Formula selection for infants

Indications	Formula category and description	Examples
Prematurity (For infants <34 weeks gestational age and/or weight <2 kg)	Premature formula: High in protein, calcium, and phosphorus Includes MCT, long-chain fat, glucose polymers, and lactose Supplemented with additional calcium, phosphorus, vitamin A, vitamin D, folate, zinc, and iron Calcium:phosphorus ratio of 2:1 Available in concentrations of 0.67, 0.74, or 1 kcal/mL (20, 24, or 30 kcal/oz) Low-iron formulations are available but are not generally recommended	Enfamil Premature Similac Special Care Breastmilk + Human Milk Fortifier (various types)^*
Premature infants, post-hospital discharge^¶ (For infants with birth weight <2000 g and/or laboratory evidence of metabolic bone disease)	Post-discharge formula: Composition similar to above Standard concentration is 0.74 kcal/mL (22 kcal/oz)	Similac Neosure Enfamil NeuroPro Enfacare
Normal gastrointestinal tract	Standard infant formula: Cow's milk protein Lactose Long-chain fat (vegetable oil blend); no MCT	Breast milk Enfamil NeuroPro Similac Pro-Advance Gerber Good Start GentlePro
Primary or secondary lactose intolerance	Lactose-free formula: Milk protein isolate or soy protein isolate Long-chain fat Lactose free	Similac Sensitive Enfamil ProSobee Similac Soy Isomil Gerber Good Start Soy
Food protein intolerance (eg, cow's milk protein intolerance)	Hydrolysate formula: Cow's milk protein hydrolysate Long-chain fat; variable MCT (0 to 55% of fat) Lactose free	Enfamil Nutramigen with Enflora LGG Enfamil Pregestimil Similac Alimentum Gerber HA
Severe protein allergy	Elemental formula: Free amino acids Moderate MCT (approximately 30% of fat); remainder long-chain fat Lactose free	Neocate Infant DHA & ARA Neocate Infant Syneo Elecare Infant Puramino Alfamino Infant
Malabsorption Intractable diarrhea Steatorrhea	Hydrolysate formula with MCT: Cow's milk protein hydrolysate Long-chain fats; moderate to high MCT (30 to 55% of fat) Lactose free	Pregestimil Similac Alimentum Gerber Extensive HA
Impaired fat absorption Chylous effusion Lymphatic disorder Metabolic disorders	High-MCT formula: Intact protein Very high MCT (84 to 90% of fat)	Portagen Monogen Enfaport Lipistart
Kidney function impairment	Renal formula for infants: Cow's milk protein (60% whey/40% casein) Long-chain fat Low iron Lower in potassium Lower in calcium and phosphorus (maintaining 2:1 ratio)	Similac PM 60/40
Galactosemia	Soy-based formula: Soy-based protein Long-chain fat Lactose free (carbohydrate supplied by glucose polymers)	Enfamil ProSobee Similac Isomil Gerber Good Start Soy

MCT: medium-chain triglycerides.

* For details on human milk fortifiers, refer to UpToDate content on nutritional content of human milk and fortification.

¶ Use of these nutritionally enriched formulas for preterm infants after discharge varies among institutions. For more detail, refer to UpToDate content on growth management of preterm infants and management of bone health in premature infants.

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Formula selection for infants