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Not yet recruitingNCT07549360LOTUSUpdated Apr 24, 2026

Leveraging Optimal Tolerance in Undernourished Infants to Support Growth

An interventional study of Infant Formula in Faltering Growth and Failure to Thrive, sponsored by Dutch Medical Food. Not yet recruiting at 1 site in Thailand. Open to participants aged 1 Month to 12 Months. Per ClinicalTrials.gov, last updated 2026-04-24.

Sponsored by Dutch Medical Food · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
35
Allocation
Not applicable
Ages
1 Month to 12 Months
Sex
All
01

Study 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.

Read the 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.

02

Conditions studied

  • Faltering Growth
  • Failure to Thrive

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Keywords

  • Faltering Growth
  • Failure to Thrive
  • Energy and Nutrient Dense Formula
  • LOTUS
  • Infacore
03

Who can participate

Ages eligible
1 Month to 12 Months
Sexes eligible
All
Accepts healthy volunteers
No

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

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
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Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrollment
35 participants (estimated)

Study arms

  • Active comparator
    Interventional

    Other: Infant Formula

Interventions

  • OtherInfant Formula

    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.

    Also known as: Energy and Nutrient Dense Infant Formula (ENDF)

05

What researchers measure

Primary outcomes

  1. Body Weight

    Body Weight

    Time frame: 8 weeks

  2. Change in body weight

    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.

    Time frame: 8 weeks

06

Study locations

1 site
  • Department of Pediatrics, Faculty of Medicine, Chulalongkorn University
    Bangkok, Bangkok 10330, Thailand
    • Chonnikant Visuthranukul, MD, PhD · Contact · deknet@gmail.com · +66 2256 4000
07

References and documents

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. PubMed 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. PubMed 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. PubMed 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. PubMed 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. PubMed 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. PubMed 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. PubMed 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. PubMed 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. PubMed 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. PubMed 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. PubMed 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. PubMed 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. PubMed 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. PubMed 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. PubMed 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

Individual participant data

Plan to share: Undecided

08

Registry details

Key details

Study ID
NCT07549360
Lead sponsor
Dutch Medical Food
Responsible party
Sponsor
First posted
Apr 24, 2026
Start date
May 15, 2026 (estimated)
Primary completion
May 15, 2026 (estimated)
Completion
May 15, 2027 (estimated)
Last update
Apr 24, 2026

Study contacts

Chonnikant Visuthranukul, MD, PhD
Contact
deknet@gmail.com
+66 2256 4000 ext. 4903
Eakkarin Mekangkul, MD
Contact

Oversight

FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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