Relationships Between Early Neonatal Nutrition and Neurodevelopment at School Age in Children Born Very Preterm.

OBJECTIVES To determine whether a new nutrition protocol designed to increase early protein intakes while reducing fluid volume in infants born very preterm was associated with altered neurodevelopment and growth in childhood. METHODS A retrospective, observational cohort study of children born <30 weeks' gestation or <1,500 grams and admitted to the neonatal unit, National Women's Hospital, Auckland, NZ, before and after a change in nutrition protocol. The primary outcome was neurodevelopmental impairment at 7 years (any of Wechsler Intelligence Scale for Children full scale IQ<85, Movement Assessment Battery for Children-2 total score ≤5 centile, cerebral palsy, blind or deaf requiring aids). Outcomes were compared between groups and for the overall cohort using generalised linear regression, adjusted for sex and birth weight z-score. RESULTS Of 201 eligible children, 128 (64%) were assessed (55/89 (62%) exposed to the old nutrition protocol, 73/112 (65%) to the new protocol). Children who experienced the new protocol received more protein, less energy and less carbohydrate in postnatal days 1-7. Neurodevelopmental impairment was similar at 7 years (30/73 (41%) vs 25/55 (45%), adjusted odds ratio (AOR) (95% confidence interval) 0.78 (0.35-1.70), P = 0.55), as was the incidence of cerebral palsy (AOR 7.36 (0.88-61.40), P = 0.07). Growth and body composition were also similar between groups. An extra one g.kg parenteral protein intake in postnatal days 1-7 was associated with a 27% increased odds of cerebral palsy (AOR 1.27 (1.03-1.57), P = 0.006). CONCLUSIONS Higher early protein intakes do not change overall rates of neurodevelopmental impairment or growth at 7 years. Further research is needed to determine the effects of higher early parenteral protein intake on motor development.