Hydrolyzed Protein Formula in Very-Low-Birth-Weight Infants: Predictors of Use and 20-Month Neurodevelopmental Outcome

TL;DR

This study examines the use of hydrolyzed protein formulas in very-low-birth-weight infants and finds no significant difference in neurodevelopmental outcomes at 20 months.

Contribution

The study provides new insights into predictors and outcomes of hydrolyzed protein formula use in preterm infants after NICU discharge.

Findings

HPF use was predicted by multiple gestation and stage 2-3 necrotizing enterocolitis.

Infants on non-HPF at eight months had worse language scores than those on HPF or MBM.

No significant difference in 20-month neurodevelopmental outcomes was found between HPF and non-HPF groups.

Abstract

Objectives: Hydrolyzed protein formulas (HPFs) are used in full-term infants to treat cow’s milk protein allergy but can result in suboptimal weight gain as compared to standard infant formulas. In preterm infants, HPF may be used to promote feeding tolerance after necrotizing enterocolitis. There is limited evidence on HPF use in preterm infants after NICU discharge. The primary objective of this study was to determine predictors of HPF use at four, eight, and 20 months corrected age (CA) post-NICU discharge, and the secondary objective was to evaluate the association between HPF use at four and eight months CA and neurodevelopmental (ND) outcome (cognitive, language, and motor indices on the Bayley Scales of Infant and Toddler Development-III) at 20 months CA in very-low-birth-weight (VLBW; birth weight < 1,500 g) infants.

Methods: This was a retrospective chart review of 419 VLBW infants born in 2008-2012. Infants were categorized by diet at four and eight months into one of three groups: any maternal breast milk (MBM), HPF, and non-HPF. ND outcome was assessed with the Bayley-III. Multiple regression adjusted for the effect of risk factors on formula use and the effect of four- and eight-month diets on 20-month ND.

Results: Forty-three (10.3%), 45 (10.7%), and 350 (83.5%) infants at four months and 22 (5.5%), 41 (10.3%), and 297 (74.4%) infants at eight months were on a diet of MBM, HPF, and non-HPF, respectively. HPF use was predicted by multiple gestation (odds ratio (OR) 3.01 (95% CI 1.57-5.99)) and stage 2-3 necrotizing enterocolitis (OR 2.54 (95% CI 1.09-5.94)) at four and eight months, respectively. In multiple regression, infants on non-HPF at eight months had worse language/receptive language scores than the other two groups.

Conclusions: In our retrospective analysis of VLBW infants, we did not observe any statistically significant difference in 20-month ND outcomes among infants who received HPF as compared to those who received non-HPF or MBM.

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