Semi-Elemental and Elemental Formulas for Enteral Nutrition in Infants and Children with Medical Complexity—Thinking about Cow’s Milk Allergy and Beyond

Abstract

Children with medical complexities, such as multi-system disorders and/or neurological impairments, often experience feeding difficulties and need enteral nutrition. They frequently have impaired motility and digestive–absorbing functions related to their underlying condition. If a cow’s milk allergy (CMA) occurs as a comorbidity, it is often misdiagnosed, due to the symptoms’ overlap. Many of the commercialized mixtures intended for enteral nutrition are composed of partially hydrolyzed cow’s milk proteins, which are not suitable for the treatment of CMA; thus, the exclusion of a concomitant CMA is mandatory in these patients for obtaining symptoms relief. In this review, we focus on the use of elemental and semi-elemental formulas in children with neurological diseases and in preterm infants as clinical “models” of medical complexity. In children with neurodisabilities, when gastrointestinal symptoms persist despite the use of specific enteral formula, or in cases of respiratory and/or dermatological symptoms, CMA should always be considered. If diagnosis is confirmed, only an extensively hydrolyzed or amino-acid based formula, or, as an alternative, extensively hydrolyzed nutritionally adequate formulas derived from rice or soy, should be used. Currently, enteral formulas tailored to the specific needs of preterm infants and children with neurological impairment presenting concomitant CMA have not been marketed yet. For the proper monitoring of the health status of patients with medical complexity, multidisciplinary evaluation and involvement of the nutritional team should be promoted.

Dysbiosis of the gut microbiota in children with severe motor and intellectual disabilities receiving enteral nutrition: A pilot study

“…Recently, several studies have reported a significantly higher prevalence of allergy in children with SMIDs receiving EN than in healthy individuals 22 . Kurihara et al found that the positive rate of latex‐specific immunoglobulin E was higher in patients with SMIDs than in healthcare professionals (25.9% vs 16.9%, respectively) 23 .…”

Pediatric formulas: Categories, composition, and considerations

“…These formulas are available in both standard and high‐calorie forms (1.0 kcal/ml vs 1.2 and 1.5 kcal/ml), with and without fiber, and in a variety of flavors. Applications include children aged 1–13 years with intolerance to polymeric/intact protein formulas or in those with altered gastrointestinal tract function 9,15 . There is at least one product designated as a high‐protein formula, containing 16% of calories from protein.…”

“…Formulas may contain other allergens, and careful attention to the label and packaging is imperative to ensure safety 11 . One must pay close attention to carbohydrate, fat, and protein content of formulas to identify potential allergens as well as intolerances 15 …”

“…11 One must pay close attention to carbohydrate, fat, and protein content of formulas to identify potential allergens as well as intolerances. 15 Family, caregiver, cultural, and religious considerations Many families and caregivers have preferences and beliefs around foods, sometimes stemming from religious dietary restrictions. Plant-based, organic, kosher, halal, and/or food-based formulas are abundant in the market and help meet these preferences.…”

Primary Prevention of Pediatric Asthma through Nutritional Interventions

“…Over the past decade, hydrolyzed milk formulas (HF), which include partially hydrolyzed formula (pHF) and extensively hydrolyzed formula (eHF), have been recommended in many countries for the potential prevention of allergic diseases in infants at high risk of atopy who cannot be breastfed [67,68]. However, a recent meta-analysis does not support this recommendation, especially regarding asthma prevention.…”