189 - Evaluating the effects of a high vs standard protein diet utilizing target fortification on growth and body composition in ELBW infants

Poster Board #: 189
Publication #: 2907-HP-QA.189

Background: Growth failure remains a challenge in human milk (HM) fed extremely low birth weight (ELBW) infants. Nutrient content in mother’s own milk (MOM) and donor HM (DHM) varies and may provide inadequate protein and energy for growth. Enteral protein requirements for ELBW infants are debated, based on limited studies, and assume standard HM protein levels to achieve protein goals of 3.5-4.5 g/kg/day with fortification.


Objective: To evaluate the effects on growth of a high versus standard protein diet utilizing targeted fortification in infants 500-1000 grams (g) birth weight (BW).


Design/Methods: In a prospective, randomized study design, infants fed an exclusive HM diet received a high or standard protein diet until 35 weeks postmenstrual age (PMA). MOM and DHM were analyzed 3 times weekly using a near-infrared HM analyzer. Once infants achieved full feeds, DHM-derived fortifier was adjusted based on analyzed protein content to target a protein goal of 3.5-3.8 g/kg/day (control) or 4.2-4.5 g/kg/day (intervention). DXA and PEA POD measurements were obtained at 36 weeks PMA. Intent to treat analysis was performed.


Results: 101 (51 control, 50 intervention) infants completed the study. There were no differences in baseline demographics (Table 1). Total energy intake (p=.72) and %MOM (p=.11) were similar between groups (Table 2). Total protein intake was 3.8 vs 4.3 g/kg/day, respectively (p<.001). There was no significant difference in weight velocity (p=1.0), length velocity (p=.68), or fat free mass (p=.79) (Table 3). During study period, increased protein intake positively correlated with weight (p=.003) and length velocity (p=.002). No signs of metabolic intolerance were observed in either group.

Conclusion(s): ELBW infants receiving a standard vs high protein diet had similar growth velocities and fat free mass from birth to 36 weeks PMA. Increased protein intake during study intervention correlated with increased weight and length velocity suggesting that higher protein intakes may promote superior growth. In this study, targeted fortification was utilized to ensure ELBW infants received recommended protein intakes, however, studies are needed to determine efficacy on growth and body composition.

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Authors/Institutions: Amy B. Hair, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, United States; Jana P. Unger, Baylor College of Medicine, Houston, Texas, United States; Laura Gollins, Texas Children's Hospital, Houston, Texas, United States; Heeju Yang, Baylor College of Medicine, Houston, Texas, United States; danielle sutton, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, United States; Pamela Gordon, Texas Children's Hospital, Houston, Texas, United States; Joseph L. Hagan, Baylor College of Medicine, Houston, Texas, United States; Roman Shypailo, Baylor College of Medicine, Houston, Texas, United States