The number of preterm infants with extremely low birth weight who survived free from neurodisability at a corrected age of 2 years was not increased by parenteral administration of an extra 1 g/day of amino acids for 5 days after birth, ProVIDe researchers report.
At 8 neonatal intensive care units, infants with birth weights of less than 1000 g received amino acids 1 g/day (intervention group) or placebo in addition to usual nutrition for the first 5 days after birth. The primary outcome was survival free from neurodisability as assessed with the Bayley Scales of Infant and Toddler Development and neurologic examination at 2 years, corrected for gestational age at birth.
“We enrolled 434 infants (217 per group) in this trial,” the authors write. “Survival free from neurodisability was observed in 97 of 203 children (47.8%) in the intervention group and in 102 of 205 (49.8%) in the placebo group (adjusted relative risk, 0.95; 95% confidence interval [CI], 0.79 to 1.14; P=0.56). Death before the age of 2 years occurred in 39 of 217 children (18.0%) in the intervention group and 42 of 217 (19.4%) in the placebo group (adjusted relative risk, 0.93; 95% CI, 0.63 to 1.36); neurodisability occurred in 67 of 164 children (40.9%) in the intervention group and 61 of 163 (37.4%) in the placebo group (adjusted relative risk, 1.16; 95% CI, 0.90 to 1.50). Neurodisability was moderate to severe in 27 children (16.5%) in the intervention group and 14 (8.6%) in the placebo group (adjusted relative risk, 1.95; 95% CI, 1.09 to 3.48). More children in the intervention group than in the placebo group had patent ductus arteriosus (adjusted relative risk, 1.65; 95% CI, 1.11 to 2.46). In a post hoc analysis, refeeding syndrome occurred in 42 of 172 children in the intervention group and 26 of 166 in the placebo group (adjusted relative risk, 1.64; 95% CI, 1.09 to 2.47). Eight serious adverse events occurred.”
Editorial: These findings show that “more is not necessarily better,” an editorialist writes. “Protein is one component of several macronutrients and numerous micronutrients that collectively nourish a growing preterm infant. The specific postnatal nutritional requirements to maximize survival and health outcomes across the range of gestational ages at birth remain a work in progress. As increasingly immature preterm babies survive to receive NICU care, nutritional requirements as well as the composition of available nutritional products must be continually reevaluated along with strategies that rely less on the vascular system and more on the gastrointestinal tract as the preferred delivery route. Appropriate nutrition for the preterm infant is lifesaving, and the importance is beyond growth; it also affects organ development, immune ontogeny, and health resilience. Achieving this ideal goal will provide a nutritional armor for preterm infants during their most vulnerable period and later in life.”