Whilst these guidelines advise on the appropriate choice of specialist infant formula, breast milk remains the optimal choice for infants. This should be promoted and encouraged where it is clinically safe to do so.
Indications
Infants will have had their pre-term nutrient enriched post discharge formula commenced on discharge from the neonatal unit by a paediatrician or paediatric dietitian, for continuation in primary care.
It is started for some babies born before 34 weeks gestation, weighing less than 2kg at birth who are not breast fed, and who require catch up growth.
These formulas should not be used in primary care to promote weight gain in babies other than those born prematurely.
Onward Referral
These infants should already be under regular review by a paediatrician.
If there are concerns regarding growth whilst the infant is on these formulas, seek advice from the paediatric dietitian.
Review and Discontinuation of Treatment
These products should be discontinued by 6 months corrected age* unless there is poor weight gain. If poor weight gain, continue formula and refer or seek advice from the paediatric dietitian.
Monitoring of growth (weight, length and head circumference) should be carried out by the Health Visitor whilst the baby is on these formulas.
If there is excessive weight gain at any stage up to 6 months corrected age*, stop the formula.
*6 months corrected age is ‘Estimated Due Date’ plus 26 weeks.
Choice of Formula
Powders versus Liquids
Powdered feeds to be used routinely. Liquid feeds should only be prescribed on recommendation of a specialist dietitian where there is a clinical need. For example in immunocompromised patients or situations where powdered feed cannot be made up safely.
Pre-term Infant Formula (powder)
Not to be routinely initiated in primary care.
SMA Gold® Prem 2 Powder
Birth up to a maximum of 6 months corrected age.
Nutriprem® 2 Powder
Birth up to a maximum of 6 months corrected age.
Pre-term Infant Formula (Liquid)
Not to be routinely prescribed unless there is a clinical need as advised by secondary care.
SMA Gold® Prem 2 Liquid
Birth up to a maximum of 6 months corrected age.
Nutriprem® 2 Liquid
Birth up to a maximum of 6 months corrected age.
Breast Milk Fortifier
Very rarely these products may be recommended post discharge by the neonatal consultant or paediatric dietitian; in these cases it should be provided by the hospital.
Vitamin and Mineral Supplementation in Pre-Term Infants
All pre-term infants are started on iron supplements on the Neonatal unit at 4 to 6 weeks of age and are discharged on Sytron 1ml once daily (unless on a high calorie infant formula or a post discharge pre-term infant formula). Iron supplementation should be continued in primary care until weaned onto a balanced diet, which includes a good source of iron such as red meat (this is often up until 1 year of actual age).
All pre-term infants born less than 34 weeks gestation or less than 1800g birth weight, on breastmilk or standard infant formula, are given 0.6ml Abidec® on discharge and this is to be continued in primary care until 1 year corrected age. After this, follow Department of Health guidelines which recommend all children are given a daily supplement containing vitamins A, C and D. These can be purchased from pharmacies or supermarkets. Patients who qualify for Healthy Start are entitled to free vitamin drops.
Infants on a post discharge pre-term formula or on a high calorie formula (e.g. Infatrini® or SMA® High Energy), do not require an iron or multivitamin supplement. If these formula are stopped before 6 months of age then Sytron® and Abidec® should be restarted.