BODY COMPOSITION OF FULL-TERM NEWBORNS AGAINST THE BACKGROUND OF INCREASED PROTEIN INTAKE IN THE INTENSIVE CARE UNIT

Abstract

To evaluate the eff ects of increased protein and L-carnitine supplementation in the feeding program of term infants withperinatal conditions on improving physical development outcomes, changes in body composition and hospital outcomes.The aim is to evaluate the eff ect of short-term increased protein intake in term infants and L-carnitine supplementation onbody composition and key indicators of physical development in children.Material and methods. To test the proposed hypothesis of neonatal nutrition, we studied the vital signs of 59 term infantsrandomized into two groups. The fi rst group (n = 30) received standard breastmilk (BM) or formula feeding, and the second group (n = 29) received a protein- fortifi ed (PF) formula and L-carnitine supplementation during the hospital stay. At the beginning and end of treatment, the children’s physical development and body composition were assessed using bioelectrical impedance.The study protocol was agreed and approved by the Regional Bioethics Committee of the Zaporizhzhia State Medical andPharmaceutical University. The study was conducted in accordance with the moral and ethical standards of the IGH/GCP, theDeclaration of Helsinki (1964 with amendments of 1975, 1983, 1989, 1996, 2000), the Convention of the Council of Europe onHuman Rights and Biomedicine, and the legislation of Ukraine. Written informed consent was obtained from the parents of the patients before the start of the study. All statistical analyses were performed using the software Statistica 13.0, TIBCO Software Inc (licence number JPZ804I382130ARCN10-J) and Microsoft Excel 2013 (licence number 00331-10000-00001-АА404). The probability of the diff erence in the absolute values of the means was determined using non-parametric methods of statistical analysis: the Mann-Whitney test (U) for unrelated groups and the Wilcoxon signed rank test (T) for related groups. Statistical signifi cance was defi ned as p < 0.05. The study was conducted within the framework of the research work of the Department of Anaesthesiology and Intensive Care Medicine of the Zaporizhzhia State Medical and Pharmaceutical University of the Ministry of Health of Ukraine – «Optimization of diagnosis and intensive care of multi etiological lesions of the brain, gastrointestinal tract, kidneys in newborns and older children», state registration number 0118U007142.Results. Infants in both groups had similar characteristics of weight, length and head circumference at baseline. Theproportions of infants of both sexes were within the 50 % percentile. In general, the proposed feeding strategy contributed to better indicators of infant physical development and a statistically signifi cant, faster recovery of body weight in the fortifi ed group. Thus, the generalised indicator of body weight of children in the GZ group was 3966.90 ± 439.08 g, compared to 3554.62 ± 452.28 g in the SC group, p = 0.0033. In general, the children who consumed more protein were transferred out of intensive care sooner – 10.00 (8.00, 12.00) days vs. 12.00 (11.00, 16.00) days, U = 235.00; p = 0.0024; discharged from hospital sooner – 21.00 (19.00, 27.00) days vs. 26.50 (22.00, 31.00) days, U = 267.00, p = 0.0109. This strategy proved to be safe, as evidenced by normal phenylalanine and urea levels at all stages of the children’s examination. Percentage analysis of body composition showed an increase in the formation of more dry mass in children on the standard diet, without protein fortifi cation and without carnitine supplementation. Thus, the percentage of FFM in the children on the standard diet was 84.71 (83.27; 85.47) % at the end of the study, compared with 83.09 (81.93; 83.96) % in the GZ group, U = 117.00; p = 0.0020. The total cohort indicator was infl uenced by the changes in body composition found in the women: in the GZ group, the percentage was 82.21 (81.55;83.10) % versus 84.71 (83.65;85.30) % in the SC group, U = 8.0; p = 0.0051. Thus, increased protein supplementation in term girls was associated with greater accumulation of fat mass, even with short-term supplementation.Conclusions. Consumption of more protein and carnitine supplementation in term neonates in the intensive care unitpromotes better growth against a background of body composition with higher fat content in females, a fact that limits the use of this strategy without further studies.