In neonatal intensive care units (NICUs), the growth retardation of preterm neonates is common. Although there are many reasons, nutrition, especially insufficient protein intake, is one of the important reasons. Accumulated decades of research since the early 1980s have shown that the intake of protein in preterm infants will affect their long-term health. At the same time, it is generally accepted that high protein intake meets the early growth rate of weight gain in premature infants that is close to the intrauterine growth rate of normal fetuses with normal fetal age and is beneficial to both short-term and long-term health in preterm infants. Long-term follow-up of preterm infants given high-protein nutrition (average within 4 weeks of birth) showed that optimizing protein intake in preterm infants is beneficial to their 16-year-old brain structure and function, including a 10% increase in the size of the caudate nucleus. Improved IQ and cognitive functions (eg, mathematical reasoning, computing power, and reading comprehension). Since the start of this study, a large number of follow-up observations have shown that early postnatal malnutrition (such as growth retardation, slow growth of head circumference and insufficient protein intake) has a significant causal relationship with the late neurocognitive impairment. Therefore, it is internationally recommended that premature infants should increase protein intake.
Although these large amounts of observational evidence suggest that there is a positive association between high protein intake and long-term health in preterm infants, the role of early protein intake in late-term infant neurodevelopment is unclear. For example, evidence-based medicine for randomized trials has not shown that the benefits of early amino acid supplementation in preterm infants, or the addition of high- and low-protein formula feedings, have a different effect on late-term neurodevelopment in preterm infants. Therefore, although there is a close relationship between early postnatal protein intake and neonatal growth, and between slow growth and late neurodevelopmental impairment, it is still controversial whether high protein can be used to improve cognitive function in preterm infants.
At the same time, the long-term follow-up results of the aforementioned preterm infants participating in the nutrition trial showed that the faster the weight gain after birth, the greater the risk factor for cardiovascular disease at a later stage. Randomized trials have also shown that high-protein diets in preterm infants increase the risk of obesity, insulin resistance, dyslipidemia, markers of inflammation, and endothelial dysfunction after the first four weeks of age. These procedural effects of early growth, known as the accelerated growth hypothesis, have now been demonstrated in randomized observational studies in several preterm populations and are applicable to full term low birth weight infants. Therefore, the rapid weight gain of infants seems to have both advantages and disadvantages for long-term health effects. But currently, based on the consensus that nutrition guidelines for preterm infants have been widely accepted, optimizing neurodevelopment is the highest priority for newborns. Taken together, this guideline supports early high protein intake to improve late-stage cognitive function without considering the risk of any increase in the prevalence of cardiovascular disease.
However, this consensus is mainly based on the study of preterm infants <31 weeks gestational age, and the risk-benefit ratio of excessively low birth weight infants compared with older, more mature, healthy preterm infants. still uncertain. At the same time, the key time points for these impacts are still unknown, and it is still controversial whether the same nutrition strategy is adopted after discharge. For example, a randomized trial of a post-discharge feeding program showed that high protein intake increased the growth rate of preterm infants, but did not find adverse effects on its late-stage physical factors or increased cardiovascular prevalence in preterm infants.
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