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Am J Perinatol 2018; 35(12): 1138-1141
DOI: 10.1055/s-0038-1645859
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Reevaluation of Protein Intake for Preterm Infants

Masahiko Kawai
1   Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Publication History

19 April 2017

20 March 2018

Publication Date:
24 April 2018 (online)

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Abstract

Growth failure caused by undernutrition is considered one of the major causes for psychomotor delay in extremely preterm infants, and the concept for “aggressive nutritional approach” is widely accepted worldwide. Based on this, postnatal early catch-up growth due to sufficient supply of nutrients including sufficient amounts of amino acids is believed to be essential for a better outcome; however, there is no definitive evidence of aggressive nutrition on better outcomes in mortality, growth, and neurodevelopment. On the contrary, epidemiological evidence suggests that low birth weight and a rapid catch-up growth after birth are major risk factors for insulin resistance and diabetes in later life; higher protein intake during postnatal period relates to higher cardiovascular risk in later life. Considering these, optimal nutrition, especially protein administration, should be reevaluated. In this review, current opinions on the nutrition for the preterm infants are surveyed. In addition, I propose a new concept for optimized protein amount for the preterm infants based on the difference of amino acid metabolism between fetuses and preterm infants.

Keywords

nutrition - amino acid - preterm infants - fetus - urea cycle
 

  • References

  • 1 Franz AR, Pohlandt F, Bode H. , et al. Intrauterine, early neonatal, and postdischarge growth and neurodevelopmental outcome at 5.4 years in extremely preterm infants after intensive neonatal nutritional support. Pediatrics 2009; 123 (01) e101-e109
    CrossrefPubMedGoogle Scholar
  • 2 Bhatia J, Mena P, Denne S, García C. Evaluation of adequacy of protein and energy. J Pediatr 2013; 162 (3, Suppl): S31-S36
    CrossrefPubMedGoogle Scholar
  • 3 Hack M, Breslau N, Weissman B, Aram D, Klein N, Borawski E. Effect of very low birth weight and subnormal head size on cognitive abilities at school age. N Engl J Med 1991; 325 (04) 231-237
    CrossrefPubMedGoogle Scholar
  • 4 American Academy of Pediatrics Committee on Nutrition. American Academy of Pediatrics Committee on Nutrition: nutritional needs of low-birth-weight infants. Pediatrics 1985; 75 (05) 976-986
    PubMedGoogle Scholar
  • 5 Lucas A, Morley R, Cole TJ. , et al. Early diet in preterm babies and developmental status at 18 months. Lancet 1990; 335 (8704): 1477-1481
    CrossrefPubMedGoogle Scholar
  • 6 Lucas A, Morley R, Cole TJ. Randomised trial of early diet in preterm babies and later intelligence quotient. BMJ 1998; 317 (7171): 1481-1487
    CrossrefPubMedGoogle Scholar
  • 7 Isaacs EB, Morley R, Lucas A. Early diet and general cognitive outcome at adolescence in children born at or below 30 weeks gestation. J Pediatr 2009; 155 (02) 229-234
    CrossrefPubMedGoogle Scholar
  • 8 Morgan C, McGowan P, Herwitker S, Hart AE, Turner MA. Postnatal head growth in preterm infants: a randomized controlled parenteral nutrition study. Pediatrics 2014; 133 (01) e120-e128
    CrossrefPubMedGoogle Scholar
  • 9 Agostoni C, Buonocore G, Carnielli VP. , et al; ESPGHAN Committee on Nutrition. Enteral nutrient supply for preterm infants: commentary from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition. J Pediatr Gastroenterol Nutr 2010; 50 (01) 85-91
    CrossrefPubMedGoogle Scholar
  • 10 Cester EA, Bloomfield FH, Taylor J, Smith S, Cormack BE. Do recommended protein intakes improve neurodevelopment in extremely preterm babies?. Arch Dis Child Fetal Neonatal Ed 2015; 100 (03) F243-F247
    CrossrefPubMedGoogle Scholar
  • 11 Singhal A. Optimizing early protein intake for long-term health of preterm infants. Nestle Nutr Inst Workshop Ser 2016; 86: 129-137
    PubMedGoogle Scholar
  • 12 Trivedi A, Sinn JKH. Early versus late administration of amino acids in preterm infants receiving parenteral nutrition. Cochrane Database Syst Rev 2013; (07) CD008771
    PubMedGoogle Scholar
  • 13 Fenton TR, Premji SS, Al-Wassia H, Sauve RS. Higher versus lower protein intake in formula-fed low birth weight infants. Cochrane Database Syst Rev 2014; (04) CD003959
    PubMedGoogle Scholar
  • 14 Schneider N, Garcia-Rodenas CL. Early nutritional interventions for brain and cognitive development in preterm infants: a review of the literature. Nutrients 2017; 9 (03) 187
    CrossrefPubMedGoogle Scholar
  • 15 Barker DJ, Osmond C. Infant mortality, childhood nutrition, and ischaemic heart disease in England and Wales. Lancet 1986; 1 (8489): 1077-1081
    PubMedGoogle Scholar
  • 16 Barker DJ, Osmond C, Golding J, Kuh D, Wadsworth ME. Growth in utero, blood pressure in childhood and adult life, and mortality from cardiovascular disease. BMJ 1989; 298 (6673): 564-567
    Google Scholar
  • 17 Hofman PL, Cutfield WS, Robinson EM. , et al. Insulin resistance in short children with intrauterine growth retardation. J Clin Endocrinol Metab 1997; 82 (02) 402-406
    PubMedGoogle Scholar
  • 18 Derraik JG, Rowe DL, Cutfield WS, Hofman PL. Decreasing birth weight is associated with adverse metabolic profile and lower stature in childhood and adolescence. PLoS One 2015; 10 (03) e0119433
    CrossrefPubMedGoogle Scholar
  • 19 Hofman PL, Regan F, Jackson WE. , et al. Premature birth and later insulin resistance. N Engl J Med 2004; 351 (21) 2179-2186
    CrossrefPubMedGoogle Scholar
  • 20 Miles HL, Hofman PL, Cutfield WS. Fetal origins of adult disease: a paediatric perspective. Rev Endocr Metab Disord 2005; 6 (04) 261-268
    CrossrefPubMedGoogle Scholar
  • 21 Hovi P, Andersson S, Eriksson JG. , et al. Glucose regulation in young adults with very low birth weight. N Engl J Med 2007; 356 (20) 2053-2063
    CrossrefPubMedGoogle Scholar
  • 22 Pandolfi C, Zugaro A, Lattanzio F. , et al. Low birth weight and later development of insulin resistance and biochemical/clinical features of polycystic ovary syndrome. Metabolism 2008; 57 (07) 999-1004
    CrossrefPubMedGoogle Scholar
  • 23 Parkinson JR, Hyde MJ, Gale C, Santhakumaran S, Modi N. Preterm birth and the metabolic syndrome in adult life: a systematic review and meta-analysis. Pediatrics 2013; 131 (04) e1240-e1263
    CrossrefPubMedGoogle Scholar
  • 24 Sipola-Leppänen M, Vääräsmäki M, Tikanmäki M. , et al. Cardiometabolic risk factors in young adults who were born preterm. Am J Epidemiol 2015; 181 (11) 861-873
    CrossrefPubMedGoogle Scholar
  • 25 Kajantie E, Strang-Karlsson S, Hovi P. , et al. Insulin sensitivity and secretory response in adults born preterm: the Helsinki Study of Very Low Birth Weight Adults. J Clin Endocrinol Metab 2015; 100 (01) 244-250
    CrossrefPubMedGoogle Scholar
  • 26 Crane JD, Yellin SA, Ong FJ. , et al. ELBW survivors in early adulthood have higher hepatic, pancreatic and subcutaneous fat. Sci Rep 2016; 6: 31560
    CrossrefPubMedGoogle Scholar
  • 27 Luo ZC, Xiao L, Nuyt AM. Mechanisms of developmental programming of the metabolic syndrome and related disorders. World J Diabetes 2010; 1 (03) 89-98
    CrossrefPubMedGoogle Scholar
  • 28 Botton J, Heude B, Maccario J, Ducimetière P, Charles MA. ; FLVS Study Group. Postnatal weight and height growth velocities at different ages between birth and 5.  y and body composition in adolescent boys and girls. Am J Clin Nutr 2008; 87 (06) 1760-1768
    CrossrefPubMedGoogle Scholar
  • 29 Hester SN, Hustead DS, Mackey AD, Singhal A, Marriage BJ. Is the macronutrient intake of formula-fed infants greater than breast-fed infants in early infancy?. J Nutr Metab 2012; 2012: 891201
    PubMedGoogle Scholar
  • 30 Singhal A, Cole TJ, Fewtrell M, Deanfield J, Lucas A. Is slower early growth beneficial for long-term cardiovascular health?. Circulation 2004; 109 (09) 1108-1113
    CrossrefPubMedGoogle Scholar
  • 31 Faienza MF, Brunetti G, Ventura A. , et al. Nonalcoholic fatty liver disease in prepubertal children born small for gestational age: influence of rapid weight catch-up growth. Horm Res Paediatr 2013; 79 (02) 103-109
    CrossrefPubMedGoogle Scholar
  • 32 Singhal A, Cole TJ, Lucas A. Early nutrition in preterm infants and later blood pressure: two cohorts after randomised trials. Lancet 2001; 357 (9254): 413-419
    CrossrefPubMedGoogle Scholar
  • 33 Cianfarani S, Germani D, Branca F. Low birthweight and adult insulin resistance: the “catch-up growth” hypothesis. Arch Dis Child Fetal Neonatal Ed 1999; 81 (01) F71-F73
    CrossrefPubMedGoogle Scholar
  • 34 Singhal A, Fewtrell M, Cole TJ, Lucas A. Low nutrient intake and early growth for later insulin resistance in adolescents born preterm. Lancet 2003; 361 (9363): 1089-1097
    CrossrefPubMedGoogle Scholar
  • 35 de Zegher F, Sebastiani G, Diaz M, Gómez-Roig MD, López-Bermejo A, Ibáñez L. Breast-feeding vs formula-feeding for infants born small-for-gestational-age: divergent effects on fat mass and on circulating IGF-I and high-molecular-weight adiponectin in late infancy. J Clin Endocrinol Metab 2013; 98 (03) 1242-1247
    CrossrefPubMedGoogle Scholar
  • 36 Ikeda N, Shoji H, Murano Y. , et al. Effects of breastfeeding on the risk factors for metabolic syndrome in preterm infants. J Dev Orig Health Dis 2014; 5 (06) 459-464
    CrossrefPubMedGoogle Scholar
  • 37 Barker DJ, Winter PD, Osmond C, Margetts B, Simmonds SJ. Weight in infancy and death from ischaemic heart disease. Lancet 1989; 2 (8663): 577-580
    Google Scholar
  • 38 Barker DJ. The fetal and infant origins of adult disease. BMJ 1990; 301 (6761): 1111
    CrossrefPubMedGoogle Scholar
  • 39 Hales CN, Barker DJ, Clark PM. , et al. Fetal and infant growth and impaired glucose tolerance at age 64. BMJ 1991; 303 (6809): 1019-1022
    CrossrefPubMedGoogle Scholar
  • 40 Barker DJ, Osmond C, Forsén TJ, Kajantie E, Eriksson JG. Trajectories of growth among children who have coronary events as adults. N Engl J Med 2005; 353 (17) 1802-1809
    CrossrefPubMedGoogle Scholar
  • 41 Rolland-Cachera MF, Deheeger M, Bellisle F, Sempé M, Guilloud-Bataille M, Patois E. Adiposity rebound in children: a simple indicator for predicting obesity. Am J Clin Nutr 1984; 39 (01) 129-135
    CrossrefPubMedGoogle Scholar
  • 42 Williams SM. Weight and height growth rate and the timing of adiposity rebound. Obes Res 2005; 13 (06) 1123-1130
    PubMedGoogle Scholar
  • 43 He Q, Karlberg J. Probability of adult overweight and risk change during the BMI rebound period. Obes Res 2002; 10 (03) 135-140
    PubMedGoogle Scholar
  • 44 Knops NB, Sneeuw KC, Brand R. , et al. Catch-up growth up to ten years of age in children born very preterm or with very low birth weight. BMC Pediatr 2005; 5: 26
    CrossrefPubMedGoogle Scholar
  • 45 Ong KK, Kennedy K, Castañeda-Gutiérrez E. , et al. Postnatal growth in preterm infants and later health outcomes: a systematic review. Acta Paediatr 2015; 104 (10) 974-986
    CrossrefPubMedGoogle Scholar
  • 46 Martin A, Connelly A, Bland RM, Reilly JJ. Health impact of catch-up growth in low-birth weight infants: systematic review, evidence appraisal, and meta-analysis. Matern Child Nutr 2017; 13 (01) DOI: 10.1111/mcn.12297.
    PubMedGoogle Scholar
  • 47 Chien PF, Smith K, Watt PW, Scrimgeour CM, Taylor DJ, Rennie MJ. Protein turnover in the human fetus studied at term using stable isotope tracer amino acids. Am J Physiol 1993; 265 (1 Pt 1): E31-E35
    PubMedGoogle Scholar
  • 48 van den Akker CH, Schierbeek H, Minderman G. , et al. Amino acid metabolism in the human fetus at term: leucine, valine, and methionine kinetics. Pediatr Res 2011; 70 (06) 566-571
    PubMedGoogle Scholar
  • 49 Lemons JA, Adcock III EW, Jones Jr MD, Naughton MA, Meschia G, Battaglia FC. Umbilical uptake of amino acids in the unstressed fetal lamb. J Clin Invest 1976; 58 (06) 1428-1434
    CrossrefPubMedGoogle Scholar
  • 50 van Veen LC, Teng C, Hay Jr WW, Meschia G, Battaglia FC. Leucine disposal and oxidation rates in the fetal lamb. Metabolism 1987; 36 (01) 48-53
    CrossrefPubMedGoogle Scholar
  • 51 van Goudoever JB, Vlaardingerbroek H, van den Akker CH, de Groof F, van der Schoor SR. Amino acids and proteins. World Rev Nutr Diet 2014; 110: 49-63
    PubMedGoogle Scholar
  • 52 van den Akker CH, van Goudoever JB. Defining protein requirements of preterm infants by using metabolic studies in fetuses and preterm infants. Nestle Nutr Inst Workshop Ser 2016; 86: 139-149
    PubMedGoogle Scholar
  • 53 van den Akker CH, te Braake FW, Schierbeek H. , et al. Albumin synthesis in premature neonates is stimulated by parenterally administered amino acids during the first days of life. Am J Clin Nutr 2007; 86 (04) 1003-1008
    CrossrefPubMedGoogle Scholar
  • 54 te Braake FW, van den Akker CH, Wattimena DJ, Huijmans JG, van Goudoever JB. Amino acid administration to premature infants directly after birth. J Pediatr 2005; 147 (04) 457-461
    CrossrefPubMedGoogle Scholar
  • 55 Denne SC, Poindexter BB. Evidence supporting early nutritional support with parenteral amino acid infusion. Semin Perinatol 2007; 31 (02) 56-60
    CrossrefPubMedGoogle Scholar
  • 56 Vlaardingerbroek H, Vermeulen MJ, Rook D. , et al. Safety and efficacy of early parenteral lipid and high-dose amino acid administration to very low birth weight infants. J Pediatr 2013; 163 (03) 638-644
    CrossrefPubMedGoogle Scholar