Formula for premature babies and day/night formula

Formula milk for premature babies and day/night formula milk. There are countless occasions when a baby may need a type of special milk, which is why manufacturers offer different types to give every baby the best solution. And if we add to that the fact that we have a premature baby, there are special milks for premature babies.

These types of formula milks for babies, among others, are the most widespread, but there are other, less well-known types that are very interesting, such as milk for premature babies and day/night formula milk.

Milk for premature babies: special formulas, characteristics and uses

Formula milks for premature babies are designed to keep the infant's growth rate in line with that of the last trimester of pregnancy, without causing excessive metabolic or excretory stress.

There are many formulas available for feeding these neonates, and which one is used will depend on the characteristics of the infant, the stage of their development, their birth weight, their gestational age, etc.

These formulas contain a larger amount of carbohydrates and lipids, so they have a higher calorie density than adapted formulas, which makes it possible to achieve a higher calorie intake with smaller volumes. They have a high protein content and part of the proteins are hydrolysed. Whey proteins predominate and they are supplemented with taurine, so the amino acid profile is as similar as possible to that of breast milk.

Lactose in special premature milk, milk for premature babies

In special formula milks for premature babies, a variable percentage of the lactose is replaced by glucose polymers, since these babies often have a partial intestinal lactase deficiency and, moreover, this achieves a higher calorie density without increasing the osmolarity of the formula.

They contain MCTs, which are absorbed better without exceeding 40% of the total fat administered and, in addition to essential fatty acids (linoleic and linolenic), long-chain polyunsaturated fatty acids such as arachidonic acid and docosahexaenoic acid are added to their active metabolites, as well as the largest possible amount of fatty acids in trans form. They have a higher calcium and phosphorus content (ratio 1.7) to promote bone mineralisation.

Indication and duration of use of special formula milk for premature babies

As the name suggests, formula milks for premature babies are formulas intended solely for preterm infants or those with low birth weight (under 2,500 g). They are usually continued until the infant reaches 38 weeks of corrected age or a weight above 2,500-3,000 g, at which point they move on to a starter formula for term infants.

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Day/night nutritional formulas

The special day/night nutritional formulas take into account the infant's nutritional pattern and are based on circadian variations in the nutritional composition of breast milk, as well as on the role of the different nutrients in milk in the baby's sleep/wake processes. This encourages the onset of sleep, helping to establish proper periods of rest and activity from the first months of life.

How do day/night nutritional milks work?

This type of day/night formula aims to reproduce the variations in the nutritional content of breast milk over the course of the day, helping to synchronise babies' wake/sleep cycles.

It achieves this through the combined and complementary use of a night-time infant milk (period between 18.00 and 6.00 h) and a day-time one (period between 6.00 and 18.00 h).

The basis of this type of milk is that, while the foetus is in the womb, its biological clock depends on the mother. And at the moment of birth, the baby does not yet have a well-developed internal clock and needs about twelve weeks to start adapting to the habits of sleeping at night and being awake during the day.

However, once this time has passed, a high percentage of newborns experience disturbances in the timing of their sleep. In order to alleviate this problem, researchers from the Department of Physiology of the University of Extremadura and the University of the Balearic Islands have developed two types of infant milk that differ in nutrient content and incorporate components that are present in breast milk and can set the baby's internal clock.

Chrononutrition for babies

The formulas that have been developed do not have the excellence of breast milk, but they are at least an approximation to its benefits. Thus, the night formula contains tryptophan, an essential amino acid that is a precursor of serotonin and melatonin, neurotransmitters that are essential for controlling the sleep-wake rhythm, and adenosine, a chemical signal that tells the brain about the need to sleep. The day formula, for its part, includes a high content of proteins A, C and E, as well as reducing tryptophan and carbohydrates.

Infants who receive the tryptophan-enriched formula during the evening and night (the dark period) show improvements in sleep parameters (duration and depth of sleep). Tryptophan promotes the synthesis of serotonin, a substance that in turn is converted into melatonin, which regulates sleep and leads to deeper, more restful sleep.

The sleep-wake rhythm is directly associated with the concentration of melatonin, a hormone secreted by the pineal gland which, among other functions, helps to promote the induction of sleep. The researchers who developed these formulas have coined the term "chrononutrition" to indicate that the choice of foods eaten according to the time of day or night can contribute significantly to the correct functioning of the body's biological rhythms.

Formula for the dietary treatment of inborn errors of metabolism

There are occasions when the baby may suffer from inborn errors of metabolism and need a special milk, and this milk must provide the right number of calories for their age, a minimum intake that ensures normal growth.

What happens to a baby with inborn errors of metabolism?

In babies who suffer from metabolic disorders of amino acids, their body is unable to control one or more essential amino acids. In the treatment of an amino acid metabolic disorder during breastfeeding, an appropriate combination of breastfeeding and the administration of milk lacking the amino acid responsible must be defined.

The most common of the amino acid metabolic disorders is phenylketonuria, in which the amino acid accumulates due to an enzyme deficiency. And the dietary treatment of the infant consists of administering an artificial formula lacking phenylalanine, in combination with a conventional formula or with breast milk to provide a small amount of phenylalanine, since all infants need this amino acid.

These babies require an amount of formula without phenylalanine to reach the necessary calories and nutrients. The amounts of formula and breast milk for a particular infant can be calculated according to body weight, age, blood phenylalanine concentrations and growth needs. And since human milk is low in phenylalanine, breast milk can make up more than half of the infant's diet.

Formulas for inborn errors of metabolism by degree

Adapting to each baby is important, which is why there are formulas for different clinical conditions:

• When the nutrient is essential, as in the case of phenylketonuria, homocystinuria, tyrosinaemia.
• In aminoacidopathies secondary to an enzyme deficiency, there are protein-free formulas that contain only carbohydrates and lipids.
• When the nutrient is not essential, the use of a special formula may not be necessary. An artificial formula can be used, provided it does not contain the nutrient that cannot be metabolised (fructose, galactose, etc.).

Conclusion: formula milk for premature babies and day/night formula milk

The conclusion of this post on formula milk for premature babies and day/night formula milk is about adapting to your baby. Because, as we always tell you, every case is unique and, obviously, in this post you will have found lots of information about the special milks that will help you better understand why your paediatrician has prescribed one or the other. It is a stage that, when we come up against these difficulties, is sometimes hard to get through, but with good help from the professionals around you, you will get to grips with the situation. What is more, it is a stage that passes; take heart, and we are here for whatever you need. (Information published in the journal Farmacia profesional "fórmulas lácteas especiales" Vol. 23)

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