Define Formula Concentration and Supplementation - Calorie Density?
Formula Concentration can be done by decreasing the amount or water added in the mixing of the formula. Standard formula has calorie density (1.67 Kcal/ml. The advancement in density should be gradual with careful monitoring, ensuring gastrointestinal and metabolic tolerance. As for proteins, diet should contain between 8-10 % (energy percent or percentage of energy). Attention needs be paid to the sodium content of the feed on increasing the formula by concentration method. In infants with severe CHD and failure to thrive, formula density should not exceed 0.8 Kcal/ml. Severely malnourished CHD infants may develop lactase deficiency and thus use of soya based infant formulas is suggested.
Increased calorie density of a formula may be achieved through .supplementation with carbohydrate or fat module. Addition of glucose and lipid maintains a lower renal solute load and osmolality. On adding more than one module component, maintenance of calorie distribution is gradual and stepwise. Care is to be taken that with supplementation the percentage of calories from proteins does not fall to less than 6-7 (energy percent or percentage of energy). Breast milk feeding/expressed breast milk is the best food for the infant. Breast milk contains 0.66 Kcal/ml; although provides nutritional and immunologic advantages it is not able to meet adequate calorie and protein intake. Thus breast-feeding may be alternated with high calorie density formula to ensure total intake of 120-140 Kcal/kg /day.