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Minimal enteral feeding within 3 d of birth in prematurely born infants with birth weight 1200 g improves bone mass by term age^1,2,3

From the Departments of Human Nutritional Sciences (HAW, SCF-W, JMS, DEF, URM, RRV, and HRK), Pediatrics and Child Health (HAW and MMS), and Obstetrics and Gynecology (MMS), University of Manitoba, Winnipeg, Canada

Background: Evidence-based practice guidelines for aggressive nutritional intervention by using parenteral amino acids (AAs) and minimal enteral feeding (MEF) as early as the first day of life have not been tested for benefits to bone mass.

Objective: We investigated whether early introduction of parenteral AAs and MEF improves growth and bone mass achieved by term age in infants born prematurely.

Design: Twenty-seven infants who were 1200 g and 32 wk gestation at birth were randomly assigned by using a 2 x 2 design to treatment of either 1 g AAs/kg within the first 24 h or 12 mL MEF · kg^–1 · d^–1 within the first 72 h of life. Nutrition and growth were documented during hospitalization, and bone mineral content (BMC) of lumbar spine 1–4, femur, and whole body was measured at term age. Biomarkers of bone metabolism were measured at weeks 1, 3, and 5 and at discharge. Statistical analysis was conducted by using 2 x 2 analysis of variance for intent to treat and for infants receiving protocol nutrition.

Results: Over the first 14 d of life, a main effect of early AAs elevated total intake of protein, and a main effect of early MEF was a higher frequency of MEF volumes exceeding >12 mL · kg^–1 · d^–1. Main effects on growth were not evident. An interaction effect was observed for osteocalcin whereby early AAs or MEF alone elevated osteocalcin. A main effect of early MEF yielded higher BMC of spine and femur.

Conclusion: Early aggressive nutrition support with MEF enhances BMC in premature infants, but early MEF or AAs do not improve growth.

Key Words: Minimal enteral feeds • parenteral amino acids • aggressive nutrition therapy • bone mineral content • very-low-birth-weight infant • premature infant