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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.
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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.
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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.
