455 - The Relationship Between Early Protein Intake and Changes to Weight Z-Score in Very Low Birth Weight Neonates

Poster Number: 455
Publication Number: 455.335

Nadia Asif, Stony Brook Children's Hospital, New Fairfield, CT, United States; Shanthy Sridhar, Stony Brook Children's Hospital, StonyBrook, NY, United States; Héctor E. Alcalá, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States; Susan Mathieson, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States; Jennifer Pynn, Stony Brook Children's Hospital, Stony Brook, NY, United States

Background: Practice variations exist in optimizing post-natal nutrition in the Very Low Birth Weight (VLBW) population. Despite the NASPGHAN recommendations for protein intake, ambiguity and controversies exist with the VLBW, SGA, and IUGR populations. Early amino acid administration in the first 24 hours of life has been shown to decrease rates of growth failure in pre-term infants at discharge, defined as growth below the 10th percentile. However, growth failure as defined by weight percentiles does not accurately predict neurodevelopmental outcomes as well as a change in Z-score. An association between earlier attainment of protein intake of 4 g/kg/day and a weight for age Z-score difference of no more than 0.8 SD below birth weight at 36 weeks post-menstrual age (PMA) and discharge remain to be determined.

Objective: To determine the association between time to achieve a protein intake of 4 g/kg/day and the change in Z-score from birth to 36 weeks PMA and discharge.

Design/Methods: This is a retrospective chart review of 370 VLBW neonates admitted to the Stony Brook Children's Hospital NICU from 2014 to 2019. Data collected included growth parameters at birth, 36 weeks PMA, and discharge, Z-scores calculated using the 2013 Fenton Growth Curve, weight Z-score change from birth to 36 weeks PMA and discharge, and protein intake on days 4, 7, 14, and 21 of life. Adjusted odds ratios with 95% confidence intervals (CI) were calculated (Table 1) to assess the association of protein intake with changes in z-scores of more than 0.8 SD below weight Z-score from birth to 36 weeks PMA and discharge. SNAPPE-II scores were included in the regression analysis to control for severity of illness.

Results: Neonates included in the study had a mean GA 29 ± 2weeks and BW 1089 ± 266grams with a mean BW Z-score -0.43 SD. Mean Z-score difference from birth at 36 weeks PMA and at discharge were -0.79 ± 0.93 and -0.74 ± 0.7 respectively. Forty-two percent lost more than 0.8 SD from birth. Protein intake of 4 g/kg/day was reached at a mean of 9 ± 7days. Regression analysis revealed an adjusted odds ratio of 1.04 (95% CI 1.01, 1.08) between days to protein goal of 4 g/kg/day and dropping ≥0.8 SD in weight Z-score from birth to 36 weeks. SNAPPE-II had a significant association with weight Z-score change from birth to 36 weeks PMA and discharge.Conclusion(s): In our study cohort, earlier achievement of 4 g/kg/day protein intake was predictive of a change in weight Z-score from birth to 36 weeks PMA in the VLBW population. Optimizing protein intake in the first two weeks of life is associated with improved z-scores at 36 weeks PMA.
Table 1: Adjusted Odds Ratio (AOR) and Confidence Intervals (CI)