Mixing instructions for fortified breastmilk and infant ...

1 infant nutrition Mixing instructions and formula descriptionsPresented by Randall Children s Newborn Services and DietitiansStandard infant formula recipes for term infantsEnfamil Newborn, infant , Gentlease, Pregestimil*, ProSobee, Enfamil AR (fortify with regular Enfamil), Nutramigen*Similac Advance (20 kcal/oz only), Alimentum, PM 60/40, Isomil (20 kcal/oz only), Similac OrganicGerber GoodStart GentleFortified BreastmilkDesired kcals/ozBreastmilk (add first)Powder2290 mL (3 oz) tsp2490 mL (3 oz)1 tsp2690 mL (3 oz)1 tsp2790 mL (3 oz)2 tsp3090 mL (3 oz)3 tspReady to Feed Formula + PowderDesired kcals/oz20 kcal/oz Ready to Feed (add first)Powder2290 mL (3 oz) tsp2490 mL (3 oz)1 tsp2690 mL (3 oz)1 tsp2790 mL (3 oz)2 tsp3090 mL (3 oz)3 tspDesired kcals/oz24 kcal/oz Ready to Feed Enfamil (add first)Powder2710 0 mL1 tsp3010 0 mL2 tspPowder OnlyDesired kcals/ozWater (add first)Powder20 (directions on can)60 mL (2 oz)1 scoop22165 mL ( oz)3 scoops24150 mL (5 oz)3 scoops26180 mL (6 oz)4 scoops27210 mL (7 oz)5 scoops30225 mL ( oz)6 scoops* Use a packed scoop/teaspoon for Nutramigen and Pregestimil (tsp = teaspoon using household/cooking measuring spoon; scoop = scoop provided in formula can).

2 All other powders should be loosely infant formula recipes for preterm infantsEnfamil EnfaCareSimilac NeoSureFortified BreastmilkDesired kcals/ozBreastmilk (add first)Powder2290 mL (3 oz) tsp2490 mL (3 oz)1 tsp2690 mL (3 oz)1 tsp2790 mL (3 oz)2 tsp3090 mL (3 oz)3 tspReady to Feed Formula + Powder (EnfaCare only)Desired kcals/ozReady to Feed* (add first)Powder2490 mL (3 oz) tsp2690 mL (3 oz)1 tsp2790 mL (3 oz)1 tsp3090 mL (3 oz)2 tsp*Standard concentration of transitional ready to feed is 22 kcal/ozPowder OnlyDesired kcals/ozWater (add first)Powder22 (directions on can)60 mL (2 oz)1 scoop24150 mL (5 oz)3 scoops26195 mL ( oz)4 scoops27180 mL (6 oz)4 scoops30210 mL (7 oz)5 scoopstsp = teaspoon (using household/cooking measuring spoons) scoop = scoop provided in formula can(continued)

3 Mixing instructions for fortified breastmilk and infant formulaCHC-4356 2016 infant FormulasFormulaDescription UseBreast milk/donor milkAll infants preterm or term infantsEnfamil/Similac AdvanceStandard milk-based formulaTerm infantsGerber Good Start/Similac Total Comfort100% whey protein formulaTerm infants GentleaseMilk-based formula with reduced levels of lactose and partially hydrolyzed proteinTerm infantsSimilac SensitiveReduced lactose, used for fussiness and gas related to lactose sensitivity Term infantsEnfamil ARMilk-based formula, including added rice to thicken formula upon contact with gastric acidsTerm infants who spit up frequentlyProSobee/IsomilSoy isolate formula, lactose/sucrose-free Note 40% chance of cross-sensitivity to soy protein with cow s milk protein with lactose intolerance and some cow s milk protein intolerance.

4 Galactosemia: use IsomilAlimentumHypoallergenic formula; lactose-free, extensively hydrolyzed protein, 33% MCT oil (medium-chain triglyceride)Severe food allergy, protein sensitivity/maldigestion, and fat malabsorptionNutramigenHypoallergenic formula; lactose/sucrose-free, extensively hydrolyzed proteinInfants who are sensitive to cow s milk proteinPregestimilHypoallergenic formula; lactose/sucrose-free, extensively hydrolyzed protein, 55% fat from MCT oil Infants with fat malabsorptionMonogenWhey protein-based formula with 90% MCT oil, not nutritionally complete (vitamins and minerals)Infants requiring decreased long-chain fatty acids, chylothoraxEnfaportMilk-based formula with 84% MCT oil, comes in liquid concentrate formInfants requiring decreased long-chain fatty acids, chylothoraxNeocate/EleCare/PurAmino/Alfa minoHypoallergenic amino acid-based formula containing MCT oilInfants with cow s milk allergy and multiple food protein intoleranceEnfaCare/NeoSureTransitional formula with extra protein (milk-based)

5 , vitamins and minerals at levels in-between premature and term formulaInfants born prematurely, used for 3 12 months CGAPM 60/40 Low-iron infant formula with decreased mineral contentInfants with hypocalcemia due to hyperphosphatemia or impaired renal functionRandall Children s Newborn ServicesLegacy Lactation ServicesNutrition and lactation follow-up service for patients who are breastfeeding or receiving fortified breast Children s Hospital at Legacy Emanuel, PortlandPhone: 503-413-2800 Legacy Good Samaritan Medical Center, PortlandPhone: 503-413-7533 Legacy Meridian Park Medical Center, TualatinPhone: 503-692-7509 Legacy Mount Hood Medical Center, GreshamPhone: 5 03 - 674 -1719 Legacy Salmon Creek Medical Center, VancouverPhone: 360 - 487-5840 Legacy Silverton Medical Center, SilvertonPhone: 503-873-1513 Randall Children s Pediatric Development and RehabilitationPediatric dietitians and Feeding ClinicPhone: 503-413-4505 October 2016 Please reference accompanying co-management and referral guideline on nutrition management of preterm infants after hospital discharge online at