0
Other Articles |

Protein Allowances for Premature Infants

Harry H. Gordon, M.D.
[+] Author Affiliations

Baltimore

From the Department of Pediatrics of Sinai Hospital and Johns Hopkins University School of Medicine, Baltimore.


JAMA. 1961;175(2):107-113. doi:10.1001/jama.1961.63040020008006b
Text Size: A A A
Published online

This paper will analyze data and concepts which underlie estimates of protein allowances for premature infants. It is fitting that this be done at Cornell University Medical School where careful metabolic and clinical studies have supplied the basis for currently popular, moderately "high" protein, moderately "low" fat feeding mixtures long advocated by Dutch and American pediatricians.

It is important to distinguish between "allowances" and "requirements." "Allowances" is a permissive term implying nutrient levels that will cover individual variations both constitutional and environmental. "Requirements" is a tyrannical term implying absolute needs for all infants. Even its expression as a range or as a mean with a standard deviation does not jibe comfortably with practice of a pediatrician who is impressed daily with the variation in appearance, behavior, and adaptability of his patients. Socioeconomic or geographic factors may necessitate attempts to estimate requirements, but adaptability to minimal intakes under limited circumstances is

REFERENCES

Mellander, O.; Vahlquist, B.; and Mellbin, T.:  Breast Feeding and Artificial Feeding: Clinical, Serological and Biochemical Study in 402 Infants, with a Survey of the Literature , Acta Paediat. 48: ( (supp. 116) ) (June) 1959;.
Gordon, H. H.; Levine, S. Z.; and McNamara, H.:  Feeding of Premature Infants: Comparison of Human and Cow's Milk , Am. J. Dis. Child. 73:442-452 ( (April) ) 1947;.
Gordon, H. H.; Levine, S. Z.; Deamer, W. C.; and McNamara, H.:  Respiratory Metabolism in Infancy and Childhood: XXIII. Daily Energy Requirements of Premature Infants , Am. J. Dis. Child. 59:1185-1202 ( (June) ) 1940;.
Kagan, B. M., and others:  Feeding Premature Infants: Comparison of Various Milks , Pediatrics 15:373-382 ( (April) ) 1955;.
Lubchenco, L. O.; Boyd, E.; and Hansmann, C.: Intrauterine Growth Standard; Birth Weights and Gestational Ages. To be published.
Horton, F. H.; Lubchenco, L. O.; and Gordon, H. H.:  Self Regulatory Feeding in Premature Nursery , Yale J. Biol. 24:4263-4272 ( (Feb.) ) 1952;.
Karelitz, S.; Schell, N. B.; and Goldman, H. I.:  Lactic Acid Milk in Feeding of Premature Infants , J. Pediat. 54:6756-6761 ( (June) ) 1959;.
Dancis, J.; O'Connell, J. R.; and Holt, L. E., Jr.:  Grid for Recording Weight of Premature Infants , J. Pediat. 33:570-572 ( (Nov.) ) 1948;.
Gruber, S.; Litvak, A. M.; Rascoff, H.; and Norton, R.:  Hospital Progress of 992 Premature Infants Fed Evaporated Milk-Carbohydrate Mixtures , J. Pediat. 35:70-76 ( (July) ) 1949;.
Gordon, H. H., and others:  Respiratory Metabolism in Infancy and in Childhood: XXIV. Daily Water Exchange of Premature Infants , Am. J. Dis. Child. 61:524-534 ( (March) ) 1941;.
Wallace, W. M.; Weil, W. B.; and Taylor, A.: Effect of Variable Protein and Mineral Intake upon Body Composition of Growing Animal , Ciba Foundation Colloquia on Ageing 4:116-153, Little, Brown & Co., Boston, 1958;.
Levin, B.; Mackay, H. M. M.; Neill, C. A.; Oberholzer, V. G.; and Whitehead, T. P.: Weight Gains, Serum Protein Levels, and Health of Breast-Fed and Artificially Fed Infants, Medical Research Council, Special Report Series No. 296, London, 1959.
Stearns, G.:  Mineral Metabolism of Normal Infants , Physiol. Rev. 19:415-438 ( (July) ) 1939;.
Widdowson, E. M., and Spray, C. M.:  Chemical Development in Utero , Arch. Dis. Childhood 26:205-214 ( (June) ) 1951;.
Young, W. F., and others:  Protein Requirements of Infants; Nutrition of Premature Infants , Arch. Dis. Childhood 25:31-51 ( (March) ) 1950;.
Dann, M.:  Influence of Diet on Ascorbic Acid Requirement of Premature Infants , J. Clin. Investigation 21:139-144 ( (March) ) 1942;.
Benjamin, H. R.; Gordon, H. H.; and Marples, E.:  Calcium and Phosphorus Requirements of Premature Infants , Am. J. Dis. Child. 65:412-425 ( (March) ) 1943;.
Von Sydow, G. V.:  Study of Development of Rickets in Premature Infants , Acta Paediat. 33: ( (supp. 11) ) 1946;.
Eek, S.; Gabrielsen, L. H.; and Halvorsen, S.:  Prematurity and Rickets , Pediatrics 20:63-76 ( (July) ) 1957;.
Pincus, J. B., and Gittleman, I. F.: Personal communication to the authors.
Epstein, F. H.; Kleeman, C. R.; Pursel, S.; and Hendrikx, A.:  Effect of Feeding Protein and Urea on Renal Concentrating Process , J. Clin. Investigation 36:635-641 ( (May) ) 1957;.
Crawford, J. D.; Doyle, A. P.; and Probst, J. H.:  Service of Urea in Renal Water Conservation , Am. J. Physiol. 196:545-548 ( (March) ) 1959;.
Levinsky, N. G.; Berliner, R. W.; and Preston, A. S.:  Role of Urea in Urine Concentrating Mechanism , J. Clin. Investigation 38:741-748 ( (May) ) 1959;.
Edelman, C. M., Jr., and Barnett, H. L.:  Role of Kidney in Water Metabolism in Young Infants, Physiologic and Clinical Considerations , J. Pediat. 56:154-179 ( (Feb.) ) 1960;.
Dancis, J.; Osborn, J. J.; and Julia, J. F.:  Studies of Immunology of Newborn Infant: V. Effect of Dietary Protein on Antibody Production , Pediatrics 12:395-398 ( (Oct.) ) 1953;.

First Page Preview

First page PDF preview

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

Mellander, O.; Vahlquist, B.; and Mellbin, T.:  Breast Feeding and Artificial Feeding: Clinical, Serological and Biochemical Study in 402 Infants, with a Survey of the Literature , Acta Paediat. 48: ( (supp. 116) ) (June) 1959;.
Gordon, H. H.; Levine, S. Z.; and McNamara, H.:  Feeding of Premature Infants: Comparison of Human and Cow's Milk , Am. J. Dis. Child. 73:442-452 ( (April) ) 1947;.
Gordon, H. H.; Levine, S. Z.; Deamer, W. C.; and McNamara, H.:  Respiratory Metabolism in Infancy and Childhood: XXIII. Daily Energy Requirements of Premature Infants , Am. J. Dis. Child. 59:1185-1202 ( (June) ) 1940;.
Kagan, B. M., and others:  Feeding Premature Infants: Comparison of Various Milks , Pediatrics 15:373-382 ( (April) ) 1955;.
Lubchenco, L. O.; Boyd, E.; and Hansmann, C.: Intrauterine Growth Standard; Birth Weights and Gestational Ages. To be published.
Horton, F. H.; Lubchenco, L. O.; and Gordon, H. H.:  Self Regulatory Feeding in Premature Nursery , Yale J. Biol. 24:4263-4272 ( (Feb.) ) 1952;.
Karelitz, S.; Schell, N. B.; and Goldman, H. I.:  Lactic Acid Milk in Feeding of Premature Infants , J. Pediat. 54:6756-6761 ( (June) ) 1959;.
Dancis, J.; O'Connell, J. R.; and Holt, L. E., Jr.:  Grid for Recording Weight of Premature Infants , J. Pediat. 33:570-572 ( (Nov.) ) 1948;.
Gruber, S.; Litvak, A. M.; Rascoff, H.; and Norton, R.:  Hospital Progress of 992 Premature Infants Fed Evaporated Milk-Carbohydrate Mixtures , J. Pediat. 35:70-76 ( (July) ) 1949;.
Gordon, H. H., and others:  Respiratory Metabolism in Infancy and in Childhood: XXIV. Daily Water Exchange of Premature Infants , Am. J. Dis. Child. 61:524-534 ( (March) ) 1941;.
Wallace, W. M.; Weil, W. B.; and Taylor, A.: Effect of Variable Protein and Mineral Intake upon Body Composition of Growing Animal , Ciba Foundation Colloquia on Ageing 4:116-153, Little, Brown & Co., Boston, 1958;.
Levin, B.; Mackay, H. M. M.; Neill, C. A.; Oberholzer, V. G.; and Whitehead, T. P.: Weight Gains, Serum Protein Levels, and Health of Breast-Fed and Artificially Fed Infants, Medical Research Council, Special Report Series No. 296, London, 1959.
Stearns, G.:  Mineral Metabolism of Normal Infants , Physiol. Rev. 19:415-438 ( (July) ) 1939;.
Widdowson, E. M., and Spray, C. M.:  Chemical Development in Utero , Arch. Dis. Childhood 26:205-214 ( (June) ) 1951;.
Young, W. F., and others:  Protein Requirements of Infants; Nutrition of Premature Infants , Arch. Dis. Childhood 25:31-51 ( (March) ) 1950;.
Dann, M.:  Influence of Diet on Ascorbic Acid Requirement of Premature Infants , J. Clin. Investigation 21:139-144 ( (March) ) 1942;.
Benjamin, H. R.; Gordon, H. H.; and Marples, E.:  Calcium and Phosphorus Requirements of Premature Infants , Am. J. Dis. Child. 65:412-425 ( (March) ) 1943;.
Von Sydow, G. V.:  Study of Development of Rickets in Premature Infants , Acta Paediat. 33: ( (supp. 11) ) 1946;.
Eek, S.; Gabrielsen, L. H.; and Halvorsen, S.:  Prematurity and Rickets , Pediatrics 20:63-76 ( (July) ) 1957;.
Pincus, J. B., and Gittleman, I. F.: Personal communication to the authors.
Epstein, F. H.; Kleeman, C. R.; Pursel, S.; and Hendrikx, A.:  Effect of Feeding Protein and Urea on Renal Concentrating Process , J. Clin. Investigation 36:635-641 ( (May) ) 1957;.
Crawford, J. D.; Doyle, A. P.; and Probst, J. H.:  Service of Urea in Renal Water Conservation , Am. J. Physiol. 196:545-548 ( (March) ) 1959;.
Levinsky, N. G.; Berliner, R. W.; and Preston, A. S.:  Role of Urea in Urine Concentrating Mechanism , J. Clin. Investigation 38:741-748 ( (May) ) 1959;.
Edelman, C. M., Jr., and Barnett, H. L.:  Role of Kidney in Water Metabolism in Young Infants, Physiologic and Clinical Considerations , J. Pediat. 56:154-179 ( (Feb.) ) 1960;.
Dancis, J.; Osborn, J. J.; and Julia, J. F.:  Studies of Immunology of Newborn Infant: V. Effect of Dietary Protein on Antibody Production , Pediatrics 12:395-398 ( (Oct.) ) 1953;.
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Response

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.