INFANT FORMULAS:

NUTRIENT COMPOSITION &

CONCENTRATION CALCULATIONS
NUTR 6100 Clinical Track
Laboratory Session 1
February 7, 2013

Ashley Goodell, FAS Project, Spring 2013

Agenda

General infant formula information

Types

of formulas
Mixing formulas

Calculations
Large

group examples
Practice in pairs

Questions / Wrap-Up

Infant Formula Basics

Quick group review
Standard formulas
Soy formulas
Protein hydrolysate formulas
Amino-acid based formulas (Elemental)
Follow-up formulas

Infant Formula Companies

Abbott Nutrition

Mead Johnson

Neocate Infant

PBM Nutritionals

Gerber Good Start

Nutricia North America

Enfamil, ProSobee, Enfacare, Nutramigen, Pregestimil

Nestl

Similac, Isomil, Neosure, Alimentum, Elecare

Bright Beginnings and other privatelabel/generic infant formulas

Wyeth

International, used to make generic formulas in U.S.

Premature Infants

Options:
Human

milk fortification
Premature infant formulas: 20 or 24 kcal/oz
Similac

Special Care 30 kcal/oz

Transitional

formulas: 22 kcal/oz

Premature formula vs. Standard:

Increased

kcal, protein, vitamins, minerals

Typically <1800 g and up to 2500 g

Premature Infant Formulas

www.abbotnutrition.com

www.enfamil.com

Fortification of Human Milk

Addition of standard formula powder or liquid

1 tsp standard formula + 100 mL BM = ~24 kcal/oz

Human Milk Fortifier (HMF)

Cows milk based
1 packet will add 2 kcal/oz per 50 mL formula

22 kcal/oz = add 1 packet per 50 mL formula

24 kcal/oz = add 2 packets per 50 mL formula

Prolacta
Condensed donor milk
Available in +4, +6, +8, and +10 concentration
Downside: VERY expensive

www.enfamil.com

Modulars

Modular products can be added to formula to

increase calories and/or protein.

Carbohydrate

Protein

Polycose (Abbott) Beneprotein

23 kcal/tbsp.
(Nestle)
(3.8 kcal/g)
4 g PRO/tbsp.
17 kcal/tbsp.

Fat
Microlipids
(Nestle)
4.5 kcal/mL
MCT oil (Nestle)
7.7 kcal/mL

Whats Wrong with Cows Milk?

During a WIC nutrition consult, a mother tells you

she has stopped breastfeeding and has started
giving her 8-month-old baby whole milk in a bottle.
What would you tell her?

Whats Wrong with Cows Milk?

AAP recommends that whole cows milk should not
be fed to infants during the first year of life.
Because
Inappropriate nutrient content

iron, linoleic acid, and vitamin E

sodium, potassium, chloride, and protein

Microscopic GI bleeds & blood loss

Intact

proteins hard on immature GI tract

Can lead to iron-deficiency anemia

Whats Wrong with Cows Milk?

Stress on the kidneys

More

concentrated protein and electrolytes results in a

high renal solute load
Can lead to dehydration
Worse during acute illness and fever, caloric dense
diet, and during renal disease and diabetes

Increased risk of allergic reaction

Case Study #1

18 m.o. girl is currently well under the 5th

percentile on the WHO weight-for-length growth
charts and has been admitted to PCMC for
stomach problems and failure to thrive. Family
lives on a farm in Cache Valley. Mom mentions that
she stopped breastfeeding baby at 8 months and
started giving her goats milk instead.
Do you see a problem?!

Others

The following should also not be fed to an infant

before 12 months of age:
Low-fat

or skim cows milk

Goats milk
Evaporated milk
Sweetened condensed milk
Soy, almond, rice beverages

All images from amazon.com

Mixing Formulas: Standard Prep

Powdered formula:
1

scoop powder to 2 oz water

Water should be added to bottle first, then
appropriate scoops of formula second.
Use provided formula scoop!
Powders

between formula brands vary in fluffiness and

scoops are therefore not interchangeable.

Liquid Concentrate:
1

oz formula concentrate to 1 oz water

Case Study #2

An 8 m.o. baby boy, admitted with fever, vomiting, and

diarrhea. MD notices babys growth since last visit is
inadequate and asks for RD consult.
Current Anthropometrics: 75th for length, between 10th
and 25th for weight, under the 5th for weight-forlength, with OFC at 50th percentile
Nutrition Interview:
About

five 6 to 7oz bottles daily

Two scoops powdered formula per 6 oz water

Do you see a problem?

Calculations
Daily Requirements
Nutrient Composition
Concentration of Formula

Important Conversion Factors

30 cc = 30 mL = 1 fluid oz
1 scoop standard powder formula = 40 kcals*
1 fl. oz. standard liquid concentrate = 40 kcal*
Standard infant formula = 20 kcal/oz prepared
0.67

kcal/mL or cc

Breast milk = 20 kcal/oz

Nutrients expressed as per 100 kcal

Assessing Needs

Energy, protein, fluid needs depend on

Age
Current

weight
Adequacy of growth
Current state of health

Use PCMC Expected Growth & Calorie Needs chart

Assessing Fluid Needs

Holliday-Segar Method:

Usual Intake for Infants

Age

Frequency of
Feedings

Volume per
Feeding

Total Volume
per Day

0-4 months

8-12

2-6 ounces

18-32 ounces

4-6 months

4-6

4-6 ounces

27-36 ounces

6-8 months

3-5

6-8 ounces

24-40 ounces

8-12 months

3-4

7-8 ounces

24-32 ounces

Practice Problems

Determine energy, protein, and fluid needs:

2.5

week old girl weighing 3.4 kg

13 month old boy weighing 10.6 kg

Nutrient Content of BM & Formula

A newborn infant is currently consuming about

2 ounces of Similac Advance every 2.5 hours.
Calculate her 24-hour kcal, protein and fluid intake.

Another Practice Problem

A 10 m.o. baby boy consumes about four 7-8 ounce

bottles of Enfamil ProSobee LIPIL each day.
Calculate

kcal, protein, and fluid intake.

Now lets go backwards

A couple has just adopted their first child, a

4-month-old baby girl, and they just want to be
reassured that she is getting the nutrition she needs.
The baby currently weighs 6.4 kg. They are
currently buying Nestle Goodstart Supreme.
Calculate this baby girls daily energy, protein, and
fluid needs and provide the parents with a total
volume of formula needed per day.

Practice Problem

A 6 m.o. baby girl currently weighs 7.1 kg.

Calculate

her energy, protein, fluid needs

Calculate total volume of Enfamil LIPIL needed each
day to fulfill these requirements.

Concentrating Formulas

Indications for increasing caloric density:

Failure

to thrive or inadequate growth

Increased energy needs due to illness
Fluid restriction
Baby unable to consume adequate volume

Cautions:

renal solute load = risk of dehydration

May not be tolerated
Risk of vitamin & mineral toxicities

Calculating Formula Concentrations

Calculate the caloric concentration of the following:

2

scoops 20 kcal/oz powder to make 4 oz formula

scoops 20 kcal/oz powder to make 5 oz formula

oz water added to 13 oz liquid concentrate

Calculating Formula Concentrations

Now, the other way.

How

many scoops of standard formula powder would

yield a 5-oz bottle of 24 kcal/oz formula?
How many ounces of water should be added to 6
ounces of liquid concentrate to yield a 22 kcal/oz
formula?
How many packets of HMF would need to be added to
5 oz of breast milk to yield a 24 kcal/oz solution?

Questions?