Lack of Evidence for Additional Protein-Energy in Enteral Nutrition for Very Low Birth Weight Preterm Infants: A Systematic Review (P11-086-19)

To investigate the evidence for the effect of protein and energy via enteral nutrition on identified outcomes in very low birthweight preterm infants. A literature search was conducted using EMBASE, CINAHL, Cochrane Central and PubMed databases for the period of January 1980-November 2017 for all peer-reviewed articles examining preterm infant nutrition. A multidisciplinary volunteer expert Workgroup and staff screened articles according to defined inclusion criteria (randomized controlled trials, enteral fed preterm infants with birthweight < 1500 gm, economically developed nations). Studies that evaluated the effect of adding protein-energy in enteral feeding, compared to a control group, were included. Data was extracted and risk of bias was evaluated using the Academy's Quality Criteria Checklist and Cochrane's Risk of Bias Tool. Data was summarized and conclusion statements were developed and graded for each identified outcome using the GRADE framework and Academy methodology. The search identified in 25,264 articles, and five articles were included. Two included studies had low risk of bias. The remaining studies had bias in the following Cochrane domains: selection (2), performance (2), and attrition (1). Eight conclusion statements were developed, five were graded as limited evidence, and three were graded as having fair evidence. Protein-energy fortification was found to have a significant positive effect on weight gain (SMD (95%CI): 1.24 (0.26,2.22)) in human milk fed VLBW preterm infants, however, no evidence of effect was found in formula or mixed fed infants. Limited evidence suggests a significant effect on fat free mass (MD (95% CI): 179 g (28.5, 386.5)) after 30 days, but no effect on fat mass. No significant effect was found on necrotizing enterocolitis, anemia, length, head circumference, or days to full feeds. Evidence was lacking regarding the effect of protein-energy fortification on identified outcomes in VLBW preterm infants. Available evidence was low in quality due to small sample sizes and heterogeneity in study populations (formula fed, human milk fed), interventions (amount of protein) and reporting of methods (protein prescription vs actual intake) and outcomes. Academy of Nutrition and Dietetics.