SMA Pro Gold Prem Number 2 Baby Milk, 400 g

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Continue Probiotics until around 34 weeks corrected age (earlier or later discontinuation at consultant discretion) Embleton NE, Pang N, Cooke RJ. Post-natal malnutrition and growth retardation: an inevitable consequence of current recommendations in preterm infants? Pediatrics 2001;107:270–3. Protein supplementation of human milk in relatively well preterm infants results in increases in short term weight gain, linear and head growth.

ESPGHAN. (2010) Enteral Nutrient Supply for Preterm Infants: Commentary from European Society for Paediatric Gastroenterology, Hepatology, and Nutrition Committee on Nutrition. JPGN;50:1-9.Bolus feeding enhances protein synthesis more than continuous feeding, and promotes greater protein anabolism (29,30) There are currently three formulas available in the UK. Nutriprem 1, Aptamil Preterm and SMA Gold Prem Pro. Consider temporary discontinuation in any baby who is seriously unwell or septicaemic and highlight its use in any discussions with the Microbiology consultan

None of the specialised term formulas are designed for use in the preterm infant. Energy needs may be met by increased volumes but these are often poorly tolerated. Concentration of formulas should never be undertaken unless under direct dietetic supervision. These medicines are considered suitable for GP prescribing following specialist initiation, including titration of dose and assessment of efficacy. Pour 25 ml of EBM into a sterile container. Before mixing with fortifier, warm up EBM to body temperature. DO NOT use a microwave to prepare or warm feeds. Nutritional Support of the Very Low Birth Weight Infant. (2008) California Perinatal Quality Care CollaborativeContinued research is ongoing with regards to the use of probiotics in the preterm infant however it is suggested that there is enough evidence of benefit to support introduction of probiotics. Mosqueda E. et al (2008) The early use of minimal entral nutrition in extremely low birthweight newborns. Journal of Perinatology; 28(4):264-9 Daly S.E et al (1993) Degree of breast emptying explains changes in the fat content, but not fatty acid composition of human milk. Exp Physiol;78(6) 741- 55

Separate and add only one sachet (1 g) of SMA Gold Prem ® Breast Milk Fortifier. Do not attempt to mix part of a sachet. Lee.J et al (2015) Oropharyngeal colostrum administration in extremely premature infants: An RCT. Paediatrics;135Morgan J., Bombell S., McGuire W. (2013) Early trophic feeding versus enteral fasting for very preterm or very low birth weight infants. Cochrane Database Syst Rev CD000504 As residuals vary so much in the early stages of feeding significant increases should not be used in isolation when deciding to limit advancement of feeds(1).

No studies have been conducted comparing the protective benefits of colostrum as mouth care versus trophic feeding. Larger studies are warranted in particular looking at the oropharyngeal exposure to colostrum as a potential protective measure against sepsis and NEC. Patole S. et al (2003) Virtual elimination of necrotising enterocolitis for 5 years – reasons? Med Hypotheses, 61, 617-22 Amber Level 3- Specialist Initiation with ongoing monitoring requirements (Full Amber Drug Guidance required)

Morley R, Fewtrell MS, A. Abbott R, Stephenson T, MacFadyen U, Lucas A.(2004) Neurodevelopment in Children Born Small for Gestational Age: A Randomized Trial of Nutrient-Enriched Versus Standard Formula and Comparison With a Reference Breastfed Group. Pediatrics;113(3):515-21. Caple J. et al (2004) Randomised controlled trial of slow versus rapid feeding volume advancement in preterm infants. Pediatrics, 114 1597-600 Dsilna A, et al (2008) Behavioural stress is affected by the mode of tube feeding in very low birth weight infants. Clinical Journal of Pain;24(5): 447-55 Regular assessment should be undertaken for evidence of any feed intolerance, particularly “high risk”: On specialist/secondary care recommendation only: for cows’ milk protein allergy or intolerance in infants with liver, gastro or cardiac disease