Randomized, Multicenter Trial of Two Different Formulas for Very Early Enteral Feeding Advancement in Extremely-Low-Birth-Weight Infants

BACKGROUNDIn extremely-low-birth-weight (ELBW) infants, formula feeding is required if human milk is not available. The tolerance of a new `high' lactose (55 g/L), low protein, low phosphate, hydrolyzed protein formula (HLF) for early enteral feeding advancement of ELBW infants was compared with that of a low lactose (1 g/L) hydrolyzed protein formula (LLF). METHODSIn a randomized multicenter trial, 99 ELBW infants were fed according to a standardized protocol beginning at 48 hours of age with 12 ml/kg daily increments. Primary outcome was the cumulative milk feeding volume (CFV) from days 3 to 14. The authors hypothesized that feeding HLF as a supplement to human milk would increase the CFV at least by 20% in at least 60% of matched pairs compared with LLF. A secondary issue was to investigate whether human milk would increase the CFV compared with formula. RESULTSThe CFV was 720 mL/kg (range, 0–962 mL/kg) with HLF and 613 mL/kg (range, 3–1,283 mL/kg) with LLF feeding. There was no 20% difference. On day 14, the median feeding volume was 103 mL/kg. The CFV was 533 mL/kg (range, 0–962 mL/kg) in infants who received less than 10% of human milk and 832 mL/kg (range, 74–1,283 mL/kg) in infants who received more than 10%. Necrotizing enterocolitis (Bell stage ≥2) occurred only with LLF feeding (n = 5;P < 0.05). CONCLUSIONSThe study failed to find the hypothesized 20% advantage of the new HLF. The observed advantage of human milk supports the hypothesis that it should be the first diet in ELBW infants; however, this hypothesis still must be confirmed in a controlled, randomized trial.