Nutrient-enriched formula versus standard term formula for preterm infants following hospital discharge

Henderson G, Fahey T, McGuire W

Published Online:

January 21, 2009

Preterm infants are often much smaller than term infants by the time that they are discharged home from hospital. This review attempted to identify evidence that feeding these infants with formula milk enriched with nutrients rather than ordinary formula designed for term infants, would increase growth rates and benefit development. Seven good quality trials were identified. These trials provided little evidence that unrestricted feeding with nutrient-enriched formula milk affects growth and development up to about 18 months of age. Long-term growth and development has not yet been assessed. Further randomised controlled trials are needed to address this question.

Abstract (click to read)

Background:

Preterm infants are often growth-restricted at hospital discharge. Feeding infants after hospital discharge with nutrient-enriched formula rather than standard term formula might facilitate "catch-up" growth and improve development.

Objectives:

To determine the effect of feeding nutrient-enriched formula compared with standard term formula on growth and development for preterm infants following hospital discharge.

Search strategy:

The standard search strategy of the Cochrane Neonatal Review Group were used. This included searches of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2007), MEDLINE (1966 - May 2007), EMBASE (1980 - May 2007), CINAHL (1982 - May 2007), conference proceedings, and previous reviews.

Selection criteria:

Randomised or quasi-randomised controlled trials that compared the effect of feeding preterm infants following hospital discharge with nutrient-enriched formula compared with standard term formula.

Data collection and analysis:

Data was extracted using the standard methods of the Cochrane Neonatal Review Group, with separate evaluation of trial quality and data extraction by two authors, and synthesis of data using weighted mean difference and a fixed effects model for meta-analysis.

Main results:

Seven trials were found that were eligible for inclusion. These recruited a total of 631 infants and were generally of good methodological quality. The trials found little evidence that feeding with nutrient-enriched formula milk affected growth and development. Because of differences in the way individual trials measured and presented outcomes, data synthesis was limited. Growth data from two trials found that, at six months post-term, infants fed with nutrient-enriched formula had statistically significantly lower weights [weighted mean difference: -601 (95% confidence interval -1028, -174) grams], lengths [-18.8 (-30.0, -7.6) millimetres], and head circumferences [-10.2 ( -18.0, -2.4) millimetres], than infants fed standard term formula. At 12 to 18 months post-term, meta-analyses of data from three trials did not find any statistically significant differences in growth parameters. However, examination of these meta-analyses demonstrated statistical heterogeneity. Meta-analyses of data from two trials did not reveal a statistically significant difference in Bayley Mental Development or Psychomotor Development Indices. There are not yet any data on growth or development through later childhood.

Authors' conclusions:

The available data do not provide strong evidence that feeding preterm infants following hospital discharge with nutrient-enriched formula compared with standard term formula affects growth rates or development up to 18 months post-term.

This record should be cited as:

Henderson G, Fahey T, McGuire W. Nutrient-enriched formula versus standard term formula for preterm infants following hospital discharge. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD004696. DOI: 10.1002/14651858.CD004696.pub3

Assessed as up to date:

June 25, 2007

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Primary Review Group:

Neonatal Group

Health topics:

Neonatal care > Feeding the low birthweight infant > Comparison of whole diets

Complementary & alternative medicine > Neonatal care > Feeding the low birthweight infant

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Nutrient-enriched formula versus standard term formula for preterm infants following hospital discharge

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