elemental formulas are available. In addition, patients with compromised
intestintal length may benefit from the addition of pectin, psylium or loperamide.
Special formulations are also available to assist patients with hepatic or renal
failure.
Most pediatric formulas have a caloric density of 1 kcal/ml, but often have
formulations in the 1.2 or 1.5 kcal/ml range. Pediasure is lactose free. Peptamen
Jr is 100% hydrolyzed whey, 60% of fat provided as MCT oil (toddler equivalent
of Pregestimil). Elecare is amino acid based, lactose free, has 33% MCT oil and
has an oral formulation that is vanilla flavored. Neocate Jr. and Vivonex are also
alternative elemental formulas. Nutritional supplementation can be accomplished
by adding Duocal (fat and carbohydrates, 42 kcal/tbsp), vegetable oil, medium
chain fat emulsions, Beneprotein or Benefiber as needed.
Newborns require 100-200 cal/kg/day for normal growth with an ideal weight
gain goal of 15-20 g/kg/day in premies or 20-30 g/day in term babies. Ideally,
infants should achieve a 1% increase in weight per day. When possible, breast
milk is the preferred nutrition in the first six to twelve months of life. Donated
expressed breast milk (EBM) can be used when the mother cannot produce
sufficient volume. EBM confers immunologic protection and may decrease the
risks for NEC. EBM is 20 kilocalories per ounce (30 ml). Infants who are
exclusively breast milk fed require 1ml/day of liquid multivitamin.