Transcript Which Infant Formula?

Which Infant Formula?
Feed Choices
Feed
Examples
Breastmilk
Energy
Kcal/100ml
Protein
g/100ml
Indications
66
1.3
1st choice
EBM can be
used as tube
feed
Standard
Infant
Formula
SMA Gold
Cow & Gate
Premium
Farleys First
Aptamil First
66
1.4
Whey based
Casein based
feeds e.g. SMA
White, C&G
Plus.
High Energy
Infant Formula
SMA High
Energy
91
2.0
Infatrini
100
2.6
Fluid
restriction,
Higher energy
requirements.
Specialised Formulas
Feed
Protein Source
Fat Source
Indications
Nutramigen
(Mead Johnson)
Hydrolysed
Casein
LCT
Malabsorption of whole
protein with/without
disaccharide intolerance
Pregestimil
(Mead Johnson)
Hydrolysed
Casein
55% MCT
As above plus fat
malabsorption
Pepti Junior
(Cow & Gate)
Hydrolysed
Whey
50% MCT
As above plus fat
malabsorption
Pepti
(Cow & Gate)
Hydrolysed
Whey
LCT
CHO – 40% lactose
Cows Milk intolerance
Nan H.A.
(Nestle)
Partially
hydrolysed whey
LCT
Atopic allergy
prophylaxis
Neocate
(SHS)
Free amino acids
LCT
Severe malabsorption/
multiple allergy
COT report on phytoestrogens
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March 2003
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‘the Working Group note the advice by the Department of
Health based on 1996 COT advice. This stated that breast
and cows’ milk formulae are the preferred sources of
nutrition for infants. However, women who have been
advised by their doctor or other health professionals to feed
their baby soy-based infant formulae should continue to do
so. In the light of new data presented in this report, which
was unavailable in 1996, the Working Group recommend
that the current advice be amended to state that soy based
infant formulae to be fed to infants only when clinically
indicated. The Working Group note that similar advice has
been issued in other countries (e.g. NZ, Australia)
Soya Formula
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Risks
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an infant receiving soya based infant formulae as
a sole source of nutrition between the ages of 4-6
months will consume approx. 4mg isoflavins/kg
bodywt/day
Studies show upto 36% of infants given soya
formulas for the management of Cows’ Milk
Protein Allergy manifest symptoms of soya protein
allergy.
Recent concerns of an increased peanut allergy in
infants fed soya based infant formula give further
support to delaying exposure to soya
CMO Statement on Soya
Based Formula. jan.2004
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Soya based formulas should not be the first
choice for the management of infants with
proven cows’ milk sensitivity
Soya based formulas should only be used in
exceptional circumstances
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Infants with cows’ milk allergy/intolerance who
refuse extensively hydrolysed/elemental formula
Vegan mothers
Galactosaemia
Hydrolysed formulas should be used as first
choice
Protein breakdown of formula
Potential
Antigenicity
High
Protein Breakdown
Intact protein
Incomplete proteins
(partially digested)
Large peptides
Small peptides
Low
Amino acids
Hydrolytic Stages of an
antigenic protein molecule
Amino Acid Formula
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Only true ‘allergen free’ formula
Hydrolysate intolerance occurs
Atopy presenting during exclusive
breast feeding (especially when FTT)
improves on a.a. formula
Multiple food allergy or
hydrolysate/breast milk intolerance.
Genetic Predisposition
Allergy risk in
family
Percentage of
new borns
No
allergies
1 Parent with
Allergy
2 Parents with
Allergy
70%
25%
5%
Probability of
later allergies in
their children
15%
20 – 40%
50 – 80%
Absolute number
of infants with
probable allergy
11
8
3
Beneficial Effects of Breast Feeding
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Sarrinen and Kayosaari 95
Greatest protection against atopic disease
– exclusive BF 1 -6 months
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Joint statement of ESPACI and ESPGHAN
(Arch. Dis Child. 96)
‘exclusive breast feeding during the first
4 -6 months of life might greatly reduce the
incidence of allergic manifestations and is
strongly recommended.’
Evidence for use of eHF as
allergy prophylaxis
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Oldeaus 97
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155 infants with FH allergy
No cows milk 9/12, fish/egg/citrus 12/12,
weaning 4/12
At weaning – pHF, eHF, CMF
Atopic symptoms at 18/12 = 81% (CMF)
66%(pHF), 51%(eHF)
Evidence for use of pHF as
allergy prophylaxis
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Chandra 97
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288 high risk infants CMF, SF, pHF
Cumulative incidence of atopy (eczema, wheeze,
rhinitis, otitus media, vomiting, diarrhoea, colic)
% culmulative allergy =
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pHF 7%
CMF 36%
SF 37%
BF 20%
Strategies for Reducing Allergy
Development Risk in Babies
Family history No history
of allergy
- Low risk
1 or both parents with
allergy
- High risk
Pregnancy
As for low risk.
However mothers may wish to
avoid peanut and peanut
containing foods.
Consume a healthy, balanced
diet during pregnancy,
containing foods from all 5
food groups. Restricting
maternal diet in pregnancy is
not advised.
Strategies for Reducing Allergy
Development Risk in Babies
Family
history
of allergy
No history
- Low risk
1 or both parents with allergy
- High risk
First 6
months
of life
Exclusive breast feeding
is the first choice
Exclusive breast feeding is the
first choice
Where formula milk is used, a
cows, milk formula is
recommended. Mothers can
also used a partially
hydrolysed formula
Where formula is used, partially
hydrolysed whey or extensively
hydrolysed casein –based milks
are recommended.
Infants at highest risk who are not
breast fed should be given
extensively hydrolysed formula
Do not use other milks, including
soya, goat or standard cows milk
formulas or off-the-shelf non
formula milks from these sources.
Strategies for Reducing Allergy
Development Risk in Babies
Family history
of allergy
No history
- Low risk
Weaning
Weaning should not start before or beyond 6 months, definitely
not before 17 weeks.
Follow expert guidelines on
the introduction of different
textures and variety into the
diet
1 or both parents with
allergy
- High risk
Don’t delay introducing the
major allergenic foods (e.g. milk,
egg, wheat, etc.) beyound 6
months of age. Planned
introduction of major allergenic
foods to be done one at a time,
at 3 – 5 day intervals.
By 12 months, all major
allergenic foods that are
normally suitable for a child of
this age should have been
introduced (excluding peanut)
Dietary Guidelines for Allergy Prevention
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Muraro et al Pediatr Allergy Immunol 2004
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Mothers should aim to breast feed exclusively for 6 months
(but at least 4 months)
If mothers cannot breast feed or choose not to, they should
use an extensively hydrolysed formula until 4 months of age.
Partially hydrolysed whey formula may have an effect in
terms of allergy prevention, although seems less than the
effects of eHF.
Allergy Prevention
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Palatability
Cost/presribability
Ethnic acceptance (pork enzyme)
Motivation of mother
Conflicting advice from health
professionals/relatives/friends
Infant ailments attributed to special
formula
Benefits of Healthy Gut Flora
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Infants with a healthy gut flora (i.e. one dominated
by beneficial bacteria, such as Bifidobacterium and/or
Lactobaccillus) have reduced risk of infection, disease
and later development of food allergy.
Decreased prevalence of eczema in high risk infants
given probiotics/lactobacillus.
Certain species of gut bacteria down regulate
inflammation
Immunological Factors: Non Breast
Milk Sources
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LCPs and Nucleotides
are added to all standard whey based formulas –
important in the development of inflammatory
chemicals and development of the infants adaptive
immune response.
Prebiotics (in the form of oligosaccharides)
Promotes the development of microbial flora similar
to that of breast-fed infants (namely, one that is
bifidobacteria-dominant)
Other Infant Formulas
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Soya formula – Wysoy, Infasoy
Low lactose formula – SMA LF,
Omneocomfort (C&G), Enfamil
Lactofree.
Thickened formula – SMA Staydown,
Enfamil AR, Omneocomfort