title: Should high-energy infant formula be given at full strength from its first day of usage?
abstract: OBJECTIVE
  To evaluate the feeding tolerance of a high-energy (1 kcal mL(-1)) infant formula (HEIF) for infants with faltering growth, weighing 2.5-8 kg, when administered at full strength from day 1 compared with stepwise introduction.
  
  
  METHODS
  Thirty infants (aged 2-43 weeks) from a supraregional children's hospital requiring a high-energy formula for faltering growth were randomly allocated to receive either a 1 kcal mL(-1) ready to feed infant formula at full strength from day 1 or the same formula in diluted form, graded to full strength over 3 days. Bowel actions, vomits and volume of feed taken were recorded daily for 2 weeks. Weight, length, head circumference and mid-upper arm circumference were recorded at recruitment and after 2 weeks.
  
  
  RESULTS
  The number of bowel actions in the first 2 days was significantly higher for the full strength group than for the stepwise group (P = 0.02); younger infants (<12 weeks) had more bowel actions over the first 2 days on the HEIF at full strength (Spearman's correlation = -0.5; P = 0.04); and infants with a total higher energy intake (kJ kg(-1)) had more frequent bowel actions over the first 4 days (Spearman's correlation = 0.48; P = 0.01). There was no significant difference between groups for growth or vomiting.
  
  
  CONCLUSIONS
  High-energy infant formula was generally well tolerated in infants under the age of 12 months with faltering growth when administered at full strength from day 1. However, younger infants (<12 weeks of age) may benefit from a graded introduction in order to avoid increased bowel frequency.
authors.affiliation: Dietetic Department, Birmingham Children's Hospital, Birmingham, UK. evanss21@onetel.com
authors.forename: Sharon
authors.initials: S
authors.lastname: Evans
authors.forename: H
authors.initials: H
authors.lastname: Twaissi
authors.forename: A
authors.initials: A
authors.lastname: Daly
authors.forename: P
authors.initials: P
authors.lastname: Davies
authors.forename: A
authors.initials: A
authors.lastname: Macdonald
mesh_terms: D004311:Double-Blind Method; D002149:Energy Intake / Q000502:physiology*; D005183:Failure to Thrive / Q000178:diet therapy*; D006128:Growth; D006801:Humans; D007223:Infant; D041943:Infant Formula / Q000008:administration & dosage*; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn / Q000254:growth & development*; D018709:Statistics, Nonparametric; D014839:Vomiting / Q000453:epidemiology*; D015430:Weight Gain