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Targeting optimal protein delivery in parenteral and enteral nutrition for preterm infants: a review of randomized, controlled trials

Journal of Perinatology (2023)Cite this article

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Abstract

Close attention to nutritional management is essential for optimizing growth and neurodevelopment of the preterm infant. Protein intake and the protein to energy ratio are the main determinants of growth and body composition. Yet large, multi-center, randomized controlled trials are lacking to guide protein delivery for the preterm infant. Until these studies are pursued, smaller trials must be used to inform clinical practice. This review summarizes the randomized controlled trials that have been performed to test the impact of higher vs. lower protein delivery to the preterm infant. We consider the trials that varied protein delivery rates during parenteral and enteral phases of nutrition. Considerable heterogeneity exists across study designs. Still, cumulative evidence from these trials provides a framework for current recommendations for protein intake in the preterm infant.

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Fig. 1: Amino acid utilization by the preterm infant.

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Acknowledgements

We would like to acknowledge Kendra Hendrickson, MS, RD, CNSC, CSP and Susan Marshall, MS, RD, CSPCC, CNSC for their nutritional expertise during preparation of this manuscript.

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The Ludeman Family Center for Women’s Health Research, University of Colorado Anschutz Medical Campus (LDB). The content of this manuscript does not represent the official views of the funding organizations.

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  1. Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Laura D. Brown & Jane Stremming

  2. Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Daniel T. Robinson

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LDB, DTR and JS performed the literature review; LDB drafted the manuscript; LDB, DTR and JS edited the manuscript and approved the final version.

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Correspondence to Laura D. Brown.

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Brown, L.D., Stremming, J. & Robinson, D.T. Targeting optimal protein delivery in parenteral and enteral nutrition for preterm infants: a review of randomized, controlled trials. J Perinatol (2023). https://doi.org/10.1038/s41372-023-01847-6

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