PP‐15 THE EFFECT OF EXTENSIVELY HYDROLYZED PROTEIN FORMULA IN PRETERM INFANTS WITH SYMPTOMATIC GASTRO‐OESOPHAGEAL REFLUX

Abstract

Background:Gaestroesophageal reflux (GER) occurs commonly in infants especially preterm infants. Current anti‐reflux medication has shown limited therapeutic benefits for this age group. Our study aims to evaluate the efficacy of extensively hydrolyzed formula feed (EHFF) compared to standard infant formula (SF) on GER episodes in preterm infants using Multichannel intraluminal impedance and pH monitoring (MII‐pH).Methods:This is a prospective crossover trial involving preterm infants >29 weeks corrected gestation age with symptoms of GER. All patiets were recruited from a single tertiary neonatal unit in Singapore. MII‐pH was performed over 48 hours. For the first 24 hours the infants were either fed on standardized infant formula (SF) or Expressed Breast Milk (EBM) depending on maternal choice. For the second 24 hours their feeds were changed to EHFF. All infants were on orogastric/nasagastric tube feeding and were given 2 to 3 hourly bolus feeding throughout the study period.Results:23 infants completed the study:14males: 9 females. Mean weight 2971 g (SD +1569 g). None of the patients were on any anti‐reflux medications (apart from one). Type of feeds during first 24 hours were EBM 8/23(35%), SF 5/23(22%) or mixed feeding 10/23(43%). GER symptoms were: desaturations16/23(70%), cough 8/23(35%), arching7/23 (30%), vomit 3/23(13%), crying2/23(8%) and apnoea1/23 (4%). The median total GER episodes (detected by pH and MII) was significantly lower during the EHFF period compared to SF/EBM period 42(21–71) vs 68(32–104) p < 0.001. The median acidic reflux episodes detected by pH was also significantly lower in EHFF vs SF/EBM period 8(4–24) vs 23(3–58) p < 0.005. Total number of refluxes detected by MII showed a significant reduction for EHFF compared to SF/EBM: 17(11–56) vs 46(20–65) p < 0.015. There was no difference in reflux index, MII bolus exposure indexes, and number of long lasting episodes (>5 min) between the 2 groups. There were no significant difference in the number of symptoms recorded between the two study period.Conclusions:Our data suggest that the number of gastroesophageal reflux was significantly lower in preterm infants fed with EHFF compared to standard formula as measured by pH‐MII monitoring. EHFF may potentially be an effective treatment modality for gastroesophageal reflux disease in infants with minimal side‐effects. The lack of symptom reduction during EHFF despite fewer GER episodes suggests that other pathology other than GER should be considered. A larger study is required to further evaluate the efficacy and mechanism of EHFF on reduction of GER in infants.