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PEDIATRICS Vol. 110 No. 6 December 2002, pp. 1199-1203

Hydrolyzed Protein Accelerates Feeding Advancement inVery Low Birth Weight Infants

Walter A. Mihatsch, MD^*, Axel R. Franz, MD^*, Josef Högel, PhD and Frank Pohlandt, MD, MS^*

^* From the Division of Neonatology and Pediatric Critical Care, Department of Pediatrics
Department for Biometry and Medical Documentation, Ulm University, 89070 Ulm, Germany

--> 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 standard 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 randomly assigned in a randomized, 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. Preprandial 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.

Key Words: hydrolyzed protein formula • early enteral nutrition • very low birth weight infant

Abbreviations: VLBW, very low birth weight • HM, human milk • HPF, hydrolyzed protein preterm infant formula • SPF, standard preterm infant formula • NEC, necrotizing enterocolitis

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Received for publication Jan 29, 2002; Accepted Jul 3, 2002.

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