In preterm infants formula feeding is often associated with hard stools, delayed gastrointestinal transport and constipation. As these problems can hamper tolerance to enteral feeding, it is desirable to attain a reduction of stool viscosity and acceleration of gastrointestinal transport.
To investigate whether a mixture of prebiotic OS (a mixture of 90% Galacto-oligosaccharides and 10% Fructo-oligosaccharides) would improve feeding tolerance in preterm infants on full enteral formula feeding. The hypotheses were that prebiotic OS would: 1. reduce stool viscosity and 2. accelerate gastrointestinal transport.
In a placebo-controlled, double-blind trial, 20 preterm infants on full enteral nutrition were randomly allocated to have their feedings supplemented with either prebiotic OS (1g/100 ml) or a placebo for 14 days. The mean gestational age was 27 (range 24–31) weeks, postnatal mean age 42 (range 11–84) days, and weight at study entry was 1,570g (range 1,080–2,300). Stool viscosity was measured by high-pressure capillary rheometry. Gastrointestinal transport time was assessed as the time from feeding carmine red to its appearance in the nappy.
Birthweight, gestational age, postnatal age, and weight at study entry did not differ between groups.
In the group receiving the prebiotic OS-supplemented formula, stool viscosity was significantly decreased at day 14 compared to the placebo group (32 (2-67) versus 158 (24-314) N; p=0.006). The prebiotic OS-supplemented group also showed a higher proportion of soft stools compared to the placebo group at day 14 (Figure 1).
The difference in gastrointestinal transit time between baseline and day 14 was significantly shortened in the prebiotic-supplemented group (p=0.037), whereas no significant difference was observed in the placebo group (Figure 2).
No adverse effects were observed.
Formula supplementation with prebiotic OS reduced stool viscosity and accelerated gastrointestinal transport in preterm infants. Further trials are required to investigate whether prebiotic OS facilitate enteral feeding advancement and early enteral nutrition, thereby eventually reducing the incidence of catheter-related nosocomial infections and improving long-term outcomes.