Hydrolysed milk in preterm infants: An open problem

Abstract

Aim: To review knowledge about the role, indications and nutritional adequacy of protein hydrolysate formulas (HF) in the preterm newborn. Methods: A review of the available literature was carried out. Results: No data support the use of HF for atopy prevention. HF could have a positive role in the early feeding of very‐low‐birthweight infants, but several concerns exist about their nutritional adequacy. Conclusion: Further investigations addressing protein and mineral metabolism as well as long‐term effects, including neurodevelopment, are needed.

Protein hydrolysate versus standard formula for preterm infants

“…These formulas contain hydrolysed, rather than intact, proteins and may also di er from standard cow's milk formulas in carbohydrate, lipid, and micronutrient type and content (Oldaeus 1997). Their use as a sole, or supplemental, enteral feed source for preterm infants has increased since the late 1990s, particularly in high-income countries, because they are perceived as being tolerated better and less likely to lead to complications than standard cow's milk formulas (Zuppa 2005). However, hydrolysed formulas are more expensive than standard formulas, and concern exists that their use in practice is not supported by high-certainty evidence (Foucard 2005).…”

“…'Hydrolysed' protein formulas containing protein digested chemically (acid/alkali) or enzymatically (protease) to oligopeptides are o en used in feeding preterm infants, especially infants with feed intolerance or clinical features (such as episodic apnoea, oxygen desaturation, or bradycardia) that are attributed to gastro-oesophageal reflux, or following gastrointestinal surgery or necrotising enterocolitis (Zuppa 2005).…”

“…When human milk is unavailable, hydrolysed formulas may be used empirically (starter formula) and therapeutically to improve feeding tolerance or reduce gastrooesophageal reflux. Possible mechanisms for these e ects include accelerated gastric emptying and intestinal transit, more e icient enteric peptide digestion, and stimulation of small intestinal enzymatic and motilin activity (Mihatsch 2001b;Zuppa 2005). If better feed tolerance reduces the time taken to establish full enteral feeding in very preterm infants, this may reduce the adverse infectious or metabolic consequences of prolonged exposure to parenteral nutrition.…”

“…It is possible that some peptides created by artificial hydrolysis may have diminished or harmful functional activities (Embleton 2013b). Concern about micronutrient bioavailability in hydrolysed formulas exists, particularly regarding whether bone minerals are well absorbed in the absence of intact casein proteins (Zuppa 2005). Another theoretical long-term risk is that the high levels of "advanced glycation end-products" in most hydrolysed formulas might be associated with development of chronic inflammatory, metabolic, or neurodegenerative diseases (Uribarri 2015).…”

Specific formulas for preterm infants, how and when

“…The use of hydrolyzed formulas has not shown a preventive role on cow's milk protein allergy, it has proven helpful in improving food tolerance (acceleration of the intestinal transit time and faster achievement of full enteral feeding), but it has a reduced nutritional value, (especially protein intake)[ 7 - 11 ].…”