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Partially hydrolyzed formula with high sn-2 palmitic acid on eosinophils and outcomes in preterm infants: PRIOR

Jialu Zhuang1, Ye Liu1, Qiongyu Liu2

  • 1Department of Neonatology, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.

Frontiers in Pharmacology
|January 28, 2026
PubMed

Insights

High sn-2 palmitic acid partially hydrolyzed formula (HPF) may reduce eosinophil-related inflammation in preterm infants. This study suggests HPF has potential for inflammation suppression without impacting hospital stay or necrotizing enterocolitis (NEC) incidence.

Area of Science:

  • Neonatal immunology
  • Pediatric gastroenterology
  • Infant nutrition

Background:

  • Preterm infants possess immature immune systems, increasing susceptibility to type 2 inflammation, characterized by eosinophil recruitment, which can worsen intestinal and respiratory inflammation.
  • Breastfeeding offers anti-inflammatory benefits through sn-2 palmitic acid and immunomodulatory factors, but formula feeding is often clinically necessary.
  • Partially hydrolyzed formula (HPF) with high sn-2 palmitic acid is hypothesized to mitigate eosinophil-related inflammation by reducing protein immunogenicity, though supporting evidence is limited.

Purpose of the Study:

  • To evaluate the impact of high sn-2 palmitic acid partially hydrolyzed formula (HPF) on eosinophil counts and related inflammatory markers in preterm infants.
  • To assess the safety and efficacy of HPF compared to standard preterm formula (SPF) regarding hospital stay duration and necrotizing enterocolitis (NEC) incidence.

Main Methods:

  • A secondary analysis of the PRIOR randomized controlled trial (RCT) involving 90 preterm infants (<34 weeks gestational age or <2000g birth weight).
  • Infants were randomized to receive either HPF (n=45) or SPF (n=45).
  • Eosinophil counts, hospital stay duration, and NEC incidence were primary and secondary outcomes, analyzed using generalized additive models.

Main Results:

  • Eighty infants completed the in-hospital phase; groups were comparable in baseline characteristics.
  • A trend towards reduced eosinophil percentage was observed with HPF after prolonged exposure (>25 days, p=0.053), suggesting potential inflammation suppression.
  • No significant differences were found in hospital stay duration (HPF: 30 days vs. SPF: 27 days) or NEC incidence (2.4% vs. 2.4%).

Conclusions:

  • HPF shows promise in potentially reducing eosinophil-mediated inflammation in preterm infants.
  • HPF did not significantly affect hospital stay duration or NEC incidence in this cohort.
  • Further research is warranted to explore the long-term immune benefits of optimized preterm formulas like HPF.
Abstract

Keywords:
eosinophilshigh sn-2 palmitic acidimmune modulationnutritional interventionpartially hydrolyzed formulapreterm infantsrandomized controlled trial

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