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Does Amount of Protein in Formula Matter for Low-Birthweight Infants? A Cochrane Systematic Review
Shahirose Premji, RN, PhD*,
Tanis Fenton, MHSc, RD and
Reg Sauve, MD, MPH, FRCPC
From the * Faculty of Nursing and
Paediatrics and Community Health Sciences,
University of Calgary, Calgary, Alberta, Canada; and the
Alberta Children's Hospital, Calgary, Alberta,
Canada
Correspondence: Shahirose Premji, RN, PhD, Assistant Professor and Neonatal
Nurse Practitioner, University of Calgary, Faculty of Nursing, 2500 University
Drive NW, Calgary, Alberta, Canada T2N 1N4. Electronic mail may be sent to
premjis{at}ucalgary.ca.
Background: High protein intake may be associated with negative
consequences such as acidosis, uremia, and elevated levels of circulating
amino acids (eg, phenylalanine levels). We performed a systematic review of
randomized controlled trials to determine whether formula-fed low-birthweight
infants could tolerate protein intakes  3.0 g/kg/d in their initial
hospital stay, without adverse consequences. Methods: Randomized
controlled trials contrasting levels of protein intakes as low (<3.0
g/kg/d), high (3.0 g/kg/d but <4.0 g/kg/d), or very high protein intake
(4.0 g/kg/d) while other nutrients were held constant, were identified
through a systematic search of the literature. Standard methods of the
Cochrane Collaboration were used by 2 independent reviewers, with the third
reviewer facilitating consensus decision making. Results: A
meta-analysis of 5 randomized trials indicated improved weight gain (weighted
mean difference [WMD] 2.36 g/kg/d; 95% confidence interval [CI]
1.31–3.40) and higher nitrogen accretion (WMD 143.7 mg/kg/d; 95% CI
128.7–158.8) with high (3.0 g/kg/d but <4.0 g/kg/d) compared with
low (< 3.0 g/kg/d) protein intakes while other nutrients were kept
constant. No data were available for IQ or Bayley scores at 18 months or later
or for very high protein intakes (4.0 g/kg/d). No significant differences
were seen in rates of necrotizing enterocolitis, sepsis, or diarrhea.
Conclusions: Accelerated weight and nitrogen accretion were noted
with higher protein intakes in "healthy" formula-fed
low-birthweight infants. This benefit could not be weighed against the adverse
consequences of elevated blood urea nitrogen levels and increased metabolic
acidosis and neurodevelopmental abnormalities.
Journal of Parenteral and Enteral Nutrition, Vol. 30, No. 6,
507-514 (2006)
DOI: 10.1177/0148607106030006507
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