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Nutrient Enriched Formula Versus (VS) Standard Formula for Your Premature / Preterm / Low Birth Weight Infant

Breast-feeding is harder than bottle feeding for a premature baby to master. The baby often has to suck harder to get milk out from the breast than the bottle. But as your baby gets stronger and bigger, breast-feeding will get easier for you and your baby. Your nurse and the lactation consultant can help you practice breast-feeding with your baby. Most of the time a baby will go home taking both breast and bottle-feedings and will transition to full breast-feeding over several weeks.

The premature baby's intestinal tract often doesn't work very well at first. The baby's stomach may empty very slowly, and it may be hard for the infant to pass bowel movements. The baby may vomit often because of looseness of the valve between the stomach and esophagus (gastroesophageal reflux). It is easy for the baby to get distended (the bowel gets filled with gas). These are all signs that the intestinal tract is immature.Intolerence to feedings is common among very small preterm infants, and most such infants will have episodes that require either temporary discontinuation of
feedings or a delay in advancing feedings.

The amount of milk a baby is fed is usually increased very slowly. It is important to make sure that the baby can manage each increase well. There may be many starts and stops in the feeding process. The baby's intestinal function improves as she gets older. It may be several weeks before the very smallest infants can take full milk feedings.

There are formulas which are made specifically for small premature infants. These formulas contain extra protein, calories, and minerals to stimulate growth in a very tiny baby.

Sometimes a baby needs a special formula because of an allergy to milk protein or because he cannot absorb nutrients from his intestine. Examples of such formulas are Nutramigen or Pregestimil.Sometimes they are called nutrient-enriched formula or or simply enriched formula.Manufacturer of such formula highlights such as:

Fortified with iron and contains all the vitamins, minerals, and nutrients required for a healthy baby's first year
Enriched with 17 mg of DHA and 34 mg of ARA per 100 Calories—the same levels as Enfamil® LIPIL®
Contains lactose, a carbohydrate that occurs naturally in breast milk
Provides nutrients found naturally in mother's milk that help develop the immune system
Manufactured to exacting FDA standards by PBM Nutritionals in the only ISO 9001:2000–certified, infant formula-manufacturing facility in the United States

But nutrient-enriched formula is no better than standard formula for feeding preterm infants after hospital discharge, according to a report in the American Journal of Clinical Nutrition.The infants fed the standard formula had significantly higher scores for all growth variables than did infants fed the enriched formula, the researchers report. The rates of weight gain and length increase were also significantly higher in the infants fed standard formula.There was also a suggestion that formula milk is less likely to be tolerated than preterm human milk .

Recently ,data suggested according to a report in the American Journal of Clinical Nutrition that enriched milk formula is no better than standard formula for feeding preterm infants after hospital discharge, .

"Our study challenges the current dogma on the use of special milk formulation for feeding the premature infants after hospital discharge," Dr. Winston W. K. Koo from Wayne State University and Hutzel Hospital, Detroit, told Reuters Health.

Koo and co-investigator Elaine M. Hockman compared the growth, bone mass, and body composition in 89 preterm infants who were randomly assigned to receive a nutrient-enriched formula or a standard formula for one year after discharge.

The infants fed the standard formula had significantly higher scores for all growth variables than did infants fed the enriched formula, the researchers report. The rates of weight gain and length increase were also significantly higher in the infants fed standard formula.

The results of X-ray imaging studies also indicated that the standard formula group had significantly higher bone mineral content, fat mass and lean mass than did the enriched formula group.

"The earlier clinical trials were inconclusive despite the theoretical benefits of enriched formulation and our study could not demonstrate any benefits from its use either in body weight, length, or different components of tissue growth, namely, the amount of bone, fat and lean tissue," Koo commented.

"Our study is, therefore, akin to finding that a drug may not work quite as well as intended when one takes a closer look."

The findings raise "multiple important issues" that require further study, he said. "Hopefully, our continuing studies of nutrition support in premature infants will provide scientifically sound recommendations in the not too distant future."

Meanwhile, he concludes: "Careful follow-up of the infant, critical review of scientific studies, and being skeptical of advertisements would go a long way in providing good patient care."