VLBW: Protein Amount (2020)

VLBW: Protein Amount (2020)

• Intervention
  In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of protein amount via enteral nutrition on mortality?

  • Conclusion

    No studies were identified that evaluated the effect of amount of protein 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 Amount (2019)
     
  In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of protein amount via enteral nutrition on weight?

  • Conclusion

    Two RCTs found a non-significantly greater weight gain (MD of 2.4g per kg per day; 95% CI, -0.4 to 5.3) by very low birthweight (VLBW) preterm infants that received greater vs. less than 3.0g per kg per day of protein from preterm infant formula for 14 to 30 days. A significant difference in weight gain (MD of 2.6g per kg per day; 95% CI, 0.1 to 5.0) was found when protein intake less or greater than 3.5g per kg per day of protein intake was compared in these same two studies.

  • 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 amount via enteral nutrition on weight?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Bhatia J, Rassin D, Cerreto M, Bee D. Effect of protein-energy ratio on growth and behavior of premature infants: preliminary findings. The Journal of Pediatrics 1991; 119:103-10
      • Hillman L, Salmons S, Erickson M, Hansen J, Hillman R, Chesney R. Calciuria and aminoaciduria in very low birth weight infants fed a high-mineral premature formula with varying levels of protein. The Journal of Pediatrics 1994; 125:288-94
  • Search Plan and Results: VLBW: Protein Amount (2019)
     
  In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of protein amount via enteral nutrition on length, head circumference, skinfold measurements and mid-arm circumference?

  • Conclusion

    One RCT found no evidence of effect of protein intake of 2.6g vs. 3.1g vs. 3.8g per kg per day on length gain, head circumference growth, skinfold measurements or mid-arm circumference, from preterm infant formula after two weeks in very low birthweight (VLBW) preterm infants. No numerical data was provided.

  • 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 amount via enteral nutrition on length, head circumference, skinfold measurements and mid-arm circumference?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Bhatia J, Rassin D, Cerreto M, Bee D. Effect of protein-energy ratio on growth and behavior of premature infants: preliminary findings. The Journal of Pediatrics 1991; 119:103-10
  • Search Plan and Results: VLBW: Protein Amount (2019)
     
  In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of protein amount via enteral nutrition on development?

  • Conclusion

    One small study reported some improvement in sub-scores on the Neonatal Behavior Assessment Scale (NBAS) development measures when very low birthweight (VLBW) preterm infants were fed higher protein intake, compared to the lower protein intakes (3.8g vs. 3.1g vs. 2.6g per kg per day), when assessed at approximately four weeks of age or 36 weeks gestational age. Half of the NBAS sub-scores were not significantly different 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 amount via enteral nutrition on development?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Bhatia J, Rassin D, Cerreto M, Bee D. Effect of protein-energy ratio on growth and behavior of premature infants: preliminary findings. The Journal of Pediatrics 1991; 119:103-10
  • Search Plan and Results: VLBW: Protein Amount (2019)
     
  In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of protein amount via enteral nutrition on bone mineral content or density?

  • Conclusion

    One RCT found no significant difference in bone mineral content (BMC) (MD of 0.010; 95% CI, -0.011 to 0.031) between VLBW preterm infants who received greater than versus less than 3.0 g/kg/day of protein from preterm infant formula during a 30-day intervention. Nor was there a significant difference in BMC (MD of 0.010; 95%CI, -0.020 to 0.040) for the same infants who received greater than versus less than 3.5 gm/kg/day kg per day. Change in BMC data was not provided.

  • 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 amount via enteral nutrition on bone mineral content/density?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Hillman L, Salmons S, Erickson M, Hansen J, Hillman R, Chesney R. Calciuria and aminoaciduria in very low birth weight infants fed a high-mineral premature formula with varying levels of protein. The Journal of Pediatrics 1994; 125:288-94
  • Search Plan and Results: VLBW: Protein Amount (2019)
     
  In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of protein amount via enteral nutrition on protein utilization?

  • Conclusion

    No evidence was identifed to evaluate the effect of protein amount via enteral nutrition on morbidities, GI function, protein utilization, or adverse effects 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 Amount (2019)