Whole body protein turnover and urea production of preterm small for gestational age infants fed fortified human milk or preterm formula

Branched-chain amino acid supplementation for improving growth and development in term and preterm neonates

BACKGROUND

Branched-chain amino acids (BCAAs) play a vital role in neonatal nutrition. Optimal BCAA supplementation might improve neonatal nutrient storage, leading to better physical and neurological development and other outcomes.

OBJECTIVES

To determine the effect of BCAA supplementation on physical growth and neurological development in term and preterm neonates. We planned to make the following comparisons: parenteral nutrition with and without BCAA supplementation; enteral BCAA supplementation versus no supplementation; and any type of supplementation including enteral, parenteral and both ways versus no supplementation. To investigate the supplementation effectiveness for different dosages assessed in the eligible trials.

SEARCH METHODS

We conducted comprehensive searches using Cochrane Neonatal's standard search strategies: Cochrane Central Register of Controlled Trials (CENTRAL 2016, Issue 6), MEDLINE, Embase and CINAHL (up to July 2016). We updated the search with CENTRAL (2019, Issue 8), MEDLINE, Embase and CINAHL (up to August 2019). We also searched clinical trials registries and reference lists of retrieved articles.

SELECTION CRITERIA

We planned to include individual and cluster-randomised and quasi-randomised controlled trials comparing BCAA supplementation versus placebo or no supplementation in term and preterm neonates. We excluded trials presented only as abstracts and cross-over trials.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed the eligibility of all potential studies identified from the search strategy. We planned to extract data using a pilot-tested standard data extraction form and assess risk of bias of the included studies following the methods described in the Cochrane Handbook for Systematic Reviews of Interventions. We planned to analyse treatment effects and report their effect estimates as per dichotomous or continuous data with 95% confidence intervals. We planned to conduct subgroup analysis to investigate heterogeneity, and perform sensitivity analysis where possible. We planned to use fixed-effect meta-analysis to combine data wherever appropriate. We planned to assess evidence quality using the GRADE approach.

MAIN RESULTS

We did not identify any potentially eligible studies that met the inclusion criteria in this review.

AUTHORS' CONCLUSIONS

We found no trial data to support or refute the idea that BCAA supplementation affects physical and neurological development and other outcomes in term and preterm neonates.

Human milk fortifiers in very low birth weight infants

The use of HMF remains an important option and has become common practice in all neonatal intensive care units. However, optimal composition of fortifiers is still undefined and more data are needed on safety and long-term benefits. Further research should be directed toward comparisons between different proprietary preparations, evaluating both short-term and long-term outcomes and adverse effects, in search of the best method of fortification.

Effect of high volume intake of mother's milk with an individualized supplementation of minerals and protein on early growth of preterm infants <28 weeks of gestation

OBJECTIVE

A prospective study was designed to evaluate the effects of high volume intake of mother's milk fortified (FMM) with an individualized supplementation of minerals and protein on tolerance, short-term somatic growth, serum concentrations of calcium, phosphorus, alkaline phosphatase, and total plasma protein in healthy preterm infants below 28 weeks of gestation.

METHODS

Sixty preterm infants were included in the FMM group, for having received >80% or more of the milk volume as their own mother's milk at 3 weeks of postnatal age to 38 weeks of corrected gestational age. This group was compared with 60 preterm infants fed exclusively preterm formula milk (PF). Intended fluid volume of the FMM group was approximately 200 and 150-170 mL/kg/d in the PF group. Mother's milk was supplemented with the goal of a daily protein intake of 3.5-4 g/kg/d. Phosphorus was supplemented from 15.5 to 31 mg per 100mL mother's milk.

RESULTS

Both feeding regimes were well tolerated. At the end of the study, nutritional management in both groups resulted in a body weight between the 25th and 50th percentiles of intrauterine growth expectations. Serum values of electrolytes, alkaline phosphatase, plasma protein, blood urea nitrogen, and urinary mineral excretion did not differ significantly between the two groups at study entry as well as at the end of the investigation.

CONCLUSIONS

Mother's milk fed at higher volumes with an individualized fortification of minerals and protein provides sufficient nutrients to allow adequate growth of preterm infants <28 weeks of gestation.

Protein metabolism in preterm infants with particular reference to intrauterine growth restriction

There is growing evidence that neonatal and long-term morbidity in preterm infants, particularly those born before 32 weeks' gestation, can be modified by attained growth rate in the neonatal period. Guidelines for optimal growth and the nutritional intakes, particular of protein, required to achieve this are not well defined. Due to delays in postnatal feeding and a lack of energy stores developed in the last trimester of pregnancy, preterm infants often suffer early postnatal catabolism until feeding is established. There are indications that infants born with intrauterine growth restriction have perturbations in protein metabolism. Therefore, they may have different protein requirements than appropriate for gestational age infants. This review summarises what is known about protein requirements and metabolism in the fetus and preterm infant, with particular emphasis on the distinct requirements of the growth-restricted infant.