title: Minimal enteral feeding within 3 d of birth in prematurely born infants with birth weight < or = 1200 g improves bone mass by term age.
abstract: BACKGROUND
  Evidence-based practice guidelines for aggressive nutritional intervention by using parenteral amino acids (AAs) and minimal enteral feeding (MEF) as early as the first day of life have not been tested for benefits to bone mass.
  
  
  OBJECTIVE
  We investigated whether early introduction of parenteral AAs and MEF improves growth and bone mass achieved by term age in infants born prematurely.
  
  
  METHODS
  Twenty-seven infants who were < or = 1200 g and < or = 32 wk gestation at birth were randomly assigned by using a 2 x 2 design to treatment of either 1 g AAs/kg within the first 24 h or 12 mL MEF x kg(-1) x d(-1) within the first 72 h of life. Nutrition and growth were documented during hospitalization, and bone mineral content (BMC) of lumbar spine 1-4, femur, and whole body was measured at term age. Biomarkers of bone metabolism were measured at weeks 1, 3, and 5 and at discharge. Statistical analysis was conducted by using 2 x 2 analysis of variance for intent to treat and for infants receiving protocol nutrition.
  
  
  RESULTS
  Over the first 14 d of life, a main effect of early AAs elevated total intake of protein, and a main effect of early MEF was a higher frequency of MEF volumes exceeding > 12 mL x kg(-1) x d(-1). Main effects on growth were not evident. An interaction effect was observed for osteocalcin whereby early AAs or MEF alone elevated osteocalcin. A main effect of early MEF yielded higher BMC of spine and femur.
  
  
  CONCLUSIONS
  Early aggressive nutrition support with MEF enhances BMC in premature infants, but early MEF or AAs do not improve growth.
authors.affiliation: Department of Human Nutritional Sciences, University of Manitoba, Winnipeg, Canada. hope.weiler@mcgill.ca
authors.forename: Hope A
authors.initials: HA
authors.lastname: Weiler
authors.forename: Shirley C
authors.initials: SC
authors.lastname: Fitzpatrick-Wong
authors.forename: Jeannine M
authors.initials: JM
authors.lastname: Schellenberg
authors.forename: Denise E
authors.initials: DE
authors.lastname: Fair
authors.forename: Ursula R
authors.initials: UR
authors.lastname: McCloy
authors.forename: Rebecca R
authors.initials: RR
authors.lastname: Veitch
authors.forename: Heather R
authors.initials: HR
authors.lastname: Kovacs
authors.forename: Mary M
authors.initials: MM
authors.lastname: Seshia
mesh_terms: D015502:Absorptiometry, Photon; D000596:Amino Acids / Q000008:administration & dosage* / Q000627:therapeutic use; D000704:Analysis of Variance; D015519:Bone Density / Q000187:drug effects*; D001846:Bone Development / Q000187:drug effects / Q000502:physiology; D004750:Enteral Nutrition; D005260:Female; D005865:Gestational Age; D006128:Growth / Q000187:drug effects; D006801:Humans; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D007234:Infant, Premature / Q000254:growth & development / Q000502:physiology*; D019102:Infant, Very Low Birth Weight / Q000254:growth & development / Q000502:physiology*; D008297:Male; D015675:Osteocalcin / Q000097:blood; D010288:Parenteral Nutrition
chemical_list: D000596:Amino Acids; D015675:Osteocalcin