VLBW: Protein-Energy (2020)

Intervention
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of protein-energy amount via enteral nutrition on mortality?
- Conclusion
  No studies were identified that evaluated the effect of amount of protein-energy intake on mortality in very low birthweight (VLBW) preterm infants.
- Grade: V
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Search Plan and Results: VLBW: Protein Energy (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of protein-energy amount via enteral nutrition on NEC?
- Conclusion
  One RCT that lacked statistical power examined the effect of human milk fortified with 1.8g vs.1.0g of bovine protein added per 100ml mother's own milk (MOM) or individualized protein fortification up to a total of 4.5g per kg for 41 days and found no incidence of necrotizing enterocolitis (NEC) in any group.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of protein-energy amount via enteral nutrition on NEC?
  - Detail
  - Quality Rating Summary
    For a summary of the Quality Rating results, click here.
  - Worksheets
    
    Maas C, Mathes M, Bleeker C, Vek J, Bernhard W, Wiechers C, Peter A, Poets C, Franz A. Effect of Increased Enteral Protein Intake on Growth in Human Milk-Fed Preterm Infants: A Randomized Clinical Trial. JAMA Pedatrics 2017; 171:16-22
- Search Plan and Results: VLBW: Protein Energy (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of protein-energy amount via enteral nutrition on anemia?
- Conclusion
  One RCT examined the effect of human milk protein-energy fortification to 3.5g per kg per day vs. human milk with no added protein or energy in very low birthweight (VLBW) preterm infants for six weeks. The effect on anemia indices at six weeks of age did not differ between groups.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of protein-energy amount via enteral nutrition on anemia?
  - Detail
  - Quality Rating Summary
    For a summary of the Quality Rating results, click here.
  - Worksheets
    
    Rönnholm K, Siimes M. Haemoglobin concentration depends on protein intake in small preterm infants fed human milk. Archives of Disease in Childhood 1985; 60:99-104
- Search Plan and Results: VLBW: Protein Energy (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of protein-energy amount via enteral nutrition on weight gain?
- Conclusion
  Protein-energy fortification appears to be effective at increasing weight gain when added (0.9g to 1g per dL) to human milk fed to very low birthweight (VLBW) preterm infants. In contrast, no effect was found on weight gain when protein with energy (3.0g to 4.7g compared to 2.8g to 3.7g per kg per day protein) was provided to VLBW preterm infants who received preterm formulas or were mixed fed.
- Grade: II
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of protein-energy amount via enteral nutrition on weight gain?
- Search Plan and Results: VLBW: Protein Energy (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of protein-energy amount via enteral nutrition on length?
- Conclusion
  The preponderance of evidence suggests that protein-energy supplementation does not affect length gain in very low birthweight (VLBW) preterm infants when it is added to either formula or human milk at any level, but evidence was inconsistent.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of protein-energy amount via enteral nutrition on length?
- Search Plan and Results: VLBW: Protein Energy (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of protein-energy amount via enteral nutrition on head circumference?
- Conclusion
  Protein-energy supplementation had no effect on head circumference gain (SMD, 0.55; 95% CI, 0.04 to 1.13) in very low birthweight (VLBW) preterm infants, when delivered for four to eight weeks.
- Grade: II
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of protein-energy via enteral nutrition on head circumference?
- Search Plan and Results: VLBW: Protein Energy (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of protein-energy amount via enteral nutrition on skinfold measurements?
- Conclusion
  Adding 0.2g to 1.2g per kg per day of protein-energy supplementation did not affect skinfold measurements after 30 days in very low birthweight (VLBW) preterm infants, but evidence was very limited.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect protein-energy amount via enteral nutrition on skinfold measurements?
  - Detail
  - Quality Rating Summary
    For a summary of the Quality Rating results, click here.
  - Worksheets
    
    Ditzenberger G, Wallen L, Phelan L, Escoe S, Collins S. Supplemental protein and postnatal growth of very low birth weight infants: a randomized trial. Journal of Neonatal-Perinatal Medicine 2013; 6:285-94
- Search Plan and Results: VLBW: Protein Energy (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of protein-energy amount via enteral nutrition on fat mass or fat-free mass?
- Conclusion
  Limited evidence suggests that adding 0.5g to 1.0g of protein-energy per kg per day (for a total of 4.2g to 4.7g per kg per day) may increase fat-free mass, but has no effect on fat mass in very low birthweight (VLBW) preterm infants after 30 days.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of protein-energy amount via enteral nutrition on fat mass or fat-free mass?
  - Detail
  - Quality Rating Summary
    For a summary of the Quality Rating results, click here.
  - Worksheets
    
    Costa-Orvay J, Figueras-Aloy J, Romera G, Closa-Monasterolo R, Carbonell-Estrany X. The effects of varying protein and energy intakes on the growth and body composition of very low birth weight infants. Nutrition Journal 2011; 10:140
- Search Plan and Results: VLBW: Protein Energy (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of protein-energy amount via enteral nutrition on developmental outcomes?
- Conclusion
  No studies were identified that evaluated the effect of protein-energy amount via enteral nutrition on developmental outcomes in very low birthweight (VLBW) preterm infants.
- Grade: V
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Search Plan and Results: VLBW: Protein Energy (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of protein-energy amount via enteral nutrition on gastrointestinal health?
- Conclusion
  In one study, MOM that was fortified 1.8g of bovine protein per 100ml of MOM, compared to 1.0g of bovine protein per 100ml MOM, had no effect on days until full enteral feeds in very low birthweight (VLBW) preterm infants.
- Grade: II
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of protein-energy amount via enteral nutrition on gastrointestinal health?
  - Detail
  - Quality Rating Summary
    For a summary of the Quality Rating results, click here.
  - Worksheets
    
    Maas C, Mathes M, Bleeker C, Vek J, Bernhard W, Wiechers C, Peter A, Poets C, Franz A. Effect of Increased Enteral Protein Intake on Growth in Human Milk-Fed Preterm Infants: A Randomized Clinical Trial. JAMA Pedatrics 2017; 171:16-22
- Search Plan and Results: VLBW: Protein Energy (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of protein-energy amount via enteral nutrition on bone mineral content?
- Conclusion
  No studies were identified that evaluated the effect of protein-energy amount via enteral nutrition on bone mineral content in very low birth weight (VLBW) preterm infants.
- Grade: V
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Search Plan and Results: VLBW: Protein Energy (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of protein-energy amount via enteral nutrition on protein utilization?
- Conclusion
  No studies were identified that evaluated the effect of protein-energy amount via enteral nutrition on protein utilization in very low brithweight (VLBW) preterm infants.
- Grade: V
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Search Plan and Results: VLBW: Protein Energy (2019)