Growth of infants born to HIV-positive mothers fed a whey-adapted acidified starter formula with prebiotics and nucleotides

Abstract

Objectives: The objectives of this study were to evaluate whether infants born to known HIV-positive mothers, but who were not themselves infected with HIV and who were fed a chemically acidified starter formula with prebiotics with or without nucleotides during their first six months, displayed growth rates equal to uninfected infants fed a chemically acidified starter formula without prebiotics or nucleotides. Design: The design was a multi-centre, double-blinded randomised controlled trial. Setting: The study was carried out in four academic hospitals, three in Johannesburg and one in Cape Town, South Africa. Subjects and intervention: The subjects were newborn infants born to consenting HIV-positive women who had previously decided not to breast feed. The infants were randomised to receive one of three milk formulas. The intervention comprised chemically acidified formula without prebiotics or nucleotides, with prebiotics only, or with prebiotics and nucleotides. Outcome measures: The outcome measures were the growth parameters through the first six months of life. Results: Of the 150 randomised infants, 50 did not complete the study and 16 (12.8% of those tested) were infected with HIV, leaving 84 infants available for analysis. All three formulas were tolerated well, with no differences in growth parameters seen with the addition of prebiotics and nucleotides. The growth rates of the study infants up to the age of six months were very good, showing an increase in Z-scores from negative values at the time of enrolment in the first week after birth to around zero for length and > 0.5 for weight. Conclusions: The three chemically acidified formulas were tolerated well and resulted in good growth over the first six months of life. No benefits were seen with the addition of prebiotics or nucleotides. The growth rates were similar to those found in previous studies of ours on biologically acidified formulas. The chemical acidification of infant formulas appears to be a realistic alternative to biological acidification should an acidified formula be required.