Effects of extensively hydrolyzed protein formula on feeding and growth in preterm infants：a multicenter controlled clinical study

YU Mu-Xue; ZHUANG Si-Qi; WANG Dan-Hua; ZHOU Xiao-Yu; LIU Xiao-Hong; SHI Li-Ping; YUE Shao-Jie; QIAN Ji-Hong; SUN Jian-Hua

doi:10.7499/j.issn.1008-8830.2014.07.006

PDF(1370 KB)

Chinese Journal of Contemporary Pediatrics ›› 2014, Vol. 16 ›› Issue (7) : 684-690. DOI: 10.7499/j.issn.1008-8830.2014.07.006

TOPIC OF NUTRITION FOR PRETERM INFANTS

Effects of extensively hydrolyzed protein formula on feeding and growth in preterm infants：a multicenter controlled clinical study

YU Mu-Xue¹, ZHUANG Si-Qi¹, WANG Dan-Hua², ZHOU Xiao-Yu³, LIU Xiao-Hong⁴, SHI Li-Ping⁵, YUE Shao-Jie⁶, QIAN Ji-Hong⁷, SUN Jian-Hua⁸

Author information +

History +

Abstract

Objective To study the effects of extensively hydrolyzed protein formula (eHF) on the feeding and growth in preterm infants through a multicenter controlled clinical study. Methods Preterm infants admitted to eight upper first-class hospitals in China between February 2012 and December 2013 were randomly selected. They were divided into two observation groups and two control groups. The first observation group consisted of preterm infants with a gestational age of <32 weeks, who were fed with eHF for 10-14 days after birth and then with standard preterm formula (SPF) until discharge. The second observation group consisted of preterm infants with a gestational age of 32-34 weeks, who were fed with SPF after birth, but were switched to eHF (7-14 days) if suffering feeding intolerance at 6-8 days after birth. The two control groups with corresponding gestational ages kept to be fed with SPF after birth. Clinical data were recorded to compare feeding condition, physical growth, blood biochemical indices, and major complications between different groups. Results A total of 328 preterm infants were enrolled. Preterm infants with a gestational age of <32 weeks in the observation group had a significantly shorter meconium evacuation time than in the corresponding control group (P<0.05). They also had significantly lower levels of serum total bilirubin at weeks 1 and 2 after birth compared with the control group (P<0.05). The observation group needed more time in reaching enteral nutrition (EN) basic energy uptake of 50 kcal/(kg·d), partial parenteral nutrition (PPN), hospitalization, and corrected gestational age at discharge compared with the controlled infants (P<0.05). There was no difference in the incidence of extrauterine growth retardation (EUGR) at discharge between the two groups (P>0.05). Preterm infants with a gestational age of 32-34 weeks in the observation group had significantly lower serum total bilirubin levels at 2 weeks after birth compared with the corresponding control group (P<0.05). They required more time in achieving EN basic energy and PPN than in the control group (P<0.05). There was no difference in the incidence of EUGR at discharge between the two groups (P>0.05). Conclusions For preterm infants, eHF can improve gastrointestinal motility, accelerate bilirubin metabolism and excretion and does not increase the incidence of EUGR.

Key words

Extensively hydrolyzed protein formula / Feeding / Growth / Preterm infant

Cite this article

EndNote

Ris (Procite)

Bibtex

Download Citations

YU Mu-Xue, ZHUANG Si-Qi, WANG Dan-Hua, ZHOU Xiao-Yu, LIU Xiao-Hong, SHI Li-Ping, YUE Shao-Jie, QIAN Ji-Hong, SUN Jian-Hua. Effects of extensively hydrolyzed protein formula on feeding and growth in preterm infants：a multicenter controlled clinical study[J]. Chinese Journal of Contemporary Pediatrics. 2014, 16(7): 684-690 https://doi.org/10.7499/j.issn.1008-8830.2014.07.006

References

[1] Neu J. Gastrointestinal development and meeting the nutritional needs of premature infants[J]. Am J Clin Nutr, 2007, 85(2): 629S-634S.
[2] Fanaro S. Feeding intolerance in the preterm infant[J]. Early Hum Dev, 2013, 89 (Suppl 2): S13-S20.
[3] Szajewska H. Extensive and partial protein hydrolysate preterm formulas[J]. J Pediatr Gastroenterol Nutr, 2007, 45(Suppl 3): S183-S187.
[4] Working GOPC, Working GONC, Working GONS. CSPEN guidelines for nutrition support in neonates[J]. Asia Pac J Clin Nutr, 2013, 22(4): 655-663.
[5] 蔡威，汤庆娅，陶晔璇，等. 中国新生儿营养支持临床应用指南[J]. 中国当代儿科杂志, 2006, 8(5): 352-356.
[6] 广东省医学会儿科学分会新生儿学组, 杨伊琳, 庄思齐, 等. 口服红霉素治疗早产儿喂养不耐受的多中心临床对照研究[J]. 中国新生儿科杂志, 2012, 27(5): 302-307.
[7] 邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学 [M]. 第4 版. 北京：人民卫生出版社, 2011.
[8] Clark RH, Thomas P, Peabody J. Extrauterine growth restriction remains a serious problem in prematurely born neonates[J]. Pediatrics, 2003, 111(5 Pt 1): 986-990.
[9] Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants[J]. BMC Pediatr, 2013, 13: 59.
[10] de Pipaon MM, Montes BM, Sanjose B, et al. Acquisition of full enteral feeds may depend on stooling pattern in very premature infants[J]. J Perinat Med, 2012, 40(4): 427-431.
[11] Mihatsch WA, Franz AR, Lindner W, et al. Meconium passage in extremely low birthweight infants and its relation to very early enteral nutrition[J]. Acta Paediatr, 2001, 90(4): 409-411.
[12] Mihatsch WA, Hogel J, Pohlandt F. Hydrolysed protein accelerates the gastrointestinal transport of formula in preterm infants[J]. Acta Paediatr, 2001, 90(2): 196-198.
[13] Mihatsch WA, Franz AR, Hogel J, et al. Hydrolyzed protein accelerates feeding advancement in very low birth weight infants[J]. Pediatrics, 2002, 110(6): 1199-1203.
[14] Corvaglia L, Mariani E, Aceti A, et al. Extensively hydrolyzed protein formula reduces acid gastro-esophageal reflux in symptomatic preterm infants[J]. Early Hum Dev, 2013, 89(7): 453-455.
[15] Mihatsch WA, Franz AR, Kuhnt B, et al. Hydrolysis of casein accelerates gastrointestinal transit via reduction of opioid receptor agonists released from casein in rats[J]. Biol Neonate, 2005, 87(3): 160-163.
[16] Riezzo G, Indrio F, Montagna O, et al. Gastric electrical activity and gastric emptying in preterm newborns fed standard and hydrolysate formulas[J]. J Pediatr Gastroenterol Nutr, 2001, 33(3): 290-295.
[17] Kliegman R. Nelson Textbook of Pediatrics[M]. Elsevier/Saunders, 2011.
[18] 王席娟. 深度水解蛋白配方乳对早产儿早期胃肠道功能的影响及机制探讨[D]. 华中科技大学学位论文, 2010.
[19] Picaud JC, Rigo J, Normand S, et al. Nutritional efficacy of preterm formula with a partially hydrolyzed protein source: a randomized pilot study[J]. J Pediatr Gastroenterol Nutr, 2001, 32(5): 555-561.
[20] Drozdowski LA, Clandinin T, Thomson AB. Ontogeny, growth and development of the small intestine: Understanding pediatric gastroenterology[J]. World J Gastroenterol, 2010, 16(7): 787-799.
[21] Rigo J, Salle BL, Picaud JC, et al. Nutritional evaluation of protein hydrolysate formulas[J]. Eur J Clin Nutr, 1995, 49 (Suppl 1): S26-S38.
[22] Maggio L, Zuppa AA, Sawatzki G, et al. Higher urinary excretion of essential amino acids in preterm infants fed protein hydrolysates[J]. Acta Paediatr, 2005, 94(1): 75-84.
[23] Florendo KN, Bellflower B, van Zwol A, et al. Growth in preterm infants fed either a partially hydrolyzed whey or an intact casein/whey preterm infant formula[J]. J Perinatol, 2009, 29(2): 106-111.
[24] 胡玉莲，夏世文. 深度水解蛋白配方奶对极低出生体质量儿喂养的影响[J]. 实用儿科临床杂志, 2011, 24(14): 1091-1092.
[25] Szajewska H, Albrecht P, Stoitiska B, et al. Extensive and partial protein hydrolysate preterm formulas: the effect on growth rate, protein metabolism indices, and plasma amino acid concentrations[J]. J Pediatr Gastroenterol Nutr, 2001, 32(3): 303-309.