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SMA Gold Prem 1

Preterm and low birthweight formula

SMA Gold Prem 1 has been reformulated to meet the latest Tsang guidelines to help support the healthy growth and development of preterm and low birthweight (LBW) infants in a hospital setting. It delivers nutrients to meet the increased nutritional needs of preterm, LBW, very low birthweight and extremely low birthweight infants to help achieve catch-up growth, including protein, Omega 3 & 6 LCPs, calcium, phosphorus and other nutrients.

Specially tailored formula

For low birthweight and preterm babies

Nutritionally complete

Suitable as the sole source of nutrition for preterm and low birthweight babies.

Omega 3 & 6

Helps brain and eye development

SMA Gold Prem 1 – supporting the healthy growth of early arrivals in hospital

“Nutritional planning should provide adequate calories for gradual normalisation in all growth variables, while attempting to avoid atypically low or excessive weight gain⁵”

SMA Gold Prem 1 is a nutritionally complete formula that complies with the latest guidelines, including Tsang, to support healthy growth and development in LBW/preterm infants whilst in hospital ^17,18

What is preterm and low birthweight?

Around 50,000 infants are born preterm (below 37 weeks gestation) in the UK each year.

Terminology:
Premature (preterm) infants are those born at or before 37 weeks. Infants who are born prematurely weigh much less than term infants and fall into one of the categories below.

What are the guidelines and recommendations?

The Committee on Nutrition of the American Academy of Pediatrics has recommended that infant formulae have concentrations no greater than 400 mOsm/kg⁵²

Hyperosmolar feeds have been shown to empty from the stomach more slowly than isotonic solutions and are associated with an increased risk of nausea, vomiting, diarrhoea and gastroesophageal reflux ⁵¹

SMA Gold Prem 1 has been carefully formulated with the immature organs of preterm/LBW infants in mind:

A blend of lactose and glucose polymers (maltodextrin) to lower formula osmolality and to help promote gastrointestinal tolerance in infants who have difficulty digesting lactose^31,32. A low potential renal solute load (202 mOsm/L) to reduce the burden on the immature kidneys of preterm/LBW infants ¹⁸

What is the protein level?

SMA Gold Prem 1 contains 2.2 g of protein per 100 ml (2.7 g/100 kcal) – this level has been clinically shown to result in a growth rate similar to the expected intrauterine growth rate 17,33

What is the calcium-to-phosphorus ratio that encourages calcium retention and bone mineralisation?

LBW/preterm infants are at risk of developing metabolic bone disease due to deficits in calcium, phosphorus and magnesium that accumulate between birth and term ²¹
SMA Gold Prem 1 has levels of calcium, phosphorus and magnesium that meet the latest Tsang Guidelines and a 1.7:1 calcium-to-phosphorus ratio that encourages bone mineralization ¹⁷

What are the guidelines and recommendations to help to support brain, eye and nervous system development?

The World Association of Perinatal Medicine (WAPM) recommends the use of infant formulae fortified with long-chain polyunsaturated fatty acids (LCPs) ³⁴
SMA Gold Prem 1 contains the Omega-6 LCP arachidonic acid (AA), and the Omega-3 LCP docosahexaenoic acid (DHA), which have been shown to help support visual acuity and brain development ^35-37. These LCPs are in the same triglyceride form as found in breast milk ³⁸ The LCPs are derived from a pure vegetable source that has been proven to be safe, effective and well tolerated ^12,39

What is the essential vitamin and mineral content of SMA Gold Prem 1 that meets the latest Tsang guidelines 17?

SMA Gold Prem 1 demonstrating significantly increased bone mineral content (BMC) by the time of hospital discharge

References

5. Casey PH. Growth of low birth weight preterm children. Semin Perin 2008; 32: 20-27.

12. Vanderhoof J et al. A multicenter long-term safety and efficacy trial of preterm formula supplemented with long-chain polyunsaturated fatty acids. J Pediatr Gastroenterol Nutr 2000; 31(2): 121-127.

16. Rao R et al. In: Tsang RC et al. Nutrition of the Preterm Infant: Scientific Basis and Practical Guidelines. 2nd ed. Cincinnati, OH: Digital Educational Publishing, Inc.; 2005: 277-310.

17. Tsang RC et al. Nutrition of the Preterm Infant: Scientific Basis and Practical Guidelines. 2nd ed. Cincinnati, OH: Digital Educational Publishing, Inc.; 2005.

18. Klein C, ed. Nutrient requirements for preterm infant formulas. J Nutr 2002; 132(6): 1395S-1577S.

21. Lapillonne A et al. Bone mineralization and growth are enhanced in preterm infants fed an isocaloric, nutrient-enriched preterm formula through term. Am J Clin Nutr 2004; 80(6): 1595-1603.

31. Cicco R et al. Glucose polymer tolerance in premature infants. Pediatrics 1981; 67(4): 498-501.

32. Auricchio S et al. Intestinal glycosidase activities in the human embryo,fetus, and newborn. Pediatrics 1965; 35(6): 944-954.

34. Koletzko B et al. The roles of long-chain polyunsaturated fatty acids in pregnancy, lactation and infancy: review of current knowledge and consensus recommendations. J Perin Med 2008; 36(1): 5-14.

35. Carlson SE et al. Visual-acuity development in healthy preterm infants:effect of marine-oil supplementation. Am J Clin Nutr 1993; 58(1): 35-42.

36. Hoffman DR et al. Effects of supplementation with cortical development in premature infants. Am J Clin Nutri 1993; 57(suppl): 807S-812S.

37. O’Connor DL et al. Growth and development in preterm infants fed longchain polyunsaturated fatty acids: a prospective, randomized controlled trial. Pediatrics 2001; 108(2): 359-371.

38. Koletzko B et al. Long chain polyunsaturated fatty acids (LC-PUFA) and perinatal development. Acta Paed 2001 Apr; 90(4): 460-464. Review.

39. Vanderhoof J et al. Evaluation of a Long-Chain Polyunsaturated Fatty Acid Supplemented Formula on Growth, Tolerance, and Plasma Lipids in Preterm Infants up to 48 Weeks Postconceptional Age. J Pediatr Gastroenterol Nutr 1999; 29: 318-326.

40. Inder T et al. Plasma vitamin A levels in the low birthweight infant – relationship to respiratory outcome. Earl Hum Dev 1998; 52: 155-168.

41. Rigo J et al. Enteral calcium, phosphate and vitamin D requirements and bone mineralization in preterm infants. Acta Paed 2007; 94: 969-974.

42. Mino M et al. Tocopherol levels in human fetal and infant liver. J Nutr Sci Vit 1977; 23: 63-69.

43. Dju M et al. Vitamin E (tocopherol) in human tissues from birth to old age. Am J Clin Nutr 1958; 6: 50-60.

44. Cruz C et al. The effect of vitamin E on erythrocyte hemolysis and lipid peroxidation in newborn premature infants. Acta Paed Scand 1983; 7: 823-826.

45. Wada M et al. Fluid and electrolytes balance in extremely preterm infants <24 weeks of gestation in the first week of life. Pediatr Int 2008; 50: 331- 336.

46. Franz A et al. Prospective randomised trial of early versus late enteral iron supplementation in infants with a birthweight of less than 1301 grams. Pediatrics 2000; 106(4): 700-706.

47. Lundström U et al. At what age does iron supplementation become necessary in low-birthweight infants? J Pediatr 1977; 91(6): 878-883.

48. Greer FR. Vitamins A, E and K. In Tsang RC, Uauy R, Koletzko B, Zlotkin SH, eds. Nutrition of the Preterm Infant: Scientific Basis and Practical Guidelines. 2nd Ed. Cincinnati, OH: Digital Educational Publishing, Inc; 2005: 141-172.

49. Koo W et al. Effect of different vitamin A intakes on very-low-birth-weight infants. Am J Clin Nutr 1995; 62:1216-1220.

50. Backström MC et al. Randomised controlled trial of vitamin D supplementation on bone density and biochemical indices in preterm infants. Arch Dis Child Fet Neonat Ed 1999; 80: F161.51. Periera-Da-Silva L et al. Osmolality of preterm formulas supplemented with nonprotein energy supplements. Eur J Clin Nutr 2008; 62: 274-278.

52. Committee on Nutrition, American Academy of Pediatrics: Commentary on breast-feeding and infant formulas, including proposed standards for formula. Pediatrics 1976; 57: 278-285.

53. SMA Gold Prem 1 Product Composition.

54. Cow & Gate NutriPrem 1 datacard. URL: www.in-practice.co.uk Accessed: 5 March 2009.

55. Milupa Aptamil Preterm Datacard. September 2008. URL:www.milupaaptamil4hcps.co.uk. Accessed: 13 March 2009.

56. Nestlé Infant Nutrition. Product Information. Item Code RO-RR-OE(NWHL007-1) 2003. Nestlé UK.