Postnatal Head Growth in Preterm Infants: A Randomized Controlled Parenteral Nutrition Study

BACKGROUND: Early postnatal head growth failure is well recognized in very preterm infants (VPIs). This coincides with the characteristic nutritional deficits that occur in these parenteral nutrition (PN) dependent infants in the first month of life. Head circumference (HC) is correlated with brain volume and later neurodevelopmental outcome. We hypothesized that a Standardized, Concentrated With Added Macronutrients Parenteral (SCAMP) nutrition regimen would improve early head growth. The aim was to compare the change in HC (Delta HC) and HC SD score (Delta SDS) achieved at day 28 in VPIs randomly assigned to receive SCAMP nutrition or a control standardized, concentrated PN regimen. METHODS: Control PN (10% glucose, 2.8 g/kg per day protein/lipid) was started within 6 hours of birth. VPIs (birth weight,1200 g; gestation,29 weeks) were randomly assigned to either start SCAMP (12% glucose, 3.8 g/kg per day protein/lipid) or remain on the control regimen. HC was measured weekly. Actual daily nutritional intake data were collected for days 1 to 28. RESULTS: There were no differences in demographic data between SCAMP (n = 74) and control (n = 76) groups. Comparing cumulative 28-day intakes, the SCAMP group received 11% more protein and 7% more energy. The SCAMP group had a greater Delta HC at 28 days (P,.001). The difference between the means (95% confidence interval) for DHC was 5 mm (2 to 8), and Delta SDS was 0.37 (0.17 to 0.58). HC differences are still apparent at 36 weeks' corrected gestational age. CONCLUSIONS: Early postnatal head growth failure in VPIs can be ameliorated by optimizing PN.