Increasing Early Protein Intake Is Associated With a Reduction in Insulin-Treated Hyperglycemia in Very Preterm Infants

Background: Impaired early protein intake in very preterm infants contributes to early growth failure and may affect long-term neurocognitive development. The authors have previously shown that a standardized concentrated neonatal parenteral nutrition (scNPN) formulation can improve the efficiency of early protein administration. They recognized that very early protein intake could be improved further by modifying the original scNPN regimen and starting PN within 4 hours. Aim: To demonstrate that the new scNPN regimen could improve very early protein intake in infants <29 weeks’ gestation without causing clinically important PN intolerance and complications. Methods: All eligible infants <29 weeks’ gestation, receiving the modified scNPN regimen and born between October 2009 and December 2010, were studied (group scNPN2). These were compared with previously studied infants, <29 weeks’ gestation and receiving the original scNPN regimen and born between June 2006 and December 2006 (group scNPN1). Infant details, actual nutrition intake, and metabolic/infection data were recorded. Results: Thirty-eight infants <29 weeks’ gestation (group scNPN2) were compared with the 38 infants previously studied (group scNPN1). PN was started earlier in group scNPN2, leading to increased mean (95% confidence interval) total protein intake (first 7 days) of 15.3 (14.5–16.1) g/kg in group scNPN2 vs 11.8 (11.0–12.6) g/kg in group scNPN1. There were no differences in calorie, lipid, and carbohydrate intake. Infants receiving insulin for hyperglycemia fell from 20 (53%) in group scNPN1 to 10 (26%) in group scNPN2. Conclusion: Increasing early protein intake is associated with a reduction in insulin-treated hyperglycemia in infants <29 weeks’ gestation.