NUTRITION FORMULARY Enteral...Halal, Kosher, Gluten free, ok for lactose intolerance. 1-13 yr, oral...

ENTERAL

NUTRITION

FORMULARY

For Infants (0-12 months)

March 2018

Contact Information

Pediatric Dietitian: Seppideh Sami

LR Pager: 1060762

Phone: (301) 319 - 7948

On Call Dietitian for Weekends & Holidays

LR Pager: 1062346

To Request Formula for Patients*

From 0630 - 1830 (Mon - Sun)

Call EAT (328) or (301) 295-0272

From 1830 - 1930 (Mon - Sun)

Call 400 - 3776

From 1930 - 0630 (Mon - Sun)

Call the CDO desk & ask for assistance

with obtaining formula from the kitchen

*Please make sure that the formula has

been entered correctly in Essentris Orders

Recipes:

For special recipes regarding fortified breast milk or

concentrated formula:

Consult the Standardized Pediatric Recipe Booklet

OR

Contact the Pediatric Dietitian or On Call Dietitian

Infant Formula Substitutions

Formula Substitution

Similac Advance Enfamil Premium or Good Start

Similac Soy Prosobee or Gerber Good Start Soy

Similac PM 60/40 None

Neosure Enfacare

Alimentum Pregestimil or Gerber Extensive HA

Nutramigen Alimentum or Gerber Extensive HA

Elecare Neocate or Nutramigen AA

73.2018_v1

WALTER REED NATIONAL MILITARY MEDICAL CENTER - PEDIATRIC FORMULARY FOR INFANTS

Product Name Expressed Breastmilk

Similac Advance

Enfamil Premium

Similac Soy Similac PM

60/40 Similac Expert

Care Alimentum Pregestimil Nutramigen

Similac Expert Care Neosure

EleCare Infant

Indications Nutrient content

varies among women.

Standard infant formula.

Available as: RTF, Powder, Liquid Conc.

Lutein Prebiotics.

Standard infant formula.

Available as: RTF, Powder, Liquid Conc. Prebiotics.

Lactose Free. Available as: RTF, Powder, Liquid Conc.

Low renal solute load. Mineral

content comparable to human milk,

low Fe, Gluten-free, Halal, Kosher. Available

in Powder.

Extensively hydrolyzed

proteins. Hypoallergenic 48% fat = MCT

Allergy/malabsorption

disorders. Available as: RTF, Powder.

Extensively hydrolyzed proteins.

Hypoallergenic 55% fat = MCT

Malabsorption, milk protein allergy, short

gut, CF, intractable diarrhea. Available as:

RTF, Powder. RTF = corn free.

Extensively hydro-lyzed proteins. Free of gluten, galactose,

lactose, sucrose, hypoallergenic

protein, allergy/malabsorption.

Available as: RTF, Powder, Liquid Conc.

Designed for premature babies.

Available as: RTF & Powder.

Elemental. Free of soy, milk, gluten, galactose,

lactose, fructose. Hypoallergenic. Food

allergies, short gut, malabsorption, intact protein intolerance. Available in powder.

Container Size N/A 352g Can 345g Can 352g Can 400g Can 454g Can 454g Can 400g Can 371g Can 400g Can

Nutrient Values per 100 ml 100 ml 100 ml 100 ml 100 ml 100 ml 100 ml 100 ml 100 ml 100 ml

Calories 63 67 67 67 67 67 67 67 73 67

Protein (g) 0.9 1.4 1.4 1.7 1.5 1.9 1.9 1.9 2.1 2.1

Protein % Cal 5 8 8.5 10 9 11 11 11 11 15

Protein Source Human Milk, Whey/Casein

Nonfat milk & whey protein concentrate

Nonfat milk & whey protein

concentrate

Soy Protein Isolate

Whey protein concentrate,

sodium caseinate

Casein hydrolysate, added amino

acids from milk

Casein hydrolysate, added

amino acids from milk

Casein hydrolysate

from milk

Nonfat milk & whey protein concentrate

100% free amino acids

Fat (g) 3.5 3.8 3.6 3.7 3.8 3.7 3.7 3.5 4.1 3.2

Fat % Cal 47 49 48 49 50 48 49 48 49 43

Fat Source Human Milk Fat

High oleic safflower, soy, & coconut oils,

DHA ARA

Palm olein, coconut, soy, & high oleic sunflower oils,

DHA ARA

High oleic, safflower, soy, & coconut oils,

DHA ARA

Soy, coconut, & high oleic

safflower oils

High oleic safflower oil, soy

oil, MCT DHA ARA

MCT, soy, corn, & high oleic sunflower

or safflower oils, DHA ARA

Palm olein, soy, coconut, & high

oleic sunflower oils, DHA ARA

49% soy oil, 29% coconut oil,

25% MCT oil, DHA ARA

High oleic, safflower, soy, 33% as

MCT DHA ARA

Carbohydrate (g) 8 7.2 7.5 7 6.9 6.9 6.8 7 7.5 7.2

Carb % kcal 47 43 43.5 41 41 41 40 41 40 42

Carb Source Lactose Lactose, galaco-oligosaccharides

Lactose, galaco-oligosaccharides,

polydextrose

Corn syrup, sucrose, fructo-

oligosaccharides Lactose

Sucrose, corn, maltodextrin

Corn syrup solids, modified corn starch

Corn syrup solids, modified

cornstarch

Corn syrup solids, lactose

Corn syrup solids

Vitamin D (IU) 1 51 40 41 41 41 33 33 52 40

Sodium (mg/mEq) 19 / 0.8 16 18 / 0.8 30 / 1.3 16 / 0.7 30 / 1.3 31 / 1.4 31 / 1.4 25 30

Potassium (mg/mEq) 48 / 1.2 71 72 / 1.9 73 / 1.9 54 / 1.4 80 / 1.2 73 / 1.9 73 / 1.9 106 100

Calcium (mg/mEq) 23 / 1.2 53 52 / 2.6 71 / 3.5 38 / 1.9 71 / 3.5 63 / 3.1 63 / 3.1 78 77

Phosphorus (mg) 13 28 29 51 19 51 35 35 46 56

Iron (mg) 0.06 0.23 1.2 1.2 0.5 1.2 1.2 1.2 1.3 1.22

Osmolality (%H20/Osm)

295 310 / 90 300 / 89 200 / 90 280 / 90 320 / 90 320 / 89 320 / 89 250 / 89 350 / 88

ENTERAL

NUTRITION

FORMULARY

For Toddlers & Children

(1 year & older)

March 2018

Contact Information

Pediatric Dietitian: Seppideh Sami

LR Pager: 1060762

Phone: (301) 319 - 7948

On Call Dietitian for Weekends & Holidays

LR Pager: 1062346

To Request Formula for Patients*

From 0630 - 1830 (Mon - Sun)

Call EAT (328) or (301) 295-0272

From 1830 - 1930 (Mon - Sun)

Call 400 - 3776

From 1930 - 0630 (Mon - Sun)

Call the CDO desk & ask for assistance

with obtaining formula from the kitchen

*Please make sure that the formula has

been entered correctly in Essentris Orders

Toddlers & Children

Formula Substitutions

Formula Substitution

PediaSure Enteral

1.0 cal PediaSure Vanilla

PediaSure

(Vanilla, Chocolate,

Strawberry)

Boost Kid Essential or

Nutren Junior

PediaSure with

Fiber Boost Kid Essential with Fiber

PediaSure 1.5 Boost Kid Essential 1.5 or

Nutren Junior 1.5

PediaSure Peptide,

Unflavored Peptamen Jr, Unflavored

Nutren 2.0 Two Cal HN

Elecare Jr

(Unflavored,

Vanilla)

Neocate Jr (Unflavored or Fla-

vored)

73.2018_v2

WALTER REED NATIONAL MILITARY MEDICAL CENTER - PEDIATRIC FORMULARY FOR TODDDLERS & CHILDREN

Product Name Compleat Pediatric

PediaSure Enteral 1.0 cal

PediaSure (Vanilla,

Chocolate & Strawberry)

Pediasure with Fiber

PediaSure 1.5 cal

PediaSure Peptide

(Unflavored)

Peptamen Jr (Unflavored)

Nutren 2.0 Elecare Jr

(Unflavored & Vanilla)

EO28 SPLASH KetoCal 4:1

Liquid

Indications

1 yr & >, TF only, Real food

ingredients such as:

chicken, fruit, cranberry juice concentrate, &

vegetables. Gluten free, ok

for lactose intolerance.

*Not for individuals with

galactosemia.

1-13 yr, Formulated for

TF. Lower osmolality than

PediaSure. Milk-based.

Sole source of nutrition or supplement.

Halal, Kosher, Gluten free, ok

for lactose intolerance.

1-13 yr, oral & TF. Delayed growth,

sole source of nutrition or

supplement. Halal, Kosher, Gluten

free, ok for lactose intolerance.

1.3 g of fiber per 100 ml

1-13 yr, Formulated for oral or TF. Sole source

of nutrition or supplement. Higher

caloric density product designed

to meet the energy requirements of

pediatric patients who are at risk for

malnutrition, require higher

caloric density, or have fluid

restrictions. Halal, Kosher, Gluten free, suitable for lactose

intolerance.

1-13 yr, oral or TF. Peptide

based. Hydrolyzed,

whey dominant protein, 60%

MCT & structured lipids, Nutraflora scFOS, a prebiotic fiber.

For: malabsorption, maldigestion. Sole source of

nutrition or supplement.

Kosher, Halal, Gluten free, ok

for lactose intolerance

Oral or TF. Elemental, free

amino acids, free of: milk protein, soy protein, fructose, galactose, lactose,

or gluten. Halal. Hypoallergenic:

protein maldigestion,

malabsorption, severe food

allergies, short bowel syndrome,

eosinophilic GI impairment,

conditions in which AA-based diet

indicated. Unflavored &

flavored. 33% of fat blend as MCT

1 yr & >, RTF, hypoallergenic,

free AA, formulat-ed for the dietary management of

children with cow milk allergy,

multiple food allergies & related

GI & allergic conditions,

including: eosino-philic esophagitis

(EoE), food protein-induced

enterocolitis syn-drome (FPIES),

short bowel syn-drome (SBS),

malabsorption & gastroesophageal

reflux (GER).

*0.6 g usable carb

Container Size 250 ml/carton 237 ml/can 237 ml/can 237 ml/can 237 ml/can 237 ml/can 250 ml/can 250 ml/can 400 g/can 237 ml/box 237 ml/carton

Nutrient Values per 100 ml 100 ml 100 ml 100 ml 100 ml 100 ml 100 ml 100 ml 100 ml 100 ml 100 ml

Calories 100 100 100 100 150 100 100 200 100 100 150

Protein (g) 3.8 3 3 3 5.9 3 3 8 3.1 2.5 3.1

Protein % Cal 15 12 12 12 16 12 12 16 15 10 8.2

Protein Source

Dehydrated chicken powder,

milk protein concentrate, pea protein isolate

Milk & whey protein con-centrate, soy

protein isolate, pea protein

Milk & whey protein

concentrate, soy protein isolate,

pea protein

Milk & whey protein con-centrate, soy

protein isolate, pea protein

Milk protein con-centrate

Whey protein hydrolysate, hydrolyzed

sodium caseinate

Enzymatically hydrolyzed

whey protein

K & Ca caseinate from milk

100% free L-amino acids

100% free amino acids

Sodium caseinate, whey

protein concentrate

Fat (g) 3.9 3.8 3.8 3.8 3.8 4.1 3.8 10.4 4.9 3.5 14.8

Fat % Cal 51 34 34 34 41 35 34 41 43 32 88.7

Fat Source Canola oil, MCT

High-oleic safflower oil, canola & tuna

oil

High-oleic safflower oil,

canola & tuna oil

High-oleic safflower oil, canola & tuna

oil

High-oleic safflower oil, soy

oil, MCT, C. Cohnii oil

Structured lipid (interesterified canola & MCT), MCT, canola oil

MCT (coconut & palm kernel oil), canola & soybean oil

MCT (coconut & palm kernel oil), canola &

corn oil

High oleic safflower oil, MCT, soy oil

Fractionated coco-nut oil, canola, high-oleic sun-flower & palm

kernel oil

High-oleic sunflower, soya

& palm oils, DHA, ARA

Carbohydrate (g) 13.2 13.9 13.9 13.9 16.0 13.4 13.6 19.6 10.7 14.6 1.7*

Carb % Cal 34 54 54 54 43 53 54 43 42 58 3.1

Carb Source

Corn syrup, cranberry juice,

fruits, veg, maltodextrin

Sugar, corn maltodextrin,

scFOS


scFOS


scFOS

Corn maltodextrin, scFOS

Corn maltodex-trin, scFOS

Maltodextrin, sugar, corn-

starch

Corn syrup, maltodextrin,

sugar Corn syrup solids

Maltodextrin, sugar

Soy fiber, re-sistant corn starch, sugar

Vitamin D (IU) 60 68 68 68 68 53 60 53 61 31 56

Sodium (mg/mEq) 76 / 3.3 38 / 1.7 38 / 1.7 38 / 1.7 38 / 1.7 72 / 3.1 46 / 2 130 / 5.7 46 / 2 20 / 0.9 103 /4.5

Potassium (mg/mEq) 164 / 4.2 131 / 3.4 131 / 3.4 131 / 3.4 165 / 4.2 135 / 3.5 132 / 3.4 192 / 4.9 153 / 3.9 93 / 2.4 165 / 4.2

Calcium (mg/mEq) 144 / 7.2 106 / 5.3 106 / 5.3 106 / 5.3 148 / 7.4 106 / 5.3 112 / 5.6 134 / 6.7 117 / 5.9 62 / 3.1 88 / 4.4

Phosphorus (mg) 100 84 84 84 106 84.4 84 134 85 62 88

Iron (mg) 1.4 1.1 1.1 1.1 1.1 1.4 1.4 2.4 1.8 0.8 1.5

Osmolality (%H20/Osm)

380 / 82 335 / 84

Vanilla - 480 Chocolate - 540

Strawberry - 480 / 84

480 / 84 370 / 78 250 / 84 260 / 84 745 / 70 590 / 84 820 / 80 260 / 77

1

Nutrition Services Department

Pediatric Formula Recipes

v2_72.2018 2

Standard Recipe Chart for Powdered Formula

WRNMMC Pediatric

Formulary

Volume of Water 1 Level Scoop Final Volume

Similac Advance;

Enfamil Premium Infant;

Enfamil Premium Newborn;

Similac Soy;

Similac PM 60 40;

Alimentum;

2 oz / 60 ml Unpacked 2.2 oz / 67 ml

Neosure 2.2 oz / 66 ml Unpacked 2.4 oz / 75 ml

Pregestimil;

Nutramigen with Enflora 2 oz / 60 ml Packed 2.2 oz / 67 ml

20 calories per ounce

3


WRNMMC Pediatric

Formulary


Similac Advance;



Similac Soy;

Similac PM 60 40;

Alimentum;

1.8 oz / 53 ml Unpacked 2 oz / 60 ml

Neosure 2 oz / 60 ml Unpacked 2.2 oz / 66 ml

Pregestimil;

Nutramigen with Enflora 1.7 oz / 53 ml Packed 2 oz / 60 ml


4


WRNMMC Pediatric

Formulary


Similac Advance;



Similac Soy;

Similac PM 60 40;

Alimentum;

1.6 oz / 48 ml Unpacked 1.9 oz / 54 ml

Neosure 1.8 oz / 55 ml Unpacked 2 oz / 60 ml

Pregestimil;

Nutramigen with Enflora 1.6 oz / 48 ml Packed 1.8 oz / 54 ml


5


WRNMMC Pediatric

Formulary


Similac Advance;



Similac Soy;

Similac PM 60 40;

Alimentum;


Neosure 1.7 oz / 48 ml Unpacked 2 oz / 60 ml

Pregestimil;

Nutramigen with Enflora 1.5 oz / 45 ml Packed 2 oz / 60 ml


6


WRNMMC Pediatric

Formulary


Similac Advance;



Similac Soy;

Similac PM 60 40;

Alimentum;



Pregestimil;



7


WRNMMC Pediatric

Formulary


Similac Advance;



Similac Soy;

Similac PM 60 40;

Alimentum;



Pregestimil;



8


WRNMMC Pediatric

Formulary


Similac Advance;



Similac Soy;

Similac PM 60 40;

Alimentum;

Elecare



Pregestimil;


Elecare Jr 1.25 oz / 38 ml Unpacked 1.5 oz / 45 ml


9


36 & 45 calories per ounce

Calories /Ounce

WRNMMC Pediatric

Formulary

Volume of Water

1 Level Scoop

Final Volume

36

(1.2 cal/ml) Elecare Jr 1.0 oz / 30 ml Unpacked 1.2 oz / 37 ml

45

(1.5 cal/ml) Elecare Jr 0.8 oz / 23 ml Unpacked 1.0 oz / 30 ml

10

Standard Recipe Chart for Diluting

1.5 cal/ml Liquid Formula

Calories /Ounce

WRNMMC Pediatric

Formulary

Volume of Water

1 Level Scoop

Final Volume

36

(1.2 cal/ml)

PediaSure 1.5;

Peptamen Jr 1.5 25 ml 100 ml 125 ml

40

(1.3 cal/ml)

PediaSure 1.5;


42

(1.4 cal/ml)

PediaSure 1.5;


NUTRITION FORMULARY Enteral...Halal, Kosher, Gluten free, ok for lactose intolerance. 1-13 yr, oral...

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Transcript of NUTRITION FORMULARY Enteral...Halal, Kosher, Gluten free, ok for lactose intolerance. 1-13 yr, oral...