Pediatric Nutrition in Practice

100 Koletzko^

a family history of allergy or atopic dermatitis that
are based mostly on partially (moderately) hydro-
lysed protein and in part on extensively hydro-
lysed protein have been developed for allergy pre-
vention. Some of these formulations were shown
to be effective for the long-term prevention of al-
lergic manifestations, in particular of atopic der-
matitis [13]. Therefore, infant formulae based on
protein hydrolysates are accepted [5] and recom-
mended for use during the first 4–6 months of life
in infants with a family history of allergy or atopy
who are not fully breastfed [14].

Preparation, Storage and Handling of
Infant Formula

Powdered formula is sterile and may contain
pathogenic bacteria such as Cronobacter spp.
which, if sufficiently multiplied once the formula

is prepared, may cause invasive infections, par-

ticularly in preterm and term neonates [15].

Therefore, it is recommended that powdered for-

mula should be freshly prepared for each feed and

be fed within a period of 2 h after preparation.

Unused prepared formula should be discarded.

Hospitals, day care centres and other institutions

should follow strict hygienic standards as well as

written guidelines for the preparation and han-

dling of formula. For neonatal wards, the use of

ready-to-feed liquid formula is encouraged where

feasible and affordable.

Follow-Up Formula for Infants

Follow-up formula (also called follow-on formu-

la) has been defined in the Codex Alimentarius as

a liquid food that contributes part of the increas-

ingly diversified weaning diet for infants from the

Table 1 (continued)

Component/unit Minimum Maximum

Other substances
Choline, mg/100 kcal 7 50
Myo-inositol, mg/100 kcal 4 40
L-Carnitine, mg/100 kcal 1.2 n.s.

n.s. = Not specified.
a The determination of the protein content of formulae based on non-hydrolysed cow’s milk protein with a protein
content between 1.8 and 2.0 g/100 kcal should be based on the measurement of true protein [(total N – NPN) × 6.25].
b Formula based on hydrolysed milk protein with a protein content <2.25 g/100 kcal should be clinically tested.
c Sucrose (saccharose) and fructose should not be added to infant formula.
d 1 mg RE (retinol equivalent) = 1 mg all-trans retinol = 3.33 IU vitamin A. Retinol contents shall be provided by
preformed retinol, while any contents of carotenoids should not be included in the calculation and declaration of
vitamin A activity.
e 1 mg α-TE (α-tocopherol equivalent) = 1 mg D-α-tocopherol. The vitamin E content shall be at least 0.5 mg α-TE/
g polyunsaturated fatty acid, using the following factors of equivalence to adapt the minimal vitamin E content to
th e nu m b e r o f f at t y a ci d d o u b l e b o n ds i n th e f o r m u l a: 0. 5 m g α -T E /g li n o l e i c a ci d (18: 2n – 6); 0.75 m g α -T E /g α - li n o l e n i c
acid (18:3n–3); 1.0 mg α-TE/g arachidonic acid (20:4n–6); 1.25 mg α-TE/g eicosapentaenoic acid (20:5n–3); 1.5 mg
α-TE/g DHA (22:6n–3).
f Niacin refers to preformed niacin.
g In populations where infants are at risk of iron deficiency, iron contents higher than the minimum level of 0.3
mg/100 kcal may be appropriate and recommended at a national level.

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 97–103

DOI: 10.1159/000375271