Breast Milk Compared with a Specialised Formula: An Evaluation of the Effect of Using a Hydrolysed Thickened Formula in the Management of Cow’s Milk Allergy in Infants: Scooping review

Abstract

Abstract Background: Mothers’ milk is the gold standard for delivering nutrition to most infants. However, some medical conditions interfere with the infant’s assimilation of mothers’ milk, such as cows’ milk allergy (CMA). Consequently, infants’ formulas aim to mimic breast milk (BM) in composition and function while avoiding the inclusion of cows’ milk. Regurgitation is a common complication associated with CMA and can be avoided by using a suitable formula. Objective: This scoping review assesses the effect of thickened hydrolysed formula on regurgitation, stools and weight gain in babies with CMA. Also, it compares the composition of BM with that of a commercially specialised CMA formula. Methodology: A literature search was conducted using the PubMed, Medline, Cochrane, Web of Science and Science Direct databases to identify trials published over the last 10 years that assessed the use of a specialised thickened hydrolysed formula with infants < 18 months who had CMA. These studies evaluated the impact of the thickened hydrolysed formula on regurgitation, weight gain and stool consistency. Studies that assessed and compared the composition of BM and the specialised CMA formula were also included. Reference lists of the articles identified were cross-checked manually. Results: A total of six trials studying 403 infants with CMA met the inclusion criteria. Based on the literature review, thickened hydrolysed formula reduced regurgitation and improved stool consistency in the majority of the infants included. The infants’ weight gain was not affected significantly. However, the clinical efficacy was dependent on the type of formula and thickeners. No clear differences could be identified regarding the effect of specific hydrolysates or thickeners. The specialised CMA formula was found to have a relatively similar composition to the BM, and it was able to provide the nutritional requirements of infants with CMA. Conclusion: A thickened hydrolysed formula is a good milk alternative for infants with CMA, successfully reducing the frequency of regurgitation episodes and improving stool consistency. Furthermore, the composition of the commercial CMA formula mimics the composition of BM fairly closely.