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Extensively and partially hydrolysed preterm formulas in the prevention of allergic diseases in preterm infants: a
H Szajewska1, J Z Mrukowicz, B Stoińska
1Department of Paediatric Gastroenterology and Nutrition, Medical University of Warsaw, Poland. hania@ipgate.pl
Insights
Extensively hydrolyzed formulas may reduce atopic dermatitis risk in high-risk infants, but do not prevent overall allergic diseases. Acceptance of these formulas was lower, requiring cautious interpretation of results.
Area of Science:
- Allergy and immunology
- Pediatric nutrition
- Dermatology
Background:
- Infants with an atopic predisposition are at higher risk for developing allergic diseases.
- Early feeding interventions, including specialized formulas, are explored to prevent atopic disease development.
- Protein hydrolysate-based formulas are hypothesized to modulate immune responses and reduce allergy incidence.
Purpose of the Study:
- To evaluate if protein hydrolysate-based preterm formulas prevent allergic diseases in infants with an atopic predisposition.
- To compare the efficacy of extensively and partially hydrolysed preterm formulas against standard preterm formula.
- To assess the incidence of specific allergic diseases, including atopic dermatitis.
Main Methods:
- A randomized, double-blind study involving 122 preterm infants with atopic predisposition.
- Infants were assigned to receive extensively hydrolysed, partially hydrolysed, or standard preterm formula until 4-5 months of age.
- Breastfed infants received fortified maternal breast milk; intention-to-treat analysis was performed.
Main Results:
- No significant difference in the overall incidence of allergic diseases at 4-5 and 12 months between formula groups.
- A significant reduction in atopic dermatitis risk by 12 months with extensively hydrolysed formula compared to standard formula.
- Increased risk of formula non-acceptance and discontinuation with extensively hydrolysed formula.
Conclusions:
- Extensively or partially hydrolysed preterm formulas did not reduce the overall incidence of allergic diseases in high-risk infants.
- Extensively hydrolysed formula significantly reduced atopic dermatitis incidence at 12 months.
- Higher rates of formula non-acceptance and discontinuation were observed with extensively hydrolysed formulas, necessitating cautious interpretation due to small sample size.
Aim:
A randomized, double-blind study was conducted to evaluate whether use of protein hydrolysate-based preterm formulas in infants with an atopic predisposition helps prevent the development of allergic diseases.
Methods:
Preterm infants (n = 122) with at least one first-degree relative (parent or sibling) with allergic disease were randomly assigned to receive an extensively or partially hydrolysed preterm formula (intervention groups) or a standard preterm formula until 4 to 5 mo of age. Infants whose parents preferred that they be breastfed received their mothers' fortified breast milk.
Results:
Intention-to-treat analysis showed that the overall incidence of allergic diseases did not significantly differ between groups at both 4-5 and 12 mo of age. However, by 12 mo, use of the extensively hydrolysed versus the standard preterm formula had significantly reduced the risk of atopic dermatitis. At 4-5 and 12 mo, there was a significantly increased risk of non-acceptance of the extensively hydrolysed formula compared with the other formulas.
Conclusions:
This study failed to show that extensively or partially hydrolysed preterm formulas in comparison with a standard preterm formula reduced the overall incidence of allergic diseases in infants at high risk for atopic disease. However, use of the extensively hydrolysed compared with a standard preterm formula significantly reduced the incidence of atopic dermatitis observed at 12 mo. Infants who received extensively hydrolysed formulas were at increased risk for intervention discontinuation for any reason, particularly non-acceptance of the formula. Because of the small number of patients eligible for this analysis, these results should be interpreted with caution.
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