PROVIDE: A randomised controlled trial of increased protein intake in extremely low birth weight babies (ELBW)

Does increased protein intake during the first week of life to improve neurodevelopmental outcomes?

Professor Frank Bloomfield
University of Auckland

What is the problem and who does it affect?

Fetal growth between 23 and 27 weeks is more rapid than at any other stage of human growth. This is also the same period of development during which extremely low birth-weight babies (ELBW; birth-weight < 1,000g) are born.

It is estimated that 250 babies are born in New Zealand either extremely pre-term or at extremely low birth-weight each year. Birth for these extremely vulnerable babies represents a nutritional emergency, as providing optimum nutrition is challenging due to their very small size, immaturity of their gastrointestinal tract and limitations on the volume of fluid they can tolerate.

Faltering growth is almost universal among these babies and it is associated with poorer long-term neuro developmental outcomes. Up to 50% of ELBW have some form of cognitive, motor or learning impairment.

 

What is this research hoping to achieve?

The research aims to determine whether increased protein intake in the first five days after birth will improve both postnatal growth and long term development in extremely low birth-weight babies.

Previous research shows that the weeks immediately after birth are the time of maximum nutritional deficiency, particularly of protein intake.

Adequate protein is critical for optimum growth and development but there is little evidence on the amount required. The study will trial a simple, inexpensive intervention replacing a non-nutritional fluid with one containing a protein. It will establish if an additional 1g/ day of protein in the first week after birth will improve the neuro developmental outcomes for these children at two years of age.