Protein hydrolysate versus standard formula for preterm infants

Area of Science:

• Neonatal nutrition
• Pediatric gastroenterology
• Clinical trials

Background:

• Protein hydrolysate formulas are often used for preterm infants when human milk is unavailable, due to perceived better tolerance.
• Concerns exist regarding the high cost of hydrolysate formulas and the lack of high-quality evidence supporting their use.

Purpose of the Study:

• To assess the impact of protein hydrolysate formula versus standard cow's milk formula on feed intolerance, necrotising enterocolitis, and other morbidities in preterm infants.

Main Methods:

• Systematic review and meta-analysis of randomized and quasi-randomized controlled trials.
• Searched multiple databases including Cochrane CENTRAL, MEDLINE, Embase, and CINAHL.
• Assessed trial eligibility, risk of bias, and extracted data; analyzed effects using risk ratios and mean differences.

Main Results:

• Eleven small trials (665 infants) with methodological limitations were included.
• No significant effects were found on feed intolerance or necrotising enterocolitis risk.
• Evidence quality was low, primarily due to imprecision and design weaknesses.

Conclusions:

• Current low-quality evidence does not support the use of protein hydrolysate formula over standard formula for preterm infants.
• Further large, pragmatic trials are necessary to establish effectiveness and cost-effectiveness.