breast milk and infant formulas lori s. brizee ms, rd, csp clinical dietitian children’s hospital...
Post on 20-Dec-2015
218 Views
Preview:
TRANSCRIPT
Breast Milk and
Infant Formulas
Lori S. Brizee MS, RD, CSPClinical Dietitian
Children’s Hospital and Regional Medical Center
Human Milk and Infant Formulas:
Breast milk
Standard Infant Formulas
Premature Infant Formulas
Specialty Infant Formulas
Modular Additives
Breast Milk Characteristics
First choice feeding for MOST infants Immunologic factors
Protective against diarrhea causing infections and otitis in infants
Trophic to GI tractWell tolerated by infants with short bowel
Fatty acids important to brain/visual development
Breast Milk vs Standard Milk Based Formulas
Energy: slightly higher
Protein: Lower, but higher quality (whey and casein)
Renal Solute load: Lower
Carbohydrate: Mainly lactose
Fats: Long chain; DHA/AA (lipases increase absorption)
Common Challenges with Breast Feeding
Baby sided problems Illness preventing/interfering
with early feeding Anatomic malformations Sleepy baby Thrush
Common Challenges with Breast Feeding Sleepy Baby
Sleep cycles REM sleep-----deep sleep (15 min
+/-) ----wake (quiet alert) If cannot wake, in deep sleep, try
again in 15+/- minutes Watch for hunger cues e.g., sucking
on hands
Common Challenges with Breast Feeding Sleepy Baby
Waking techniques Hold by armpits and dangle Put feet on hard surface Spin around Last resort: stroke palate with finger
until sucking, then take finger out and put nipple in.
Common Challenges with Breast Feeding
Mom sided problems Low milk supply
Frequent feeding, pump after feeding Medications: Reglan, Domperidone
Fenugreek Sore Nipples Clogged ducts Mastitis Yeast Infection
Breast Feeding: Is baby getting enough?
Regain birthweight by 1 week Newborn to 2 months gain > 1
ounce per day Newborn to 4-6 weeks: 2-10 bowel
movements per day Bowel movements are better clue
than wet diapers.
Standard Infant Formulas, Milk or Soy Based………..
Formula Brands Ross
Similac/Isomil/Alimentum Mead Johnson
Enfamil/Prosobee/Enfacare Nestle
Good Start Wyeth
Generic in USA; Gold Brands; SMA SHS
NeoCate, DuoCal
Milk Based Formulas
Standard 0-12 months Similac with/without iron Enfamil with Good Start Essentials/Good Start Supreme Wyeth Generic
Standard 0-12 mos with DHA/ARA Similac Advance with iron Enfamil Lipil with/without iron Good Start Supreme DHA/ARA Wyeth formulas
Milk Based Formulas
Older Infant and toddler formulas Similac 2 Advance (9-24 mos) Enfamil Next Step Lipil (9-24 mos) Good Start 2 Essentials (4 to24 mos) Wyeth Generic “follow on formulas”
Increased Calcium Increased protein (Good Start and Enfamil) Intended to compliment nutrients in solid milk
Milk Based FormulasCharacteristics
Blend of Whey and Casein Proteins (8.2-9.6 % total calories)
Carbohydrate: lactose
Fats: long chain
Meet needs of healthy infant
Soy Formulas
Isomil/Isomil DF /Isomil Advance/Isomil Advance 2
Prosobee/Prosobee Lipil/Next Step Prosobee
Good Start Essentials Soy/Good Start 2 Essentials Soy
Wyeth All iron fortified
Soy FormulasCharacteristics compared to Milk Based
Higher protein (lower quality) Higher sodium, calcium, and
phosphorus Carbohydrate: Corn syrup solids,
sucrose, and/or maltodextrin; lactose free Fats: Long chain Meet needs of healthy infants
Predigested protein based infant formulas
Protein Hydrolysate Formulas
Alimentum Advance Pregestimil/Pregestimil Lipil Nutramigen Lipil
Protein Casein hyrolysate + free AA’s
Fat (Alimentum and Pregestimil) Medium
chain + Long chain triglycerides;
(Nutramigen) Long chain triglycerides
Carbohydrate: Lactose free
Elemental formula for infants
Elemental Infant Formula
NeoCate (SHS)Protein: Free Amino AcidsFat: Long chainCarbohydrate: Lactose FreeIndications for use: Food Allergy or
intolerance to peptides or whole protein
Premature Infant Breast Milk Additives and Formulas
Enfamil Human Milk Fortifier Similac Human Milk Fortifier
Powdered breast milk additives
Similac Natural Care Advance Liquid breast milk additive
Similac Special Care Advance
Enfamil Premature +/- Lipil
Premature FormulasGeneral Characteristics compared to Standard
Increased Protein,Vitamins & Minerals
For infants born at <1.5kg up to 2000-2500gm
Feeding of infants > 2500 gm risk of vitamin toxicities
Premature formulas vary in nutrient content
Post Premature Infant formula
“Post” Premature Formulas
NeoSure Advance EnfaCare Lipil
Standard Dilution: 22 kcal/oz Protein: between standard and Premature Vitamins: Higher than standard,significantly
lower than Premature Calcium and Phosphorus: between standard
and Premature
Other Specialty Formulas
Portagen (Mead Johnson)85% fat MCT, 15% fat Corn oilUsed for infants with chylothorax
Similac PM 60/40 (Ross)Low in Ca, P, K+ and NA; 2:1 Ca:P ratioUsed for infants with Renal Failure
Formulas for Metabolic DisordersSeveral condition specific products by Ross
and Mead Johnson
Modular Products to Increase Energy/Protein
Modular Products to increase Energy or Protein
Carbohydrate Fat Protein
Polycose (Ross)
MicroLipid (Mead Johnson)
ProMod (Ross)
Moducal (Mead Johnson)
Safflower Oil Casec (Mead Johnson)
Super Soluble DuoCal (SHS)
Products to Augment Energy and Protein in Breast Milk
Human Milk Fortifiers For Premature infants less than 2000-
2500gm only
Standard Infant Formula Powder* 1 teaspoon to 100mL = 24kcal/oz+/-
Do Not Add CHO or Fat w/o protein: Final product is TOO LOW in protein
Finding Up to Date Information
www.ross.com Similac products
www.meadjohnson.com Enfamil products
www.verybestbaby.com Nestle products
www.wyethnutritionals.com generic products
www.brightbeginnings.com lower cost formulas made
by Wyeth www.shsna.com/html/Hypoallergenic.htm
Neocate formulas
When Baby is Not Growing
Normal Weight gain and linear growth Guo et al J Pediatrics 1991
Assess Feeding
Number feedings/day
Feeding environment
BF: baby “empties” breasts each feeding
Formula: volume per feeding
Vomiting? Diarrhea? Medical issues that increase
needs/decrease intake?
When Baby is Not Growing
Increase number of feedings/day
If baby <6 months d/c solids, increase breast milk or formula
Monitor weight weekly
If no improvement in 1 week consider increasing caloric concentration of breast milk or formula to 24 kcal/oz.
When Baby is Not Growing
In cases of increased need due to medical condition or fluid limit, may need to go higher than 24 kcal/oz
In all cases monitor closely watch for Signs of dehydration (baby may take less volume of
concentrated feed) Vomiting Diarrhea
Increasing Caloric Density of Formula
Concentrate formula (decrease water added):
* Calculate kcals desired (e.g. 30 oz of 24 kcal/oz formula = 720kcal)
* Divide kcals by kcal/oz of liquid or scoop of powder (e.g. 720 kcal divided by 40 kcal/oz liquid conc. = 18 oz liquid conc. Formula).
* Add water to make final volume (12 oz water + 18 oz liquid conc. Formula = 30 oz 24kcal/oz formula)
Using Modulars to Increase Calories
Example: Making 30 oz of 30 kcal per oz formula (30oz X 30kcal/oz = 900 kcal)
* Start with 24 kcal/oz formula: 24kcal/oz X 30oz = 720 kcal
* 900kcal - 720 kcal = 180 kcal from modulars
* Use Polycose and Micro lipid to make up additional kcals (approximately 90 kcal of each)
Using Modulars to Increase Calories continued
* Polycose 23 kcal/TBSP 90 kcal /23kcal/TBSP =3.9TBSP (use 4 TBSP X 23
kcal = 92 kcal; still need 88 kcal)
* Microlipid 4.5 kcal/mL 88 kcal/4.5 kcal/mL =19.55 mL (use 20 mL X 4.5
kcal = 90 kcal)
Final calculation: 720kcal + 92 kcal + 90 kcal =
902 kcal/30oz =30.07 kcal/oz
Know What You Are Feeding Caloric density, protein, fat and carbohydrate vitamin and
mineral content. Osmolality: goal is for <400mOsm/kg H2O; can slowly go
up to 700 Meds/modulars increase osmolality
Renal Solute Load: goal is for less than 300mOsm/l (all infant and pediatric meet this recommendation when concentrated up to 30 kcal/oz.) Addition of protein will increase Renal Solute Load
top related