SCAMP: standardised, concentrated, additional macronutrients, parenteral nutrition in very preterm infants: a phase IV randomised, controlled exploratory study of macronutrient intake, growth and other aspects of neonatal care

BMJ · 2011

Measurement SCAMP (38) Control (n=41) Difference Clinical Significance

OFC at Randomization (SDS) −1.57 (0.82) −1.50 (0.68) 0.07 Baseline comparable

Δ OFC over 28 days (mm) 31 (9) 26 (8) +5 mm ✓ IMPROVED

Δ OFC SDS over 28 days +0.04 (0.61) −0.27 (0.63) +0.31 SDS ✓ Prevented decline

OFC SDS at 36 weeks CGA(SDS) −0.91 (1.12) −1.31 (1.25) +0.40 SDS ✓ Improved

-Neurodevelopment was secondary outcome Underpowered; all p>0.05; cannot conclude benefit

-36% loss to follow-up Selection bias; only 79/150 assessed

-Bayley III limitations Known to underestimate delay; inter-rater reliability not checked

-Complex multi-component intervention Cannot isolate which component (protein vs energy vs minerals) drives benefit

-Head growth gain lost by day 28 Days 1–14 advantage disappears days 15–28

-Head growth ≠ neurodevelopment Early growth improved but Bayley scores NOT better at 2–3 years

-No long-term follow-up School-age outcomes, IQ, cerebral palsy rate unknown

-Early intensive PN (+0.5 g/kg protein, +9 kcal/kg energy) improves head growth +5 mm/28 days

-Greatest benefit in <27 week infants (+7 mm)

-Safe when minerals/electrolytes supplemented (no increased sepsis or hyperglycemia)

-Incremental escalation (days 1–4) prevents refeeding syndrom