Short-Term Gastrointestinal Tolerance and Oxygenation Changes After a Locust Bean Gum-Containing Formula in Preterm Infants: A Retrospective Paired Cohort Study

Background/Objectives: Gastrointestinal dysmotility, abdominal discomfort, and feeding-related respiratory instability are common in preterm infants. Although locust bean gum (LBG)-containing formulas are used for regurgitation, their short-term effects on gastrointestinal tolerance in neonatal intensive care settings are not well defined. We evaluated short-term changes in gastrointestinal tolerance and oxygenation after initiation of an LBG-containing formula and explored whether postmenstrual age (PMA) modified the response. Methods: This retrospective paired cohort study included 26 infants who received an LBG-containing anti-regurgitation formula, either alone or combined with human milk. Standardized ordinal scores (0–2) for stool consistency, straining, abdominal distension, gas passage, abdominal tenderness, mean oxygen saturation (SpO₂) category, and desaturation frequency were recorded at baseline (Day 0), Day 3, and Day 7. Paired comparisons were performed using the Wilcoxon signed-rank test, and PMA-stratified differences were explored using Kruskal–Wallis analysis. Results: By Day 7, soft/normal stools were observed in 96.2% of infants (p = 0.00017), severe straining resolved in 87.5% (p = 1.6 × 10⁻⁵), abdominal distension improved in 96.2% (p = 2.4 × 10⁻⁶), and gas passage normalized in all infants (p = 0.00025). Mean SpO₂ category improved significantly (p = 0.0023), and the proportion of infants with rare or no desaturation increased from 61.5% to 96.2%. Growth velocity remained clinically acceptable. Infants with PMA < 34 weeks showed the largest improvements across outcomes. Conclusions: In this retrospective paired cohort, initiation of an LBG-containing formula was associated with short-term improvement in gastrointestinal tolerance and oxygenation indices in preterm infants. Exploratory subgroup analyses suggested possible heterogeneity of response across postmenstrual age strata; these observations require confirmation in adequately powered prospective studies.