Infant and Enteral Formula Ordering

Providing the right nutrition to infants who cannot feed by mouth is a critical part of neonatal and pediatric care. This page offers a concise overview of the process for ordering infant and enteral formulas, covering the types of products available, clinical considerations, ordering steps, and bestpractice tips for safe delivery.

1. Why Proper Formula Selection Matters

Infants who require enteral feeding may have prematurity, congenital anomalies, metabolic disorders, or critical illness that limits oral intake. Selecting an appropriate formula can:

• Support growth and neurodevelopment.
• Prevent nutritional deficiencies or excesses.
• Minimize the risk of feeding intolerance, necrotizing enterocolitis (NEC), and allergic reactions.

2. Major Categories of Infant Formulas

3. Clinical Assessment Before Ordering

Before placing an order, the care team should complete a systematic assessment:

1. Gestational age & birth weight: Determines calorie & protein targets.
2. Medical diagnosis: Identify conditions such as NEC, short bowel syndrome, or metabolic disease.
3. Current feeding tolerance: Volume, residuals, abdominal distension, stool pattern.
4. Laboratory values: Electrolytes, albumin, prealbumin, specific metabolite levels.
5. Allergy history: Document known food allergies or eosinophilic disorders.

4. Steps to Order Infant/Enteral Formula

4.1 Verify Prescription Details

The attending physician or neonatal specialist must write a clear prescription that includes:

• Product name and manufacturer.
• Target volume (mL/kg/day) and feeding schedule.
• Caloric density (kcal/oz or kcal/mL).
• Duration of use (e.g., until weight 2kg or review in 7days).
• Special instructions (e.g., reconstitute to 24kcal/oz, use sterile water only).

4.2 Check Inventory & Expiration

Pharmacy or nutrition services should verify product availability and expiration dates. If the requested formula is out of stock, an equivalent alternative must be approved by the prescriber.

4.3 Enter Order into the EHR

Typical fields in the Electronic Health Record (EHR) include:

• Medication/Formula name.
• Route Enteral NG/Ttube/PO.
• Strength e.g., 24kcal/oz, 24g protein/L.
• Dosage 120mL/kg/day divided q8h.
• Start/Stop dates.

4.4 Review & Approve

Pharmacy or a clinical nutritionist reviews the order for appropriateness, potential drugnutrient interactions, and formulary compliance. After verification, the order is approved and sent to the central dispensing unit.

4.5 Delivery to the Bedside

Once prepared, the formula is delivered in a sterile bag or container. Nursing staff must:

• Check the label against the order.
• Confirm correct volume and temperature.
• Document the administered amount and any residuals.

5. Monitoring After Initiation

Continuous monitoring ensures the infant is receiving adequate nutrition and helps catch complications early.

• Weight: Daily weight checks; aim for 1520g/kg/day gain in preemies.
• Fluid balance: Inputoutput chart, attention to urine output.
• Biochemistry: Electrolytes, glucose, and specific metabolic markers every 23days.
• Tolerance: Observe for abdominal distension, vomiting, or high gastric residuals.
• Allergic reactions: Rash, wheezing, or anaphylaxis signs demand immediate review.

6. Common Pitfalls & Tips

• Incorrect concentration: Always doublecheck reconstitution instructions. A 20kcal/oz formula given as 24kcal/oz can cause hyperglycemia.
• Using tap water: For most neonatal formulas, use sterile or boiledthencooled water to avoid bacterial contamination.
• Overflowing the feeding tube: Verify tube size and flow rate; use appropriate infusion pumps.
• Missing allergy documentation: Failure to note a cowmilk allergy may lead to severe reactions.
• Expiration oversight: Rotating stock and checking dates prevents administration of degraded nutrients.

7. Resources for Clinicians

For further information, consult the following reputable sources:

• NICHD Neonatal Nutrition
• European Society for Paediatric Gastroenterology
• USDA Food Safety for Formula Preparation
• American Academy of Pediatrics

Note: This guide is intended for educational purposes and should be used in conjunction with local institutional protocols and the judgment of qualified healthcare professionals.