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Randomized trial of high nutrient density formula versus standard formula in chronic lung disease
M S Fewtrell1, C Adams, D C Wilson
1Infant and Child Nutrition Group, MRC Dunn Nutrition Unit, Cambridge, UK.
Insights
Providing concentrated formula to infants with chronic lung disease did not improve growth or respiratory outcomes. Higher nutrient density did not benefit these vulnerable infants despite increased energy and protein intake.
Area of Science:
- Neonatal Medicine
- Pediatric Nutrition
- Respiratory Medicine
Background:
- Infants with chronic lung disease often have increased nutritional needs and compromised respiratory function.
- Optimizing nutrient delivery is crucial for growth and clinical outcomes in these infants.
- Concentrated formulas may improve nutrient intake and reduce fluid volume, potentially benefiting respiratory status.
Purpose of the Study:
- To evaluate if a higher nutrient-density formula improves growth and respiratory outcomes in preterm infants with chronic lung disease.
- To determine if reduced feeding volume associated with concentrated formula benefits respiratory status.
Main Methods:
- A randomized controlled trial involving 60 preterm infants requiring supplemental oxygen at 28 days of age.
- Infants were assigned to receive either a low-density (24 kcal/oz) or high-density (30 kcal/oz) formula.
- Feeding volumes were adjusted to deliver specific nutrient intakes, with the low-density group receiving 180 ml/kg/day and the high-density group 145 ml/kg/day.
Main Results:
- No significant differences were observed in growth parameters, respiratory outcomes, edema, or diuretic requirements between the two groups.
- Infants receiving the high-density formula had a significantly greater intake of total energy (143 vs 134 kcal/kg/day) and protein (3.9 vs 3.6 g/kg/day).
- The increased intake in the high-density group was partly due to the low-density group not achieving their target feeding volume.
Conclusions:
- The use of high-density formula in preterm infants with chronic lung disease did not lead to improved growth or respiratory outcomes.
- Despite a modest increase in energy and protein intake, concentrated formulas did not confer clinical benefits in this population.
- Further research may be needed to identify optimal nutritional strategies for infants with chronic lung disease.
Abstract:
To test the hypothesis that the nutrient intake and growth of infants with chronic lung disease would be improved by providing nutrients in more concentrated form, and that the lower volume would improve respiratory status, 60 preterm infants requiring supplemental oxygen at 28 days of age were randomly assigned a low-density (24 kcal/oz) formula fed at 180 ml/kg/day, or a high-density (30 kcal/oz) formula at 145 ml/kg/day. There was no difference in growth, respiratory outcome, oedema or diuretic requirement between dietary groups. Infants fed the high nutrient density formula had significantly greater total energy (143 vs 134 kcal/kg/day) and protein (3.9 vs 3.6 g/kg/day) intakes, largely because the low-density formula group did not achieve the designated 180 ml/kg/day. In conclusion, use of a high-density formula in infants with chronic lung disease did not improve growth or respiratory outcome, despite a small increase in total energy and protein intake.