Preterm Formula Research Articles

High versus low medium chain triglyceride content of formula for promoting short term growth of preterm infants.

In-hospital growth of most very low birth weight infants remains below the 10th percentile of reference intrauterine growth curves (Ehrenkranz 1999). To improve growth, fat is added to preterm formula in the form of medium chain triglycerides (MCT) or long chain triglycerides (LCT). MCT are easily accessible to the preterm infant with an immature digestive system while LCT are important in the development of the retina and visual acuity. Both have been incorporated into preterm formulas in varying amounts, but their effect on the preterm infant's short term growth is unclear. To determine among preterm, formula fed infants, does high MCT as opposed to low MCT (high LCT) formula promote higher short term growth rates. MEDLINE (1966-2002), CINAHL (1982-2002), Cochrane Controlled Trials Register (The Cochrane Library, Issue 4, 2001), conference proceedings, and reference lists of articles were searched. All randomized trials comparing the effects of exclusive feeding of high versus low MCT formula (for a minimum of one week) on the short term growth of healthy, preterm infants. Two reviewers assessed each study's quality and extracted data on growth parameters as well as adverse effects from included studies. All data used in analysis were continuous, and therefore weighted mean differences with 95% confidence intervals were reported. Eight randomized trials studying a total of 182 infants were included. There was no evidence of difference in short term growth parameters when high and low MCT formulas were compared. The meta-analysis of weight gain based on five studies yielded a WMD of -0.35 g/kg/d (95% CI -1.44, 0.74). Similarly, meta-analysis of weight gain in g/d based on two studies showed no evidence of difference (WMD 2.09 g/d, 95% CI -1.46, 5.64). Length gain, based on five studies, showed a non-significant WMD of 0.14 cm/wk (95% CI -0.04, 0.31). Head circumference gain, based on data from five studies, showed a non-significant WMD -0.03 cm/wk (95% CI -0.15, 0.08). Only one study reported skin fold thickness gain, with a mean difference -0.15 mm/wk (95% CI -0.41, 0.11), again not significant. Subgroup analyses according to % MCT in the high MCT formula, by 10% intervals, showed no evidence of effect of high MCT on short term weight gain within any subgroup. There are conflicting data (two studies) as to formula tolerance. There is no evidence of effect on incidence of necrotizing enterocolitis (NEC), based on small numbers in two trials. No studies were located addressing long term growth parameters or neurodevelopmental outcomes. There is no evidence of difference between MCT and LCT on short term growth, gastrointestinal intolerance, or necrotizing enterocolitis. Therefore, neither formula type could be concluded to improve short term growth or have less adverse effects. Further studies are necessary because the results from the included eight studies are imprecise due to small numbers and do not address important long term outcomes. Additional research should aim to clarify effects on formula tolerance and on long term growth and neurodevelopmental outcomes, and include larger study populations to better evaluate effect on NEC incidence.

The role of fats in the lifecycle stages: pregnancy and the first year of life.

Fish oil supplementation during pregnancy has been tested in several trials, with small positive effects on length of gestation; there have been no beneficial or harmful effects on cognitive development or growth of infants as a result of fish oil supplementation in pregnancy. The strongest evidence for good developmental outcomes for infants supports breastfeeding for at least six months. Preterm infants are at the greatest risk of DHA deficiency and there is strong evidence for the positive effects of DHA on visual and cognitive outcomes that has resulted in all Australian preterm formulas being supplemented with DHA. Debate continues about the importance of DHA supplementation for term infants; the current consensus is that the benefits of DHA supplementation in term infants are smaller than for preterm infants.

Early nutrition and leptin concentrations in later life

Formula feeding or overweight in infancy may increase the later risk of obesity, but the mechanisms involved are uncertain. Because obesity is associated with high leptin concentrations relative to fat mass, programming of leptin concentrations may be one mechanism by which early nutrition influences later obesity. We tested the hypothesis that high nutrient intake or formula feeding in infancy programs greater leptin concentrations relative to fat mass in later life. Serum leptin concentrations were measured by radioimmunoassay in 197 adolescents aged 13-16 y who were born preterm and randomly assigned at birth to receive either a nutrient-enriched preterm formula or banked donated breast milk (trial 1) or a preterm formula or a standard formula (trial 2). Fat mass was estimated with the use of bioelectrical impedance analysis. After combining the results of trials 1 and 2 as planned, the ratio of leptin to fat mass was significantly greater in the children who received the preterm formula (geometric : 0.84 microg x L(-1) x kg(-1)) than in those who received standard formula or banked breast milk (0.62 microg x L(-1) x kg(-1); mean difference: 30.8%; 95% CI for difference: 8.4%, 53.2%; P = 0.007). The difference between the diet groups remained significant after adjustment for age, sex, Tanner stage, social class, and fat mass. Human milk intake was significantly associated with lower leptin concentrations relative to fat mass in adolescence (P = 0.023), independent of potential confounding factors. Programming of relative leptin concentrations by early diet may be one mechanism that links early nutrition with later obesity.

Nutrient Requirements For Preterm Infant Formulas

Achieving appropriate growth and nutrient accretion of preterm and low birth weight (LBW) infants is often difficult during hospitalization because of metabolic and gastrointestinal immaturity and other complicating medical conditions. Advances in the care of preterm-LBW infants, including improved nutrition, have reduced mortality rates for these infants from 9.6 to 6.2% from 1983 to 1997. The Food and Drug Administration (FDA) has responsibility for ensuring the safety and nutritional quality of infant formulas based on current scientific knowledge. Consequently, under FDA contract, an ad hoc Expert Panel was convened by the Life Sciences Research Office of the American Society for Nutritional Sciences to make recommendations for the nutrient content of formulas for preterm-LBW infants based on current scientific knowledge and expert opinion. Recommendations were developed from different criteria than that used for recommendations for term infant formula. To ensure nutrient adequacy, the Panel considered intrauterine accretion rate, organ development, factorial estimates of requirements, nutrient interactions and supplemental feeding studies. Consideration was also given to long-term developmental outcome. Some recommendations were based on current use in domestic preterm formula. Included were recommendations for nutrients not required in formula for term infants such as lactose and arginine. Recommendations, examples, and sample calculations were based on a 1000 g preterm infant consuming 120 kcal/kg and 150 mL/d of an 810 kcal/L formula. A summary of recommendations for energy and 45 nutrient components of enteral formulas for preterm-LBW infants are presented. Recommendations for five nutrient:nutrient ratios are also presented. In addition, critical areas for future research on the nutritional requirements specific for preterm-LBW infants are identified.

Supplementation of a bovine milk formula with an oligosaccharide mixture increases counts of faecal bifidobacteria in preterm infants

Background: The establishment of a balanced intestinal microflora which may protect against infection is desirable for the preterm infant. Objective: To investigate the effect of a preterm formula milk supplement...

Docosahexaenoic acid and arachidonic acid enhance growth with no adverse effects in preterm infants fed formula

Objective: To determine if docosahexaenoic acid (DHA) and arachidonic acid (ARA) supplementation influences growth or visual acuity of formula-fed premature infants. Study design: Double-blind, multi-center study of 194 premature infants given preterm formula with no DHA or ARA (control), 0.15% energy DHA, or 0.14% DHA + 0.27% ARA from single-cell triglycerides for at least 28 days and then fed term formula (no DHA or ARA) to 57 weeks postmenstrual age (PMA), with 90 breast-fed term infants as reference. Results: Infants fed DHA+ARA formula gained weight significantly faster (post-hoc analysis) during preterm formula feeding than control infants (34.7 vs. 30.7 g/d) and had weights and weight:length ratios not different from term breast-fed infants at 48 and 57 weeks PMA. Infants fed control or DHA formula had lower body weights than term infants. Red blood cell phosphatidylethanolamine ARA was significantly correlated to weight gain during preterm formula feeding and to weight and length at 40, 48, and 57 weeks PMA (r = 0.19 to 0.24, P =.004-.02). Providing DHA or DHA+ARA during the preterm period had no effect on subsequent visual acuity or incidence of adverse events. Conclusions: Feeding DHA+ARA from single-cell triglycerides enhances weight gain in formula-fed premature infants with no evidence of adverse effects. (J Pediatr 2002;140:547-54)

Enteral feeding of the preterm infant

Preterm infants pose a major nutritional challenge. The importance of early nutrition is emphasized by accumulating evidence that it influences long-term health and development as well as short-term growth and outcome. Human milk has many benefits for preterm infants. In the short term it is better tolerated than formula milk with a lower risk of necrotizing enterocolitis. In the longer term it is associated with improved neurodevelopment and lower blood pressure. Human milk should be supplemented with phosphorus as a minimum, and, if infant growth is inadequate, with a multi-nutrient fortifier. Protein intake is as important as energy intake, and the use of carbohydrate supplements alone is inappropriate. Where human milk is unavailable or insufficient to meet the infant's full requirements, preterm formula should be used. After discharge from hospital, formula-fed infants should preferably receive a nutrient-enriched post-discharge formula. The need for nutrient supplements in infants breast-fed after discharge requires further investigation.

Growth after neonatal arterial switch operation for D-transposition of the great arteries.

The objective of this study was to evaluate growth in infants with d-transposition of the great arteries (d-TGA) who underwent switch operation (anatomical correction) in the early neonatal period. Growth data (at birth and 1, 3, 6, 12, and 24 months of age) were retrieved in 23 infants with d-TGA who survived the operation without major complications. Measures were transformed into z scores and compared with normative data for age. Following surgery, infants showed low z scores for weight, height, and head circumference. Weight and height showed a trend to reach normal ranges between 6 and 12 months of age, and the z scores were positive at 24 months. z scores for head circumference were still negative at 24 months of age. No dietary interventions were implemented during this period, and the infants were fed their own mothers' milk or, before discharge, high-calorie, preterm formula. Following anatomical correction for d-TGA in the early neonatal period, infant growth shows a characteristic pattern, with parameters normalized by 12 months of age in most cases. Head growth shows a different pattern, although gross motor development seems unaffected.

Plasma and erythrocyte levels of trace elements and related antioxidant enzyme activities in low-birthweight infants during the early postnatal period.

To discover the relationship between antioxidant enzyme activities and trace elements in low-birthweight infants during the early postnatal period, we analysed catalase (CAT), CuZn-superoxide dismutase (CuZn-SOD) and glutathione peroxidase (GSH-Px) activities in erythrocytes. and compared them with Fe, Cu. Zn and Se levels in plasma, and Cu, Zn and Se levels in erythrocytes until 16 wk after birth. Thirteen low-birthweight infants whose mean birthweight and gestation were 1520 +/- 293 g and 32.0 +/- 2.8 wk were enrolled in this study. All infants were without chronic complications, well nourished, and predominantly fed standard formula or preterm formula based on cow's milk, commercially available in Japan. Cu and Zn levels in erythrocytes did not decline after birth, in contrast to a temporal decrease in plasma Zn. Erythrocyte CAT activity was significantly higher at 16 wk than that at birth or 4 wk of age. Erythrocyte CuZn-SOD activity did not change throughout the study period. Only Se in plasma and erythrocytes decreased remarkably after birth, which resulted in a significant decline in erythrocyte GSH-Px activity at 8 and 16 wk (11.2 +/- 2.0 and 11.0 +/- 1.1 U/g Hb) compared to that at birth (12.4 +/- 2.1 U/g Hb). During the early postnatal period. erythrocyte CAT and CuZn-SOD activities did not decrease in formula-fed, low-birthweight infants. Japanese commercial formula not supplemented with Se, however, caused postnatal plasma and erythrocyte Se deficiency and a concomitant decline in erythrocyte GSH-Px activity in the same subjects.

Plasma and erythrocyte levels of trace elements and related antioxidant enzyme activities in low‐birthweight infants during the early postnatal period

To discover the relationship between antioxidant enzyme activities and trace elements in low‐birthweight infants during the early postnatal period, we analysed catalase (CAT), CuZn‐superoxide dismutase (CuZn‐SOD) and glutathione peroxidase (GSH‐Px) activities in erythrocytes, and compared them with Fe, Cu, Zn and Se levels in plasma, and Cu, Zn and Se levels in erythrocytes until 16 wk after birth. Thirteen low‐birthweight infants whose mean birthweight and gestation were 1520 ± 293 g and 32.0 ± 2.8 wk were enrolled in this study. All infants were without chronic complications, well nourished, and predominantly fed standard formula or preterm formula based on cow's milk, commercially available in Japan. Cu and Zn levels in erythrocytes did not decline after birth, in contrast to a temporal decrease in plasma Zn. Erythrocyte CAT activity was significantly higher at 16 wk than that at birth or 4 wk of age. Erythrocyte CuZn‐SOD activity did not change throughout the study period. Only Se in plasma and erythrocytes decreased remarkably after birth, which resulted in a significant decline in erythrocyte GSH‐Px activity at 8 and 16 wk (11.2 ± 2.0 and 11.0 ± 1.1 U/g Hb) compared to that at birth (12.4 ± 2.1 U/g Hb). Conclusion: During the early postnatal period, erythrocyte CAT and CuZn‐SOD activities did not decrease in formula‐fed, low‐birthweight infants. Japanese commercial formula not supplemented with Se, however, caused postnatal plasma and erythrocyte Se deficiency and a concomitant decline in erythrocyte GSH‐Px activity in the same subjects.

Clinical Research: Comparing Alternatives to an Extensive Hydrolyzed Protein Formula in Feeding Premature Infants Following Gastrointestinal Resection and Enterostomy Placement

Objective: Parenteral nutrition and extensive protein hydrolysates (EPH) are standard nutrition therapy for infants after gastrointestinal (GI) resection and enterostomy placement. This retrospective, nonrandomized study compared feeding regimens in this population of infants. Methods: Thirty‐five premature infants with GI resections between 1 and 74 cm and enterostomy placement were fed fortified human milk (FEBM), preterm formula, or EPH. Feeding tolerance, growth, and biochemical indicators of nutritional status were monitored. Results: Study groups were dissimilar in birth weight. However, growth and feeding tolerance were consistent among groups. More alkaline phosphatase and serum phosphorus values were outside the reference range in the FEBM group. Sixty percent of all infants studied thrived on enteral feedings. Conclusions: These findings suggest no increased risks for premature infants fed preterm formula as the feeding regimen postintestinal resection. We also demonstrated that it is possible to achieve approximately full volumes of feeding in most cases with uncomplicated GI disease.

Effects of Human Milk Fortification on Morbidity Factors in Very Low Birth Weight Infants

The use of human milk as a sole source of nutrients for preterm infants has been the subject of debate in recent years. We studied the morbidity factors associated with hospitalization of very low birth weight (VLBW) infants fed human milk with and without fortification. One hundred VLBW infants were randomly assigned to two groups with stratification for gestation and weight. The control group (n=50; mean birth weight 1239+/-186 g and mean gestation 29.3+/-2.1 wks) was fed human milk only, and in the fortifier group (n=50; mean birth weight 1245+/-191 g and mean gestation 29.5+/-2.1 wks), human milk was enriched with a fortifier after the babies reached a volume of 140 mL/kg/day by the enteral route. Weight was measured twice weekly, biochemical indices of nutritional and bone status and serum electrolytes were obtained weekly, and clinical evidence for sepsis, necrotizing enterocolitis and feeding intolerance was assessed regularly until infants were discharged. Hospital stay was less than 45 days in the majority (94%) of the babies in the fortifier group, whereas the majority (66%) of the babies in the control group stayed for more than 45 days (P<0.01). Low serum phosphorus and raised alkaline phosphatase levels were seen more frequently in the control group without fortification (P<0.01), as well as hyponatremia (P<0.01), late metabolic acidosis of prematurity (P<0.01) and culture-proven sepsis (P<0.05). There was no significant difference in the occurrence of necrotizing enterocolitis between the two groups (P>0.05). Human milk fortification has beneficial effects on the growth of VLBW infants and decreases hospital stay and morbidity associated with prematurity and very low birth weight, with economic and psychological benefits for the parents.

Protective Effect of Dietary Oligofructose against Cecitis Induced by Clostridia in Gnotobiotic Quails

Selected oligosaccharides appear to be a class of potential agents against digestive diseases. The aim of this study was to investigate the effect of diet supplementation with oligofructose (OF) in the prevention of neonatal necrotizing enterocolitis (NEC)-like lesions induced by clostridial species using gnotobiotic quails. Germ-free quails were inoculated with three pre-term fecal specimens involving C. perfringens and differing in bacterial levels and associations. They were fed for 3 weeks either a control diet (inducing NEC-like lesions) or an OF-containing diet, where 3% of OF replaced 3% of the 6% of lactose in the control diet. When fed the control diet, NEC-like lesions varied from 17% in group 1 ( C. perfringens < 10 6 CFU/g, Klebsiella ) to 67% in group 2 ( C. perfringens ca. 10 7 CFU/g, C. difficile ) and group 3 ( C. perfringens ca. 10 8 CFU/g, C. difficile , C. paraputrificum ). Supplementation with OF led to the inhibition of the disease in group 1 and to less extensive tissue necrosis and a sharp decrease in haemorrhages in groups 2 and 3. Only in group 3 was the OF beneficial effect associated with a decrease in C. perfringens (ca. 10 6 /g, p<0.05) and C. paraputrificum . Whatever the group, OF did not alter caecal pH or short-chain fatty acid concentrations. Health promoting effects of OF against NEC-like lesions caused by a polymicrobial infection were demonstrated. The possible mechanisms involved are discussed. Oligosaccharides in human milk have major physiological functions. Therefore, a supplementation with a synthetic analogue could offer a new approach to improve pre-term formula milk. Keywords: gnotobiotic quails, neonatal necrotizing enterocolitis, oligosaccharides, pre-term neonates.

Leptin levels in preterm human breast milk and infant formula.

Leptin, a hormone present in breast milk, is involved in energy regulation and metabolism. The purpose of this investigation was to determine whether leptin is present in either preterm breast milk (PBM) or preterm formula (PF). The effects of delivery methods and pasteurization on leptin levels also were evaluated. PBM samples were obtained from 29 mothers who delivered infants at between 23 and 34 weeks' gestation. Leptin levels were measured in PBM and PF with the use of a radioimmunoassay specific for human and bovine leptin, respectively. Milk samples were pasteurized by fast- and slow-heating methods. PBM and PF spiked with human leptin were delivered through catheters by bolus and continuous administration to determine the effects of delivery method on recoverable leptin levels. Median PBM leptin concentration was 5.28 ng/mL (intraquartile range: 24.79). Birth gestational age, birth weight, and gender of the infant did not significantly influence PBM leptin levels. Neither bolus nor continuous feeding practices affected leptin levels in PBM or spiked PF. However, pasteurization significantly reduced the amount of detectable leptin in PBM. PBM leptin levels were highly variable and similar to levels reported for term breast milk. There was no effect of postnatal age on PBM leptin concentrations. Sterilization decreased detectable leptin levels, whereas feeding practices had no adverse effect on the quantity of leptin delivered. Although no infant formula contained leptin, leptin could be added to formula and delivered through various feeding methods without loss.

Nutritional Efficacy of Preterm Formula With a Partially Hydrolyzed Protein Source: A Randomized Pilot Study

ABSTRACTBackgroundDecreased nitrogen levels, calcium intestinal absorption rates, and plasma amino acid imbalances were reported for preterm infants who were fed partially hydrolyzed preterm formulas. In this pilot study, we evaluated a new formula with modified nitrogen and calcium sources.MethodsDuring their second week of life, 16 preterm infants were randomly assigned to one of two groups: 9 were fed the new partially hydrolyzed formula and 7 were fed a conventional formula. Nutrient balance was performed at the end of the first month of life. Amino acid concentrations and anthropometric parameters were measured at theoretical term.ResultsBirth weight and gestational age (mean ± SD) were similar in the two groups (28.9 ± 7.0 weeks and 1183 ± 242 g vs. 27.7 ± 1.0 weeks and 1139 ± 162 g). Median nitrogen absorption rates (85% vs. 89%;P = 0.03) and biological values (59% vs. 69%;P = 0.13) were lower for infants who were fed the new formula than for those fed the conventional formula. After correction for difference in nitrogen intake, there was no significant difference in nitrogen retained between the two groups (P = 0.11). Plasma amino acid concentrations were also similar in the two groups. Median calcium absorption tended to be higher in the new‐formula group than in the conventional‐formula group (54% vs. 45%, P = 0.19). At theoretical term, infants fed the conventional formula were heavier than infants fed the new formula (3559 ± 362 g vs. 3193 ± 384 g, P = 0.04).ConclusionsBecause nitrogen content is 10% higher in hydrolyzed‐protein formula than in entire‐protein formula, appropriate nitrogen retention, plasma amino acid profile, and mineral use can be achieved with the new partially hydrolyzed formula. Further studies with larger groups are needed to evaluate the effect on growth.

Long chain polyunsaturated fatty acids (LC‐PUFA) and perinatal development

This paper reports on the conclusions of a workshop on the role of long chain polyunsaturated fatty acids (LC-PUFA) in maternal and child health. The attending investigators involved in the majority of randomized trials examining LC-PUFA status and functional outcomes summarize the current knowledge in the field and make recommendations for dietary practice. Only studies published in full or in abstract form were used as our working knowledge base. For healthy infants we recommend and strongly support breastfeeding as the preferred method of feeding, which supplies preformed LC-PUFA. Infant formulas for term infants should contain at least 0.2% of total fatty acids as docosahexaenoic acid (DHA) and 0.35% as arachidonic acid (AA). Since preterm infants are born with much less total body DHA and AA, we suggest that preterm infant formulas should include at least 0.35% DHA and 0.4% AA. Higher levels might confer additional benefits and should be further investigated because optimal dietary intakes for term and preterm infants remain to be defined. For pregnant and lactating women we consider it premature to recommend specific LC-PUFA intakes. However, it seems prudent for pregnant and lactating women to include some food sources of DHA in their diet in view of their assumed increase in LC-PUFA demand and the relationship between maternal and foetal DHA status.

Extensive and Partial Protein Hydrolysate Preterm Formulas: The Effect on Growth Rate, Protein Metabolism Indices, and Plasma Amino Acid Concentrations

ABSTRACTBackgroundThe use of protein hydrolysate preterm formulas is restricted because data on their nutritional adequacy are scarce. The authors evaluated the rate of growth and indices of protein metabolism in low‐birth weight infants fed extensive and partial protein hydrolysate preterm formula followed for 12 weeks.MethodsA total of 61 low‐birth weight infants were assigned randomly to receive extensive protein hydrolysate preterm formula (EH; n = 16), partial protein hydrolysate preterm formula (PH; n = 15), and standard preterm formula (SF; n = 15), or were fed their own mother's fortified breast milk (FBM; n = 15). The infants were investigated at study entry, and at 4, 8, and 12 weeks after study entry.ResultsThere were no differences with respect to growth rate (weight gain, increments in length and head circumference), urea, albumin, prealbumin, transferrin, and plasma amino acid concentrations (except for tyrosine on a single occasion) according to the degree of hydrolysis. There were also no differences between groups fed hydrolyzed formulas and SF. However, several differences were found when EH and PH were compared with FBM. Weight gain from the entry to 12 weeks, serum urea at 12 weeks, and total plasma essential amino acids at 8 weeks were significantly higher in groups fed EH and PH than in those fed FBM. In addition, valine was significantly higher in groups fed PH (P &lt; 0.05) than in the group fed FBM at 8 and 12 weeks, tyrosine was higher in EH and PH in comparison with FBM at 4 weeks, and in PH versus FBM at 12 weeks after study entry.ConclusionsThis study suggests that experimental EH and PH are at least nutritionally equivalent to SFs.

Extensive and Partial Protein Hydrolysate Preterm Formulas: The Effect on Growth Rate, Protein Metabolism Indices, and Plasma Amino Acid Concentrations

The use of protein hydrolysate preterm formulas is restricted because data on their nutritional adequacy are scarce. The authors evaluated the rate of growth and indices of protein metabolism in low-birth weight infants fed extensive and partial protein hydrolysate preterm formula followed for 12 weeks. A total of 61 low-birth weight infants were assigned randomly to receive extensive protein hydrolysate preterm formula (EH: n = 16), partial protein hydrolysate preterm formula (PH: n = 15), and standard preterm formula (SF; n = 15), or were fed their own mother's fortified breast milk (FBM; n = 15). The infants were investigated at study entry, and at 4, 8, and 12 weeks after study entry. There were no differences with respect to growth rate (weight gain, increments in length and head circumference), urea, albumin, prealbumin, transferrin, and plasma amino acid concentrations (except for tyrosine on a single occasion) according to the degree of hydrolysis. There were also no differences between groups fed hydrolyzed formulas and SF. However, several differences were found when EH and PH were compared with FBM. Weight gain from the entry to 12 weeks, serum urea at 12 weeks, and total plasma essential amino acids at 8 weeks were significantly higher in groups fed EH and PH than in those fed FBM. In addition, valine was significantly higher in groups fed PH (P < 0.05) than in the group fed FBM at 8 and 12 weeks, tyrosine was higher in EH and PH in comparison with FBM at 4 weeks, and in PH versus FBM at 12 weeks after study entry. This study suggests that experimental EH and PH are at least nutritionally equivalent to SFs.

Effect of Preterm Formula With and Without Long‐Chain Polyunsaturated Fatty Acids on the Urinary Excretion of F2‐Isoprostanes and 8‐Epi‐Prostaglandin F2α

ABSTRACTBackgroundThe objective of this study was to evaluate the effect of conventional and long‐chain polyunsaturated fatty acids (LCP)‐enriched preterm formula on the endogenous formation of F2‐isoprostanes and 8‐epi‐prostaglandin (PG) F2α as possible markers of lipid peroxidation in preterm infants during their first weeks of life.MethodsIn a prospective, randomized, double‐blind study, infants received either formula enriched with LCP (n = 8), standard preterm formula (n = 7), or (expressed) breast milk (n = 8). Urine was sampled at study entry and after the study period of 3 weeks. The formation of F2‐isoprostanes and 8‐epi‐PGF2α was evaluated by measuring the urinary excretion by gas chromatography–mass spectrometry.ResultsNo differences in the urinary excretion of F2‐isoprostanes and 8‐epi‐PGF2α were observed at the end of the study period.ConclusionsThis result suggests that supplementation of a preterm formula with LCP for a period of 3 weeks does not stimulate lipid peroxidation in preterm infants.

The Use of Human Milk for Premature Infants

Various methods have been reported and used clinically to augment the nutrient supply for human milk-fed premature infants. These methods include specialized maltinutrient powdered mixtures (fortifiers), complete liquid formulas designed to be mixed with human milk, complete powdered formulas to be mixed with human milk, and alternate feeding of human milk and preterm formula. Although the optimum nutrition of premature infants is unknown, data are accumulating to suggest that human milk, fortified with additional nutrients, is appropriate for tube-fed infants. The use of fortified human milk typically provides premature infants adequate growth, nutrient retention, and biochemical indices of nutritional status when fed at approximately 180 mL/kg/d compared with unfortified human milk. Data are needed to determine the precise quantity of nutrients to be added as supplements. Nutrient interactions have not been explored in detail. Although large quantities of calcium seem to be needed, the exogenous calcium may affect fat absorption adversely. Manipulation of milk may affect the intrinsic host-defense properties of the milk. Compared with preterm formula, the feeding of fortified human milk may provide significant protection from infection and NEC. Lastly, the potential stimulation of an enteromammary pathway through skin-to-skin contact provides species-specific antimicrobial protection for premature infants. Several of these areas require additional exploration. Thus, for premature infants, neonatal centers should encourage the feeding of fortified human milk, together with skin-to-skin contact, as reasonable methods to enhance milk production while potentially facilitating the development of an enteromammary response.