SMA Pro Gold Prem Number 2 Baby Milk, 400 g

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Speak to parents and offer them written information (this guideline or PIL or both if they would like). Specific written consent is not needed but information should be available for parents so they understand why we choose to use probiotics and then document this in the notes (as we do for blood transfusion.) Current evidence does not support the firm recommendation of one strategy among the many alternatives, however published data indicate that: Gastric residuals up to 2ml in infants <750g and up to 3ml in infants 750g – 1500g were treated as normal in the studies by Mihatsch and Bertino(54,16). We have been leading in baby nutrition research for over 100 years and are proud to introduce our ranges of SMA ® PRO Follow-on and Growing Up Milk, SMA ® ADVANCED Follow-on and Growing Up Milks and LITTLE STEPS ® Follow-on Milk which can be used as part of a varied balanced diet. All have been expertly developed with nature in mind to help support babies’ unique nutritional needs. These contain vitamins A, C and D, as well as iron.

However, some infants with feed intolerance may have significant intra-abdominal or other problems. Bellander. M. et al(2003) Tolerance to early human milk feeding is not compromised by Indomethacin in preterms with PDA. ActaPaediatrica: 921074-8 Leeds Primary Care: Prescribing specialist infant formula in Cow’s Milk Protein Allergy (CMPA), Gastro-oesophageal reflux disease (GORD) & lactose intolerance

Morgan J., Bombell S., McGuire W. (2013) Early trophic feeding versus enteral fasting for very preterm or very low birth weight infants. Cochrane Database Syst Rev CD000504 Karagianni P. et al (2010) Early versus delayed minimal enteral feeding and risk for necrotising enterocolitis in preterm growth restricted infants with abnormal antenatal Doppler results. Am J Perinatol; 27(5):367-73 Jocson MAL, Mason EO, Schanler RJ.(1997) The Effects of Nutrient Fortification and Varying Storage Conditions on Host Defense Properties of Human Milk. Pediatrics; 100(2):240-43. ESPGHAN. (2010) Enteral Nutrient Supply for Preterm Infants: Commentary from European Society for Paediatric Gastroenterology, Hepatology, and Nutrition Committee on Nutrition. JPGN;50:1-9. Modi .N (2006) Donor Breast Milk Banking – unregulated expansion requires evidence of benefit (letter) BMJ; 333:1133-4

Chauhan M. et al (2008) Enteral Feeding for very low birth weight infants – reducing the risk of necrotising enterocolitis. Arch Dis Child Fetal Neonatal Ed 93:F162-66 Gastric feeding stimulates digestive processes whereas transpyloric feeding has the potential benefits of delivering nutrients past the pylorus and gastro oesophageal junction for the management of gastro oesophageal reflux (GOR) disease. These feeds have to be continuous, which may account for the reduction in symptoms of GOR. Transpyloric feeding is not routinely recommended in preterm infants as no benefits have been found and they have been associated with a greater incidence of gastrointestinal disturbance. (22) Colaizy TT1, Carlson S, Saftlas AF, Morriss FH Jr. (2012) Growth in VLBW infants fed predominantly fortified maternal and donor human milk diets: a retrospective cohort study. BMC Pediatr; 12:124Grey Drugs are locally-agreed medicines which are only recommended for restricted use within the Leeds Health Economy. Human milk is the preferred feed for premature infants as it offers in the short term, strong protection against infection and necrotising enterocolitis (NEC), and in the long term improved neurocognitive development. Recent evidence shows the reduction in NEC risk using human milk to be dose dependent. (59) Gastric motility more rapidly normalises if feeds are started early and offered frequently rather than being withheld.(50) Despite this feeds are frequently stopped, or advances held on the basis of “feed intolerance”. The definition of intolerance includes not only the presence and colour of gastric residuals, but also vomiting, increases in abdominal girth or abdominal tenderness, presence of abnormal or blood stained stool, absence of bowel sounds, abdominal wall discolouration, or a combination(1). As all of these can occur in the healthy premature infant who is tolerating feeds(55) careful clinical assessment is essential to prevent unnecessary limitations of enteral feeds, reliance on parenteral nutrition, increase nosocomial infection, delay enteral feeding and poor growth. Corvaglia L., Martini S., Battistini B., Rucci P., Aceti A., Faldella G. (2014) Bolus vs. continuous feeding: effects on splanchnic and cerebral tissue oxygenation in healthy preterm infants. Pediatr Res. 2014 Jul;76(1):81-5 Arslanoglu S, Moro GE, Ziegler EE. (2009) Preterm infants fed fortified human milk receive less protein than they need. J Perinatol. 29(7):489-92.

They also comment that when infants are able to absorb colostrum through the oral mucosa they also absorb maternal antibodies and anti-inflammatory substances which are protective against disease and infection. (9) Continued research is ongoing with regards to the use of probiotics in the preterm infant however it is suggested that there is enough evidence of benefit to support introduction of probiotics. Nutritional Support of the Very Low Birth Weight Infant. (2008) California Perinatal Quality Care Collaborative Feed immediately after opening. For hygienic reasons, discard unfinished feed as soon as possible, and always within 1 hour. Guidelines for making up special feeds for infants and children in hospital. (2007). Food Standards Agency.

Factors contributing to nutrient deficits are numerous, though fluid restriction is often the greatest contributor. The majority of infants will meet their nutritional requirements with between 150 and 180ml/kg of an appropriate feed, therefore interruption and reductions in feeds to below 150ml/kg should be minimised. Where prolonged fluid restrictions are unavoidable in the older formula fed infant eg cardiac disease, consideration should be given to the use of nutrient dense term formulas such as SMA High Energy or Infatrini. High energy, low volume liquid feed with lower electrolyte profile making it suitable for patients with renal disease