Randomized, multicenter trial of two different formulas for very early enteral feeding advancement in extremely-low-birth-weight infants

Background: In extremely-low-birth-weight (ELBW) infants, formula feeding i s required if human milk is not available. The tolerance of a new 'high' la ctose (55 g/L), low protein, low phosphate, hydrolyzed protein formula (HLF ) for early enteral feeding advancement of ELBW infants was compared with t hat of a low lactose (I g/L) hydrolyzed protein formula (LLF). Methods: In a randomized multicenter trial, 99 ELBW infants were fed accord ing to a standardized protocol beginning at 48 hours of age with 12 ml/kg d aily increments. Primary outcome was the cumulative milk feeding volume (CF V) from days 3 to 14. The authors hypothesized that feeding HLF as a supple ment to human milk would increase the CFV at least by 20% in at least 60% o f matched pairs compared with LLF. A secondary issue was to investigate whe ther human milk would increase the CFV compared with formula. Results: The 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 da y 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%. Necrot izing enterocolitis (Bell stage 2) occurred only with LLF feeding (n = 5; P < 0.05). Conclusions: The 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 stil l must be confirmed in a controlled, randomized trial.