Enteral Nutrition: Types of Formula

	Breast Milk or Processed Donor Breast Milk (PDBM)  Formula of choice for breast, bottle, and tube feeding Psychological benefits with breast feeding 20 kcal/ounce or 20 kcal/30 mL Protein source is whey -- increased bioavailability Isotonic (290 mOsm/kg water) Low renal solute load (~90 mOsm/L) Carbohydrate source is lactose (promotes absorbtion of Ca, Mg, P) Immunologic protection Increased absorbtion by containing digestive enzymes Contains bile salt stimulated lipase Content of vitamins A, D, C, thiamin, riboflavin, and iodine can be affected by materal diet
	Preterm Formula (Similac Special Care)  For less than 1800 grams, or if labs show increased nutrient needs 20 to 24 kcal/ounce (about the same osmolarity for both energy densities) Whey protein, as in breast milk About 50% more protein than term formulas Carbohydrate source is lactose 10-15% of fat is MCT to facilitate absorption Calcium and Phosphate content is higher than in term formulas for improved bone mineralization Increased vitamins and minerals
	Intermediate Formula (Similar Neocare)  For greater than 1800 gram infants or for discharge to home when term formula is inadequate 22 kcal/ounce About 30% more protein than term formulas Carbohydrate source is lactose 25% of fat is MCT oil Fortified with vitaminas and minerals
	Elemental Formula:  Used for GI disturbances or malabsorption, for example in short gut syndrome in infants with more than 50% bowel resection.  Pregestimil Protein is casein hydrolysate and free amino acids Carbohydrate is modified corn starch and glucose Fat is corn oil, and 55% is MCT oil Alimentum Protein is casein hydrolysate and free amino acids Carbohydrate is sucrose Fat is corn oil, and 50% is MCT oil Neocate Protein is free aminio acids Carbohydrate is corn syrup solids and modified corn starch Fat is safflower oil and refined vegetable oil Higher in calcium and phosphorus
	Protein Modified Formula: Used for protein sensitivities  Nutramigen: for casein and soy protein intolerance Protein is casein hydrolysate Carbohydrate is corn syrup solids and modified corn starch Fat is corn oil Isomil: for milk protein intolerance Protein is soy protein isolate Carbohydrate is corn syrup solids and sucrose Fat is coconut and soy oil Phytates from soy may decrease calcium and phosphorus absorption