BackgroundFormula-fed (FF) infants often have harder stools and higher stool concentrations of fatty acid soaps compared to breastfed infants. Feeding high sn-2 palmitate or the prebiotic oligofructose (OF) may soften stools, reduce stool soaps, and decrease fecal calcium loss.MethodsWe investigated the effect of high sn-2 palmitate alone and in combination with OF on stool palmitate soap, total soap and calcium concentrations, stool consistency, gastrointestinal (GI) tolerance, anthropometrics, and hydration in FF infants. This double-blind trial randomized 165 healthy term infants 25–45 days old to receive Control formula (n = 54), formula containing high sn-2 palmitate (sn-2; n = 56), or formula containing high sn-2 palmitate plus 3 g/L OF (sn-2+OF; n = 55). A non-randomized human milk (HM)-fed group was also included (n = 55). The primary endpoint, stool composition, was determined after 28 days of feeding, and was assessed using ANOVA accompanied by pairwise comparisons. Stool consistency, GI tolerance and hydration were assessed at baseline, day 14 (GI tolerance only) and day 28.ResultsInfants fed sn-2 had lower stool palmitate soaps compared to Control (P =0.0028); while those fed sn-2+OF had reduced stool palmitate soaps compared to both Control and sn-2 (both P <0.0001). Stool total soaps and calcium were lower in the sn-2+OF group than either Control (P <0.0001) or sn-2 (P <0.0001). The HM-fed group had lower stool palmitate soaps, total soaps and calcium (P <0.0001 for each comparison) than all FF groups. The stool consistency score of the sn-2+OF group was lower than Control and sn-2 (P <0.0001), but higher than the HM-fed group (P <0.0001). GI tolerance was similar and anthropometric z-scores were <0.2 SD from the WHO growth standards in all groups, while urinary hydration markers were within normal range for all FF infants.ConclusionsIncreasing sn-2 palmitate in infant formula reduces stool palmitate soaps. A combination of high sn-2 palmitate and OF reduces stool palmitate soaps, total soaps and calcium, while promoting softer stools.Trial registrationThis study was registered on http://www.clinicaltrials.gov: number NCT02031003.Electronic supplementary materialThe online version of this article (doi:10.1186/1475-2891-13-105) contains supplementary material, which is available to authorized users.

To study feeding tolerance in infants fed formula with increased sn-2 palmitate and oligofructose (sn-2+OF) in a real-world setting, healthy Chinese infants were enrolled in this 48-day observational study on their current feeding regimens: exclusively breastfed (BF; n = 147), exclusively sn-2+OF formula-fed (FF; n = 150), or mixed-fed with breast milk and sn-2+OF formula (MF; n = 163). Throughout the study, incidence (90% confidence interval) of hard stools was ≤2.1% (0.0-5.3) in FF and 0.8% (0.0-3.5) in MF, with no hard stools in BF. Incidence of watery stools was ≤5.0% (1.0-9.2) in FF and ≥5.1% (2.4-9.3) in MF and BF. Gastrointestinal tolerance scores, although low in all groups (lower scores indicating better tolerance), were slightly higher (P ≥ .03) in FF (17.5 ± 4.8) and MF (18.2 ± 5.0) versus BF (16.3 ± 3.2) at mid-study; this difference disappeared at study end. Overall, low incidences of hard and watery stools and good feeding tolerance were observed in infants fed sn-2+OF formula.

Background The feeding scheme of premature newborns changed in recent years. The latest recommendations emphasise the intensification both of parenteral and enteral nutrition from the first days of life. Methods We compared two groups of VLBW newborns born in our institution in 2010 and 2013. We analysed how the changes of our nutritional treatment influenced chosen parameters in both groups of newborns. Changes included: more intensive full TPN from first hours of life, earlier enteral nutrition (EN), faster increasing of EN, less restrictive fluid policy during first week of life, supplementation of proteins during EN and more exact growth charts. Results The demographic parameters of both groups were very similar. In 2013 compared to 2010 we found smaller average weight loss after birth (6,4% vs 9,7%; p < 0,05), faster return to birth weight (8 vs 12,5 days; p < 0,01) and higher average daily weight gain (21,5 vs 19,6 g/day; p < 0,05). The mean duration of TPN use was slightly shorter (18 vs 20 days; NS). Extra uterine growth restriction at the time of discharge decreased significantly but still was 43,3% in 2013. Improvement has taken place mainly in the subgroup of ELBW infants. The incidence of severe NEC declined from 10% in 2010 to 6,4% in 2013. Conclusions We revealed that our changes caused improvement of nutrition and brought beneficial effect on the growing parameters of our premature newborns without increasing the incidence of NEC. Background and aims Formula containing increased sn-2 palmitate with oligofructose (sn-2+OF) may improve stool consistency. We hypothesised that hard and watery stool incidence among infants fed a-lactalbumin-enriched formula with sn-2 +OF would be ≤2.5% (upper limit of 80% CI < 5.0%). Methods Healthy term infants (n = 440) aged~42 days were enrolled in this 48-day study on their current feeding regimens: formula-fed (n = 142), HM-fed (n = 143), or mixed-fed (n = 155). Stool consistency was assessed at 4 visits using a 3-day diary with validated 5-point scale (1 = watery, 5 = hard). Gastrointestinal (GI) tolerance was assessed using a validated questionnaire (score range = 13-65; lower values indicate better tolerance). Results Incidence of hard stools across visits ranged from 0.7% [80% CI: 0.1-2.7] to 2.1% [0.8-4.6] for formula-fed infants, with incidence rates ≤0.8% in mixed-fed, and no hard stools reported in HM-fed groups. Incidence of watery stools ranged PS-268