Protein hydrolysate versus standard formula for preterm infants

Area of Science:

• Neonatal nutrition
• Pediatric gastroenterology

Background:

• Protein hydrolysate formulas are often used for preterm infants when human milk is unavailable.
• Concerns exist regarding the cost and evidence supporting the use of protein hydrolysate formulas over standard cow's milk formulas.

Purpose of the Study:

• To assess the impact of feeding preterm infants hydrolysed formula versus standard cow's milk formula.
• To evaluate the effects on feed intolerance, necrotising enterocolitis, and other morbidities and mortality.

Main Methods:

• Systematic review and meta-analysis of randomised and quasi-randomised controlled trials.
• Searched multiple databases including Cochrane CENTRAL, MEDLINE, Embase, and CINAHL.
• Assessed trial eligibility, risk of bias, and extracted data using GRADE approach for evidence quality.

Main Results:

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

Conclusions:

• Current low-certainty evidence does not support the use of protein hydrolysate formula over standard formula for preterm infants.
• Existing data are insufficient to conclude benefits for feed intolerance or necrotising enterocolitis.
• Large, pragmatic trials are necessary to determine effectiveness and cost-effectiveness.