Feeding Very Low Birth Weight Premature Infants With Extensively Hydrolyzed Protein Formula During Neonatal Period

ObjectiveFeeding intolerance is common in very low birth weight(VLBW)premature infants.It has been reported in the literature that feeding with extensively hydrolyzed protein formula(eHPF)can speed up the establishment of enteral feeding,but current research results are contradictory.And the nutritional adequacy of eHPF in VLBW premature infants is still uncertain.This study was designed to investigate the effectiveness of eHPF in the establishment of enteral nutrition in VLBW premature infants,with particular attention to nutritional safety in the neonatal period.MethodsThis study was a prospective controlled cohort study of a minority population,conducted at the Third Affiliated Hospital of Guangzhou Medical University,starting on May 1st,2015 and ending on December 31 st,2015.When the baby was admitted to the neonatal intensive care unit,the parents were informed about the benefits of breast milk which was recommended to feed the baby.If breast milk was not available,parents were told about the advantages and disadvantages of the two formulas: eHPF and preterm formula(PTF),and were told that they could choose one of them to feed their baby.Infants fed with eHPF were assigned to the study group,and infants fed with PTF were used as control group.At the same time,the study subjects strictly enforced the inclusion and exclusion criteria.The feeding process,physical growth and blood biochemical indicators were strictly monitored and/or evaluated.Results(1)A total of 56 VLBW premature infants were included at admission,but 16 infants were excluded later.Among them,14 premature infants were later transferred to feed with breast milk,one infant was transferred to other hospital for congenital heart disease on postnatal 12 days,and one infant died after care withdrawal on postnatal 20 days due to economic burden.At last,a total of 40 VLBW infants were completed in the study.(2)There were no significant differences in baseline demographics between the PTF-group and eHPF-group(both P > 0.05).(3)The infants in eHPF-group could be fed more volume of milk than those in PTF-group on postnatal 14 days(P = 0.017).And a higher proportion of infants gained full feed within neonatal period in eHPF-group than that in PTF-group(P = 0.038).(4)On postnatal 7,14,21,28 days and at discharge,body weight,length,and head circumference in eHPF-group didn’t differ from those in PTF-group(P > 0.05);and neither were the incidences of growth retardation(P > 0.05).(5)On postnatal 28 days,the blood concentrations of total protein,albumin,urea nitrogen,creatinine,cholesterol,triglyceride,phosphate,calcium,iron,magnesium,zinc,manganese,copper,23 amino acids and 26 carnitines,were not significantly different between the two groups(all P > 0.05).(6)There was no significant difference in the incidence of major complications between the two groups during hospitalization(both P > 0.05).However,the actual feeding intolerance rate in PTF-group appeared to be higher than in eHPF-group(60.0% vs 37.5%),and only one infant in the PTF group was diagnosed with necrotizing enterocolitis(stage IIb).Conclusions(1)Feeding with eHPF doesn’t have a significant adverse effect on the physical growth and nutritional status of VLBW premature infants during the neonatal period.(2)Compared with PTF,feeding with eHPF can promote the establishment of enteral nutrition in VLBW premature infants.