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Should high-energy infant formula be given at full strength from its first day of usage?
Sharon Evans1, H Twaissi, A Daly
1Dietetic Department, Birmingham Children's Hospital, Birmingham, UK. evanss21@onetel.com
Insights
High-energy infant formula (HEIF) is well tolerated in infants with faltering growth. Younger infants (<12 weeks) may benefit from a gradual introduction to avoid increased bowel frequency.
Area of Science:
- Pediatric Nutrition
- Gastroenterology
- Infant Growth and Development
Background:
- Faltering growth in infants requires specialized nutritional support.
- High-energy infant formula (HEIF) is often prescribed for these infants.
- Feeding tolerance is a key concern when initiating HEIF.
Purpose of the Study:
- To assess the feeding tolerance of a 1 kcal/mL HEIF in infants with faltering growth.
- To compare the tolerance of HEIF administered at full strength versus a stepwise introduction.
- To evaluate the impact on bowel habits, vomiting, and growth parameters.
Main Methods:
- Randomized controlled trial involving 30 infants (2-43 weeks) with faltering growth.
- Two groups: immediate full-strength HEIF versus 3-day stepwise introduction.
- Daily monitoring of bowel actions, vomiting, and feed volume for 2 weeks.
- Anthropometric measurements (weight, length, head/arm circumference) at baseline and 2 weeks.
Main Results:
- No significant differences in overall growth or vomiting between the groups.
- Higher frequency of bowel actions in the first 2 days for the full-strength group (P=0.02).
- Younger infants (<12 weeks) and those with higher energy intake experienced more frequent bowel actions.
Conclusions:
- HEIF at full strength is generally well-tolerated in infants with faltering growth.
- A graded introduction of HEIF may be beneficial for infants under 12 weeks to mitigate increased bowel frequency.
- HEIF is a viable option for managing faltering growth in infants.
Objective:
To evaluate the feeding tolerance of a high-energy (1 kcal mL(-1)) infant formula (HEIF) for infants with faltering growth, weighing 2.5-8 kg, when administered at full strength from day 1 compared with stepwise introduction.
Methods:
Thirty infants (aged 2-43 weeks) from a supraregional children's hospital requiring a high-energy formula for faltering growth were randomly allocated to receive either a 1 kcal mL(-1) ready to feed infant formula at full strength from day 1 or the same formula in diluted form, graded to full strength over 3 days. Bowel actions, vomits and volume of feed taken were recorded daily for 2 weeks. Weight, length, head circumference and mid-upper arm circumference were recorded at recruitment and after 2 weeks.
Results:
The number of bowel actions in the first 2 days was significantly higher for the full strength group than for the stepwise group (P = 0.02); younger infants (<12 weeks) had more bowel actions over the first 2 days on the HEIF at full strength (Spearman's correlation = -0.5; P = 0.04); and infants with a total higher energy intake (kJ kg(-1)) had more frequent bowel actions over the first 4 days (Spearman's correlation = 0.48; P = 0.01). There was no significant difference between groups for growth or vomiting.
Conclusions:
High-energy infant formula was generally well tolerated in infants under the age of 12 months with faltering growth when administered at full strength from day 1. However, younger infants (<12 weeks of age) may benefit from a graded introduction in order to avoid increased bowel frequency.
