Background Postnatal head growth failure is well recognised in very preterm infants (VPI), the largest deficit occurs at 3–4 weeks followed by some catch-up growth until 36weeks corrected gestational age (36wCGA). Head circumference (HC) is correlated with brain volume and later neurodevelopmental outcome. Early nutritional deficits commonly occur in parenteral nutrition (PN) dependent VPI. We hypothesised that a Standardised, Concentrated with Added Macronutrients Parenteral (SCAMP) nutrition regimen would improve early head growth.
Aim To compare the change in HC (ΔHC) and standard deviation score (ΔSDS) achieved at day 28 in VPI randomised to receive SCAMP nutrition (12% glucose, 3.8g/kg/day protein/lipid) or a control standardised, concentrated PN regimen (10% glucose, 2.8g/kg/day protein/lipid).
Methods The double-blind study (ISRCTN: 76597892) received ethical approval. Control PN was started within 6 hours of birth. Following parental consent, VPI (<1200g; <29 weeks) were randomised (day 2–5) to either start SCAMP or remain on the control regimen. HC was measured at randomisation, day 7 and then weekly until 36wCGA. Actual daily nutritional intake, biochemical and metabolic data were collected for day 1–28. Weekly growth data and major preterm complications were collected until 36wCGA.
Results 150/196 eligible infants were randomised at mean age 73.5 hours. Mean (SD) birthweight (g) and gestation (weeks) was: 900(158) versus 884(183) and 26.8(1.3) versus 26.6(1.4) in SCAMP (n = 74) and control (n = 76) groups respectively. SCAMP achieved higher mean actual protein/energy intakes (calculated weekly) with largest difference occurring in week 2: 25.5g/kg versus 20.9g/kg and; 762kcal/kg versus 664kcal/kg.
Differences in ΔHC are already apparent at day 7 (p < 0.05) with the greatest difference at 3–4 weeks (28-day-ΔHC difference equates to 6% difference head/brain volume). Group HC differences are still apparent at 36wCGA (p < 0.05).
Conclusion Early postnatal head growth failure in VPI can be prevented by optimising PN.