Gastric Electrical Activity and Gastric Emptying in Preterm Newborns Fed Standard and Hydrolysate Formulas Protein hydrolysate formula maintains homeostasis of plasma amino acids in preterm infants. Hydrolysed protein accelerates the gastrointestinal transport of formula in preterm infants Application effect of extensively hydrolyzed milk protein formula and follow-up in preterm children with a gestational age of less than 34 weeks: study protocol for a randomized controlled trial A randomised multicentre study of human milk versus formula and later development in preterm infants. Effects of human milk or formula feeding on the growth, behavior, and protein status of preterm infants discharged from the newborn intensive care unit. Extensively and partially hydrolysed preterm formulas in the prevention of allergic diseases in preterm infants: a randomized, double‐blind trial Effects of prolonged exposure to partially hydrolyzed milk protein. Hydrolyzed protein accelerates feeding advancement in very low birth weight infants. Optimal Growth and Lower Fat Mass in Preterm Infants Fed a Protein-enriched Postdischarge Formula Supplementation of a bovine milk formula with an oligosaccharide mixture increases counts of faecal bifidobacteria in preterm infants [Incidence and symptoms of cow's milk protein intolerance following acute gastroenteritis in young infants. Effect of a hypoallergenic diet]. Effects of cow milk versus extensive protein hydrolysate formulas on infant cognitive development Tolerance of a standard intact protein formula versus a partially hydrolyzed formula in healthy, term infants Latent anaphylactic sensitisation of infants of low birth weight to cows' milk proteins. Safety and efficacy of a new extensively hydrolyzed formula for infants with cow's milk protein allergy. Allergies in high-risk schoolchildren after early intervention with cow's milk protein hydrolysates: 10-year results from the German Infant Nutritional Intervention (GINI) study.
Background Because infant formulas containing hydrolyzed cow milk protein are used to reduce feeding intolerance and to improve gastric emptying , the effect on gastrointestinal motility of a hydrolysate formula was compared with that of a st and ard preterm formula . Methods Thirty-six preterm newborns with a gestational age of 32.2 ± 2.3 weeks were assigned r and omly to st and ard formula or hydrolyzed formula .  Cutaneous electrogastrography and ultrasound examination of gastric emptying were performed simultaneously to evaluate gastrointestinal motility before and after the test meal . All recording sessions were performed 1 week after infants had reached full enteral feeding . Results No significant difference in gastrointestinal symptoms was noted in the newborns fed the different formulas . In particular , regurgitation and vomiting were observed in 78 % versus 64 % of preterm newborns after st and ard and hydrolyzed formula , respectively ( Fisher exact test , not significant ) . No differences were found in terms of gastric electrical activity and gastric emptying time between the two groups . Conclusions It seems unnecessary to use hydrolysate formulas to improve motility in preterm infants BACKGROUND Plasma amino acid concentrations were measured in preterm infants who were fed either a new hydrolyzed cow 's milk protein formula or a st and ard preterm infant formula .  It was hypothesized that feeding with the hydrolysate results in prepr and ial amino acid concentrations that are significantly different from the concentrations found when feeding with the st and ard formula . METHODS Fifteen preterm infants , median gestational age , 29 weeks ( range , 24 - 32 weeks ) ; birth weight , 1241 g ( range , 660 - 1900 g ) ; and postnatal age , 18 days ( range , 7 - 54 days ) receiving full enteral feedings ( > 150 ml/kg x day ) , were enrolled . The intervention was r and omized allocation to the formula with hydrolyzed or natural cow 's milk protein ( the whey/casein ratio was 60:40 in both formulas ) . In a crossover design , each formula was fed for 5 days , and plasma amino acids were analyzed on day 4 or 5 of each 5-day period . RESULTS In spite of the 12 % higher amino acid intake with hydrolysate formula , the median individual plasma amino acid concentrations were virtually identical with both formulas , and they were within the 10th and the 90th percentile of the reference of levels in the umbilical cord artery after elective cesarean delivery or of breast-fed newborn infants . The median concentrations of lysine and aspartic acid were higher with hydrolyzed formula feeding ( p<0.05 ; two-tailed Mann-Whitney test ) . With both formulas , single amino acid concentrations were out of the reference values . CONCLUSION Virtually identical plasma amino acid concentration patterns were measured with the new hydrolyzed preterm infant formula and the st and ard preterm infant formula , but longitudinal studies are required before the studied protein hydrolysate can be recommended for preterm feeding in general Vomiting , large gastric residuals and abdominal distension are common in very immature infants on formula feeding . The present trial investigated whether a protein hydrolysate formula reduces the gastrointestinal transit time in preterm infants . Fifteen preterm infants ( median gestational age 29 ( 24–32 ) wk , birthweight 1241 ( 660–1900 ) g , postnatal age 18 ( 5–54 ) d ) on full enteral feeds ( > 150 ml/kg*d ) were enrolled . It was hypothesized that the gastrointestinal transit time is at least 2 h shorter when protein hydrolysate formula is fed compared with st and ard preterm formula . In a r and omized cross‐over design study , each formula was fed for 5 d. On days 4 and 9 the gastrointestinal transit time was estimated using carmine red . The protein hydrolysate formula had a markedly shorter gastrointestinal transit time ( 9.8 h ) than the st and ard formula ( 19 h ) ( p= 0.0022 , two‐sided Mann‐Whitney U test ) Background The average incidence of preterm birth in the world is up to 11.1 % , and deaths of preterm children account for more than 50 % of neonatal deaths . Gastrointestinal function of preterm children with a gestational age less than 34 weeks is immaturely developed . For preterm children who can only be fed with formula due to their mothers ’ sickness , choosing a suitable formula can not only meet the high nutritional needs of preterm children , but also solve their low gastrointestinal tolerability , and is thus very important . Methods / Design The study is a prospect i ve , r and omized , single-blind and controlled clinical trial . Preterm children with a gestational age less than 34 weeks meeting the inclusion criteria who can not be breastfed will be included . To demonstrate the application effect of extensively hydrolyzed milk protein formula on the target population , preterm children will be r and omized into two groups , 185 subjects in each group . The observation group will be fed with extensively hydrolyzed milk protein ( 100 % whey protein ) formula , while the control group will be fed with preterm children ’s formula until the children are discharged from the neonatal intensive care unit ( NICU ) . All the formula involved in this study will be from Dumex . After discharge , both groups will be uniformly fed with formula for 0 to 6-month-old infants . For statistical analysis , a chi-square test and Student ’s t test will be applied using SAS 9.4 . Discussion This will be the first r and omized controlled clinical study with long-term observation of the growth and development of preterm children during the NICU stay and at 3-month follow-up after discharge from the NICU . Results from this study will be used to determine whether the extensively hydrolyzed formula is more suitable for the low gastrointestinal tolerability of preterm children , and also whether feeding preterm children who are fed with such formula during the NICU stay with ordinary infant formula after discharge from the NICU would affect the normal growth and development of preterm children in the early stage of their lives . Trial registration This study was registered with the Chinese Clinical Trial Registry ( http://www.chictr.org.cn/ ) with number ChiCTR-IOR-14005696 , on December 22 , 2014 Whether breast milk influences later neurodevelopment  has been explored in non-r and omised studies , potentially confounded by social and demographic differences between feed groups . Here in a strictly r and omised prospect i ve multicentre trial , Bayley psychomotor and mental development indices ( PDI and MDI ) were assessed at 18 months postterm in survivors of 502 preterm infants assigned to receive , during their early weeks , mature donor breast milk or a preterm formula .  These diets were compared as sole enteral feeds or as supplements to the mother 's expressed breast milk . No differences in outcome at 18 months were seen between the two diet groups despite the low nutrient content of donor milk in relation to the preterm formula and to the estimated needs of preterm infants . These results contrast with those reported from our parallel two centre study that compared infants r and omly assigned a st and ard term formula or the preterm formula during their early weeks ; those fed st and ard formula , now regarded as nutritionally insufficient for preterm infants , were substantially disadvantaged in PDI and MDI at 18 months post-term . It is shown here that infants from that study fed solely on st and ard formula had significantly lower developmental scores at 18 months than those fed on donor breast milk in the present study ; yet the st and ard formula had a higher nutrient content than the donor milk . Thus , donor milk feeding was associated with advantages for later development that may have offset any potentially deleterious effects of its low nutrient content for preterm infants . As these outcome advantages were not confounded by the social and educational biases usually associated with mothers ' choice to breast feed , our data add significant support to the view that breast milk promotes neurodevelopment The growth , behavior , and protein status of 59 healthy preterm ( mean gestational age 30 wk ) infants fed either human milk or one of three infant formulas were studied post-discharge from the hospital . Formula-fed infants received either a st and ard term formula , a st and ard preterm formula , or an experimental preterm formula from discharge to 8 wk of age . From 8 to 16 wk , all formula-fed infants received the st and ard term formula . At 2 , 8 , and 16 wk , anthropometric , dietary intake , blood biochemistry , amino acid , and Brazelton Neonatal Behavioral Assessment measurements were evaluated . Weights , lengths , and head circumferences were similar for all feeding groups at discharge . After discharge all formula-fed infants were heavier than human milk-fed infants . Length and head circumference values and plasma urea nitrogen and retinol-binding protein concentrations were not different among dietary groups . Formula-fed infants had higher plasma concentrations of numerous amino acids compared with those of human milk-fed infants during the first 8 wk but not at 16 wk . There were no differences among the feeding groups in the Brazelton assessment . This study found little effect on the growth or behavioral or protein status of preterm infants discharged from the hospital who were fed either human milk or formulas design ed for term or preterm infants Aim : A r and omized , double‐blind study was conducted to evaluate whether use of protein hydrolysate‐based preterm formulas in infants with an atopic predisposition helps prevent the development of allergic diseases . Methods : Preterm infants ( n= 122 ) with at least one first‐degree relative ( parent or sibling ) with allergic disease were r and omly assigned to receive an extensively or partially hydrolysed preterm formula ( intervention groups ) or a st and ard preterm formula until 4 to 5 mo of age . Infants whose parents preferred that they be breastfed received their mothers ' fortified breast milk . Results : Intention‐to‐treat analysis showed that the overall incidence of allergic diseases did not significantly differ between groups at both 4–5 and 12 mo of age . However , by 12 mo , use of the extensively hydrolysed versus the st and ard preterm formula had significantly reduced the risk of atopic dermatitis . At 4–5 and 12 mo , there was a significantly increased risk of non‐acceptance of the extensively hydrolysed formula compared with the other formulas Formulas containing proteins with reduced potential to sensitize might be effective in reducing the risk of atopic disease , but such products should be nutritionally adequate . We design ed a r and omized , double-blind study to evaluate nutritional adequacy and sensitization potential of a formula containing partially hydrolyzed whey-predominant milk proteins .  Subjects were term infants enrolled at birth . Infants in group A were fed human milk , and group B received the partially hydrolyzed formula ; group C , fed a formula containing intact whey-predominant milk proteins , served as control subjects . We recorded anthropometric measurements and symptoms of formula intolerance at monthly intervals for 4 months in 205 infants .  Milk IgE and IgG antibodies were measured until 8 months of age in 63 infants .  Daily weight gain was not significantly different among the groups . Gastrointestinal symptoms attributed to feeding intolerance were also comparable . Increases in serum IgG antibodies were significantly greater in group C throughout the study . There were no significant differences in IgE antibodies . Thus a formula containing partially hydrolyzed whey-predominant milk protein promoted adequate growth and induced a lesser priming effect for IgG antibody response than did an intact whey-predominant formula BACKGROUND Feeding intolerance is common in very low birth weight ( VLBW ; < 1500 g ) infants .  Hydrolyzed protein preterm infant formula ( HPF ) has been shown to accelerate the gastrointestinal transit of formula . The aim of this study was to investigate whether HPF improves early feeding tolerance compared with st and ard preterm infant formula ( SPF ) . We hypothesized that HPF would accelerate early enteral feeding advancement . METHODS Primary outcome was the time from initiation of milk feeds until full feeds ( 150 mL/kg birth weight/d ) were achieved in infants who received < 10 % human milk ( HM ) to exclude HM as a confounder . Because the availability of HM was not predictable at the time of enrollment , all eligible VLBW infants ( n = 129 ) were r and omly assigned in a r and omized , controlled trial to receive HPF or SPF if HM was not available . Infants who received > 10 % HM ( n = 42 ) were excluded . Milk bolus feeding every 2 to 3 hours was started at the discretion of the attending physician and advanced by 16 mL/kg/d . Prepr and ial gastric residuals were tolerated up to 5 mL/kg ; otherwise , feedings were reduced or withheld . Data are shown as median ( 5th and 95th percentile ) . RESULTS Forty-six and 41 ( HPF vs SPF ) infants received < 10 % HM . There was no significant difference with regard to birth weight , gestational age , and onset of milk feeds ( day 3 [ 1 - 8 ] vs 4 [ 2 - 6 ] ) . The time from initiation of milk feeds to full feeds was significantly shorter with HPF feeding ( 10 [ 9 - 27 ] vs 12 [ 9 - 28 ] days ) . CONCLUSION HPF improved the feeding tolerance and enabled a more rapid establishment of full enteral feeding in VLBW infants compared with SPF Background and Objectives : Postdischarge formulas with extra energy and protein improve short-term growth but may also influence long-term body composition in an unwanted manner . Energy- and protein-enriched formulas with an increased protein-to-energy ratio improves gain of lean mass . The objective of the study was to investigate whether feeding a nutrient-enriched formula without extra energy after term , usually 3 to 4 weeks after discharge , would influence growth and body composition in infancy . Methods : In this r and omized controlled trial preterm infants were fed fortified human milk or preterm formula until term . At term , 102 infants were r and omized to a nutrient-enriched formula without extra energy or st and ard formula until 6 months corrected age . Twenty-six infants received unfortified human milk after term . At term and 6 months corrected age , anthropometry and a dual-energy x-ray absorptiometry ( DEXA ) scan were performed . Lean and fat mass ( FM ) were corrected for height . Results : There were no differences in growth or body size between the feeding groups . Infants fed the enriched formula gained less FM and had lower FM corrected for body size at 6 months corrected age than infants fed st and ard formula . Infants fed human milk had lower lean mass and higher FM corrected for body size at 6 months corrected age than formula-fed infants . Conclusions : Feeding nutrient-enriched formula without extra energy after term does not change quantity of growth but does influence type of weight gain and body composition of preterm infants . Infants fed the nutrient-enriched formula had lower FM corrected for body size at 6 months corrected age than infants fed st and ard formula or human milk 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 consisting of oligosaccharides in similar proportions to human milk on the faecal flora and stool characteristics of preterm infants . Study design : To resemble the effect of human milk , an oligosaccharide mixture consisting of 90 % galacto-oligosaccharides and 10 % fructo-oligosaccharides was used to supplement a st and ard preterm formula at a concentration of 10 g/l . This supplemented formula was studied in 15 preterm infants , and the results were compared with those found in 15 infants fed a formula supplemented with maltodextrin as placebo .  A group fed fortified mother 's milk  was investigated as a reference group ( n = 12 ) . On four days during a 28 day feeding period ( 1 , 7 , 14 , and 28 ) , the faecal flora was investigated , and stool characteristics , growth , and possible side effects were recorded . Results : During the study period , the number of bifidobacteria in the group fed the oligosaccharide supplemented formula increased to the upper range of bifidobacteria counts in the reference group . The difference between the supplemented and non-supplemented groups was highly significant ( p = 0.0008 ) . The stool characteristics were also influenced by the supplement : the stool frequency after 28 days was significantly lower in the control group than in the oligosaccharide supplemented group ( p = 0.0079 ) and the reference group ( p < 0.0001 ) . Over the study period , the stool consistency in the control group became harder , but remained fairly stable in the other two groups . There was no effect of the different diets on the incidence of side effects ( crying , regurgitation , vomiting ) or on weight gain or length gain . Conclusion : Supplementing preterm formula with a mixture of galacto- and fructo-oligosaccharides at a concentration of 10 g/l stimulates the growth of bifidobacteria in the intestine and results in stool characteristics similar to those found in preterm infants fed human milk . Therefore prebiotic mixtures such as the one studied may help to improve intestinal tolerance to enteral feeding in preterm infants In a prospect i ve r and omized study we investigated in 28 mainly bottle-fed infants younger than 60 days whether in acute gastroenteritis a hypoallergenic formula could prevent the development of cow 's milk protein intolerance . Group 1 ( 14 infants ) was fed with a formula adapted to human milk , Group 2 ( 14 infants ) got a semi-elementary formula ( Alfaré ) . After 3 months group II was exposed to cow 's milk protein with a st and ardized challenge and the incidence of CMPI in both groups was calculated . All cases with the acute form of CMPI occurred in group II ( 5/12 ) whereas in group I only one infant suffered from the protracted mild form of the disease . Inspite of the relatively small number of prob and s we conclude from our results that in infants who are not totally breast-fed in the post-enteritic period feeding with a formula adapted to human milk is preferable to hypoallergenic semi-elementary preparations . An allergen free period of 3 months seems to induce symptoms of cow 's milk intolerance , probably as a booster-effect to early sensibilisation Abstract Little research has focused on infant developmental effects , other than growth , of formulas that differ substantially in the form of protein . To examine development of infants fed formulas differing in free amino acid content , we r and omized 0.5-month-old infants ( n = 79 ) to either a  control group who fed only cow milk formula ( CMF ) during the first 8 months ( CMF8 ) , or to one of two experimental groups : one experimental group fed extensively protein hydrolyzed formula ( EHF ) for 1–3 months during first 4.5 months ( EHF1 - 3 ) of life , and the other fed EHF for 8 months ( EHF8 ) . The Mullen Scales of Early Learning were administered monthly from 1.5 to 8.5 months to assess fine ( FM ) and gross ( GM ) motor control , receptive ( RL ) and expressive ( EL ) language , visual reception ( VR ) , and an early learning composite ( ELC ) . Across the 5.5–8.5-month time period , when compared to CMF8 infants , GM scores in EHF1 - 3 infants averaged 1.5 points higher ( 95 % CI 0.1 , 3.0 ) and in EHF8 infants 2.2 points higher ( 95 % CI 0.3 , 4.0 ) . Similarly , VR scores averaged 1.9 points higher ( 95 % CI 0.1 , 3.8 ) in EHF1 - 3 infants and 2.2 points higher ( 95 % CI −0.2 , 4.5 ) in EHF8 infants . EHF8 infants ’ RL scores averaged 1.8 points lower ( 95 % CI 0.1 , 3.6 ) than CMF8 infants . These data suggest that the form of protein in infant formula may impact cognitive development and that the higher free amino acid content in breast milk may be a contributing factor to the differential cognitive development between breastfed and CMF-fed infants . Clinical Trial Registration : clinical trials.gov NCT00994747 Background Parents who perceive common infant behaviors as formula intolerance-related often switch formulas without consulting a health professional . Up to one-half of formula-fed infants experience a formula change during the first six months of life . Methods The objective of this study was to assess discontinuance due to study physician-assessed formula intolerance in healthy , term infants . Infants ( 335 ) were r and omized to receive either a st and ard intact cow milk protein formula ( INTACT ) or a partially hydrolyzed cow milk protein formula ( PH ) in a 60 day non-inferiority trial . Discontinuance due to study physician-assessed formula intolerance was the primary outcome . Secondary outcomes included number of infants who discontinued for any reason , including parent-assessed . Results Formula intolerance between groups ( INTACT , 12.3 % vs. PH , 13.7 % ) was similar for infants who completed the study or discontinued due to study physician-assessed formula intolerance . Overall study discontinuance based on parent- vs. study physician-assessed intolerance for all infants ( 14.4 vs.11.1 % ) was significantly different ( P = 0.001 ) . Conclusion This study demonstrated no difference in infant tolerance of intact vs. partially hydrolyzed cow milk protein formulas for healthy , term infants over a 60-day feeding trial , suggesting nonst and ard partially hydrolyzed formulas are not necessary as a first-choice for healthy infants . Parents frequently perceived infant behavior as formula intolerance , paralleling previous reports of unnecessary formula changes . Trial Registration clinical trials.gov : Latent systemic anaphylactic sensitisation to cows ' milk was assessed in 61 preterm infants who were r and omly assigned to receive either a special formula for preterm infants based on cows ' milk or banked breast milk or one or other of these as a supplement to maternal milk .  A single sample of venous blood was taken near to the time of discharge from the neonatal intensive care unit , and the histamine release by blood basophils in response to in vitro challenge with cows ' milk and anti-IgE was measured . Compared with the blood from infants fed on human milk , that from infants fed on preterm formula showed a significant increase in histamine release to challenge with cows ' milk , the response being greater in blood from infants of lower birth weight and gestational age . A smaller but significant increase in blood histamine release with anti-IgE challenge was observed in the group fed on preterm formula . Infants of low birth weight fed on preterm formula based on cows ' milk may develop latent systemic sensitisation more rapidly than infants born at term . The clinical importance of this requires further investigation Cow 's milk protein allergy ( CMPA ) is best treated by complete elimination of cow 's milk from the diet . For infants with CMPA who can not be breast-fed , formulas based on extensively hydrolyzed proteins or on amino acids are the preferred substitutes for cow 's milk-based formulas . In this study , we compared the tolerance and growth of infants with CMPA who were fed a new extensively hydrolyzed formula containing lactose ( eHF ) with those who were fed an amino acid formula ( AAF ) . This was a prospect i ve , multi-center , r and omized , reference-controlled study . Seventy-seven infants < 12 months old with suspected CMPA were enrolled . In 66 of these , CMPA was confirmed by oral challenge in a double-blind , placebo-controlled food challenge ( DBPCFC ) or by a medical history of severe allergic reaction to cow 's milk and a positive skin prick test . These infants were then tested for their reaction to eHF and AAF in a DBPCFC . All infants tolerated both formulas and were r and omized to receive either eHF ( n = 34 ) or AAF ( n = 32 ) for 180 days . Growth ( weight , length , and head circumference ) and tolerance [ skin , gastro-intestinal , and respiratory tract symptoms of allergy ] were evaluated after 30 , 60 , 90 , and 180 days . There were no significant differences between the two groups in any of the growth measurements . Length and head circumference were similar to Euro-growth st and ards , but weight was slightly lower . Gastro-intestinal and respiratory tract symptoms of allergy were also similar in the two groups . However , whereas SCORAD scores for atopic dermatitis remained constant throughout the study in infants-fed eHF , there was a slight decrease in those fed AAF . Infants-fed eHF had significantly fewer incidents of vomiting than infants-fed AAF and a significantly higher frequency of soft stools . The new eHF is safe and well tolerated in infants diagnosed with CMPA BACKGROUND The long-term effect of nutritional intervention with hydrolysate infant formulas on  allergic manifestations in high-risk children is uncertain . OBJECTIVE We sought to investigate the effect of hydrolysate infant formulas on allergic phenotypes in children with family history of allergies at school age . METHODS We analyzed data from participants of the prospect i ve German Infant Nutritional Intervention study after 10 years of follow-up . At birth , children were r and omly assigned to receive , for the first 4 months , one of 4 blinded formulas as breast milk substitute , if necessary : partially hydrolyzed whey formula ( pHF-W ) , extensively hydrolyzed whey formula ( eHF-W ) , extensively hydrolyzed casein formula ( eHF-C ) , or st and ard cow 's milk formula . Outcomes were parent-reported , physician-diagnosed allergic diseases . Log-binomial regression models were used for statistical analysis . RESULTS The relative risk for the cumulative incidence of any allergic disease in the intention-to-treat analysis ( n = 2252 ) was 0.87 ( 95 % CI , 0.77 - 0.99 ) for pHF-W , 0.94 ( 95 % CI , 0.83 - 1.07 ) for eHF-W , and 0.83 ( 95 % CI , 0.72 - 0.95 ) for eHF-C compared with st and ard cow 's milk formula . The corresponding figures for atopic eczema/dermatits ( AD ) were 0.82 ( 95 % CI , 0.68 - 1.00 ) , 0.91 ( 95 % CI , 0.76 - 1.10 ) , and 0.72 ( 95 % CI , 0.58 - 0.88 ) , respectively . In the per- protocol analysis ( n = 988 ) effects were stronger . The period prevalence of AD at 7 to 10 years was significantly reduced with eHF-C in this analysis , but there was no preventive effect on asthma or allergic rhinitis . CONCLUSION The significant preventive effect on the cumulative incidence of allergic diseases , particularly AD , with pHF-W and eHF-C persisted until 10 years without rebound , whereas eHF-W showed no significant risk reduction . There is insufficient evidence of ongoing preventive activity at 7 to 10 years of age
The identified trials provide only low quality evidence about the effects of feeding preterm infants  with protein hydrolysate versus st and ard formula .
The existing data did not support conclusions that feeding with protein hydrolysate affects the risk of feed intolerance or necrotising enterocolitis .
BACKGROUND When human milk is not available for feeding preterm infants , protein hydrolysate rather than st and ard cow 's milk formulas ( with intact proteins ) are often used because they are perceived as being tolerated better and less likely to lead to complications .
However , protein hydrolysate formulas are more expensive than st and ard formulas , and concern exists that their use in practice is not supported by high- quality evidence .
OBJECTIVES To assess the effect of feeding preterm infants with hydrolysed formula ( versus st and ard cow 's milk formulas )  on the risk of feed intolerance , necrotising enterocolitis , and  other morbidity and mortality in preterm infants .