Navigating Infant Formula – - PowerPoint Presentation

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Navigating Infant Formula –Everything We Need to Know, But Don’t Always Want to Ask

Adrienne Z. Udarbe, MS, RDN

Pinnacle Prevention

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OverviewInfant Formula Review by Indications for Use

Navigating the Options with Caregivers

Partnering with Providers for Success

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First and Foremost

“Breast milk is the optimal source of nutrition for the infant but, when breast milk is not available, iron-fortified infant formula is an appropriate alternative for the infant’s first year of life.”

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FormulationIn comparison to breastmilk:

Lower in fat

Higher in carbohydrate, protein, and minerals

48-50% Fat

40-45% CHO

9% PRO

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Review – Indications for Use

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Milk-Based FormulasIndication: Standard milk-based for full-term infants 0-12 months

Composition:

~ 8% Protein (Whey:Casein ratios vary by brand)

~ 48% Fat

~ 44% CHO

Ingredients: Nonfat milk, lactose, vegetable oil (palm olein, coconut, soy and high oleic sunflower oils), whey protein concentrate…

19 kcal and 20 kcal

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Soy-Based Formulas

Indication: Few indications over a cow milk-based formula. Limited to infants with galactosemia and hereditary lactase deficiency (rare) and in situations in which a vegetarian diet is preferred.

For infants with documented cow milk protein allergy, extensively hydrolyzed protein formula should be considered, because 10% to 14% of these infants will also have a soy protein allergy.

Composition:

~ 10% Protein (Partially hydrolyzed Soy)

~ 46% Fat Palm olein oil, soy oil, coconut oil, high oleic safflower or sunflower oil, and single cell oil)

~ 44% CHO (Maltodextrin, sucrose)

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Lactose-Free FormulasNot to be confused with reduced-lactose formulas, such as Similac Sensitive or Similac Total Comfort, with is hydrolyzed milk-based proteins

Ingredients and composition similar to soy-based

Lactose replaced by another sugar, usually corn syrup and sucrose

See Hypoallergenic

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Hypoallergenic Formulas

Indication: For infants with diagnosed allergy, protein sensitivity to intact proteins, or fat malabsorption

Examples: Alimentum, Nutramigen, Pregestimil (For Fat Malabsorption such as with Steatorrhea, Cystic Fibrosis, or Short Bowel Syndrome), Gerber Extensive HA

Lactose-Free and Galactose-Free

Composition:

~ 11% Protein - Hydrolyzed (Casein Hydrolysate, L-Cystine, L-Tyrosine, L-Tryptophan)

~ 48% Fat (Safflower Oil, Medium-Chain Triglycerides, Soy Oil, DHA, ARA)

~ 41% CHO (Corn Maltodextrin, Sugar)

Gerber Extensive HA: 100% hydrolyzed whey protein and 49% MCT

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Metabolic FormulasIndication: For the specialized nutrient needs of individuals who have an inherited metabolic disorder.

Composition varies by formula in relation to metabolic condition

Examples:

Abbott: Calcilo XD, Cyclinex, Glutarex, Hominex, I-Valex, Phenex, Pro-Phree, Propimex, ProViMin, RCF, Tyrex

Mead Johnson: BCAD, GA, HCY, LMD, OA, PFD, Phenyl-Free, Tyros, WND

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Premature FormulasIndication: Increased caloric density, protein, and some vitamins and minerals compared to standard term formula to help support weight and growth in babies born prematurely.

Examples: Enfamil Enfacare and Similac Expert Care Neosure

Composition:

~11-13% Protein, ~44-47% Fat, ~42-43% CHO

22 kcal/oz, 24 kcal/oz, and 30 kcal/oz

Not lactose-free or galactose-free

Other considerations: Renal Solute Load, see manufacturer website and consult with medical team (consider growth vs stress)

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Increased Calorie PrepIndication: For infants who need more calories with less volumeLiquid concentrate and powdered formula recipes tailored by desired calories per ounce

Recommended to use liquid concentrate when possible for increased calorie preparation Rx’s

Manufacturer websites have dilution/yield guides as well

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Human Milk FortifiersIndication: May be recommended by a provider for premature or low birth weight breast fed infants to be added to expressed breast milk

Ingredients: water, whey, MCT oil, vegetable oil, vitamins, minerals

~32% protein, ~62% fat, ~6% CHO

Preparation:

Available in powder and concentrate

2 kcal/oz with 50 mL (1.7 ounces) breastmilk = 1 packet powder

4 kcal/oz with 25 mL (0.8 ounces) breastmilk = 1 packet powder

Caution with ELBW infants due to hypercalcemia

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Other…“Closest to Breastmilk”Stages: Premature, Newborn, Infant, Toddler

Expert Care

For Spit-Up

Fortifiers

“Organic”/”Non-GMO”

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Marketing

Sooth

Gentle

Bursting with Happiness

For Supplementation

Tummy Troubles

Fussy Babies

Natural Defense

Easy to Digest

Comfort Proteins

Etc.

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Navigating the Options with Caregivers

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Perception vs Condition

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Changing Formulas

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Responding to Concerns

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Partnering with Providers for Success

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Opportunities with Providers – You’re the Expert

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Questions?adrienneudarbe@pinnacleprevention.org