1. INFANT FORMUA PRODUCTS

2. Introduction Human milk is most physiologically suited to infants
Optimal source for feeding infants till 12 months
Human milk is the only source of nutrition till 6 months of life.
For infants whose mother cannot or will not breast feed them, alternatives are needed

3. Infant physiology and growth: GI and renal systems GI maturation
Infant Formula Products: Introduction
Infant physiology and growth: GI and renal systems
GI maturation
Second trimester of pregnancy: all segments of GIT are formed
Third trimester; maximal GI growth and differentiation.
Preterm infants (before 32 weeks of gestation)
Transition from intrauterine to extra uterine feeding requires maturation of many physiologic processes, e.g….
Nutritive sucking: weeks of gestation. No problem in term infants, but in premature,,,,,
Preterm (before 34 weeks) cannot coordinate sucking, swallowing and breathing

4. Definition of Premature Birth
􀂃 The WHO and AAP define premature birth as the delivery of an infant before 37 weeks of gestation.
A full term infant: weeks of gestation
􀂃 The NCHS of the CDC generally reports data
on three categories of preterm birth:
1. Overall preterm, less than 37 weeks
2. Moderately preterm, 32 and 36 weeks
3. Very preterm births, less than 32 weeks

5. Early infancy:
Liquid nutrition only: poor coordination of complex tongue movements and swallowing
Frequent feeding: limited stomach capacity: ml at birth, ml at 1 month
Term infants: gastric and pepsin secretion peaks at 10 days, in preterm basal acid output is low
Milk in the stomach increases pH, poor pepsin activity

6. CHO digestion: lactase, sucrase, maltase, isomaltase, glucoamylase are mature. Lactase activity may be immature in premature infants.
Pancreatic amylase is low in full term infants, till 1 year of life. Salivary amylase may compensate for that
Low pancreatic lipase concentration, bile salt synthesis is low, lingual and gastric lipases compensate
Protein digestion and absorption are mature

7. Kidney maturation:
Ability of the kidney to excrete solute load
Glomerular filtration starts in the 9th week of fetal life
GFR increases after birth and reaches adult level at age of 3

8. Growth:
Average birth weight: 3.5 Kg
Premature infants: LBW: less than 2500 gm
VLBW: less than 1500 gm
6-10% weight loss after birth
Weight gain: 20-25gm daily till 4th month, 12gm/day for the coming 8 months
Double the weight by 4 months and triple by 12 months
Changes in body composition occurs as well: at birth, total boy water is 70% and decreases to 60% at 1 year. Adipose tissue increases
Normal values are expressed as percentiles: see growth charts

10. Introduction, cont. Nutritional standards
Acceptable growth needs a balance between adequate intake: absorption and utilization of energy.
Recommended Dietary Allowance (RDA), energy requirements
Components of a healthy infant diet
Fluid:100ml/kg per day for the first 10 kg + 50ml/kg for each additional kg. Water intake in the first 6 months is derived from breast milk or formula
CHO: 40-50% of total calories. Should be balanced with fat intake to allow better development.
Lactose is the primary source.
Lactose intolerance: lactase deficiency
Congenital lactase deficiency is rare
Secondary lactase deficiency: in some cases of gastroenteritis

12. Introduction, cont.
3. Protein and amino acids: 2.2gm/kg/day (birth-6 months), 1.6gm/kg/day (6-12 months)
Composition
Essential a.a.: isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, valine
Conditionally essential a.a.:cystein, taurine, tyrosine, histidine
4. Fat and essential fatty acids
Most dense source of calories in the diet
Supplies 40-50% of the energy intake of infants
Essential PUFA: Linoliec acid, linolenic acid: precursors for LCPUFA: DHA and ARA
5. Micronutrients
-Vitamins
Biotin, choline, inositol
Minerals: calcium, phosphorous, Iron, zinc, copper, manganese

13. Milk production Lactating mammary gland:
Branching network of ducts formed of epithelial cells ending in extensive lobulo alveolar clusters that are the site of milk secretion
Alveoli are surrounded by myoepithelial cells that function in milk ejection, and a vascularized connective tissue containing adipocytes and fibroblasts
Ejection of milk requires contraction of the myoepithelial cells stimulated by oxytocin
Lactating alveolar cell: highly active secretory cell
numerous mitochondria
Extensive rough endoplasmic reticulum
Well developed Golgi apparatus
Epithelium is connected by tight junctions
Basal side contacts myoepithelial cells and the basement mem