Journal of Clinical Nutrition & Dietetics

Growth and Tolerance with an Amino Acid Based Enteral Formula: A Two-year Retrospective Study from a Children's Rehabilitation Hospital

Background: This study aimed to identify characteristics of a medically complex pediatric population that was fed an amino acid-based formula containing Medium-Chain Triglycerides (AA-MCT).

Methods: We examined calorie/protein prescription and intake, formula tolerance, concomitant use of Gastrointestinal (GI) medications, and growth (weight, height, Body Mass Index (BMI) z-scores). We reviewed medical records of children from a Hospital Rehabilitation Center, identifying those with a history of a tube-fed formula switch to the AA-MCT (n=23). We recorded demographic data (age, sex, diagnosis) and compiled outcomes data (formula intake, tolerance, GI medications, growth) at key time points over two years (pre-switch, at switch and post-switch).

Results: At AA-MCT initiation, mean age was 7.5 years and 48% of children had evidence of GI dysfunction. Atopic dermatitis and food allergies were present in 22%, others had genetic or metabolic disorders with severe GI impairment. Following switch to AA-MCT, mean calorie and protein intake increased, weight and height for age measures, and BMI z-scores were within expected ranges for most children. A reduction in GI medications was observed for some after the switch.

Conclusions: Children with medical complexity switched to AA-MCT formula demonstrated growth. Formula was well tolerated, as shown by increased intake of formula, appropriate growth for age and BMI z-scores up to 1 year post-switch.

Keywords: Amino acid formula; Pediatric nutrition; Medically complex child; Enteral nutrition; Gastrointestinal impairment; Malabsorption; Cow’s milk protein allergy.

Acronyms: AAF: Amino acid-based formula; AA-MCT: Amino acid-based formula, Alfamino® Junior; AAP: American academy of pediatrics; BMI: Body max index; CMPA: Cow’s milk protein allergy; CP: Cerebral palsy; EH: Extensively hydrolyzed; EoE: Eosinophilic esophagitis; ESPGHAN: European society for pediatric gastroenterology hepatology and nutrition; FPIES: Food protein-induced enterocolitis; GERD: Gastroesophageal reflux disease; GI: Gastrointestinal; MCT: Medium-chain triglycerides; WHO: World health organization.

Author(s): Amy Hulsey*, Pamela Cekola, Aimee Henrikson, Heidi Reichert, Sarah S Cohen and Krysmaru Araujo Torres

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