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Hydrolyzed protein accelerates feeding advancement in very low birth weight infants
Walter A Mihatsch1, Axel R Franz, Josef Högel
1Division of Neonatology and Pediatric Critical Care, Department of Pediatrics, Ulm University, 89070 Ulm, Germany. walter.mihatsch@medizin.uni-ulm.de
Insights
Hydrolyzed protein preterm infant formula (HPF) accelerates feeding advancement in very low birth weight (VLBW) infants. This study found HPF improved feeding tolerance and enabled faster achievement of full enteral feeding compared to standard preterm infant formula (SPF).
Area of Science:
- Neonatal Nutrition
- Gastroenterology
- Pediatric Clinical Trials
Background:
- Feeding intolerance is a significant challenge for very low birth weight (VLBW) infants.
- Hydrolyzed protein preterm infant formula (HPF) has demonstrated potential in accelerating gastrointestinal transit.
- This study aimed to compare HPF with standard preterm infant formula (SPF) for early feeding tolerance.
Purpose of the Study:
- To investigate if HPF improves early feeding tolerance in VLBW infants compared to SPF.
- To test the hypothesis that HPF accelerates early enteral feeding advancement.
Main Methods:
- A randomized controlled trial involving 129 VLBW infants was conducted.
- Infants received either HPF or SPF, excluding those with significant human milk intake.
- The primary outcome measured was the time to achieve full enteral feeds (150 mL/kg/day).
Main Results:
- No significant differences were observed in birth weight, gestational age, or onset of milk feeds between groups.
- Infants receiving HPF achieved full enteral feeds significantly faster than those on SPF (10 days vs. 12 days).
Conclusions:
- HPF significantly improved feeding tolerance in VLBW infants.
- HPF facilitates a more rapid establishment of full enteral feeding compared to SPF.
Background:
Feeding intolerance is common in very low birth weight (VLBW; <1500 g) infants. Hydrolyzed protein preterm infant formula (HPF) has been shown to accelerate the gastrointestinal transit of formula. The aim of this study was to investigate whether HPF improves early feeding tolerance compared with standard preterm infant formula (SPF). We hypothesized that HPF would accelerate early enteral feeding advancement.
Methods:
Primary outcome was the time from initiation of milk feeds until full feeds (150 mL/kg birth weight/d) were achieved in infants who received <10% human milk (HM) to exclude HM as a confounder. Because the availability of HM was not predictable at the time of enrollment, all eligible VLBW infants (n = 129) were randomly assigned in a randomized, controlled trial to receive HPF or SPF if HM was not available. Infants who received >10% HM (n = 42) were excluded. Milk bolus feeding every 2 to 3 hours was started at the discretion of the attending physician and advanced by 16 mL/kg/d. Preprandial gastric residuals were tolerated up to 5 mL/kg; otherwise, feedings were reduced or withheld. Data are shown as median (5th and 95th percentile).
Results:
Forty-six and 41 (HPF vs SPF) infants received <10% HM. There was no significant difference with regard to birth weight, gestational age, and onset of milk feeds (day 3 [1-8] vs 4 [2-6]). The time from initiation of milk feeds to full feeds was significantly shorter with HPF feeding (10 [9-27] vs 12 [9-28] days).
Conclusion:
HPF improved the feeding tolerance and enabled a more rapid establishment of full enteral feeding in VLBW infants compared with SPF.