Leveraging Optimal Tolerance in Undernourished Infants to Support Growth

NCT07549360 — Not applicable, Not yet recruiting, 35 participants, Dutch Medical Food

ClinicalTrials Daily  ·  Areas  ·  Conditions  ·  Drugs  ·  Sponsors  ·  
RegistryNCT07549360, acronym LOTUS
StatusNot yet recruiting
PhaseNot applicable
Study typeInterventional; na, single group, masking: none, treatment
Enrollment35 (Estimated)
SponsorDutch Medical Food (Industry)
ConditionsFaltering Growth, Failure to Thrive
InterventionsInfant Formula (Other)
Datesstart 2026-05-15 (estimated), primary completion 2026-05-15 (estimated), completion 2027-05-15 (estimated), first posted 2026-04-24, last updated 2026-04-24
Locations1 site in Thailand

Related Papers Related Patents Related Grants Related Experts
All trials for Faltering Growth All trials for Failure to Thrive All trials of Infant Formula

-Summary

The goal of this study is to learn if InfaCore (IC) an energy and nutrient dense formulation (ENDF) can improve growth and tolerance in infants with or at risk of growth faltering when fed IC.

Expand all sections  ·  Collapse all

+Detailed description

Rationale: The definition of FG/FTT was established by a group of experts in a report published in 2023 (Cooke et al., 2023). In this report they agreed a fall in weight-for-age z-score (WAZ) of ≥1.0 SD over a period of 1 or more months (excluding the first 2 weeks after birth) which includes at least 2-3 growth measurements (Cooke et al., 2023). It is also important to consider infants at risk who have static weight for extended periods e.g., >/=4 weeks. FG/FTT affects different populations and is estimated to be 10% of infants globally.

InfaCore (IC) an energy and nutrient dense formulation is indicated for infants and young children with FG/FTT defined above or for those at risk of developing e.g., with static weight for extended periods. At risk infants might include some or all of the following those with congenital heart disease (CHD) admitted for surgical procedures, those with critical illness (CI) or on the PICU, infants cystic fibrosis (CF) or other respiratory conditions including chronic lung disease (CLD), some forms of severe cerebral palsy (CP), and those requiring a surgical procedure or post-surgery.

Objective: To demonstrate growth and tolerance in infants with or at risk of growth faltering when fed IC an Energy and Nutrient Dense Formula (ENDF).

Study design: A prospective, single-centre, single-arm open label pilot study to show growth and tolerance in infants with/at risk of FG/FTT when fed an ENDF for 8 weeks.

+Arms and interventions

ArmTypeInterventionsDescription
InterventionalActive comparatorOther: Infant Formula
  • Infant Formula (Other), also known as Energy and Nutrient Dense Infant Formula (ENDF): Prospective, single-center, single-arm open label pilot study to show growth and tolerance in infants with/at risk of FG/FTT when fed an ENDF for 8 weeks.

+Outcome measures

Primary outcomes

  • Body Weight [8 weeks]: Body Weight
  • Change in body weight [8 weeks]: The primary outcome is the change in weight-for-age Z-score from baseline to study completion, regardless of whether the value increases or decreases.

+Eligibility

Sex: All, ages: 1 Month to 12 Months

Inclusion Criteria:

* Infants aged from 1 month to </=12 months of age
* Infants taking at least 50% of daily intake from infant formula
* Diagnosis of FG (a fall in WAZ of ≥1.0 SD over 1 month or more - not including the first 2 weeks after birth) or risk of FG (static weight for >/= 1 month)
* Infants >/=37 weeks gestation at time of recruitment
* Parent/ legal guardian willing to provide written informed consent

Exclusion Criteria:

* Exclusively Breastfed infants
* Infants with other medical problems that might independently affect intake (oral or otherwise) or who have specific nutrient needs not met by IC e.g. some gastrointestinal malformations, some renal and liver conditions, inborn errors of metabolism, galactosemia
* Infants on total parenteral nutrition
* Infants with cow milk protein allergy
* Infants with soy allergy
* Infants who participated in other studies within 2 weeks prior to recruitment
* Situations where the investigator has concerns about the willingness or ability of the parents/caregivers to comply with protocol requirements
* Infants who are on a vegan diet
* Infants who are allergic to fish
* Infants born preterm <37 weeks gestation

+Locations (1)

FacilityCityCountryStatus
Department of Pediatrics, Faculty of Medicine, Chulalongkorn UniversityBangkok, BangkokThailand

+Publications

  • Zhang H, Gu Y, Mi Y, Jin Y, Fu W, Latour JM. High-energy nutrition in paediatric cardiac critical care patients: a randomized controlled trial. Nurs Crit Care. 2019 Mar;24(2):97-102. doi: 10.1111/nicc.12400. Epub 2018 Dec 9. PMID 30548121
  • World Health Organization (WHO). Child Growth Standards. [Online]. Available from: https://www.who.int/tools/child-growth-standards/standards/weight-for-age (Accessed August 2025).
  • Joint WHO/FAO/UNU Expert Consultation. Protein and amino acid requirements in human nutrition. World Health Organ Tech Rep Ser. 2007;(935):1-265, back cover. PMID 18330140
  • Valla FV, Berthiller J, Gaillard-Le-Roux B, Ford-Chessel C, Ginhoux T, Rooze S, Cour-Andlauer F, Meyer R, Javouhey E. Faltering growth in the critically ill child: prevalence, risk factors, and impaired outcome. Eur J Pediatr. 2018 Mar;177(3):345-353. doi: 10.1007/s00431-017-3062-1. Epub 2017 Dec 14. PMID 29243190
  • Shoham J, Duffield A. Proceedings of the World Health Organization/ UNICEF/World Food Programme/United Nations High Commissioner for Refugees Consultation on the management of moderate malnutrition in children under 5 years of age. Food Nutr Bull. 2009 Sep;30(3 Suppl):S464-74. doi: 10.1177/15648265090303S306. No abstract available. PMID 19998867
  • Pineda D, Bingham R, Gates A, Thompson AB, Stansfield BK. Osmolality of fortified donor human milk: An experimental study. JPEN J Parenter Enteral Nutr. 2024 Jan;48(1):57-63. doi: 10.1002/jpen.2558. Epub 2023 Sep 17. PMID 37608726
  • Novak EM, Innis SM. Impact of maternal dietary n-3 and n-6 fatty acids on milk medium-chain fatty acids and the implications for neonatal liver metabolism. Am J Physiol Endocrinol Metab. 2011 Nov;301(5):E807-17. doi: 10.1152/ajpendo.00225.2011. Epub 2011 Jul 26. PMID 21791621
  • Jackson AA. Protein requirements for catch-up growth. Proc Nutr Soc. 1990 Oct;49(3):507-16. doi: 10.1079/pns19900059. No abstract available. PMID 2080182
  • Hulst JM, Zwart H, Hop WC, Joosten KF. Dutch national survey to test the STRONGkids nutritional risk screening tool in hospitalized children. Clin Nutr. 2010 Feb;29(1):106-11. doi: 10.1016/j.clnu.2009.07.006. Epub 2009 Aug 13. PMID 19682776
  • Food And Nutrition (FAO). Technical report series 1. 2001. [Online]. Available from: https://openknowledge.fao.org/server/api/core/bitstreams/65875dc7-f8c5-4a70-b0e1-f429793860ae/content (Accessed August 2025)
  • Eveleens RD, Dungen DK, Verbruggen SCAT, Hulst JM, Joosten KFM. Weight improvement with the use of protein and energy enriched nutritional formula in infants with a prolonged PICU stay. J Hum Nutr Diet. 2019 Feb;32(1):3-10. doi: 10.1111/jhn.12603. Epub 2018 Oct 14. PMID 30318663
  • Evans S, Twaissi H, Daly A, Davies P, Macdonald A. Should high-energy infant formula be given at full strength from its first day of usage? J Hum Nutr Diet. 2006 Jun;19(3):191-7; quiz 199-201. doi: 10.1111/j.1365-277X.2006.00689.x. PMID 16756534
  • Ellis ZM, Tan HSG, Embleton ND, Sangild PT, van Elburg RM. Milk feed osmolality and adverse events in newborn infants and animals: a systematic review. Arch Dis Child Fetal Neonatal Ed. 2019 May;104(3):F333-F340. doi: 10.1136/archdischild-2018-315946. Epub 2018 Dec 6. PMID 30523072
  • EUROPEAN DIRECTIVE - COMMISSION DELEGATED REGULATION (EU) (2016) - of 25 September 2015. Supplementing Regulation (EU) No 609/2013 of the European Parliament and of the Council as regards the specific compositional and information requirements for food for special medical purposes. 128. [Online]. Available from: file:///C:/Users/garve/Downloads/CELEX_32016R0128_EN_TXT.pdf
  • EUROPEAN DIRECTIVE - COMMISSION DELEGATED REGULATION (EU) (2016). Compositional and information requirements for infant formula and follow-on formula. 127. [Online]. Available from: https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:32016R0127&qid=1650372664210&from=EN. (Accessed 2025)
  • Cooke R, Goulet O, Huysentruyt K, Joosten K, Khadilkar AV, Mao M, Meyer R, Prentice AM, Singhal A. Catch-Up Growth in Infants and Young Children With Faltering Growth: Expert Opinion to Guide General Clinicians. J Pediatr Gastroenterol Nutr. 2023 Jul 1;77(1):7-15. doi: 10.1097/MPG.0000000000003784. Epub 2023 Mar 28. PMID 36976274
  • Clarke SE, Evans S, Macdonald A, Davies P, Booth IW. Randomized comparison of a nutrient-dense formula with an energy-supplemented formula for infants with faltering growth. J Hum Nutr Diet. 2007 Aug;20(4):329-39. doi: 10.1111/j.1365-277X.2007.00805.x. PMID 17635310
  • Braegger C, Decsi T, Dias JA, Hartman C, Kolacek S, Koletzko B, Koletzko S, Mihatsch W, Moreno L, Puntis J, Shamir R, Szajewska H, Turck D, van Goudoever J; ESPGHAN Committee on Nutrition:. Practical approach to paediatric enteral nutrition: a comment by the ESPGHAN committee on nutrition. J Pediatr Gastroenterol Nutr. 2010 Jul;51(1):110-22. doi: 10.1097/MPG.0b013e3181d336d2. PMID 20453670
  • Ballard O, Morrow AL. Human milk composition: nutrients and bioactive factors. Pediatr Clin North Am. 2013 Feb;60(1):49-74. doi: 10.1016/j.pcl.2012.10.002. PMID 23178060
  • Alsharkawy A, Foud E, Mujahed A et al. Nutritional assessment and rehabilitation in children with bronchiectasis and childhood interstitial lung diseases: effects on pulmonary functions and clinical severity. Egypt Pediatric Association Gaz 2021;69, 42