Hydrolyzed Proteins in Preterm Infants

Milk proteins are an essential component of the diet of preterm infants who have high requirements. Hydrolyzed proteins (HPs) have been introduced in infants' formulas (HPFs) to treat gastrointestinal disorders and to prevent allergic diseases. Several studies have evaluated the adequacy of HPs in preterm infants. Protein source significantly influences plasma amino acid concentrations. Protein utilization and efficiency are usually lower with HPFs compared to formulas with intact proteins. When protein intake is similar, a lower weight gain is generally observed with HPFs and a 10% increase in protein content is usually necessary to compensate for this reduction in protein utilization. Mineral absorption may also be reduced and no data exist for trace elements and vitamins. Most HPFs are associated with accelerated gastrointestinal transit time and softer stools but without clear benefit on feeding tolerance. Preterm infants seem to be at similar risk of allergic diseases than term infants, but the preventive effect of HPFs has not been sufficiently explored in preterm infants. Most modern HPFs designed for preterm infants are well tolerated and have adapted their nutrient content to improve nutrient absorption and retention. However, their benefits and safety have not been demonstrated and, therefore, further high-quality studies are needed.