UZ Brussel, Department of Paediatrics, Vrije Universiteit Brussel, Brussels, Belgium.
Allergy & Immunology Centre, Pantai Hospital, Kuala Lumpur, Malaysia.
Nutrition. 2019 Jan;57:268-274. doi: 10.1016/j.nut.2018.05.018. Epub 2018 Jun 20.
Guidance and evidence supporting routine use of partially hydrolyzed formula (pHF) versus intact cows' milk protein (CMP) formula are limited in non-exclusively breastfed infants. The aim of this review was to better clarify issues of routine use of pHF in non-exclusively breastfed infants who are not at risk for allergic disease by using a systematic review and Delphi Panel consensus.
A systematic review and Delphi consensus panel (consisting of eight8 international pediatric allergists and gastroenterologists) was conducted to evaluate evidence supporting growth, tolerability, and effectiveness of pHF in non-exclusively breastfed infants.
None of the studies reviewed identified potential harm of pHF use compared with CMP in non-exclusively breastfed infants. There was an expert consensus that pHF use is likely as safe as intact CMP formula, given studies suggesting these have comparable nutritional parameters. No high-quality studies were identified evaluating the use of pHF to prevent allergic disease in non-exclusively breastfed infants who are not at risk for allergic disease (e.g., lacking a parental history of allergy). Limited data suggest that pHF use in non-exclusively breastfed infants may be associated with improved gastric emptying, decreased colic incidence, and other common functional gastrointestinal symptoms compared with CMP. However, because the data are of insufficient quality, the findings from these studies have to be taken with caution. No studies were identified that directly compared the different types of pHF, but there was an expert consensus that growth, allergenicity, tolerability, effectiveness, and clinical role among such pHF products may differ.
Limited data exist evaluating routine use of pHFs in non-exclusively breastfed infants, with no contraindications identified in the systematic review. An expert consensus considers pHFs for which data were available to be as safe as CMP formula as growth is normal. The preventive effect on allergy of pHF in infants who are not at risk for allergic disease has been poorly studied. Cost of pHF versus starter formula with intact protein differs from country to country. However, further studies in larger populations are needed to clinically confirm the benefits of routine use of pHF in non-exclusively breastfed infants. These studies should also address potential consumer preference bias.
在非母乳喂养且不存在过敏风险的婴儿中，部分水解配方（pHF）与完整牛奶蛋白配方（CMP）相比，常规使用的指导和证据有限。本研究旨在通过系统评价和德尔菲专家小组共识，更清楚地阐明在非母乳喂养且不存在过敏风险的婴儿中常规使用 pHF 的问题。
对系统评价和德尔菲专家小组（由 8 位国际儿科过敏和胃肠病专家组成）进行了评估，以评估非母乳喂养且不存在过敏风险的婴儿中 pHF 的生长、耐受性和有效性的证据。
没有一项研究表明与非母乳喂养且不存在过敏风险的婴儿相比，使用 pHF 存在潜在危害。专家共识认为，鉴于研究表明这些配方具有可比的营养参数，使用 pHF 与使用完整的 CMP 配方一样安全。没有高质量的研究评估在非母乳喂养且不存在过敏风险的婴儿中使用 pHF 预防过敏疾病（例如，缺乏过敏史）。有限的数据表明，与 CMP 相比，pHF 在非母乳喂养且不存在过敏风险的婴儿中使用可能与改善胃排空、降低绞痛发生率和其他常见功能性胃肠道症状有关。但是，由于数据质量不高，必须谨慎对待这些研究的结果。没有发现直接比较不同类型 pHF 的研究，但专家共识认为，这些 pHF 产品的生长、致敏性、耐受性、有效性和临床作用可能不同。
系统评价中未发现评估非母乳喂养且不存在过敏风险的婴儿常规使用 pHF 的研究，也未发现禁忌证。专家共识认为，现有数据表明 pHF 与 CMP 配方一样安全，因为婴儿的生长正常。对于不存在过敏风险的婴儿，pHF 对过敏的预防作用研究甚少。pHF 与含有完整蛋白质的起始配方的价格因国家而异。然而，需要在更大的人群中进行进一步的研究，以在临床上证实非母乳喂养且不存在过敏风险的婴儿常规使用 pHF 的益处。这些研究还应解决潜在的消费者偏好偏差问题。
