TABLE 1

CLASS Breast milk Term formula

Infant Formulas and their Indications

BRAND NAMES Gerber Good Start Gentle Enfamil Premium Infant; Good Start Protect; Similac Advanced Enfamil Premature; Similac Special Care 24 with Iron Enfacare; Similac Neosure Enfamil Prosobee; Good Start Soy; Similac Isomil Similac Sensitive CALORIES (KCAL PER OZ) 20 20 20 CARBOHYDRATE SOURCE Lactose Lactose Lactose PROTEIN SOURCE Human milk Cows milk Cows milk INDICATIONS Preferred for all infants Appropriate for most infants Marketed to promote eye and brain development <34 wk gestational age Weight < 1800 g 3436 wk gestational age Weight ! 1800 g Congenital lactase deficiency, galactosemia Congenital lactase deficiency, primary lactase deficiency, galactosemia Milk protein allergy

Term formula with DHA and ARA Preterm formula

24

Lactose

Cows milk

Enriched formula Soy formula

22 20

Lactose Corn-based

Cows milk Soy

Lactose-free formula

20

Corn-based

Cows milk

Hypoallergenic formula Nonallergenic formula

Similac Alimentum; Enfamil Nutramigen; Enfamil Pregestimil Elecare; Neocate Infant; Nutramigen AA Enfamil AR; Similac Senstive for Spit-Up

20

Corn or Sucrose

Hydrolyzed proteins Amino acids Cows milk

20 20

Corn or Sucrose Lactose (thickened with rice starch)

Milk protein allergy Gastroesophageal reflux

20 Childrens Health

Antireflex formula

Adapted from OConnor NR. Infant formula. Am Fam Physician 2009;79:56570. Abbreviations: ARA arachidonic acid; DHA docosahexaenoic acid.

1080

(for formula-fed infants) and should assess the number of wet diapers and stools daily. Initially infants should consume 10 to 15 mL per feeding for the first 24 to 36 hours, gradually increasing to 30 to 45 mL by the fourth day of life. Breast-fed infants should feed 15 to 20 minutes each side. At the time of discharge to home, all newborns should be feeding 8 to 12 times a day, or every 2 to 3 hours. This interval can be increased to every 4 hours at night, and parents should be encouraged to wake any infants who sleep for longer than this duration. If an infant has lost more than 10% of his or her birth weight, the care team should consider delaying discharge to review the infants nutritional status and feeding habits. Caregivers should be attentive to infant cues of hunger and satiety to provide an ideal feeding pattern for each infant. Voiding and stooling patterns change with age and can also be influenced by the infants diet. All newborns should have at least one wet diaper and one stool within the first 24 hours of life. If this does not occur, close observation and further work-up is indicated to rule out structural or metabolic abnormalities. During the first week of life, infants usually void and stool with every feeding or even more often. Beyond the first week, infants should have at least 4 to 6 voids daily regardless of diet. Formula-fed infants might have one stool every other day up to 2 to 3 stools daily. Because of the higher percentage of protein that is absorbed in breast milk, breast-fed infants can go up to 10 days between stools. Physicians should review with families the signs and symptoms (emesis, refusal to feed, lethargy, inconsolability, and abdominal distention) that indicate an infant with infrequent stooling should be medically evaluated. Breast-fed infants also have stools that are described as loose, yellow, and seedy. Caregivers should be educated that this is a normal stool color and consistency and is not considered diarrhea. Medical providers can also calculate an infants nutritional needs and compare to the actual intake. Nutritional needs are

represented as kcal/kg per day (KKD). The following formula can be used: KKD Volume in mL consumed in 24 h 20 kcal=oz Weight in kg 30

During the first 3 months of life, infants should consume an intake that equals 90 to 135 kcal/kg per day. This intake goal should lead to a weight gain of approximately 25 to 30 g daily. From 3 to 6 months of age, infants gain at a slightly slower rate of approximately 15 to 20 g per day (Table 2). For example, a 2-month-old who weighs 6 kg should consume between 810 mL to 1215 mL daily. At subsequent visits an infant can be assessed for adequate growth using standardized, gender-specific growth curves. Attention should be paid to growth parameters including weight, length, head circumference, and weight-for-length. Weightfor-length charts are used during the first 2 years of life as a gross equivalent to body-mass-index charts used for children older than 2 years. For years, practices defined adequate weight gain using growth charts as designed by the National Center for Health Statistics (NCHS), a branch of the Centers for Disease Control and Prevention (CDC). These charts were last

TABLE 2

Expected Growth Velocities during Infancy

WEIGHT GAIN (g/d) 2530 1520 10 LENGTH (cm/mo) 2.5 2.5 1.25 HEAD CIRCUMFERENCE (cm/wk) 0.5 0.5 0.25

AGE 03 mo 36 mo 612 mo