Impact of High Protein Intake on Preterm Infants

Sufficient protein intake is essential for the growth and development of preterm infants. This study examined the impacts of high protein (HP) versus low protein (LP) diets on neurodevelopment, growth, and biochemical issues in these children.

We conducted a systematic search for randomized and quasi-randomized trials involving protein supplementation in preterm infants (born before 37 weeks of gestation) in accordance with PRISMA guidelines, utilizing three databases and four registers. A random-effects model was employed to evaluate the effects of HP (≥3.5 g/kg/d) compared to LP (<3.5 g/kg/d).

The study revealed the following:

• Analysis of 44 studies indicated that HP intake may slightly lower the likelihood of survival without neurodisability by 12 months, with low certainty evidence.

• Additionally, HP might increase the risk of cognitive impairment at toddler age (two studies, 436 children; RR 1.36 [0.89, 2.09]), also with low certainty evidence.

• At discharge or 36 weeks, HP intake was associated with higher weight and head circumference z-scores.

• However, HP likely raised the risk of conditions such as hypophosphatemia, hypercalcemia, refeeding syndrome, and elevated blood urea, while reducing the risk of hyperglycemia.

To summarize, a HP diet for preterm infants may negatively affect neonatal metabolism and contribute to future neurodisability, exhibiting limited short-term benefits for growth.

Impact statement

Recommending high protein intake after birth for preterm infants may be detrimental to their survival, neurological health, and metabolism during infancy, with no significant growth benefits beyond the neonatal phase.
Protein intake of ≥3.5 g/kg/d is not advisable for preterm infants.

Source: Das, S., McClintock, T., Cormack, B.E. et al. High protein intake on later outcomes in preterm children: a systematic review and meta-analysis. Pediatr Res 97, 67–80 (2025). https://doi.org/10.1038/s41390-024-03296-z

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