SMA Pro Gold Prem Number 2 Baby Milk, 400 g

Product Information

SMA Gold Prem ® Breast Milk Fortifier is a powdered preparation which provides extra protein, energy, calcium, omega 3 and 6 and vitamins A & E to help provide the increased nutrition required by these vulnerable infants. SMA Gold Prem ® Breast Milk Fortifier is available in 1 g sachets – this will help to fortify smaller volumes of breast milk. Daly S.E et al (1993) Degree of breast emptying explains changes in the fat content, but not fatty acid composition of human milk. Exp Physiol;78(6) 741- 55 Trophic feeds, defined as initial milk feeds of up to 1ml/kg/hr, aim to prepare the gut for subsequent advancement of enteral feeds.

Place cap on container, gently shake the container until the powder is fully dissolved. Feed immediately. SMA Gold Prem ® Breast Milk Fortifier can be given from a bottle or via a naso-gastric tube. Discard any milk remaining after each feed. Embleton NE, Pang N, Cooke RJ. Post-natal malnutrition and growth retardation: an inevitable consequence of current recommendations in preterm infants? Pediatrics 2001;107:270–3. Trophic feeds are small volumes of milk given to stimulate the bowel that are maintained for up to 7 days and not intended to contribute to nutrition. The maximum volume is 1ml/kg/hour or 24ml/kg/day.(9) There is no recognised consensus on duration or method of delivery.(10) The most recent evidence from the SIFT study showed that slow advancement of feeding in very low birthweight infants did not reduce the risk of NEC showing no advantage in increasing at 18ml/kg/day versus 30ml/kg/day. (14)

If feeding contraindicated/feeding intolerance, colostrum should be used buccally as mouth care (see below).

If on fortified EBM with protein supplements total fluid volume should not exceed 150ml/kg/day due to a theoretical risk of protein toxicity. Modi .N (2006) Donor Breast Milk Banking – unregulated expansion requires evidence of benefit (letter) BMJ; 333:1133-4 Hay W Jr. (2009) Optimizing protein intake in preterm infants. Journal of Perinatology; 29(7): 465–466.Gastric motility more rapidly normalises if feeds are started early and offered frequently rather than being withheld.(50) Despite this feeds are frequently stopped, or advances held on the basis of “feed intolerance”. The definition of intolerance includes not only the presence and colour of gastric residuals, but also vomiting, increases in abdominal girth or abdominal tenderness, presence of abnormal or blood stained stool, absence of bowel sounds, abdominal wall discolouration, or a combination(1). As all of these can occur in the healthy premature infant who is tolerating feeds(55) careful clinical assessment is essential to prevent unnecessary limitations of enteral feeds, reliance on parenteral nutrition, increase nosocomial infection, delay enteral feeding and poor growth.

Brown J, Embleton N, Harding J, McGuire W. (2016) Multi-nutrient fortification of human milk for preterm infants. Cochrane Database Syst Rev CD000343First choice for severe cow's milk protein allergy or when an extensively hydrolysed product (e.g. Althera, Nutramigen, Aptamil Pepti) does not resolve symptoms