The use of extensively hydrolysed and amino acid feeds beyond cow’s milk allergy: a national survey

Abstract

Background Extensively hydrolysed formulas (EHFs) and amino acid formulas (AAFs) with proven hypoallergenicity are used for children suffering from cow’s milk allergy, when breast milk is not available. However, these feeds are often used in other medical conditions where tolerance and absorption of whole protein is affected, frequently without assessment of efficacy. This practice survey assessed the use of these feeds in paediatric conditions other than cow’s milk allergy; aiming to describe the population, growth parameters and micronutrient status. Methods Four National Health Service tertiary paediatric centres participated in this practice survey. Inclusion: children between 0 and 18 years, consuming >25% of their estimated energy requirements of an EHF/AAF for any condition other than allergic disease. Anonymised data were collected: (i) descriptive information; (ii) indications; (iii) type and route of feeding; (iv) growth status and nutritional deficiencies; and (v) medication and vitamin and mineral supplementation. Results One hundred‐and‐ninety‐one children were included with a median age of 19 months (interquartile range 4–63]. Seventeen percent (33/191) were on AAFs and 83% (158/191) were on EHFs. The feeds were commonly used in cancer for 26% and in critical illness for 31%. The majority (73%) of children had enteral feeds via a nasogastric tube. Nutritional biomarkers were performed in 29% of children and 83% were on a vitamin or mineral supplement. Conclusions This practice survey found that EHFs and AAFs were used in a variety of medical conditions. Indications for feed choice varied, and evidence‐based research supporting the use was scarce. Awaiting further research, children on these types of feeds should have regular nutritional monitoring.

Hydrolysed proteins in infant formula and child neurodevelopment up to the age of 3·5 years: the nationwide Étude Longitudinale Française depuis l’Enfance (ELFE) birth cohort

“…As expected, the use of hydrolysed formulas, in particular the extensively hydrolysed ones, aligned with the presence of cow’s milk protein allergy and a family history of allergy. Such findings reflect current recommendations and/or common practices regarding the use of hydrolysed formulas (32,53,54) . There is scarce evidence regarding long-term effects (at least over 1 year of age) on child neurodevelopment of the use of infant formula in infancy.…”

“…Of note, indicators for developmental delays in early infancy were not considered. Developmental outcomes may indirectly relate to the choice of infant formula since limited tolerance to standard feeds and regurgitation, which appear more common among children with developmental delays (64,65) , may have prompted the use of hydrolysed formulas in infancy (7,53) . Moreover, due to the small size ( n 1) of the analytical sample consuming elemental formula, it was collapsed with the most similar category in terms of free amino acid content, namely extensively hydrolysed formula ( n 69).…”

The clinical burden of cow's milk allergy in early childhood: A retrospective cohort study

“…HAF prescription for at least three months was therefore used as a diagnostic proxy for the CMA cohort, in the absence of a read‐code. Chronic conditions were excluded as described in the methodology, which is expected to have omitted children requiring HAF for chronic conditions outside of allergy 64 and for a 2–4 week diagnostic elimination diets 9 . However, this pragmatic approach meant that all of the CMA cohort had a HAF prescription.…”

The health economic impact of cow's milk allergy in childhood: A retrospective cohort study

“…In the absence of CMA diagnostic read‐codes, children were included in the CMA cohort if they had a HAF prescription for at least three consecutive months. Whilst the full eligibility criteria was likely to exclude children receiving HAF for conditions other than allergy, 47 or as an elimination diet for diagnostic purposes, 20 this resulted in 100% of the CMA cohort having current or historic HAF prescriptions. This may exceed the rates of HAF prescription typically observed in clinical practice, as breastmilk is recommended as the optimal nutrient source for infants with CMA 1,2,6 .…”