment
  • Neonatology

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