(18) Effects of Early Enteral vs. Parenteral Protein Intake on Growth and Neurodevelopment in Very Low Birth Weight Preterm Infants

Rebecca D. Henkel, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Ting Ting Fu, Cincinnati Children's Hospital Medical Center, United States; Maria Barnes-Davis, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Nehal Parikh, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

Background: Poor postnatal growth is associated with neurodevelopmental impairment in children born preterm. Early protein intake is a substrate for neuronal growth. Studies maximizing early protein intake have shown inconsistent effects on growth and neurodevelopment. Subgroup analyses in some studies and evidence from animal models suggest that enteral protein intake may lead to improved growth and neurodevelopment compared to parenteral.

Objectives: To investigate the hypothesis that higher proportion of enteral vs. parenteral protein in the first 28 days is associated with improved growth and neurodevelopment in very low birth weight (VLBW) infants.

Design/Methods: This is a preliminary analysis of 72 patients from a cohort of 270 VLBW infants enrolled in the Cincinnati Infant Neurodevelopment Early Prediction Study, a multicenter cohort of infants born ≤32 weeks gestation. Clinical data including birth and hospital course were prospectively collected. Infants had neurodevelopmental testing at 2 years corrected age with the Bayley Scales of Infant Development, 3rd edition (BSID-III). Energy and macronutrient intake data for the first 28 days were obtained from the medical record. Total intake and proportion of enteral vs. parenteral intake were correlated with growth and neurodevelopmental outcome, controlling for Clinical Risk Index for Babies (CRIB-II) score as a measure of illness severity. Primary outcomes were change in head circumference (HC) z-score and BSID-III cognitive score. Secondary outcomes were growth at 28 days and BSID-III motor and language scores.

Results: Table 1 presents baseline characteristics. Table 2 summarizes intake and growth in the first 28 days. Proportion of enteral vs. parenteral protein was not associated with growth or neurodevelopmental outcome. Higher total and enteral protein and calorie intake were correlated with higher cognitive and motor composite score on the BSID-III (p < 0.05); however, this association became non-significant when controlling for CRIB-II score. There were no significant correlations between nutritional intake and growth metrics.

Conclusion: These preliminary results indicate that enteral protein and energy intake may have greater effect on neurodevelopmental outcomes than parenteral, however this may be mediated by severity of illness. Future analysis of the complete VLBW cohort will include advanced quantitative brain MRI metrics, which may be more sensitive than neurodevelopmental outcomes to evaluate our hypothesis.