Protein administration guideline for the premature infants, concensus

Toto Wisnu Hendrarto,

Indonesia Pediatric Society, Neonatology Working Group
Harapan Kita Women and Children Hospital, Jakarta

Background
Extra uterine growth restriction (EUGR) is one of the main problem will be faced in the
management of premature infants especially with the gestation less than 32 weeks.
Extremely premature infants born less than 28 weeks and who have weight less than 1000
gram are at the highest risk for EUGR. Unstable condition during the first week of life
delays the extremely premature from receiving needed amount of nutrition to achieve the
nutrition accretion.
Current evidence supported the administration of early aggressive nutrition in the
ELBW infant for extra uterine growth improvement. Early aggressive nutrition
intervention is the early administration of amino acids, intra lipids and minimal enteral
feeding. The early administration of protein is safe and has been shown to prevent
catabolism, promote nitrogen balance and protein synthesis without increasing blood urea
nitrogen (BUN) levels and disrupting acid base balance.
Recommendation
Amino acids administrations will promotes protein synthesis and it should start right after
birth at a rate of 2-3g/kg/day in order to achieve the protein requirement. The rate should
be increased by 0.5-1g/kg/day until reaching a maximum of 4g/kg/day for the premature
infants with the birth weight > 1000 gram and 4.5g/kg/day for the premature infants with
the birth weight ≤ 1000 gram. The early administration of protein to ELBW infants has
been shown to improve weight, length, and head circumference at 36 weeks post
conceptual age. The composition of the amino acids should be content the conditionally
essential amino acid that are tyrosine, cystein, taurine, histidine, glycine,
glutamine, arginine.