There is a ‘growing’ feeling that we don’t give enough protein to our preterm infants, especially during the enteral phases of nutrition. Fortified maternal breast milk use is associated with lower overall rates of weight gain, despite all its benefits. Also the emphasis on weight gain as the major outcome variable may be misplaced. Body composition at term of former extremely low gestational age preterms is quite abnormal. A recent RCT investigated whether giving more protein in the fortifier would improve growth.
Miller J, Makrides M, Gibson RA, McPhee AJ, Stanford TE, Morris S, Ryan P, Collins CT: Effect of increasing protein content of human milk fortifier on growth in preterm infants born at <31 wk gestation: a randomized controlled trial. Am J Clin Nutr 2012, 95(3):648-655. http://www.ajcn.org/content/95/3/648
92 infants of less than 31 weeks were randomized, at the end of the study the higher protein infants weighed more, but the length and head circumference was not increased. This may have been a lack of power. So further larger trials will be required to figure out how to improve preterm infants growth and body composition.
An abstract presented at this years PAS meeting in Boston by our group [4510.111] Eliminating Postnatal Growth Restriction with an Aggressive TPN and feeding Protocol. Marianne Lapointe, Josee Mandeville, Keith Barrington, Annie Janvier. Neonatology, Sainte-Justine Hospital, University of Montreal, Montreal, QC, Canada. Showed that we have practically eliminated postnatal growth restriction by having an aggressive TPN and feeding protocol. But we certainly do still see infants who have a good weight, but their length is less than it should be.