The identified trials provide only low quality evidence about the effects of feeding preterm infants  with protein hydrolysate versus st and ard formula .
The existing data did not support conclusions that feeding with protein hydrolysate affects the risk of feed intolerance or necrotising enterocolitis .
BACKGROUND When human milk is not available for feeding preterm infants , protein hydrolysate rather than st and ard cow 's milk formulas ( with intact proteins ) are often used because they are perceived as being tolerated better and less likely to lead to complications .
However , protein hydrolysate formulas are more expensive than st and ard formulas , and concern exists that their use in practice is not supported by high- quality evidence .
OBJECTIVES To assess the effect of feeding preterm infants with hydrolysed formula ( versus st and ard cow 's milk formulas )  on the risk of feed intolerance , necrotising enterocolitis , and  other morbidity and mortality in preterm infants .
PP-15 THE EFFECT OF EXTENSIVELY HYDROLYZED PROTEIN FORMULA IN PRETERM INFANTS WITH SYMPTOMATIC GASTRO-OESOPHAGEAL REFLUX
Background : Gaestroesophageal reflux ( GER ) occurs commonly in infants especially preterm infants . Current anti-reflux medication has shown limited therapeutic benefits for this age group . Our study aims to evaluate the efficacy of extensively hydrolyzed formula feed ( EHFF ) compared to st and ard infant formula ( SF ) on GER episodes in preterm infants using Multichannel intraluminal impedance and pH monitoring ( MII-pH ) . Methods : This is a prospect i ve crossover trial involving preterm infants > 29 weeks corrected gestation age with symptoms of GER . All patiets were recruited from a single tertiary neonatal unit in Singapore . MII-pH was performed over 48 hours . For the first 24 hours the infants were either fed on st and ardized infant formula ( SF ) or Expressed Breast Milk ( EBM ) depending on maternal choice . For the second 24 hours their feeds were changed to EHFF . All infants were on orogastric/nasagastric tube feeding and were given 2 to 3 hourly bolus feeding throughout the study period . Results : 23 infants completed the study : 14males : 9 females . Mean weight 2971 g ( SD + 1569 g ) . None of the patients were on any anti-reflux medications ( apart from one ) . Type of feeds during first 24 hours were EBM 8/23(35 % ) , SF 5/23(22 % ) or mixed feeding 10/23(43 % ) . GER symptoms were : desaturations16/23(70 % ) , cough 8/23(35 % ) , arching7/23 ( 30 % ) , vomit 3/23(13 % ) , crying2/23(8 % ) and apnoea1/23 ( 4 % ) . The median total GER episodes ( detected by pH and MII ) was significantly lower during the EHFF period compared to SF/EBM period 42(21–71 ) vs 68(32–104 ) p < 0.001 . The median acidic reflux episodes detected by pH was also significantly lower in EHFF vs SF/EBM period 8(4–24 ) vs 23(3–58 ) p < 0.005 . Total number of refluxes detected by MII showed a significant reduction for EHFF compared to SF/EBM : 17(11–56 ) vs 46(20–65 ) p < 0.015 . There was no difference in reflux index , MII bolus exposure indexes , and number of long lasting episodes ( > 5 min ) between the 2 groups . There were no significant difference in the number of symptoms recorded between the two study period . Conclusions : Our data suggest that the number of gastroesophageal reflux was significantly lower in preterm infants fed with EHFF compared to st and ard formula as measured by pH-MII monitoring . EHFF may potentially be an effective treatment modality for gastroesophageal reflux disease in infants with minimal side-effects . The lack of symptom reduction during EHFF despite fewer GER episodes suggests that other pathology other than GER should be considered . A larger study is required to further evaluate the efficacy and mechanism of EHFF on reduction of GER in infants
The identified trials provide only low quality evidence about the effects of feeding preterm infants  with protein hydrolysate versus st and ard formula .
The existing data did not support conclusions that feeding with protein hydrolysate affects the risk of feed intolerance or necrotising enterocolitis .
BACKGROUND When human milk is not available for feeding preterm infants , protein hydrolysate rather than st and ard cow 's milk formulas ( with intact proteins ) are often used because they are perceived as being tolerated better and less likely to lead to complications .
However , protein hydrolysate formulas are more expensive than st and ard formulas , and concern exists that their use in practice is not supported by high- quality evidence .
OBJECTIVES To assess the effect of feeding preterm infants with hydrolysed formula ( versus st and ard cow 's milk formulas )  on the risk of feed intolerance , necrotising enterocolitis , and  other morbidity and mortality in preterm infants .