title: Hydrolysed protein accelerates the gastrointestinal transport of formula in preterm infants Extensively hydrolyzed protein formula reduces acid gastro-esophageal reflux in symptomatic preterm infants. Extensively and partially hydrolysed infant formulas for allergy prophylaxis Growth in preterm infants fed either a partially hydrolyzed whey or an intact casein/whey preterm infant formula Application effect of extensively hydrolyzed milk protein formula and follow-up in preterm children with a gestational age of less than 34 weeks: study protocol for a randomized controlled trial Gastric Electrical Activity and Gastric Emptying in Preterm Newborns Fed Standard and Hydrolysate Formulas [Effects of extensively hydrolyzed protein formula on feeding and growth in preterm infants: a multicenter controlled clinical study]. Hydrolyzed protein accelerates feeding advancement in very low birth weight infants. Nutritional Efficacy of Preterm Formula With a Partially Hydrolyzed Protein Source: A Randomized Pilot Study Correlation between early neonatal diet and atopic symptoms up to 5-7 years of age in very low birth weight infants: follow-up of randomized, double-blind study. Extensively and partially hydrolysed preterm formulas in the prevention of allergic diseases in preterm infants: a randomized, double‐blind trial Higher urinary excretion of essential amino acids in preterm infants fed protein hydrolysates Nutritional evaluation of various protein hydrolysate formulae in term infants during the first month of life Nutritional evaluation of protein hydrolysate formulas. Hydrolysed proteins in preterm formula: influence on plasma aminoacids, blood fatty acids and insulinaemia Gastric emptying in preterm infants. National Institute of Child Health and Human Development Postnatal malnutrition and growth retardation: an inevitable consequence of current recommendations in preterm infants? Protein hydrolysate formula maintains homeostasis of plasma amino acids in preterm infants. [Effect of extensively hydrolyzed formula on growth and development of infants with very/extremely low birth weight]. PP-15 THE EFFECT OF EXTENSIVELY HYDROLYZED PROTEIN FORMULA IN PRETERM INFANTS WITH SYMPTOMATIC GASTRO-OESOPHAGEAL REFLUX
abstract: Vomiting , large gastric residuals and abdominal distension are common in very immature infants on formula feeding . The present trial investigated whether a protein hydrolysate formula reduces the gastrointestinal transit time in preterm infants . Fifteen preterm infants ( median gestational age 29 ( 24–32 ) wk , birthweight 1241 ( 660–1900 ) g , postnatal age 18 ( 5–54 ) d ) on full enteral feeds ( > 150 ml/kg*d ) were enrolled . It was hypothesized that the gastrointestinal transit time is at least 2 h shorter when protein hydrolysate formula is fed compared with st and ard preterm formula . In a r and omized cross‐over design study , each formula was fed for 5 d. On days 4 and 9 the gastrointestinal transit time was estimated using carmine red . The protein hydrolysate formula had a markedly shorter gastrointestinal transit time ( 9.8 h ) than the st and ard formula ( 19 h ) ( p= 0.0022 , two‐sided Mann‐Whitney U test ) BACKGROUND Gastro-esophageal reflux ( GER ) is diagnosed frequently in preterm infants . Pharmacological treatment of GER has some potential side effects . Conservative treatment of GER should be the first-line approach and should include body positioning and diet modifications . Formula-fed preterm infants experience frequently symptoms of feeding intolerance . Hydrolyzed protein formula ( HPF ) is often used in these infants due to their effects on gastrointestinal motility . AIMS To investigate the role of an extensively HPF ( eHPF ) on GER indexes in formula-fed preterm infants with symptoms of both GER and feeding intolerance . STUDY DESIGN R and omized crossover trial . SUBJECTS Preterm infants ( gestational age ≤33 weeks ) with symptoms of feeding intolerance ( large gastric residuals , abdominal distension and constipation ) and GER ( frequent regurgitations and /or postpr and ial desaturations ) . OUTCOME MEASURES GER indexes detected by 24-h combined multichannel intraluminal impedance and pH monitoring . GER indexes detected after 4 feeds of an eHPF were compared to those detected after 4 feeds of a st and ard preterm formula ( SPF ) by Wilcoxon signed ranks test . A p<0.05 was considered statistically significant . RESULTS eHPF significantly reduced the number of GERs detected by pH monitoring ( p=0.036 ) and also the reflux index ( p=0.044 ) compared to SPF . No differences in impedance bolus exposure indexes nor in GER height were detected . CONCLUSIONS The use of an eHPF should be evaluated for reducing esophageal acid exposure in preterm infants with feeding intolerance and symptoms of GER . Future research should focus on the evaluation of an eHPF adequate for preterm infants in improving clinical symptoms of GER The allergy preventive effect of extensively ( N ) and partially ( PH ) hydrolysed cows ’ milk formulas compared with a regular formula ( RM ) was assessed in 155 infants with a family history of allergy . No cows ’ milk was given during the first nine months of life and no egg and fish  up to 12 months of age . Breast feeding mothers avoided the same foods . At weaning the infants were r and omised to one of the formula groups . The cumulative incidence of atopic symptoms at 18 months was 51 , 64 , and 84 % in the N , PH , and RM groups , respectively . From 6 to 18 months there were significantly less cumulative atopic symptoms in the N group compared with the RM group , and significantly less than the PH group up to 6 ( N = 25 % ; PH = 46 % ) and 9 months ( N = 34 % , PH = 58 % ) . At 9 months significantly fewer infants in the N group ( 10 % ) than in the PH group ( 33 % ) had a positive skin prick test to eggs . The findings support an allergy preventive effect of an extensively hydrolysed formula , but not of a partially hydrolysed formula , during the first 18 months of life of high risk infants Objective : To compare feeding tolerance , nutrient intake and growth in preterm infants ( ⩽32 weeks , ⩽1750 g ) fed either a st and ard nonhydrolyzed whey – casein ( nHWC ) or a partially hydrolyzed whey ( pHW ) preterm infant formula .  Study Design : In this double-blind r and omized controlled trial infants were fed either formula for at least 3 weeks . Intake was monitored daily , serum chemistries and growth weekly . Data were analyzed using analysis of covariance . Result : A total of 80 infants were enrolled , 72 completed the study . No differences were noted in demographic characteristics . No differences were detected in feeding tolerance , intakes ( 118±21 vs 119±14 ; nHWC vs pHW ) or growth weight , 28±1.5 vs 28±1.6 g per day ; length , 1.0±0.7 vs 1.0±0.6 cm per week ; head circumference , 0.9±0.4 vs 1.0±0.44 cm per week ) . At the end of study , blood urea nitrogen ( 5.2±3.1 < 6.7±2.3 mg per 100 ml , nHWC < pHW ) , total serum proteins ( 4.7±0.4 > 4.4±0.5 g per 100 ml ) and albumin ( 2.7±0.3 > 2.6±0.4 g per 100 ml ) differed . Conclusion : A pHW preterm infant formula was not associated with improved feeding tolerance , enteral intake or growth but differences in serum chemistries . These are unlikely to be clinical ly relevant because values were well within normal limits for preterm infants , whereas growth was identical in both groups and paralleled that ‘ in utero ’ Background The average incidence of preterm birth in the world is up to 11.1 % , and deaths of preterm children account for more than 50 % of neonatal deaths . Gastrointestinal function of preterm children with a gestational age less than 34 weeks is immaturely developed . For preterm children who can only be fed with formula due to their mothers ’ sickness , choosing a suitable formula can not only meet the high nutritional needs of preterm children , but also solve their low gastrointestinal tolerability , and is thus very important . Methods / Design The study is a prospect i ve , r and omized , single-blind and controlled clinical trial . Preterm children with a gestational age less than 34 weeks meeting the inclusion criteria who can not be breastfed will be included . To demonstrate the application effect of extensively hydrolyzed milk protein formula on the target population , preterm children will be r and omized into two groups , 185 subjects in each group . The observation group will be fed with extensively hydrolyzed milk protein ( 100 % whey protein ) formula , while the control group will be fed with preterm children ’s formula until the children are discharged from the neonatal intensive care unit ( NICU ) . All the formula involved in this study will be from Dumex . After discharge , both groups will be uniformly fed with formula for 0 to 6-month-old infants . For statistical analysis , a chi-square test and Student ’s t test will be applied using SAS 9.4 . Discussion This will be the first r and omized controlled clinical study with long-term observation of the growth and development of preterm children during the NICU stay and at 3-month follow-up after discharge from the NICU . Results from this study will be used to determine whether the extensively hydrolyzed formula is more suitable for the low gastrointestinal tolerability of preterm children , and also whether feeding preterm children who are fed with such formula during the NICU stay with ordinary infant formula after discharge from the NICU would affect the normal growth and development of preterm children in the early stage of their lives . Trial registration This study was registered with the Chinese Clinical Trial Registry ( http://www.chictr.org.cn/ ) with number ChiCTR-IOR-14005696 , on December 22 , 2014 Background Because infant formulas containing hydrolyzed cow milk protein are used to reduce feeding intolerance and to improve gastric emptying , the effect on gastrointestinal motility of a hydrolysate formula was compared with that of a st and ard preterm formula . Methods Thirty-six preterm newborns with a gestational age of 32.2 ± 2.3 weeks were assigned r and omly to st and ard formula or hydrolyzed formula .  Cutaneous electrogastrography and ultrasound examination of gastric emptying were performed simultaneously to evaluate gastrointestinal motility before and after the test meal . All recording sessions were performed 1 week after infants had reached full enteral feeding . Results No significant difference in gastrointestinal symptoms was noted in the newborns fed the different formulas . In particular , regurgitation and vomiting were observed in 78 % versus 64 % of preterm newborns after st and ard and hydrolyzed formula , respectively ( Fisher exact test , not significant ) . No differences were found in terms of gastric electrical activity and gastric emptying time between the two groups . Conclusions It seems unnecessary to use hydrolysate formulas to improve motility in preterm infants 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 r and omly 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 st and ard 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 BACKGROUND Feeding intolerance is common in very low birth weight ( VLBW ; < 1500 g ) infants .  Hydrolyzed protein preterm infant formula ( HPF ) has been shown to accelerate the gastrointestinal transit of formula . The aim of this study was to investigate whether HPF improves early feeding tolerance compared with st and ard preterm infant formula ( SPF ) . We hypothesized that HPF would accelerate early enteral feeding advancement . METHODS Primary outcome was the time from initiation of milk feeds until full feeds ( 150 mL/kg birth weight/d ) were achieved in infants who received < 10 % human milk ( HM ) to exclude HM as a confounder . Because the availability of HM was not predictable at the time of enrollment , all eligible VLBW infants ( n = 129 ) were r and omly assigned in a r and omized , controlled trial to receive HPF or SPF if HM was not available . Infants who received > 10 % HM ( n = 42 ) were excluded . Milk bolus feeding every 2 to 3 hours was started at the discretion of the attending physician and advanced by 16 mL/kg/d . Prepr and ial gastric residuals were tolerated up to 5 mL/kg ; otherwise , feedings were reduced or withheld . Data are shown as median ( 5th and 95th percentile ) . RESULTS Forty-six and 41 ( HPF vs SPF ) infants received < 10 % HM . There was no significant difference with regard to birth weight , gestational age , and onset of milk feeds ( day 3 [ 1 - 8 ] vs 4 [ 2 - 6 ] ) . The time from initiation of milk feeds to full feeds was significantly shorter with HPF feeding ( 10 [ 9 - 27 ] vs 12 [ 9 - 28 ] days ) . CONCLUSION HPF improved the feeding tolerance and enabled a more rapid establishment of full enteral feeding in VLBW infants compared with SPF Background Decreased nitrogen levels , calcium intestinal absorption rates , and plasma amino acid imbalances were reported for preterm infants who were fed partially hydrolyzed preterm formulas . In this pilot study , we evaluated a new formula with modified nitrogen and calcium sources . Methods During their second week of life , 16 preterm infants were r and omly assigned to one of two groups : 9 were fed the  new partially hydrolyzed formula and 7 were fed a conventional formula . Nutrient balance was performed at the end of the first month of life . Amino acid concentrations and anthropometric parameters were measured at theoretical term . Results Birth weight and gestational age ( mean ± SD ) were similar in the two groups ( 28.9 ± 7.0 weeks and 1183 ± 242 g vs. 27.7 ± 1.0 weeks and 1139 ± 162 g ) . Median nitrogen absorption rates ( 85 % vs. 89%;P = 0.03 ) and biological values ( 59 % vs. 69%;P = 0.13 ) were lower for infants who were fed the new formula than for those fed the conventional formula . After correction for difference in nitrogen intake , there was no significant difference in nitrogen retained between the two groups ( P = 0.11 ) . Plasma amino acid concentrations were also similar in the two groups . Median calcium absorption tended to be higher in the new-formula group than in the conventional-formula group ( 54 % vs. 45 % , P = 0.19 ) . At theoretical term , infants fed the conventional formula were heavier than infants fed the new formula ( 3559 ± 362 g vs. 3193 ± 384 g , P = 0.04 ) . Conclusions Because nitrogen content is 10 % higher in hydrolyzed-protein formula than in entire-protein formula , appropriate nitrogen retention , plasma amino acid profile , and mineral use can be achieved with the new partially hydrolyzed formula . Further studies with larger groups are needed to evaluate the effect on growth The influence of early feeding on the risk of atopic diseases has been studied in full-term newborns , not in very low birth weight infants ( VLBW ) . The study evaluated effect of early feeding of VLBW infants with either cow 's milk-based formula ( CMF ) or extensively hydrolyzed milk formula ( HF ) on incidence of atopic diseases and markers of atopy at 5 - 7 years of age . This was a follow-up of the r and omized , double-blind study evaluating the influence of different enteral feeding protocol s on the early morbidity of VLBW infants . In the original study 80 children were r and omly allocated into 2 groups receiving during first month of life HF ( experimental group ) or CMF ( control group ) . At the age of 5 - 7 years , 62 children among 74 available ( 84 % ) with mean birthweight 1124 g were evaluated according to st and ardized ISAAC ( International Study of Asthma and Allergies in Childhood ) protocol . Total IgE level , specific IgE , lymphocyte CD4+CCR4+/CD4+CXCR3 + ratio and skin prick tests ( SPT ) were done . Prevalence of obvious allergic diseases was not significantly different between the studied groups ( HF : 12/33 ; CMF : 6/29 ; RR [ relative risk ] HF vs CMF : 1.76 ; 95%CI [ confidence interval ] : 0.76 - 4.09 ) . Comparison of atopic status across groups revealed similar rate of positive markers of atopy : IgE ( RR : 2.57 95%CI : 0.91 - 8,08 ) , SPT ( RR : 5.13 ; 95%CI : 0.93 - 31.6 ) , lymphocyte CD4+CCR4+/CD4+CXCR3 + ratio ( OR : 2.32 ; 95%CI : 0.78 - 7.53 ) in the both studied groups . Based on the carried out follow-up study we were unable to confirm the usefulness of hydrolyzed formula in prevention of allergy in an unselected cohort of very low birth weight infants Aim : A r and omized , double‐blind study was conducted to evaluate whether use of protein hydrolysate‐based preterm formulas in infants with an atopic predisposition helps prevent the development of allergic diseases . Methods : Preterm infants ( n= 122 ) with at least one first‐degree relative ( parent or sibling ) with allergic disease were r and omly assigned to receive an extensively or partially hydrolysed preterm formula ( intervention groups ) or a st and ard preterm formula until 4 to 5 mo of age . Infants whose parents preferred that they be breastfed received their mothers ' fortified breast milk . Results : Intention‐to‐treat analysis showed that the overall incidence of allergic diseases did not significantly differ between groups at both 4–5 and 12 mo of age . However , by 12 mo , use of the extensively hydrolysed versus the st and ard preterm formula had significantly reduced the risk of atopic dermatitis . At 4–5 and 12 mo , there was a significantly increased risk of non‐acceptance of the extensively hydrolysed formula compared with the other formulas Aim : Protein hydrolysates have been introduced in preterm formulae , but it is not clear whether they are needed for the feeding of preterm infants . We design ed a r and omized , controlled trial to test the effects of a preterm formula with hydrolysed cow 's milk proteins on short‐term growth and urinary and plasma amino acids levels . Methods : Infants with a birthweight 1750 g and gestational age 34 wk fed a conventional preterm infant formula ( formula B ) or a hydrolysed formula ( formula A ) .  Weight was measured daily ; length , head circumference , mid‐arm circumference and total skinfold thickness were measured weekly . Blood and urine were analysed for amino acid concentrations at start , 14 and 28 d. Results : Twenty‐one infants met the criteria for r and omization . The daily feeding volumes were : formula A 172.8±5.6 vs formula B 170.1±2.8 ml/kg/d . Infants fed with formula A showed slower weight gain ( 17.4±3.4 vs 20.5±3.3 g/kg/d ; p=0.045 ) and lower mean change in Z‐scores for weight ( −0.18±0.16 vs 0.00±0.09 ; p=0.009 ) and for head circumference ( −0.06±0.13 vs 0.06±0.13 ; p=0.049 ) . After 14 d , infants receiving formula A had statistically significant higher urinary levels of essential amino acids compared to infants receiving formula The aim of the study was to compare , during the first month of life , growth parameters , biochemical indices of protein metabolism and plasma amino acid concentrations in newborn infants fed either human milk ( n = 23 ) , three different whey hydrolysate formulae ( WHF 1 , n = 13 ; WHF 2 , n = 10 ; WHF 3 , n = 13 ) , a soy-collagen hydrolysate formula ( SCHF n = 18 ) or a whey-casein hydrolysate formula ( WCHF , n = 20 ) .  Growth parameters and the various protein concentrations determined in the infants fed WHF 1 and WHF 2 were similar to the values observed with human milk . With WHF 3 , growth in weight , length and head circumference and serum total protein concentrations were reduced significantly whereas blood urea nitrogen was increased . With SCHF , growth in weight and length as well as serum total protein and transferrin concentration were decreased significantly , whereas serum IgG concentration was increased . With WCHF growth in length and serum transferrin concentration were decreased compared to the human milk group . In the various groups , the plasma amino acid pattern reflected the amino acid content of the formula . Whey hydrolysate formula induced mainly an increase in threonine and a decrease in tyrosine concentrations .  Soy-collagen hydrolysate formula led to an increase of non-essential amino acids , such as glycine and hydroxyproline , and a decrease in plasma lysine and cystine .  Whey-casein hydrolysate formula induced a plasma amino acid pattern close to the profile observed with human milk . Nevertheless , the plasma concentrations of most of the various amino acids were higher . ( ABSTRACT TRUNCATED AT 250 WORDS Growth parameters , biochemical indice of protein metabolism and plasma Amino acid ( AA ) concentrations were investigated during the first month of life in term infants ( n = 61 ) fed various protein hydrolysate formulas ( whey ( WHF , n = 3 ) , soy collagen ( SCHF , n = 1 ) and whey-casein hydrolysate formulas ( WCHF , n = 1 ) ) . In addition , metabolic balance studies were performed in 10 infants fed WHF and in 5 fed WCHF . Comparatively to breast fed infants , growth reduction and decrease in plasma protein concentrations were observed with the use of one of the WHF and in a lesser extent with the SCHF and the WCHF . Plasma amino acid pattern reflected the AA content of the formulas . Whey hydrolysate formulas induced mainly an increase in threonine and a decrease in tyrosine concentrations .  Soy-collagen hydrolysate formula led to an increase of non-essential amino acids , such as glycine and hydroxyproline and a decrease in plasma lysine and cystine .  Whey-casein hydrolysate formula induced a plasma amino acid pattern close to the profile observed in breast fed infant . Metabolic balance studies showed a relative reduction in nitrogen absorption and utilisation in the infants fed the WHF and the WCHF . In addition a drastic reduction in fat , calcium and phosphorus absorption was also observed with the use of the WCHF . In preterm infants ( n = 19 ) fed whey predominant hydrolysed preterm formulas ( n = 3 ) , metabolic balance studies an plasma AA concentration were evaluated at the end of the first month of life at 34 weeks of gestation age . Comparatively to similar preterm infants fed conventional preterm formulas , a relative reduction in nitrogen absorption ( 83 % vs 90 % ) and retention ( 64 vs 70 % ) as well as in phosphorus absorption ( 78 vs 89 % ) was observed . Calcium retention was similar ( 48 vs 45 mg/kg/d ) but calcium intake was significantly higher in infants fed hydrolysate formulas 120 vs 91 mg/kg/d . Plasma amino acid concentrations were related to amino acid composition of the formulas . Compared with the st and ard preterm formulas , all three protein hydrolysate formulas led to a significant increase in plasma threonine and a decrease in tyrosine and phenylalanine concentrations . In addition , there was a reduction in plasma histidine , valine , leucine , cystine , methionine and /or tryptophane with some of the hydrolysate formulas used . In conclusion , these studies provide evidence that protein hydrolysed formulas are not equivalent to whole protein formulas in terms of nutritional efficiency for preterm and term infants . Therefore further extensive nutritional studies on growth , biochemical indices of protein metabolism and metabolic balance , including minerals and trace elements , appear to be necessary before maintaining and promoting the use of such formulas for teh potential benefits on atopic disease in preterm and in full-term newborn infants The data from the present investigation differ from those of the previous study . The new version of hydrolysed protein formula did not induce changes in insulinaemia or in the insulinaemia/glycaemia ratio in pre‐ and postpr and ial sample s when compared with the intact protein formula . The investigation also confirmed that branch chain aminoacids regulate insulin secretion and that the length of chain is insulinotropic for fatty acids , while the degree of unsaturation is not able to reduce insulin secretion in the newborn baby . This could be caused by stimulation of insulin output activated by the C20:5 n 3 ; the effects of fatty acids are probably related more to the variable composition of cell membrane than to the fatty acids circulating levels An ultrasonic technique was used to compare gastric emptying after a feed of expressed breast milk and formula milk in a blind , cross over study of preterm infants . Fourteen infants ( median gestational age 33 weeks ) were studied on 46 occasions . Each infant received a nasogastric feed of either expressed breast milk or formula milk , and the alternative at the next feed . Real time ultrasound images of the gastric antrum were obtained and measurements of antral cross sectional area ( ACSA ) were made before the feed and then sequentially after its completion until the ACSA returned to its prefeed value . The half emptying time ( 50 % delta ACSA ) was calculated as the time taken for the ACSA to decrease to half the maximum increment . On average , expressed breast milk emptied twice as fast as formula milk : mean 50 % delta ACSA expressed breast milk 36 minutes ; formula milk 72 minutes . The technique was reproducible and there was no significant difference between the emptying rates of feeds of the same type for an individual infant . These data show that breast milk has a major effect on gastric emptying , which may have important implication s for preterm infants who have a feed intolerance due to delayed gastric emptying The National Institute of Child Health and Human Development conducts and supports research on all stages of human development from preconception to adulthood in order to better underst and the health of children , youths , adults , families , and communities . Health and human development information is made easily available on the site with a simple A to Z list , along with clinical trials and health education campaign information . Links to clinical trials , news releases , publications , and related web sites are also available , as well as information on research being conducted at present and supported by the National Institute of Child Health and Human Development BACKGROUND Nutrient intakes meeting recommended dietary intakes ( RDIs ) take time to establish and once established are rarely maintained throughout hospital stay in preterm infants . A nutrient deficit , therefore , accrues . RDI are based on needs for maintenance and growth , with no provision to replace this deficit . We , therefore , hypothesized that postnatal malnutrition and growth retardation were inevitable in infants fed current RDI . METHODOLOGY Dietary intakes were prospect ively collected , by a single observer ( N.P. ) , on a daily basis in a group of preterm infants ( n = 105 ; birth weight < /=1750 g ; gestational age < /=34 weeks ) admitted to neonatal intensive care unit over a 6-month period . Actual was subtracted from recommended energy ( 120 kcal/kg/day ) and protein ( 3 g/kg/day ) intakes and nutritional deficits calculated . Infants were weighed on admission and throughout hospital stay . The data were analyzed using a combination of repeated measures analysis of variance and stepwise regression analysis . RESULTS Nutrient intakes meeting current RDIs were rarely achieved during early life . By the end of the first week , cumulative energy and protein deficits were 406 + /- 92 and 335 + /- 86 kcal/kg and 14 + /- 3 and 12 + /- 4 g/kg in infants < /=30 and those at > /=31 weeks . By the end of the fifth week , cumulative energy and protein deficits were 813 + /- 542 and 382 + /- 263 kcal/kg and 23 + /- 12 and 13 + /- 15 g/kg and the z scores were -1.14 + /-.6 and -.82 + /-.5 for infants at < /=30 and > /=31 weeks . Stepwise regression analysis indicated that variation in dietary intake accounted for 45 % of the variation in changes in z score . CONCLUSIONS Preterm infants inevitably accumulate a significant nutrient deficit in the first few weeks of life that will not be replaced when current RDIs are fed . This deficit can be directly related to subsequent postnatal growth retardation.postnatal growth retardation , preterm infants BACKGROUND Plasma amino acid concentrations were measured in preterm infants who were fed either a new hydrolyzed cow 's milk protein formula or a st and ard preterm infant formula .  It was hypothesized that feeding with the hydrolysate results in prepr and ial amino acid concentrations that are significantly different from the concentrations found when feeding with the st and ard formula . METHODS Fifteen preterm infants , median gestational age , 29 weeks ( range , 24 - 32 weeks ) ; birth weight , 1241 g ( range , 660 - 1900 g ) ; and postnatal age , 18 days ( range , 7 - 54 days ) receiving full enteral feedings ( > 150 ml/kg x day ) , were enrolled . The intervention was r and omized allocation to the formula with hydrolyzed or natural cow 's milk protein ( the whey/casein ratio was 60:40 in both formulas ) . In a crossover design , each formula was fed for 5 days , and plasma amino acids were analyzed on day 4 or 5 of each 5-day period . RESULTS In spite of the 12 % higher amino acid intake with hydrolysate formula , the median individual plasma amino acid concentrations were virtually identical with both formulas , and they were within the 10th and the 90th percentile of the reference of levels in the umbilical cord artery after elective cesarean delivery or of breast-fed newborn infants . The median concentrations of lysine and aspartic acid were higher with hydrolyzed formula feeding ( p<0.05 ; two-tailed Mann-Whitney test ) . With both formulas , single amino acid concentrations were out of the reference values . CONCLUSION Virtually identical plasma amino acid concentration patterns were measured with the new hydrolyzed preterm infant formula and the st and ard preterm infant formula , but longitudinal studies are required before the studied protein hydrolysate can be recommended for preterm feeding in general OBJECTIVE To study the effect of extensively hydrolyzed formula on the growth and development in  very low birth weight ( VLBW ) and extremely low birth weight ( ELBW ) infants . METHODS A total of 375 VLBW or ELBW infants were enrolled and divided into an observation group ( 187 infants ) and a control group ( 188 infants ) using a r and om number table . The infants in the observation group were given extensively hydrolyzed formula , and when the amount of extensively hydrolyzed formula reached 10 mL/time , it was changed to the st and ard formula for preterm infants . The infants in the control group were given st and ard formula for preterm infants . Both groups were fed for 4 consecutive weeks and were compared in terms of incidence rate of feeding intolerance , time to establish full enteral feeding , time to complete meconium excretion , number of spontaneous bowel movements , growth and development , motilin level at 4 and 10 days after feeding , and incidence rate of infection . RESULTS Compared with the control group , the observation group had a lower rate of feeding intolerance ( P<0.05 ) , a shorter duration to full enteral feeding and time to complete meconium excretion ( P<0.05 ) , a higher mean number of daily spontaneous bowel movements ( P<0.05 ) , higher body weight ( 1 793±317 g vs 1 621±138 g ; P<0.05 ) , head circumference ( 30.5±1.1 cm vs 30.0±1.6 cm ; P<0.05 ) , and body length ( 43.9±1.2 cm vs 42.1±2.0 cm ; P<0.05 ) , a higher motilin level at 4 and 10 days after feeding ( P<0.05 ) , and a significantly lower infection rate ( P<0.05 ) . CONCLUSIONS Extensively hydrolyzed formula can increase motilin level , improve gastrointestinal feeding tolerance , promote early growth and development , and reduce the incidence of infection  in VLBW and ELBW infants Background : Gaestroesophageal reflux ( GER ) occurs commonly in infants especially preterm infants . Current anti-reflux medication has shown limited therapeutic benefits for this age group . Our study aims to evaluate the efficacy of extensively hydrolyzed formula feed ( EHFF ) compared to st and ard infant formula ( SF ) on GER episodes in preterm infants using Multichannel intraluminal impedance and pH monitoring ( MII-pH ) . Methods : This is a prospect i ve crossover trial involving preterm infants > 29 weeks corrected gestation age with symptoms of GER . All patiets were recruited from a single tertiary neonatal unit in Singapore . MII-pH was performed over 48 hours . For the first 24 hours the infants were either fed on st and ardized infant formula ( SF ) or Expressed Breast Milk ( EBM ) depending on maternal choice . For the second 24 hours their feeds were changed to EHFF . All infants were on orogastric/nasagastric tube feeding and were given 2 to 3 hourly bolus feeding throughout the study period . Results : 23 infants completed the study : 14males : 9 females . Mean weight 2971 g ( SD + 1569 g ) . None of the patients were on any anti-reflux medications ( apart from one ) . Type of feeds during first 24 hours were EBM 8/23(35 % ) , SF 5/23(22 % ) or mixed feeding 10/23(43 % ) . GER symptoms were : desaturations16/23(70 % ) , cough 8/23(35 % ) , arching7/23 ( 30 % ) , vomit 3/23(13 % ) , crying2/23(8 % ) and apnoea1/23 ( 4 % ) . The median total GER episodes ( detected by pH and MII ) was significantly lower during the EHFF period compared to SF/EBM period 42(21–71 ) vs 68(32–104 ) p < 0.001 . The median acidic reflux episodes detected by pH was also significantly lower in EHFF vs SF/EBM period 8(4–24 ) vs 23(3–58 ) p < 0.005 . Total number of refluxes detected by MII showed a significant reduction for EHFF compared to SF/EBM : 17(11–56 ) vs 46(20–65 ) p < 0.015 . There was no difference in reflux index , MII bolus exposure indexes , and number of long lasting episodes ( > 5 min ) between the 2 groups . There were no significant difference in the number of symptoms recorded between the two study period . Conclusions : Our data suggest that the number of gastroesophageal reflux was significantly lower in preterm infants fed with EHFF compared to st and ard formula as measured by pH-MII monitoring . EHFF may potentially be an effective treatment modality for gastroesophageal reflux disease in infants with minimal side-effects . The lack of symptom reduction during EHFF despite fewer GER episodes suggests that other pathology other than GER should be considered . A larger study is required to further evaluate the efficacy and mechanism of EHFF on reduction of GER in infants
target: The identified trials provide only low quality evidence about the effects of feeding preterm infants  with protein hydrolysate versus st and ard formula .
  The existing data did not support conclusions that feeding with protein hydrolysate affects the risk of feed intolerance or necrotising enterocolitis .
background: BACKGROUND When human milk is not available for feeding preterm infants , protein hydrolysate rather than st and ard cow 's milk formulas ( with intact proteins ) are often used because they are perceived as being tolerated better and less likely to lead to complications .
  However , protein hydrolysate formulas are more expensive than st and ard formulas , and concern exists that their use in practice is not supported by high- quality evidence .
  OBJECTIVES To assess the effect of feeding preterm infants with hydrolysed formula ( versus st and ard cow 's milk formulas )  on the risk of feed intolerance , necrotising enterocolitis , and  other morbidity and mortality in preterm infants .