Ask CRN

Ask

CRN

QUESTION

renal insufficiency (CRI) requiring modification of volume and/or caloric and protein content, clinical practitioners might do well to defer to commercial infant formula. Several formulas have been used successfully in this population. Preterm infants with CRI, especially those diagnosed with bronchopulmonary dysplasia, present significantly increased risk for undernutrition and poor growth and require extraordinary nutritional management. Additionally, infants requiring fluid restriction also require nutrient supplementation to ensure adequate intake. Breast-feeding does not allow accurate volume assessment, and pumping breast milk regularly could prove strenuous over time. Although breast feeding should not be discouraged in all cases, the concept and acceptance of formula feeds should be part of the nutritional education given to the parents of these special infants. The only acceptable outcome is normal growth and development.

What are the guidelines for breastfeeding infants with renal insufficiency during the first year of life?

ANSWER From Nancy Spinozzi, RD, Children’s Hospital, Boston, MA: Human milk provides the best source of nutrition for full-term infants; however, commercial infant formulas remain viable substitutes for infants despite the fact that they lack an immunochemical composition. It is well documented that cow’s milk is contraindicated in any infant younger than 12 months old. The medical decision to use formula in favor of human milk is one of clinical judgement. In the case of infants with chronic

o 1995 by the National 1051-2276/95/0503-0012$3.00/O

Journal

of Renal

Nutrition,

Kidney

Vol

Foundation,

5, No 3 (July),

Inc.

1995:

p 161

161