1 extra scoop
of formula

Tolerability
trouble

1 extra scoop
of formula

Slow catch-up
growth

1 extra scoop
of formula

Malnutrition

Tolerability
trouble

Delayed catch-up
to growth goals

Suboptimal
protein

Surgery
delayed

Incorrect nutrient
delivery

Outcomes at risk

Standard.
But not up to
your standards.

Concentrating standard formula for infants with failure to thrive (FTT) doesn’t measure up

You do everything you can to help your full-term infants with FTT. You provide the calories and nutrients they need to catch up—or, in some cases, to prepare them for life-saving procedures.

But today’s standard of care often falls short of expert guidelines,* putting your efforts—and their outcomes—at risk.

Infants with FTT can’t afford any more obstacles to thriving and health

Concentrating standard formula has been among the most common options for FTT infants in the United States. But this approach has been considered sub-standard in other countries for decades—because it has so many drawbacks.

Hear from pediatric dietitian Dr. Luise Marino, as she explains why concentrating infant formulas isn’t up to her standards.

FTT: A Serious Problem with
a Sub-Standard Solution

How the standard of care is putting outcomes at risk

infographicContent Unbalanced nutrition 6 Although concentrating and fortifying can help achieve higher calorie levels, they do not produce a balance of nutrients tailored for babies with FTT. Mix-ups and contamination When mixing powdered formulas, there’s always a danger of mistakes 9-11 or external contamination. 12-14 And the risk of errors, burden on caregivers, and extra staff time only increase when adding extra formula, fortifying, or supplementing with modular nutrition products. 5 Inadequate hydration 4 Concentrating infant formula may come with concerns about inadequate hydration and even dehydration due to insufficient free water and high potential renal solute load (PRSL). 1,4,5 Insufficient protein 3 Standard infant formulas typically provide ≈8% of calories in the form of protein, even when concentrated – this falls short of the WHO/FAO/UNU target of 9-12% to support catch-up growth with appropriate lean tissue gain. 8 The step-up slowdown 2 To reduce risk of tolerability issues, many infants are slowly transitioned to higher- calorie feeds to reach their goal calorie level, 2,3 losing precious time to the incremental “step-up method.” This slow approach may impede weight gain, which is especially worrisome in babies for whom pivotal procedures are delayed until they reach a healthier weight. 6,7 T roubling tolerability 1 Concentrating powdered infant formula increases osmolality, 1 which can be hard for infants to tolerate. 2,3 Hyperosmolar feeds can bring concern of osmotic diarrhea, 1,4,5 delaying catch-up goals.
Troubling tolerability

Concentrating powdered infant formula increases osmolality,1 which can be hard for infants to tolerate.2,3 Hyperosmolar feeds can bring concern of osmotic diarrhea,1,4,5 delaying catch-up goals.

The step-up slowdown

To reduce risk of tolerability issues, many infants are slowly transitioned to higher-calorie feeds to reach their goal calorie level,2,3 losing precious time to the incremental “step-up method.” This slow approach may impede weight gain, which is especially worrisome in babies for whom pivotal procedures are delayed until they reach a healthier weight.6,7

Insufficient protein

Standard infant formulas typically provide ≈8% of calories in the form of protein, even when concentrated – this falls short of the WHO/FAO/UNU target of 9-12% to support catch-up growth with appropriate lean tissue gain.8

Inadequate hydration

Concentrating infant formula may come with concerns about inadequate hydration and even dehydration due to insufficient free water and high potential renal solute load (PRSL).1,4,5

Mix-ups and contamination

When mixing powdered formulas, there’s always a danger of mistakes9-11 or external contamination.12-14 And the risk of errors, burden on caregivers, and extra staff time only increase when adding extra formula, fortifying, or supplementing with modular nutrition products.

Unbalanced nutrition

Although concentrating and fortifying can help achieve higher calorie levels, they do not produce a balance of nutrients tailored for babies with FTT.

It’s time to raise the standard, with Fortini™

Nutricia is dedicated to helping you provide a strong start for your most vulnerable patients. As a trusted worldwide leader in specialized infant formula, we’re proud to bring Fortini to the United States. It’s the first and only ready-to-feed, 30 kcal/fl oz formula specifically calibrated for the unique needs of term FTT infants — and it’s just as tolerable as standard 20 kcal/fl oz formulas.15-17

With Fortini, achieving feeding goals never has to wait.

Using a nutrient- and energy-dense feed has revolutionized our practice.

Dr. Luise Marino
Clinical Academic Pediatric Dietitian
Southampton General Hospital

Fortini is coming soon—be the first to know when it’s ready.

Sign up to be among the first to sample Fortini, and to stay up-to-date with exclusive clinical content and information on this care-changing approach to managing FTT.

Failure. We’re coming for you.

In the meantime, be sure to check out the wealth of resources below—so you can learn more about the shortcomings of concentrating and fortifying infant formulas, and be primed to foster the transition from faltering to flourishing.

Infographic
Nutrition should never have to wait
Video
There’s a better way
with Dr. Luise Marino
Video
The drawbacks of an imbalanced feed
with Dr. Luise Marino
Video
The importance of proper protein
with Dr. Luise Marino
Video
The real-world impact of poor weight gain
with Dr. Luise Marino
Video
Clinical studies on the use of high energy and protein infant formula
with Dr. Rosan Meyer
Video
The profound consequences of concentrating mistakes
with Dr. Luise Marino
Video
What is the expert recommended protein energy ratio for catch up growth?
with Dr. Rosan Meyer
Video
What is the window of opportunity in failure to thrive?
Dr. Rosan Meyer
Video
What are the benefits of using a high energy and protein infant formula?
Dr. Rosan Meyer
Video
The added urgency of congenital heart disease (CHD)
Dr. Luise Marino
Video
A revolutionary, ready-to-use solution is coming
with Dr. Luise Marino

*World Health Organization; Food and Agriculture Organization of the United Nations; United Nations University. Protein and amino acid requirements in human nutrition: report of a joint FAO/WHO/UNU expert consultation. 2007.
Known as Infatrini outside the U.S.

References: 1. Steele JR, et al. Determining the osmolality of over-concentrated and supplemented infant formulas. J Hum Nutr Diet. 2013;26:32-7. 2. Slicker J, et al. Nutrition algorithms for infants with hypoplastic left heart syndrome; birth through the first interstage period. Congenit Heart Dis. 2013;8:89-102. 3. Roman B. Nourishing little hearts: nutritional implications for congenital heart defects. Pract Gastroenterol. 2011;35:11-34. 4. Pereira-da-Silva L, et al. Osmolality of preterm formulas supplemented with nonprotein energy supplements. Eur J Clin Nutr. 2008;62:274-8. 5. Fomon SJ, et al. Renal solute load and potential renal solute load in infancy. J Pediatr. 1999;134:11-4. 6. Reddy VM. Low birth weight and very low birth weight neonates with congenital heart disease: timing of surgery, reasons for delaying or not delaying surgery. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2013;16:13-20. 7. Alsoufi B, et al. Low-weight infants are at increased mortality risk after palliative or corrective cardiac surgery. J Thorac Cardiovasc Surg. 2014;148:2508-14.e1. 8. World Health Organization; Food and Agriculture Organization of the United Nations; United Nations University. Protein and amino acid requirements in human nutrition: report of a joint FAO/WHO/UNU expert consultation. 2007. 9. Renfrew MJ, et al. Formula feed preparation: helping reduce the risks; a systematic review. Arch Dis Child. 2003;88:855-8. 10. Plaster SE, et al. Variability of infant formula scoop weights. J Am Diet Assoc. 1996;96:A-64. 11. Altazan AD, et al. Unintentional error in formula preparation and its simulated impact on infant weight and adiposity. Pediatr Obes. 2019;14:e12564. 12. Rocha Carvalho ML, et al. Hazard analysis and critical control point system approach in the evaluation of environmental and procedural sources of contamination of enteral feedings in three hospitals. JPEN J Parenter Enteral Nutr. 2000;24:296-303. 13. Fagerman KE. Limiting bacterial contamination of enteral nutrient solutions: 6- year history with reduction of contamination at two Institutions. Nutr Clin Pract. 1992;7:31-6. 14. Labiner-Wolfe J, et al. Infant formula-handling education and safety. Pediatrics. 2008;122 Suppl 2:S85-90. 15. Clarke SE, et al. Randomized comparison of a nutrient-dense formula with an energy-supplemented formula for infants with faltering growth. J Hum Nutr Diet. 2007;20:329-39. 16. van Waardenburg DA, et al. Critically ill infants benefit from early administration of protein and energy-enriched formula: a randomized controlled trial. Clin Nutr. 2009;28:249-55. 17. Cui Y, et al. Effects and tolerance of protein and energy-enriched formula in infants following congenital heart surgery: a randomized controlled trial. JPEN J Parenter Enteral Nutr. 2018;42:196-204. 18. Evans S, et al. Should high-energy infant formula be given at full strength from its first day of usage? J Hum Nutr Diet. 2006;19:191-7. 19. de Betue CT, et al. Increased protein-energy intake promotes anabolism in critically ill infants with viral bronchiolitis: a double-blind randomised controlled trial. Arch Dis Child. 2011;96:817-22. 20. de Betue CT, et al. Arginine appearance and nitric oxide synthesis in critically ill infants can be increased with a protein-energy-enriched enteral formula. Am J Clin Nutr. 2013;98:907-16. 21. Eveleens RD, et al. Weight improvement with the use of protein and energy enriched nutritional formula in infants with a prolonged PICU stay. J Hum Nutr Diet. 2019;32:3-10. 22. Scheeffer VA, et al. Tolerability and effects of the use of energy-enriched infant formula after congenital heart surgery: a randomized controlled trial. JPEN J Parenter Enteral Nutr. 2020;44:348-54.