Dietary management of infants and young children with feeding difficulties and unsatisfactory weight gain using a nutritionally complete hypercaloric infant formula. practical considerations from clinical cases

Figures & data

Table 1. Description of the hypercaloric whey peptide-based infant formula

Nutrients and characteristics	Unit	Per 100 mL (100 kcal)
Energy	kcal	100
Proteins (100% partially hydrolyzed whey)	g	2.6
Carbohydrates	g	10.3
Fat (41% of palmitic acid in sn-2 position)	g	5.4
DHA	mg	20
Micronutrients	Nutritionally complete and designed as per Commission Delegated Regulation (EU) 2016/128
Osmolarity	332 mOsm/L

Abbreviations: DHA, docosahexaenoic acid; EU, European Union.

Table 2. Patient 1 – changes in the feeding regimen across time

Current feeding regimen	Nutritional value	Modified feeding regimen					Nutritional value
(A)Changes in the feeding regimen during first hospitalization (21 December 2018–5 months of life)
		Day	HEPF			IF
IF: 7 × 60 mL/day	281 kcal/day	Days 1–2	1x 60 mL			6x60 mL	300
		Days 3–5	3x 60 mL			4x 60 mL	340
		From Day 5	5x 60 mL			2x 60 mL	380
TOTAL	281 kcal (80 kcal/kg of body weight/day; 80% of ER)	TOTAL					380 kcal (110 kcal/kg of body weight/day; 110% of ER)
(B)Changes in the feeding regimen at the first follow-up visit because of enteral nutrition intolerance (13 February 2019–7 months of life)
		HEPF		IF
HEPF: 5 × 70 mL IF: 2 × 70 mL Intermittent feeding via pump (30 mL/h) Each feeding duration: 2 h	112 kcal/kg of body weight/day (112% of ER)	Reduction in volume to 5 × 50 mL (each feeding: 2 h)		Commence of overnight continuous feeding via pump (300 mL/6-9 h)			450 kcal (115 kcal/kg of body weight/day)
(C)Changes in the feeding regimen during second hospitalization (28 February 2019–7 months of life)
		Day	Infasource®		IF
HEPF: 5 × 50 mL IF: 300 mL/6 h at night	450 kcal/day	Day1	5x 50 mL		300 mL/6 h		450
		Day 2	5x 55 mL		300 mL/6 h		470
		From Day 3	5x 60 mL		250 mL/5 h		470
TOTAL	450 kcal (112.5 kcal/kg of body weight/day)	TOTAL					470 kcal (117.5 kcal/kg of body weight/day)
(D)Feeding regimen and nutritional status at 6 weeks after initiating Infasource® (16 April 2019–9 months of life) Principal feeding problem: long feeding time
Infasource® 7 × 70 mL by pump (35 mL/h) Night infusion was stopped Attempts to feed the girl by mouth (blended vegetables given by teaspoon; up to 60 mL/serving)	490 kcal/kg of body weight/day (107 kcal/kg of body weight/day)	-					-

Abbreviations: BMI, body mass index; ER, energy requirement; h, hour; HEPF, high-energy polymeric formula; IF, infant formula; WHO, World Health Organization.

Figure 1. Changes in the anthropometric measurements (A: weight, B: length and C: body mass index, BMI) using the World Health Organization (WHO) growth charts, before and after adding infasource® (nestlé health science, Biessenhofen, DE) to the feeding regimen. patient 1 (diamond); patient 2 (x mark); patient 3 (dots)

Table 3. Patient 1 – changes in the feeding regimen and resulting changes in the nutritional status during the total 4-month follow-up

Recommended feeding regimen	IF: 7 × 70 mL 80 kcal/kg of body weight/day (80% of ER)	HEPF: 5 × 60 mL + IF – 2 × 60 mL 380 kcal (110 kcal/kg of body weight/day; 110% of ER)	Infasource®: 5 × 60 mL + IF – 250 mL/5 h 470 kcal (117.5 kcal/kg of body weight/day; 117.5% of ER)
Nutritional status as a result of the recommended feeding regimen	21 December 2018 (5 months of life) Weight: 3.5 kg (<3^rd percentile as per WHO) Length: 54.5 cm (<3^rd percentile as per WHO) BMI: 11.8 kg/m^2 (<3^rd percentile as per WHO) Weight-to-length ratio (<3^rd percentile as per WHO)	13 February 2019 (7 months of life): Weight: 3.9 kg (<3^rd percentile as per WHO) + 400 g Length: 57.5 cm (<3^rd percentile as per WHO) + 3.5 cm BMI: 11.8 kg/m^2 (<3^rd percentile as per WHO) Weight-to-length ratio (<3^rd percentile as per WHO)	16 April 2019 (9 months of life): Weight: 4.6 kg (<3^rd percentile as per WHO) +700 g Length: 60 cm (<3^rd percentile as per WHO) +2.5 cm BMI: 12.7 kg/m^2 (<3^rd percentile as per WHO) Weight-to-length ratio (<3^rd percentile as per WHO)

Abbreviations: BMI, body mass index; ER, energy requirements; h, hour; HEPF, high-energy polymeric formula; IF, infant formula; WHO, World Health Organization.

Figure 2. Patient 4 – changes in body weight during 3 months of follow-up using the World Health Organization (WHO) growth charts, before and after adding infasource® (nestlé health science, biessenhofen, DE) to the feeding regimen