VLBW: Non-Protein Energy (2020)

VLBW: Non-Protein Energy (2020)

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

  • Conclusion

    Fortification of already fortified human milk with human milk cream did not affect risk of mortality compared to fortified human milk alone after approximately nine weeks in very low birthweight (VLBW) preterm infants, but evidence was 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 of non-protein energy via enteral nutrition on mortality?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Hair A, Blanco C, Moreira A, Hawthorne K, Lee M, Rechtman D, Abrams S. Randomized trial of human milk cream as a supplement to standard fortification of an exclusive human milk-based diet in infants 750-1250 g birth weight. The Journal of Pediatrics 2014; 165:915-20
  • Search Plan and Results: VLBW: Non-Protein Energy (2019)
     
  In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of non-protein energy via enteral nutrition on sepsis?

  • Conclusion

    Fortification of already fortified human milk with human milk cream did not affect risk of sepsis, compared to fortified human milk alone after approximately nine weeks in very low birth weight (VLBW) preterm infants, but evidence was 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 of non-protein energy via enteral nutrition on sepsis?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Hair A, Blanco C, Moreira A, Hawthorne K, Lee M, Rechtman D, Abrams S. Randomized trial of human milk cream as a supplement to standard fortification of an exclusive human milk-based diet in infants 750-1250 g birth weight. The Journal of Pediatrics 2014; 165:915-20
  • Search Plan and Results: VLBW: Non-Protein Energy (2019)
     
  In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of non-protein energy via enteral nutrition on necrotising enterocolitis??

  • Conclusion

    Fortification of already fortified human milk with human milk cream did not affect incidence of necrotizing enterocolitis (NEC) compared to fortified human milk alone after approximately 9 weeks in very low birthweight (VLBW) preterm infants, but evidence was 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 of non-protein energy via enteral nutrition on necrotising enterocolitis?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Hair A, Blanco C, Moreira A, Hawthorne K, Lee M, Rechtman D, Abrams S. Randomized trial of human milk cream as a supplement to standard fortification of an exclusive human milk-based diet in infants 750-1250 g birth weight. The Journal of Pediatrics 2014; 165:915-20
  • Search Plan and Results: VLBW: Non-Protein Energy (2019)
     
  In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of non-protein energy via enteral nutrition on weight gain?

  • Conclusion

    Increasing non-protein energy in infant formula for up to 35 weeks did not affect weight gain. However, when breast milk was supplemented with non-protein energy in the form of human-based fat or cream for one to two months, weight gain increased by a  MD of 1.05g per kg per day; 95% CI, 0.12 to 1.97, compared to the groups consuming human milk alone in very low birthweight (VLBW) preterm infants.

  • 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 non-protein energy via enteral nutrition on weight gain?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Hair A, Blanco C, Moreira A, Hawthorne K, Lee M, Rechtman D, Abrams S. Randomized trial of human milk cream as a supplement to standard fortification of an exclusive human milk-based diet in infants 750-1250 g birth weight. The Journal of Pediatrics 2014; 165:915-20
      • Romera G, Figueras J, Rodríguez-Miguélez J, Ortega J, Jiménez R. Energy intake, metabolic balance and growth in preterm infants fed formulas with different nonprotein energy supplements. Journal of Pediatric Gastroenterology and Nutrition 2004; 38:407-13
      • Spencer S, McKenna S, Stammers J, Hull D. Two different low birth weight formulae compared. Early Human Development 1992; 30:21-31
      • van Goudoever J, Sulkers E, Lafeber H, Sauer P. Short-term growth and substrate use in very-low-birth-weight infants fed formulas with different energy contents. The American Journal of Clinical Nutrition 2000; 71:816-21
  • Search Plan and Results: VLBW: Non-Protein Energy (2019)
     
  In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of non-protein energy via enteral nutrition on length gain?

  • Conclusion

    Non-protein-energy supplementation for up to nine weeks did not affect length (SMD, 0.81cm per week; 95% CI, 0.03 to 0.19) in very low birthweight (VLBW) preterm infants, compared to usual care, regardless of feeding type or source of the non-protein energy.

  • 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 non-protein energy via enteral nutrition on length gain?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Hair A, Blanco C, Moreira A, Hawthorne K, Lee M, Rechtman D, Abrams S. Randomized trial of human milk cream as a supplement to standard fortification of an exclusive human milk-based diet in infants 750-1250 g birth weight. The Journal of Pediatrics 2014; 165:915-20
      • Polberger S, Axelsson I, Räihä N. Growth of very low birth weight infants on varying amounts of human milk protein. Pediatric Research 1989; 25:414-9
      • Romera G, Figueras J, Rodríguez-Miguélez J, Ortega J, Jiménez R. Energy intake, metabolic balance and growth in preterm infants fed formulas with different nonprotein energy supplements. Journal of Pediatric Gastroenterology and Nutrition 2004; 38:407-13
      • van Goudoever J, Sulkers E, Lafeber H, Sauer P. Short-term growth and substrate use in very-low-birth-weight infants fed formulas with different energy contents. The American Journal of Clinical Nutrition 2000; 71:816-21
  • Search Plan and Results: VLBW: Non-Protein Energy (2019)
     
  In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of non-protein energy via enteral nutrition on head circumference gain?

  • Conclusion

    Non-protein energy supplementation for up to nine weeks did not affect head circumference (MD, 0.05cm per week; 95% CI, 0.03 to 0.13) in very low birthweight (VLBW) preterm infants, compared to usual care, regardless of feeding type or source of the non-protein energy.

  • 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 non-protein energy via enteral nutrition on head circumference gain?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Hair A, Blanco C, Moreira A, Hawthorne K, Lee M, Rechtman D, Abrams S. Randomized trial of human milk cream as a supplement to standard fortification of an exclusive human milk-based diet in infants 750-1250 g birth weight. The Journal of Pediatrics 2014; 165:915-20
      • Polberger S, Axelsson I, Räihä N. Growth of very low birth weight infants on varying amounts of human milk protein. Pediatric Research 1989; 25:414-9
      • Romera G, Figueras J, Rodríguez-Miguélez J, Ortega J, Jiménez R. Energy intake, metabolic balance and growth in preterm infants fed formulas with different nonprotein energy supplements. Journal of Pediatric Gastroenterology and Nutrition 2004; 38:407-13
      • van Goudoever J, Sulkers E, Lafeber H, Sauer P. Short-term growth and substrate use in very-low-birth-weight infants fed formulas with different energy contents. The American Journal of Clinical Nutrition 2000; 71:816-21
  • Search Plan and Results: VLBW: Non-Protein Energy (2019)
     
  In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of non-protein energy via enteral nutrition on skinfold measurements?

  • Conclusion

    Two RCTs suggest that adding non-protein energy to formula may increase subscapular, suprailiac and leg skinfold thickness measurements when consumed for two to three weeks in very low birthweight (VLBW) preterm infants. However, evidence was 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 of non-protein energy via enteral nutrition on skinfold measurements?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Romera G, Figueras J, Rodríguez-Miguélez J, Ortega J, Jiménez R. Energy intake, metabolic balance and growth in preterm infants fed formulas with different nonprotein energy supplements. Journal of Pediatric Gastroenterology and Nutrition 2004; 38:407-13
      • van Goudoever J, Sulkers E, Lafeber H, Sauer P. Short-term growth and substrate use in very-low-birth-weight infants fed formulas with different energy contents. The American Journal of Clinical Nutrition 2000; 71:816-21
  • Search Plan and Results: VLBW: Non-Protein Energy (2019)
     
  In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of non-protein energy via enteral nutrition on body fat percentage?

  • Conclusion

    One small study suggests that non-protein energy supplementation may increase body fat percentage 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 of non-protein energy via enteral nutrition on body fat percentage?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • van Goudoever J, Sulkers E, Lafeber H, Sauer P. Short-term growth and substrate use in very-low-birth-weight infants fed formulas with different energy contents. The American Journal of Clinical Nutrition 2000; 71:816-21
  • Search Plan and Results: VLBW: Non-Protein Energy (2019)
     
  In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of non-protein energy via enteral nutrition on development, gastrointestinal function, bone mineral content or adverse effects?

  • Conclusion

    No research was identified to evaluate the effect of non-protein energy on development, gastrointestinal function, bone mineral content or adverse effects.

  • 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: Non-Protein Energy (2019)
     
  In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of non-protein energy via enteral nutrition on protein utilization?

  • Conclusion

    Very limited evidence suggests that the addition of 1.3g medium chain triglycerides (MCT) oil per day to preterm formula for 11 days does not affect nitrogen retention (SMD, 2mg per kg per day; 95% CI, 27.81 to 31.81) in very low birthweight (VLBW) preterm infants.

  • 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 non-protein energy via enteral nutrition on protein utilization?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Romera G, Figueras J, Rodríguez-Miguélez J, Ortega J, Jiménez R. Energy intake, metabolic balance and growth in preterm infants fed formulas with different nonprotein energy supplements. Journal of Pediatric Gastroenterology and Nutrition 2004; 38:407-13
  • Search Plan and Results: VLBW: Non-Protein Energy (2019)