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Dietitians (NDIGuk)Clinical guidelines/position statementsExclusive BreastfeedingNB - These both relate to term infants 1. WHO statements on exclusive breastfeeding: 2. BDA Paediatric Group statement on exclusive breastfeeding tries to give a pragmatic interpretation of the above for infants in the UK at: Preparation of infant formulas from powderThere have been some major changes to guidance on preparation of infant formula in recent years both in hospital and at home. This is due to concerns over the 'sterilisation process' of infant formula powders not effectively removing all risk of contamination, particularly Enterobacter sakazaki, so boiled water at a higher temperature than previously thought is required and feeds should preferably be made just prior to feeding rather than for 24 hours. Parents who have had previous children may not be aware of these changes so should be educated by hospital staff prior to discharge from maternity wards and neonatal units and/or community health professionals at home. Guidance from the Dept of Health on preparation of infant formulas at home for health professionals and a practical information leaflet for parents is available at: Guidelines for preparation of feeds in hospital have been produced for the UK and are published by the Food Standards Authority and are available at: Use of soya formulas1. DoH statement 3. BDA Paed Gp position statement on use of soya protein for infants gives a pragmatic interpretation of this topic for infants in the UK at: Breast Milk FortificationThe use of breast milk fortifiers often poses a complex set of arguments as to when, how, what and who should receive additional nutrients for preterm growth. There is a wide variation in use across the U.K and Ireland which makes a definitive consensus difficult to achieve. A discussion paper based on available evidence and current practices is being produced by members of NDIG for publication in the near future. It can be used as a basis for individuals to produce their own clinical practice guideline. Weaning Preterm InfantsThere has always been considerable debate about the most appropriate time to introduce foods other than human breast milk or infant formula to the infant born prematurely. Should we use the same indicators as for infants born at term and if so, when using age should this age be from premature birth, expected date of delivery or somewhere in between? Since the Department of Health issued the following statement on breastfeeding in 2003 this question has been even more uncertain. ‘Breastfeeding is the best form of nutrition for infants. Exclusive breastfeeding is recommended for the first six months (26 weeks) of an infant’s life as it provides all the nutrients a baby needs. ’ Vitamin supplementationA survey of practice in UK neonatal units carried out in 1996 and repeated in 2001(NDIG unpublished) showed huge variation in use of vitamin supplements due partly to the large variation in amounts provided by different milks – breast milk, fortified breast milk, low birthweight formulas and post discharge formulas, but also due to routine prescribing of supplements regardless of intake from milk. Following repeated supply problems with the already limited range of vitamin preparations available in the UK, members of NDIG have collected the necessary information in order to make recommendations to form the basis for a clinical practice guideline on this topic in collaboration with members of BAPM. Specialised Formulas - www.bda.uk.com/resources/leaflets_paediatric |
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