Use of extensively hydrolysed formula for refeeding neonates postnecrotising enterocolitis: a nationwide survey-based, cross-sectional study

Abstract

ObjectiveTo evaluate the prevalence of and reasons for using extensively hydrolysed formulas (EHFs) of cow's milk proteins in the French neonatal units as well as the modality of their prescription for refeeding infants recovering from necrotising enterocolitis (NEC).MethodsA multicentre nationwide cross-sectional study using a questionnaire to address the prevalence of use and the reasons for prescribing EHF in hospitalised neonates and to examine the protocols and the actual reasons for their use for refeeding infants in recovery from NEC. The questionnaire was sent to only 1 senior neonatologist in each neonatal unit included in the study.ResultsMore than half of the French neonatal units participated in the survey. 91% of the surveyed units used EHF. Of 1969 infants hospitalised on the day the survey was run, 12% were fed on an EHF. 11% of the EHF prescriptions were due to previous NEC. The main reasons for using an EHF to feed infants post-NEC were the absence of human milk (75%) and surgical management of NEC (17%). When given, EHF was mainly prescribed for a period varying between 15 days and 3 months. None of the involved units continued using the EHF after 6 months of age. More than half of the surveyed units acknowledged hospitalising infants for the initiation of weaning EHF but only 21% of them tested these infants for cow's milk allergy.ConclusionsThe prevalence of EHF use in the French neonatal units is high. Refeeding infants post-NEC is one of the main reasons for such a high prevalence. The main incentive for using an EHF is the absence of human breast milk, either maternal or donor.

Nutrition Management of Necrotizing Enterocolitis

“…Human breast milk remains the feed of choice in this population as well. Lapillonne et al conducted a nationwide cross‐sectional questionnaire‐based study among French neonatal ICUs to describe the frequency and reasons for using EHF. The authors found that among 1969 hospitalized infants, 12% were receiving EHF.…”

“…According to the survey, the main reasons for using an EHF when feeding post‐NEC neonates were the absence of human milk (75%) and the need for surgical management of NEC (17%). Because these formulas do not typically contain lactose and may contain significant amounts of MCTs, the authors postulate that they may be better absorbed by an infant recovering from NEC . This advantage afforded to infants recovering from NEC may be unnecessary.…”

“…Because these formulas do not typically contain lactose and may contain significant amounts of MCTs, the authors postulate that they may be better absorbed by an infant recovering from NEC. 32 This advantage afforded to infants recovering from NEC may be unnecessary. This was determined by Schaart et al 33 in 2007.…”

How to feed a baby recovering from necrotising enterocolitis when maternal milk is not available

“…However, many clinicians chose to use hydrolysed formula following NEC,25 either as an extensively hydrolysed formula, where residual peptides have molecular weights of <1.5–3.0 kDa or partially hydrolysed formula (PHF) where residual peptides are 3–10 kDa 26. Of note, many routinely used preterm formula in Europe are PHF, although there are no studies showing benefits over a whole protein formula.…”

Faster Gastric Emptying Is Unrelated to Feeding Success in Preterm Infants: Randomized Controlled Trial

“…The impact on GE is often considered an important factor in the choice of infant formulas in preterm infants. Infant formulas with demonstrated faster GE are often selected [2,3,4,5] in clinical practice despite a lack of clear association with improved clinical outcomes.…”