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VLBW: Formula Enrichment (2020)

Download the Formula Enrichment Table (PDF) which includes specific formula information for each included study in this subtopic.

Intervention
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of formula enrichment via enteral nutrition on mortality?
- Conclusion
  No studies were identified that evaluated the effect of formula enrichment on mortality in very low birthweight (VLBW) preterm infants.
- Grade: V
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Search Plan and Results: VLBW: Formula Enrichment (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of formula enrichment via enteral nutrition on rickets?
- Conclusion
  In one RCT, very low birthweight (VLBW) infants receiving hyper-caloric milk formula had no difference in risk of developing rickets compared to standard bovine milk formula by four months of age.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of formula enrichment via enteral nutrition on rickets?
  - Detail
  - Quality Rating Summary
    For a summary of the Quality Rating results, click here.
  - Worksheets
    
    Kulkarni P, Dorand R, Bridger W, Payne J, Montiel D, Hill J. Rickets in premature infants fed different formulas. Southern Medical Journal 1984; 77:13-6, 20
- Search Plan and Results: VLBW: Formula Enrichment (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of formula enrichment via enteral nutrition on weight gain?
- Conclusion
  In one study, enriching preterm infant formula in the newborn intensive care unit (NICU) increased weight gain during three-day balance studies. However, enrichment post-discharge, whether in infants with or without bronchopulmonary dysplasia (BPD), did not affect weight gain.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of formula enrichment via enteral nutrition on weight gain?
- Search Plan and Results: VLBW: Formula Enrichment (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of formula enrichment via enteral nutrition on length gain?
- Conclusion
  In very low birthweight (VLBW) preterm infants, iso-caloric formula enrichment with protein and micronutrients in post-discharge infants found no significant effect on length gain [SMD, -0.2 (95% CI, -0.9 to 0.5)].
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of formula enrichment via enteral nutrition on length gain?
- Search Plan and Results: VLBW: Formula Enrichment (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of formula enrichment via enteral nutrition on head circumference gain?
- Conclusion
  Two RCTs demonstrated no effect of formula enrichment on head circumference in post-discharged very low birthweight (VLBW) infants.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of formula enrichment via enteral nutrition on head circumference gain?
- Search Plan and Results: VLBW: Formula Enrichment (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of formula enrichment via enteral nutrition on body mass?
- Conclusion
  One RCT examining very low birthweight (VLBW) infants in the newborn intensive care unit (NICU) determined that formula enrichment with eight grams per L of protein, and micronutrients (but not calories) may increase lean body mass in males and females and decrease body fat in girls, compared to standard formula after four months.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of formula enrichment via enteral nutrition on body mass?
- Search Plan and Results: VLBW: Formula Enrichment (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of formula enrichment via enteral nutrition on bone mineral content?
- Conclusion
  In two RCTs with post-discharge very low birthweight (VLBW) infants, enrichment of iso-caloric formula with protein and micronutrients increased bone mineral content and accretion after two to four months, however, in one study the difference between groups was not significant after a two-month follow-up.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of formula enrichment via enteral nutrition on bone mineral content?
- Search Plan and Results: VLBW: Formula Enrichment (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of formula enrichment via enteral nutrition on protein utilization?
- Conclusion
  In two RCTs in hospitalized or post-discharge very low birthweight (VLBW) infants, formula with added protein (an additional 4.8g to 6.0g per L formula) and micronutrients, compared to an iso-caloric formula with lower levels of these nutrients, demonstrated no effect on nitrogen absorption (MD, 1.6mg per kg per day; 95% CI, -0.07 to 4.0), but absolute nitrogen retention was increased (MD, 100.0mg per kg per day; 95% CI, 80.0 to 119.9).
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of formula enrichment via enteral nutrition on protein utilization?
- Search Plan and Results: VLBW: Formula Enrichment (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of formula enrichment via enteral nutrition on morbidities, gastrointestinal function, or adverse effects?
- Conclusion
  No studies were identified that evaluated the effect of formula enrichment on morbidities, gastrointestinal function, or adverse effects.
- Grade: V
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Search Plan and Results: VLBW: Formula Enrichment (2019)
In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of formula enrichment via enteral nutrition on development?
- Conclusion
  In one RCT with high risk of bias, post-discharge very low birth weight (VLBW) infants provided with formula with added calories (80kcal/dL), protein (2.4 g/dL) calcium and phosphorus, compared to another formula with fewer calories (70kcal/dL), protein (1.7g/dL) , calcium and phosphorus found no difference between groups in Griffiths development scores.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In VLBW preterm infants (less than or equal to 1,500g at birth), what is the effect of formula enrichment via enteral nutrition on development?
  - Detail
  - Quality Rating Summary
    For a summary of the Quality Rating results, click here.
  - Worksheets
    
    Agosti M, Vegni C, Calciolari G, Marini A. Post-discharge nutrition of the very low-birthweight infant: interim results of the multicentric GAMMA study. Acta Paediatrica (Oslo, Norway : 1992). Supplement 2003; 91:39-43
- Search Plan and Results: VLBW: Formula Enrichment (2019)