Effect of prophylactic use of hydrolyzed protein formula on gastrointestinal diseases and physical growth in preterm infants: a Meta analysis / 中国当代儿科杂志

OBJECTIVES@#To systematically evaluate the effect of prophylactic use of hydrolyzed protein formula on gastrointestinal diseases and physical development in preterm infants.@*METHODS@#A computerized search was performed in the databases including China National Knowledge Infrastructure, Wanfang Data, Weipu, PubMed, Embase, and the Cochrane Library to identify randomized controlled trials of the effect of prophylactic use of hydrolyzed protein formula on gastrointestinal diseases and physical growth in preterm infants. RevMan 5.3 software was used to perform a Meta analysis for the included studies.@*RESULTS@#A total of 7 randomized controlled studies were included. The results of Meta analysis showed that compared with the whole protein formula, the prophylactic use of hydrolyzed protein formula could reduce the risk of neonatal necrotizing enterocolitis (RR=0.40, P=0.04) and feeding intolerance (RR=0.40, P=0.005), and had no significant effect on the growth of weight, length and head circumference (P>0.05).@*CONCLUSIONS@#Compared with the whole protein formula, the prophylactic use of hydrolyzed protein formula in preterm infants may reduce the occurrence of necrotizing enterocolitis and feeding intolerance, and can meet the nutrient requirement of physical development. However, the evidence is limited, and the results of this study cannot support the routine prophylactic use of hydrolyzed protein formula in preterm infants.

A clinical study on the effects of extensively hydrolyzed protein formula enteral nutrition of very/extremely low birth weight infants / 中国新生儿科杂志

Objective To study the clinical effects of extensively hydrolyzed protein formula (eHPF) and standard preterm infant formula (SPF) in very/extremely low weight (V/ELBW) infants.To provide a theoretical basis for the early feeding of V/ELBW infants.Method From August 2015 to August 2016, V/ELBW infants (gestational age <32 w and birth weight <1500 g) hospitalized in our neonatal ward were randomly assigned into eHPF group and SPF group .The eHPF group received eHPF feeding from birth to corrected gestational age of 32 weeks, and then fed with SPF;the SPF group was fed with SPF after birth.The clinical data of the two groups were compared including the time needed to regain birth weight , the time needed to achieve total enteral nutrition , the duration of nasogastric tube usage , the complications and blood biochemical indexes .Result A total of 85 cases were included in the eHPF group , and 91 cases in the SPF group.The hospitalization duration , weight increase rate , nasogastric tube duration , the time needed to regain birth weight , the time needed to achieve total enteral nutrition of eHPF group were better than SPF group [ ( 38.4 ±7.8 ) d vs.( 42.1 ±11.0 ) d, ( 25.5 ±10.1 ) g/d vs.( 21.8 ±7.8 ) g/d, (12.1 ±4.0) d vs.(16.0 ±3.8) d, (11.6 ±3.9) d vs.(13.0 ±3.8) d, (9.3 ±2.2) d vs.(14.3 ±1.8) d], and the differences were statistically significant (P<0.05).No statistically differences existed on discharge weight between the two groups ( P>0.05 ) .Compared with the SPF group , the incidences of cholestasis, NEC and feeding intolerance were lower in the eHPF group (22.7% vs.24.3%, 6.8% vs. 7.2%, 15.9%vs.17.1%) , and the differences were statistically significant ( P<0.05 ) .No significant differences existed on the incidence of extrauterine growth retardation between the two groups (P>0.05). No significant differences existed on serum total bilirubin level at 7 d after birth between the two groups ( P>0.05).Compared with the SPF group , the serum total bilirubin at 14 d was lower in the eHPF group [(40.3 ±23.0)μmol/L vs.(53.6 ±26.5) μmol/L], the serum total protein [(50.5 ±3.7) g/L vs. (46.7 ±5.3) g/L] and albumin[(31.3 ±4.1) g/L vs.(29.4 ±5.2) g/L] at 21 d were higher, the differences were statistically significant ( P<0.05 ) .Conclusion eHPF can shorten the time needed to achieve total enteral nutrition and regain birth weight , accelerate the regression of hyperbilirubinemia , reduce the incidences of feeding intolerance and NEC , and it is a safe and effective choice for enteral nutrition in V/ELBW infants.

Impact of lactose-free hydrolyzed protein formula on feeding intolerance and weight gain in very low birth weight infants / 中国新生儿科杂志

Objective To study whether a lactose-free,hydrolyzed protein formula would ameliorate feeding intolerance and weight gain in very low birth weight infants.Methods The study was conducted on very low birth weight infants ( gestational age ≤34 weeks, birth weight ≤1500 g) in our NICU from August 2010 to August 2013. According to the number of admission, the cases were assigned into lactose-free hydrolyzed protein formula group ( hydrolyzed protein group) and preterm formula group. The data of basic information ( gestational age, birth weight, way of labor, sex, asphyxia ), commencement of feeding time ( days) , enteral caloric intake, parenteral nutrition caloric intake, The time ( days) required to regain birth weight, weight gain index, days of parenteral nutrition, prealbumin level, feeding intolerance, the incidence of necrotizing enterocolitis ( NEC ) and extrauterine growth retardation(EUGR)werecollected.Results A total of 83 infants were recruited in the study. 40 infants were in hydrolyzed protein group and 43 infants were in preterm formula group. There were no differences between groups for basic information ( P>0. 05). The weight gain index of hydrolyzed protein group was higher than that of preterm formula group (13. 5 ± 2. 4 g/d vs. 11. 9 ± 3. 7 g/d, P=0. 036). There were less cases of feeding intolerance in hydrolyzed protein group than in preterm formula group & nbsp;(28/40 vs. 38/43, P=0. 038). The differences of the incidence of NEC (1/40 vs. 2/43) and EUGR (21/40vs.25/43)showed no significance statistically.Conclusions Lactose-free hydrolyzed protein formula can obviously improve feeding intolerance and early weight gain of premature infants.

A study on the effects of extensively hydrolyzed formula for very/extremely low birth weight infants / 中国新生儿科杂志

Objective To study the effects of extensively hydrolyzed formula forvery/extremely low birth weight(VLBW/ELBW)infants.Methods From Jun.2013 to Oct.2015,78VLBW/ELBW infants admitted to our hospital within 12 hours of birth were randomly assigned into two groups:hydrolyzed protein formula feeding group ( hydrolyzed formula group) and preterm formula feeding group (control group). Infants with hospital stay <28 days were excluded. Prospective study was conducted between two groups comparing the duration of meconium discharge, the time required for total enteral feeding average hospital stay, feeding intolerance and physical growth and blood biochemical indices on the28thday.Results A total of 78 infants were enrolled,35 in hydrolyzed formula group and 43 in control group. Comparing with control group, feeding intolerance in hydrolyzed formula group was significantly lower ( 25. 7℅ vs. 72. 0℅) . The duration of meconium discharge [ ( 4. 9 ± 0. 8 ) d vs. (8. 8 ± 1. 6)d], the time required for total enteral feeding[(13. 4 ± 2. 0) d vs. (18. 9 ± 2. 6) d] and average hospital stay duration [ ( 33. 7 ± 5. 1 ) d vs. ( 41. 8 ± 6. 8 ) d ] was shorter in hydrolyzed formula group ( P<0. 05). The body length on the 28th day in hydrolyzed formula group was longer than control group[ (43. 8 ± 1. 2 ) cm vs. ( 42. 6 ± 2. 0 ) cm, P < 0. 05 ] . The concentration of serum albumin [ (32. 5 ± 3. 0 ) g/L vs. ( 30. 0 ± 4. 5 ) g/L ] and hemoglobin [ ( 112. 4 ± 11. 4 ) g/L vs. ( 106. 3 ± 13. 0) g/L] in hydrolyzed formula group were significantly higher than the control group( P<0. 05). No significant difference was found between the two groups regarding the time required returning to birth weight [(10. 9 ±2. 2)d vs. (10. 1 ±1. 7)d],body weight [(1759 ±107)g vs. (1627 ±435)g], head circumference[(30. 3 ± 1. 0)cm vs. (29. 7 ± 1. 6)cm] on the 28th day and the incidence of extrauterine growthretardation(EUGR)(40.0℅vs.44.1℅)atdischarge.Conclusions Comparing with preterm formula feeding, early feeding with extensively hydrolyzed formula can reduce the incidence of feeding intolerance on VLBW/ELBW infants. Extensively hydrolyzed formula also can accelerate meconium discharge, reduce hospital stay duration and the time required for total enteral feeding. But the growth of weight and head circumference on the 28th day and the incidence of EUGR at discharge were not altered by extensively hydrolyzed formula.

Nutritional status of premature neonates fed with extensively hydrolyzed protein formula / 中华临床营养杂志

Objective To analyze the nutritional status of premature neonates first fed with extensively hydrolyzed protein formula.Methods From January 2013 to December 2014, 157 premature neonates hospitalized in Neonatal Intensive Care Unit of Shanghai Children's Medical Center who were first fed with extensively hydrolyzed protein formula were enrolled.Clinical data were recorded, including related diseases, birth weight and gestational age, nutrients intake, and growth charts.Two groups were divided according to the existence or absence of feeding intolerance, and three groups were divided based on birth weight (＜ 1 500 g, 1 500 ～ 2 500 g,and ≥2 500 g).Results A total of 60 (38.2％) premature infants had feeding intolerance.The lower the birth weight and gestational age, the higher the frequency of feeding intolerance, and the incidence of feeding intolerance in ＜ 1 500 g group was 71.1％.Compared with the feeding tolerance group, the feeding intolerance group had significantly smaller birth weight [(1 620 ±440) g vs.(1 980 ±421) g, P =0.000], gestatonal age [(31.3 ±2.6) weeks vs.(33.0 ±2.1) weeks, P =0.000], birth head circumference [(28.9 ±2.2) cm vs.(30.4±1.9) cm, P=0.000], and birth length [(41.1 ±3.9) cmvs.(43.2±3.4) cm, P=0.000],but significantly longer time before transfer formula [(26.4 ± 17.6) d vs.(7.9 ± 5.3) d, P =0.000] and time before reaching sufficient feeding [(21.5 ± 10.0) d vs.(13.8 ± 6.2) d, P =0.000].The time of first feeding [＜ 1 500 g group (6.1 ±5.1) d, 1 500 ～2 500 g group (3.8 ±2.5) d, ≥2 500 g group (3.3 ± 1.2) d,P =0.002], time before transfer formula [＜ 1 500 g group (28.7 ± 18.3) d, 1 500 ～ 2 500 g group (9.7 ± 8.1) d, ≥2 500 g group (7.0 ±3.8) d, P =0.000] and time before reaching sufficient feeding [＜ 1 500 g group (24.0±10.4) d, 1 500～2 500 g group (14.3±6.0) d, ≥2 500 g group (11.4±3.5) d, P=0.000] increased along with the decrease of birth weight.The proportions of infants receiving parenteral nutrition in the feeding intolerance group (93.3％) and ＜ 1 500 g group (97.8％) were higher, with more calorie intake from parenteral nutrition [＜ 1 500 g group (325.9 ± 59.4) kJ/ (kg · d), 1 500 ～ 2 500 g group (281.2±64.8) kJ/ (kg·d), ≥2 500 g group (269.9 ±43.9) kJ/ (kg·d),P=0.001] and longer duration [＜ 1 500 g group (27.1 ± 14.5) d, 1 500 ～2 500 g group (13.0 ±7.0) d, ≥2 500 g group (8.7 ± 3.4) d, P =0.000].In terms of growth indicators, the increase in head circumference was significantly higher in the feeding intolerance group than in the feeding tolerance group [(0.7 ± 0.6) cm/week vs.(0.6 ± 0.5) cm/week, P =0.045].The increases in body weight and head circumference in the ＜ 1 500 g group were significantly higher than in the other 2 birth weight groups [body weight: ＜ 1 500 g group (21.8 ± 9.5) g/d, 1500～2500ggroup(4.2±7.6) g/d, ≥2 500 g group (4.9 ±11.9) g/d,P=0.000;head circumference : ＜ 1 500 g group (0.8 ± 0.4) cm/week, 1 500 ～ 2 500 g group (0.5 ± 0.4) cm/week, ≥ 2 500 g group (0.6 ± 0.8) cm/week, P =0.005].After controlling the variable of feeding intolerance,weight gain was negatively associated with gestational age (r =-0.666, P =0.035), birth weight (r =-0.700, P =0.024), head circumference (r =-0.846, P =0.002), and the day of returning to birth weight (r =-0.697, P =0.025), while positively associated with head circumference gain (r =0.672, P =0.033).There were no relationship between weight gain and birth length, the day of first feeding, time before transfer formula, time before reaching sufficient feeding, parenteral nutrition calorie and duration, days of hospital stay and complications.Conclusions First fed with extensively hydrolyzed protein formula, the growth in feeding intolerant premature infants may be similar to the feeding tolerant ones, which is associated with parenteral nutrition support.Premature infants with lower gestational age, birth weight, and head circumference may be more suitable for extensively hydrolyzed protein formula feeding.