Hydrolyzed Proteins in Preterm Infants

Abstract

Milk proteins are an essential component of the diet of preterm infants who have high requirements. Hydrolyzed proteins (HPs) have been introduced in infants' formulas (HPFs) to treat gastrointestinal disorders and to prevent allergic diseases. Several studies have evaluated the adequacy of HPs in preterm infants. Protein source significantly influences plasma amino acid concentrations. Protein utilization and efficiency are usually lower with HPFs compared to formulas with intact proteins. When protein intake is similar, a lower weight gain is generally observed with HPFs and a 10% increase in protein content is usually necessary to compensate for this reduction in protein utilization. Mineral absorption may also be reduced and no data exist for trace elements and vitamins. Most HPFs are associated with accelerated gastrointestinal transit time and softer stools but without clear benefit on feeding tolerance. Preterm infants seem to be at similar risk of allergic diseases than term infants, but the preventive effect of HPFs has not been sufficiently explored in preterm infants. Most modern HPFs designed for preterm infants are well tolerated and have adapted their nutrient content to improve nutrient absorption and retention. However, their benefits and safety have not been demonstrated and, therefore, further high-quality studies are needed.

Semi-Elemental and Elemental Formulas for Enteral Nutrition in Infants and Children with Medical Complexity—Thinking about Cow’s Milk Allergy and Beyond

“…Conversely, no differences were found regarding length gain and head circumference growth [34,36]. These findings suggest that the HMFs have lower nutritional efficiency, and an average increase of 10% in protein content is desirable to achieve the same protein retention rate as standard preterm formula [33,37]. Bone mineralization seemed not to be affected by the type of milk, although a lower mineral absorption was often experienced by neonates fed with HMF [37].…”

“…These findings suggest that the HMFs have lower nutritional efficiency, and an average increase of 10% in protein content is desirable to achieve the same protein retention rate as standard preterm formula [33,37]. Bone mineralization seemed not to be affected by the type of milk, although a lower mineral absorption was often experienced by neonates fed with HMF [37]. No data are currently available in regard to the influence of HMFs on trace elements and vitamin absorption.…”

“…Uncertainty characterizes the incidence of late-onset infections and of allergic diseases (atopic dermatitis, gastrointestinal symptoms, wheezing) after the first year of life [31]. Then, as for term infants, the familiarity appears to be the main risk factor for developing allergic diseases [37]. Last, there is a lack of evidence regarding hospital stay duration, mortality and neurodevelopmental outcomes [31].…”

Comparative effectiveness of liquid human milk fortifiers: A systematic review and meta‐analysis

“…Collectively, alternative protein liquid HMF products were developed in response to 2 primary concerns with powder HMF: (1) early exposure to intact bovine protein has been associated with necrotizing enterocolitis (NEC) and proinflammatory responses, 7–9 and (2) powdered infant feeding products have been associated with late‐onset sepsis due to contamination with Cronobacter ( Enterobacter) sakazakii 10–12 . Hydrolyzed protein liquid HMFs, moreover, are formulated to target higher (28%–34%) protein delivery compared with powder HMFs; this is a >10% increase in protein hydrolysate thought necessary to achieve protein retention equivalent to intact protein 13 . Although higher protein delivery is consistent with the updated American Academy of Pediatrics consensus guidelines 14 on nutrition needs of VLBW preterm infants, liquid HMFs have the drawback of displacing greater volumes of maternal HM (Table 1).…”

Estudo do crescimento pondero-estatural, do metabolismo protéico e do estado relativo ao cálcio, fósforo e magnésio em crianças nascidas com muito baixo peso (peso ≤ 1500g) e alimentadas com três diferentes dietas do 15º ao 45º dias de vida

“…A patogênese do raquitismo do RNPT-MBP, também denominado osteopenia da prematuridade ou doença óssea metabólica, é multifatorial, como a deficiente ingestão de cálcio e/ou fósforo, deficiência de vitamina D, mal-absorção intestinal, deficiência de cobre, aumento da carga ácida, terapia crônica com diurético e nutrição parenteral (SHAW, 1976;ROWE et al, 1979;BOSLEY;VERRIER-JONES;CAMPBELL, 1980;CHUDLEY et al, 1980;KULKARNI et al, 1980;CALLENBACH et al, 1981;TOOMEY et al, 1982;KNIGHT et al, 83;JAMES et al, 1986;LINDROTH et al, 1986;MAcMAHON et al, 1989). Entretanto, considera-se como fator mais importante a deficiência na oferta de cãlcio e fósforo (GREER & TSANG, 1985;SENTERRE, 1991).…”