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Effects of High versus Standard Early Protein Intake on Growth of Extremely Low Birth Weight Infants

Maggio, Luca; Cota, Francesco; Gallini, Francesca; Lauriola, Valeria; Zecca, Chiara; Romagnoli, Costantino

Journal of Pediatric Gastroenterology & Nutrition: January 2007 - Volume 44 - Issue 1 - p 124–129
doi: 10.1097/01.mpg.0000237927.00105.f7
Original Articles

Objectives: Early provision of protein has been shown to limit catabolism and could improve growth. Our objective was to determine whether early aggressive protein intake improved growth outcomes of extremely low birth weight (ELBW) infants.

Patients and Methods: ELBW infants were included in the study if they had no major congenital anomalies or renal failure and were still hospitalized at 36 weeks postmenstrual age. In 25 infants (HP) the early protein intake was planned to be 20% greater than in 31 historical controls (SP).

Results: The 2 groups were similar in the baseline characteristics. The mean protein intake during the first 14 days of life was significantly greater in the HP group (3.1 ± 0.2 vs 2.5 ± 0.2 g/kg/d; P<0.0001). HP group showed lower postnatal weight loss (−3.1%; 95% confidence interval [CI] −5.9, −0.2) and earlier regain of birth weight (−4.1 days; 95% CI −6.6, −1.7). Mean blood urea nitrogen and bicarbonate levels were similar; mean serum glucose level was lower in the HP group (−21,7 mg/dL; 95% CI −41.9,−1.5). HP infants had a reduced fall in weight z score (−0.57; 95% CI −1.01, −0.12) and in length z score (−0.51; 95% CI −0.97, −0.05) from birth to discharge.

Conclusion: Early high protein intake was associated with improved weight and length growth outcomes at discharge. These findings highlight the benefits of aggressive protein intake immediately after birth.

Division of Neonatology, Department of Paediatrics, Catholic University of the Sacred Heart, Rome, Italy

Received 4 December, 2005

Accepted 3 July, 2006

Address correspondence and reprint requests to Luca Maggio, Division of Neonatology, Department of Paediatrics, Catholic University of the Sacred Heart, I-00168 Rome, Italy (e-mail:

This work was presented at the 45th European Society for Paediatric Research meeting in Stockholm, September 2004.

© 2007 Lippincott Williams & Wilkins, Inc.