A Meta Analysis Of Clinical Application Of Hydrolyzed Protein Formula

Objective Hydrolyzed protein formula with digestible absorption，hypoallergenic andother characteristics has helped to improve gastrointestinal function and prevention of allergicdisease of infants，especially preterm infants clinically，but the findings are not consistent, thepurpose of this study is running a meta-analysis to further evaluate the efficacy of hydrolyzedprotein formula in clinical applications.Method Papers were retrieved from Medline, Embase, Elsevier, Ovid, CochraneLibrary and Chinese Academic Journal, WanFangDATA, VIP Chinese Scientific JournalsDatabase, Chinese Biomedical Literature Database such various domestic literature databasesup to the year of2013. RCT were assessed according to Jadad score, and using softwareapplication Revman5.2to analyze data comprehensively.Results24RCTs were included,12papers scored≥3points were divided intohigh-quality literature;12papers which scored≤2points were divided into low-qualityliterature.2308cases were included in the study. Meta analysis results showed:(1) HPF group (regardless the degree of protein hydrolysis, gestational age) comparedwith the control group：①HPF can promote the meconium excretion WMD (Weightedaverage)=-1.17（95%CI：-1.40,-0.94） p＜0.00001, quickly achieve total enteral feedingtime WMD＝-0.83（95%CI：-1.19,-0.46） p＜0.00001；②Length WMD=0.04(95%CI:-0.45.0.53), weight WMD=28.61(95%CI:-54.77,111.99), head circumference(WMD=0.7295%CI:-1.24,2.68), length growth rate WMD=0.03(95%CI:-0.08.0.14),weight growth rate WMD=1.83(95%CI:-1.78,5.44), with no significant difference betweenthe two groups (P>0.05);③Total plasma protein WMD=-0.37(95%CI:-2.63,1.89),albumin WMD=2.99, WMD=0.09,95%CI:(-1.99,7.98), calcium (95%CI:-0.22,0.39) andphosphorus WMD=0.15,95%CI:(-0.08,0.38) had no difference (P>0.05), for prealbuminWMD=0.02,95%CI:(0.01,0.03) and urea nitrogen WMD=0.49,95%CI:(0.08,0.90),theHPF group higher than the control group, but the reference95%CI value for the real significance is not clinical use.④HPF on eczema efficiency [RR=1.4895%CI（1.24，1.76）p＜0.00001] higher than that of the control group, the recurrence rate [RR=0.30,95%CI（0.17，0.50）p＜0.00001] lower than that of the control group.(2) Sub group of partially hydrolyzed protein formula(pHF) compared with control group:①Length WMD=-0.10(95%CI:-0.47.0.26), weight WMD=-120.56(95%CI:-428.13187.00)and head circumference WMD=0.61(95%CI:-2.11,3.33), with no significant differencebetween the two groups (P>0.05).②pHF on eczema efficiency [RR=1.4195%CI（1.05，1.89）p=0.02] higher than that of the control group.(3) Sub group of extensively hydrolyzed protein formula (eHF) compared with controlgroup:①eHF can promote meconium excretion WMD=-1.17(95%CI:-1.41,-0.94) d, P <0.00001, quickly achieve total enteral feeding time WMD=-1.41(95%CI:-1.99,-0.82) d, P <0.00001.②Length WMD=0.1595%CI:(-0.67.0.97), p=0.72, weight WMD=55.9195%CI:(-109.28221.09), p=0.51, with no significant difference between the two groups.③eHF on eczema efficiency [RR=1.6095%CI（1.24,2.06），p=0.0003] higher than that of thecontrol group.(4) Comparison the effects of HPF group and control group on early feeding in preterminfants:①HPF can promote meconium excretion WMD=-1.1795%CI:(-1.41,-0.94) d, P<0.00001, quickly achieve total enteral feeding time WMD=-1.4195%CI:(-1.99,-0.82) d, P<0.00001, reduce the incidence of feeding intolerance [RR=0.71,95%CI:（0.56，0.91）P=0.005].②Length WMD＝0.25（95%CI：-0.85,1.35），p=0.66, weight WMD＝-134.08（95%CI：-558.29,290.13），p=0.54, with no significant difference between the two groups.③HPF can increase serum motilin level [less than2days after birth WMD=85.0895%CI:(14.51155.64), p=0.02,7-10days WMD=123.4795%CI:(30.80216.15), p=0.009,12-15days WMD=136.4795%CI:(-17.65,255.29), p=0.02], GAS levels in the two groups at lessthan2days after birth WMD=-1.6095%CI:(-12.85,9.64) and7-10days WMD=2.2395%CI:(-7.10,11.55), showed no significant difference (P>0.05), but born12-15days WMD=16.3795%CI:(5.97,26.76), p=0.002,GAS of PHF group higher than the control group.④Anemia RR＝1.0695%CI：（0.74,1.52）, metabolic acidosis RR＝1.0295%CI：（0.61,1.70）, transient dysfunction of liver and kidney RR＝0.4595%CI：（0.18,1.12） during the period offeeding were all with no significant difference between the two groups.Conclusion （1） Hydrolyzed protein formula play a positive role in improvinggastrointestinal function in preterm infant as well as the treatment and prevention recurrent ofeczema.（2）Hydrolyzed protein formula(HPF) can promote the meconium excretion, achievedtotal enteral feeding in short time, more rapid recovery of birth weight, can meet the nutrientrequirement of infants.（3）Hydrolyzed protein formula can increase the level of serum motilin.