Nutrição hiperproteica em recém-nascidos com muito baixo peso e evolução de índices antropométricos até a alta hospitalar: ensaio clínico randomizado

Abstract

Although several studies on preterm nutrition have been conducted, there is no consensus about the best nutritional strategy to adopt. Currently the growth rate of this population is not similar on that found in the intrauterine environment. This study aims to assess whether the higher enteral protein intake during hospitalization promotes improvement of anthropometric indices in hospital discharge. We conducted a randomized clinical trial of 117 preterm infants born between January 2009 and July 2013 with weight ≤1500 grams and gestational age ≤ 32 weeks in a tertiary health care unit, excluding those born with serious defects, gauging their anthropometric measures at birth and at discharge. We randomized the preterms drawing into two groups. group 1 (n = 53) was subjected to a daily enteral protein intake of 4.5 grams of protein/ kg /day, while group 2 (n = 64) received 3.5 grams of protein / kg / day. We avaliated if the enteral nutrition with higher protein content than commonly used in neonatal intensive care units and also described in the literature, promotes anthropometric differences in hospital discharge. In the results analisis, we verified that there was a statistically significant difference for return to birth weight (p = 0.02), Z-score variation in relation to birth weight (p = 0.03) and Z-score variation over the length of birth (p = 0.02) when comparing groups 1 and 2. There were no statistically significant differences in the incidence of necrotizing enterocolitis (p = 0.70, RR 0.88), weight deficit at discharge (p = 0 27, RR 0.70), growth restriction at discharge (p = 0.39, RR 0.82) and deficit of head circumference at discharge (p = 0.45, RR 0.67). It was concluded, despite the methodological limitations of the study, that patients in group 1 had a lower decrease of Z-scores in relation to birth weight and length of birth when compared to group 2, and need less time to recover birth weight. There was no difference between groups for hospitalization time, as well as complications of interest (necrotizing enterocolitis, underweight high, growth restriction in discharge and deficit of cephalic circumference at discharge).