https://apsapedsurg.org/wp-content/uploads/2020/09/APSAHandbookofSurgicalCriticalCare_Jun52014.pdf
Management of fluid and electrolytes as well as acquisition of all macronutrients (carbohydrates, lipids, proteins) and micronutrients are facilitated by the normal function of gastrointestinal absorption.
Infectious complications are diminished by direct nutritional support of the intestinal mucosa.
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.
Many special diets are available for patients with specific needs
For patients with inadequate digestive function due to intestinal loss, predigested or elemental formulas are available.
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.
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 is 20 kilocalories per ounce (30 ml).
Infants who are exclusively breast milk fed require 1ml/day of liquid multivitamin.
The nutrient composition of most infant formulas simulates maternal milk: protein 8-12%; carbohydrates 41-43%; fat 41-49%.
Enfamil, Similac, and Good Start are made from bovine milk.
Isomil and Prosobee, based on soy protein and corn syrup, can be used in infants with lactose or milk protein intolerance.
Pregestimil and Alimentum are bovine milk based with hydrolyzed protein and are thought to benefit patients with suboptimal digestion and absorption such as short bowel syndrome, malabsorption, cystic fibrosis, and biliary atresia.
Pregestimil and Portagen are formulas with the highest percentage of medium chain triglycerides and are used in children with lymph leak and some fatty acid disorders.
Neocate and Elecare are elemental and are used in patients with severe milk protein allergies and those with other digestive problems whose nutrition has failed on Pregestimil and Alimentum.
Premature infant formulas are indicated for preterm infants with birth weights <1800 grams to account for their immature digestive tract.
Similac Special Care and Enfamil Premature are only available in premixed 20, 24, and 30 kcal/ounce formulations.
Preemies typically are fed with 22 kcal/oz formula
Human Milk Fortifier (HMF) is a bovine milk based powder that can be added to EBM to increase caloric density.
Similac PM 60/40, used in renal failure patients, has the same amount of protein as term infant formula (whey:casein content of 60:40), the same mineral content as human milk, and less Na, K, and Phosphate than term infant formulas.
Carbohydrate-free formulas are indicated in patients who have disorders of carbohydrate absorptionsuch as disaccharidase deficiencies.