Formula Switch Leads to Enteral Feeding Tolerance Improvements in Children With Developmental Delays

Abstract

Background: Children with developmental delays are often dependent on enteral nutrition. The aim of our study was to evaluate improvement in tolerance parameters in these children who were switched from an intact protein formula to a 100% whey, peptide-based formula. Methods: A retrospective chart review of children with developmental delays who were failing to reach adequate nutritional goals on standard polymeric formulas were switched to a 100% whey peptide-based formula. Enteral volume goals, caloric goals, and change in medication used to improve feeding tolerance were assessed before and after formula switch. Results: Medical records of 13 children (aged 8.4 ± 4.6 years) met criteria. All children had a primary diagnosis of developmental delay, and 77% were fed via gastrostomy tube. Of the 13 children assessed, 92% experienced improved feeding tolerance, and 75% of these reported the time to improvement within 1 week after formula switch. Feeding tolerance parameters that improved were vomiting (86%), gagging and retching (75%), high residual volumes (63%), constipation (43%), diarrhea (100%), and poor weight gain (100%). Conclusion: Switching to a 100% whey, peptide-based formula improved symptoms of feeding intolerance in the majority of these developmentally delayed children.

Nutritional Ketosis Increases NAD+/NADH Ratio in Healthy Human Brain: An in Vivo Study by 31P-MRS

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Transition to peptide‐based diet improved enteral nutrition tolerance and decreased healthcare utilization in pediatric home enteral nutrition

“…There is a paucity of data to guide clinicians on pediatric HEN practice, especially in the presence of EFI. In 2016, Minor et al 12…”

The use of extensively hydrolysed and amino acid feeds beyond cow’s milk allergy: a national survey

“…Our findings indicate that poor tolerance of standard feeds, reflected by vomiting and diarrhoea are common reasons for choosing an EHF or AAF, when not using these feeds as standard practice. Although feeding intolerance is well documented in many paediatric diagnoses (8,(23)(24)(25) , quantifying the severity or frequency of intolerance that requires a feed change is ambiguous and varies between centres and diagnoses. In our practice survey, an energy-dense whey-based EHF was used by one centre as routine practice in their young critically ill children.…”

“…In addition manufacturers need to also demonstrate safety and efficacy with regard to normal physical growth in infants (6) . However, as a result of the characteristics of EHF and AAF, including peptides, amino acids, glucose polymers and varying levels of medium chain and long chain fatty acids, they are also commonly used in the nutritional support of a variety of acute and chronic childhood illnesses affecting the gastrointestinal tract and are chosen to manage symptoms of gastrointestinal dysmotility (7,8) , malabsorption (9)(10)(11) , drug-induced mucositis (12) and feed intolerance (13) , using a wide variety of definitions to characterise an intolerance to a standard feed (14) . The evidence to recommend the use of AAFs and EHFs in many of these conditions is limited (14)(15)(16) , in addition to lack of defined criteria for the assessment and monitoring of tolerance, efficacy or adequacy.…”