Relationships Between Early Neonatal Nutrition and Neurodevelopment at School Age in Children Born Very Preterm.

To determine whether a new nutrition protocol designed to increase early protein intakes while reducing fluid volume in infants born very preterm was associated with altered neurodevelopment and growth in childhood.A retrospective, observational cohort study of children born <30 weeks' gestation or <1,500 grams and admitted to the neonatal unit, National Women's Hospital, Auckland, NZ, before and after a change in nutrition protocol. The primary outcome was neurodevelopmental impairment at 7 years (any of Wechsler Intelligence Scale for Children full scale IQ<85, Movement Assessment Battery for Children-2 total score ≤5 centile, cerebral palsy, blind or deaf requiring aids). Outcomes were compared between groups and for the overall cohort using generalised linear regression, adjusted for sex and birth weight z-score.Of 201 eligible children, 128 (64%) were assessed (55/89 (62%) exposed to the old nutrition protocol, 73/112 (65%) to the new protocol). Children who experienced the new protocol received more protein, less energy and less carbohydrate in postnatal days 1-7. Neurodevelopmental impairment was similar at 7 years (30/73 (41%) vs 25/55 (45%), adjusted odds ratio (AOR) (95% confidence interval) 0.78 (0.35-1.70), P = 0.55), as was the incidence of cerebral palsy (AOR 7.36 (0.88-61.40), P = 0.07). Growth and body composition were also similar between groups. An extra one g.kg parenteral protein intake in postnatal days 1-7 was associated with a 27% increased odds of cerebral palsy (AOR 1.27 (1.03-1.57), P = 0.006).Higher early protein intakes do not change overall rates of neurodevelopmental impairment or growth at 7 years. Further research is needed to determine the effects of higher early parenteral protein intake on motor development.