NICU

Formula Feeding

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Formula Feeding, Bottle Feeding, Term Formula, Enriched Formula, Preterm Formula, Soy Formula, Lactose-Free Formula, Hypoallergenic Formula, Nonallergenic Formula, Antireflux Formula, Toddler Formula

  • Management
  • Formula Amounts (Human Milk needs no supplementation)
  1. Age 0-1 weeks: 15-20 ounces/day (term infant)
    1. Calculation: 5 oz/kg/day (150 ml/kg/day) divided over 6-8 feeds/day
    2. Per-feed: 1-2 ounces every 2-3 hours (increases to 2-4 ounces/feed after first 1-2 weeks)
    3. Calories: 150 kcal/kg/day
  2. Age 0-1 months: 18-24 ounces/day
  3. Age 1-2 months: 22-28 ounces/day
  4. Age 2-3 months: 25-32 ounces/day
  5. Age 3-4 months: 28-32 ounces/day
  6. Age 4-5 months: 27-39 ounces/day
  7. Age 5-6 months: 27-45 ounces/day
  • Types
  1. Term Formula
    1. Commercial products: Enfamil with iron, Similac with Iron, Carnation Good Start
    2. Cow's Milk formula with lactose carbohydrate source and 20 kcals/ounce
    3. Preferred option for most term infants
  2. Term Formula with long-chain polyunsaturated Fatty Acids
    1. Commercial products: Enfamil Lipil, Good Start DHA/ARA, Similac Advance
    2. Cow's Milk formula with lactose carbohydrate source and 20 kcals/ounce
    3. DHA and ARA postulated to improve eye and brain development (no benefit in most RCTs)
  3. Enriched Formula
    1. Commercial products: Enfacare, Similac Neosure
    2. Cow's Milk formula with lactose carbohydrate source and 22 kcals/ounce
    3. Indicated as transition from Preterm Formula to Term Formula for those 34-36 weeks, >1800 g
  4. Preterm Formula
    1. Commercial products: Enfamil 24 premature, Preemie SMA 24, Similac 24 Special Care
    2. Cow's Milk formula with lactose carbohydrate source and 24 kcals/ounce
    3. Indicated for hospitalized Premature Infants <34 weeks gestation and <1800 gram weight
  5. Soy Formula
    1. Commercial products: Enfamil Prosobee, Good Start Soy, Similac Isomil
    2. Soy Formula with corn-based carbohydrate source and 20 kcals/ounce
    3. Indicated for Galactosemia, congenital Lactase Deficiency, Vegan families
    4. Not indicated for colic, milk protein allergy or Acute Gastroenteritis recovery
  6. Lactose-Free Formula
    1. Commercial products: Enfamil Lactofree, Similac Sensitive
    2. Cow's milk formula with corn-based carbohydrate source and 20 kcals/ounce
    3. Indicated for Galactosemia, Lactase Deficiency, Gastroenteritis recovery in low weight infants
    4. Not indicated for colic (nothing is, although may be tried) or milk protein allergy
  7. Hypoallergenic Formula
    1. Commercial products: Similac Alimentum, Enfamil Nutramigen, Enfamil Progestimil
    2. Hydrolyzed formula with corn or sucrose-based carbohydrate source and 20 kcals/ounce
    3. Indicated for milk protein allergy (Eczema, Asthma)
  8. Nonallergenic Formula
    1. Commercial products: Elecare, Neocate, Nutramigen AA
    2. Amino acid formula with corn or sucrose-based carbohydrate source and 20 kcals/ounce
    3. Indicated for milk protein allergy, Atopy (Eczema, Asthma)
  9. Antireflux Formula
    1. Commercial products: Enfamil AR, Similac Sensitive RS
    2. Cow's Milk formula, lactose-based thickened with rice starch and 20 kcals/ounce
    3. Indicated for Gastroesophageal Reflux
      1. Typically this is made at home by thickening Term Formula with rice cereal.
  10. Toddler Formula
    1. Commercial products: Enfamil Next Step, Good Start 2, Similac Go and Grow
    2. Cow's Milk formula with lactose carbohydrate source and 20 kcals/ounce
    3. Marketed as transition or alternative to whole milk, but no evidence of benefit
  • Management
  • Feeding Timing
  1. Normal frequency: 6 or more feedings per day
  2. Normal feeding time per bottle: 20-30 minutes
  3. Short feeding time: <15 minutes
    1. Consider purchasing nipple with smaller holes
  4. Long feeding time: >35 minutes
    1. Consider increasing nipple hole size
  • Management
  • Formula Preparation
  1. Heating formula
    1. Formula only needs to be room Temperature
    2. Mix formula after heating, test against parent's skin
  2. Use formula immediately after preparation
    1. Discard any unused formula in bottle
  • Management
  • Sanitation of bottles
  1. Carefully wash all bottles and nipples before use
  2. Use only hot, soapy water (no need to sterilize)