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Late metabolic acidosis and poor weight gain in moderately pre-term babies fed with a casein-predominant formula: a
1Department of Paediatrics, Prince of Wales Hospital (The Chinese University of Hong Kong), Shatin.
Insights
Casein-predominant infant formula is linked to metabolic acidosis and poor weight gain in preterm infants. Whey-predominant formulas are recommended for better infant health outcomes.
Area of Science:
- Neonatal nutrition
- Pediatric gastroenterology
Background:
- Neonatal units often use casein-predominant formulas for preterm infants due to cost.
- Early observations noted a cluster of metabolic acidosis cases potentially linked to formula type.
Purpose of the Study:
- To investigate the association between formula type and acid-base balance in preterm infants.
- To compare weight gain in preterm infants fed different formula compositions.
Main Methods:
- Study included 70 healthy, moderately preterm (32-35 weeks) Chinese infants.
- Compared outcomes in infants fed casein-predominant, "humanized" whey-predominant, and special low-birthweight formulas.
- Monitored acid-base status and weight gain over an 8-week period.
Main Results:
- Casein-predominant formula was associated with significant metabolic acidosis.
- Acidosis persisted for up to 8 weeks in some infants on casein-predominant formula.
- Infants on casein-predominant formula showed poorer weight gain compared to other groups.
Conclusions:
- Casein-predominant low protein formula is linked to adverse acid-base balance and growth in preterm infants.
- "Humanized" whey-predominant or special low-birthweight formulas are preferable for moderately preterm infants.
- The potential cost savings of casein-predominant formulas may be offset by longer hospital stays.
Abstract:
When our neonatal unit opened in 1984 our formula feeding policy for moderately preterm babies was for casein-predominant rather than "humanized" whey-predominant milk formulae to be given. However, an early cluster of cases of late persistent metabolic acidosis prompted an investigation into the acid-base status and weight gain in preterm infants. This study of 70 healthy, moderately preterm (32-35 weeks) Chinese babies has convincingly shown that a casein-predominant low protein formula is associated with significant metabolic acidosis, persisting sometimes for as long as 8 weeks, and poor weight gain when compared with infants fed on either a humanized or a special low-birthweight formula. This is an important message for the many neonatal units in developing countries where the cost of humanized formulae might initially seem prohibitive, encouraging instead casein-predominant formulae when breast milk is not available. Any additional expense incurred in using humanized formulae will be compensated for by the shortened time spent in hospital.