Related Experiment Videos
Intolerance to protein hydrolysate infant formulas: an underrecognized cause of gastrointestinal symptoms in infants
J A Vanderhoof1, N D Murray, S S Kaufman
1Department of Pediatrics, University of Nebraska Medical Center, Creighton University, Omaha, USA.
Insights
Many infants with formula protein intolerance symptoms did not improve with casein hydrolysate formula (CHF). Switching to an amino acid-based formula (AAF) resolved symptoms in most infants, indicating AAF effectiveness for persistent formula protein intolerance.
Area of Science:
- Pediatric Gastroenterology
- Clinical Nutrition
- Allergy and Immunology
Background:
- Formula protein intolerance is a common concern in infants.
- Casein hydrolysate formula (CHF) is often used for managing these symptoms.
- Some infants continue to experience symptoms despite CHF feeding.
Purpose of the Study:
- To evaluate the efficacy of an amino acid-based infant formula (AAF) in infants with persistent symptoms of formula protein intolerance while on CHF.
- To identify infants who may benefit from AAF when CHF is ineffective.
Main Methods:
- Twenty-eight infants with persistent symptoms on CHF were enrolled.
- Sigmoidoscopy with rectal biopsy was performed.
- Infants were switched to an AAF (Neocate) for 2 weeks.
- Symptom resolution was assessed, followed by a re-challenge with CHF in some infants.
Main Results:
- Twenty-five of 28 infants showed symptom resolution after switching to AAF.
- Upon re-challenge, 8 infants tolerated CHF, while the rest experienced symptom recurrence.
- Histologic findings varied, including eosinophilic infiltration and normal biopsies.
Conclusions:
- Not all infants with apparent formula protein-induced colitis respond adequately to CHF.
- Amino acid-based formulas can be effective for infants with persistent symptoms unresponsive to CHF.
- This suggests a subset of infants may require more specialized hypoallergenic formulas.
Abstract:
The purpose of this study was to determine the effectiveness of an amino acid-based infant formula in infants with continued symptoms suggestive of formula protein intolerance while they were receiving casein hydrolysate formula (CHF). Twenty-eight infants, 22 to 173 days of age, were enrolled; each had received CHF for an average of 40 days (10 to 173 days) and continued to have bloody stools, vomiting, diarrhea, irritability, or failure to gain weight, or a combination of these symptoms. Sigmoidoscopy with rectal biopsy was performed in all infants. The infants then received an amino acid-based infant formula, Neocate, for 2 weeks. After 2 weeks of treatment, 25 of the infants demonstrated resolution of their symptoms and underwent challenge with CHF. Of the 25 who were challenged, eight tolerated the CHF and the remainder had recurrence of their symptoms. The histologic features in these infants varied from eosinophilic infiltration to normal. We conclude that not all infants with apparent formula protein-induced colitis respond to CHF and that these infants may have resolution of their symptoms when fed an amino acid-based infant formula.