支持常规使用部分水解配方(pHF)与完整牛奶蛋白(CMP)配方的指导和证据在非纯母乳喂养的婴儿中受到限制。本综述的目的是通过系统评价和DelphiPanel共识,更好地阐明非纯母乳喂养婴儿常规使用pHF的问题,这些婴儿没有过敏性疾病的风险。
进行了系统评价和德尔菲共识小组(由8位国际儿科变态反应学家和胃肠病学家组成),以评估支持生长的证据,耐受性,以及pHF在非纯母乳喂养婴儿中的有效性。
在非纯母乳喂养的婴儿中,与CMP相比,没有一项研究发现使用pHF的潜在危害。专家一致认为,使用pHF可能与完整的CMP配方一样安全,鉴于研究表明这些具有可比的营养参数。没有发现高质量的研究来评估使用pHF来预防没有过敏性疾病风险的非纯母乳喂养婴儿的过敏性疾病(例如,缺乏父母的过敏史)。有限的数据表明,在非纯母乳喂养的婴儿中使用pHF可能与改善胃排空有关,绞痛发生率降低,与CMP相比,其他常见的功能性胃肠道症状。然而,因为数据质量不足,这些研究的结果必须谨慎对待。没有研究确定直接比较不同类型的pHF,但是有一个专家共识,增长,变应原性,耐受性,有效性,和这些pHF产品之间的临床作用可能不同。
评估非纯母乳喂养婴儿常规使用pHF的数据有限,在系统评价中没有发现禁忌症。专家共识认为,可获得数据的pHF与CMP公式一样安全,因为生长正常。对没有过敏性疾病风险的婴儿对pHF过敏的预防作用研究甚少。pHF与完整蛋白质的起始配方的成本因国家而异。然而,需要在更大人群中进行进一步的研究,以在临床上证实非完全母乳喂养婴儿常规使用pHF的益处.这些研究还应解决潜在的消费者偏好偏差。
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.