Modular nutritional supplements

Modular nutritional supplements

Most premature infants require >120 kcal/kg/d enterally to thrive. Micropremies may require a higher caloric intake than this to achieve catch-up growth. Furthermore, infants with cardiopulmonary disease (esp. BPD) have a higher energy expenditure and may require 130 -150 kcal/kg/d for appropriate growth.

As premature infants are often relatively fluid-restricted (due to CLD or GERD), it can be difficult to achieve adequate caloric intakes for some infants even with breast milk fortifiers and preterm formulas. Patients who are have inadequate growth rates on full volume 24 kcal/oz feeds may need additives in their feeds to increase their nutritional value/caloric density.

Carbohydrate additives	Calories	Amount to add to increase calories by 2 kcal//oz
polycose powder	8 kcal/tsp	¼ tsp to each oz of feeds
polycose liquid	2 kcal/cc	1cc to each oz of feeds

Fat additives	Calories	Amount to add to increase calories by 2 kcal//oz
MCT oil	7.7 kcal/cc	0.25 cc to each oz
Corn oil	8.4 kcal/cc	0.25 cc to each oz

Physicians should specify the means via which they wish to achieve a caloric increase in the orders, with guidance from a nutritionist. When adding > 2 kcal/oz to a formula, attempt to maintain a balance of fat and carbohydrate intake.

Dietary services will prepare specialized formulas in 16 oz. batches. The nurses prepare fortified breast milk using specific recipes.

Babies who are able to tolerate full feeds of EPF, SSC, or breast milk supplemented with HMF are receiving the recommended intake of ~3.5 g/kg/d of protein. However, if a baby is fluid restricted, protein intake is also limited. Also, if the baby is fed breast milk supplemented with SNC, average protein delivery is only 2.4 g/kg/d on full feeds. These babies should have a protein supplement added to their feeds. Babies on adequate calories who are gaining weight but have poor linear growth (< 1 cm/week) should also be considered for a protein supplement.

ProMod is a powdered protein supplement derived from whey. One gram of ProMod contains 0.76g protein. (1 tsp ProMod adds ~1 g protein.) As Dietary services makes 16 oz of a specialized formula at a time, the amount of ProMod to add to provide an individual infant with a target protein intake requires multiple calculations.

Kira Mollenkopf, the NICU nutritionist, (beeper #835-8955), can assist in calculating appropriate additives and caloric intakes for our small patients.

References:

Premer DM, Georgieff MK. Nutrition for ill neonates. Pediatrics in Review 1999; 20: e56-e62. http://www.pedsinreview.org/cgi/content/full/20/9/e56

Kuschel CA, Harding JE. Protein supplementation of human milk for promoting growth in preterm infants. Cochrane Database of Systematic Reviews. http://www.nichd.nih.gov/cochrane/kuschel3/kuschel.HTM