SUSU FORMULA UNTUK BAYI

DAN MAKANAN ENTERAL BAYI

DAN ANAK

Y. ENDANG BUDIWIARTI, SKM. MPH.RD

Feeding Recommendations
• Considerations
 Growth in infancy
 Physiology of infancy
▫ GI
▫ Renal
 Infant Development
 Nutrient requirements
 Health and prevention
Feeding the Infant

• Choices:
▫ Human Milk
▫ Standard Infant Formula
(Cow, Soy)
▫ Hypoallergenic (hydrolysates
vs amino acid based
▫ Other specialty formulas
▫ Preterm
▫ Post discharge formulas for
preterm infants
• “No two hemispheres of
any learned professor’s
brain are equal to two
healthy mammary glands
in the production of a
satisfactory food for
infants”
- Oliver Wendell Holmes
FORMULA BAYI
• Adalah formula sebagai penganti ASI untuk bayi
sampai umur 6 bl, yg secara khusus
diformulasikan untukmenjadi satu2 nya sumber
gizi dlm bula pertama kehidupan sampai bayi
diperkenalkan dg MPASI
• Komposisi harus mengikuti Codex Alimentarius
atau BPOM
• Formula Bayi Untuk Keperluan Medis
Khusus adalah pangan bagi bayi yang diolah atau
diformulasi secara khusus dan disajikan sebagai
tatalaksana diet pasien bayi sehingga secara tunggal
dapat memenuhi kebutuhan gizi bayi dengan
gangguan, penyakit atau kondisi medis khusus
selama beberapa bulan pertama kehidupannya
sampai saat pengenalan MP-ASI dan hanya boleh
digunakan dibawah pengawasan tenaga medis.
• (Penuntun diet anak)
 Susu
Susu sapi
Komposisi Kolostrum ASI matur Formula
(rata-rata)
Bayi*
Min Max GUL**
KOMPOSISI
Protein (g) 2.3 1.05±0.2 3.14 1.21 2.01 -
KOLUSTRUM,
Lemak (g) 2.9 3.9±0.4 5.7 2.95 4.02 -
ASI SUSU SAPI
Karbohidratg) 7.2±0.25 7.3 6.03 9.38 - & FORMULA
Asam Linoleat
- 560 125 201 938 BAYI
(g)

Vitamin A (mcg) 89 67±20 216 40 120 -

Vitamin D (mcg) - 0.06±0.01 3 0.67 1.68 -

Vitamin E (mg) 1.28 0.23±0.1 0.1 0.34 - 3.35

Vitamin K (mcg) 0.23 0.21±0.01 5 2.68 - 18.09

Vitamin C (mg) 4.4 4±1 2.3 6.7 -

Tiamin (mg) 0.15 0.25 0.59 0.40 - 0.20

Riboflavin (mg) 0.025 0.035±0.003 252 0.54 - 0.34 Sumber :

Holland, et all. Dalam Clinical
Niacin (mg) 0.075 0.15±0.02 131 201 - 1.0 Paediatric Dietetic, 1994.
Vitamin B6 (mg) 0.12 9.3±0.8 66 0.23 - 1.17 Nutrition in Pediatrics, 2003
Dalam Penuntun Diet Anak 2014
Asam folat *Codex Stan 72-1981 Revisi 2007
- 4 8 6.7 - 33.5 ** GUL: Guidance Upper Level
(mcg)
Cow’s Milk Based Formula: Protein
▫ whey proteins of human and cow’s milk are different
and have different amino acid profiles.
 Major whey proteins of human milk at a lactalbumin
(high levels of essential aa) , immunoglobulins, and
lactoferrin( enhances iron transportation)
 Cow’s milk has low levels of these proteins and high
levels of b lactoglobulin
▫ Infants appear to thrive equally well with either whey
or casein predominant formulas.
Cow’s Milk Based Formula: Fat & CHO
• Fat: butterfat of cow’s milk is replaced with
vegetable fat sources to make the fatty acid
profile of cow’s milk formulas more like those of
human milk and to increase the proportion of
essential fatty acids
• Cho: Lactose is the major carbohydrate in most
cows’ milk based formulas.
Soy Formulas
• Protein: soy protein isolate with added
methionine
• Fat: vegetables oils
• Cho: usually corn based products
 Soy Formulas
Characteristics compared to Milk Based

• Higher protein (lower quality)

• Higher sodium, calcium, and
phosphorus
• Carbohydrate: Corn syrup solids,
sucrose, and/or maltodextrin; lactose free
• Fats: Long chain
• Meet needs of healthy infants
Possible Concerns about Soy Formulas:
AAP
• 60% of infants with cowmilk protein induced
enterocolitis will also be sensitive to soy protein -
damaged mucosa allows increased uptake of antigen.
• Contains phytates and fiber oligosacharides so will
inhibit absorption of minerals (additional Ca is added)
• Higher levels of osteopenia in preterm infants given soy
formulas
• Phytoestrogens at levels that demonstrate physiologic
activity in rodent models
• Higher aluminum levels
Jenis Formula Bayi
CODEX Alimentarius dan European Society for
Paediatric Gastroenterology, Hepatology,
Nutrition (ESPGHAN) Committee on Nutrition
membagi formula bayi (infant formula) dalam 3
jenis, yaitu :
1. Formula awal (starting formula)
Formula awal harus dapat memenuhi
kebutuhan energi dan zat-zat gizi esensial bagi
bayi sampai umur 1 tahun.
Contoh : SGM 1, Lactogen 1, Bebelac 1, S26,
Vitalac 1, NAN 1, dll
2. Formula lanjutan (follow-up formula). BPOM RI
2010
a. Formula lanjutan usia 7 – 12 bulan
Formula lanjutan dapat diberikan mulai dari
umur 7 bulan dan bersama-sama dengan
makanan tambahan misalnya buah, bubur susu
dan nasi tim sampai umur 1 tahun. Contoh :
SGM 2, Lactogen 2, Promil, Nan 2, dll
b. Formula lanjutan usia 1 – 3 tahun
Contoh : Bebelac 3, dancow 3, bendera 3, SGM
3, dll
3. Formula untuk tujuan khusus medis
Formula untuk tujuan khusus medis meliputi formula untuk
a. bayi prematur : SGM BBLR, Pre NAN, S26 LBW, Enfamil
A+PF, dll
b. alergi susu sapi :
• Protein terhidrolisa parsial (unutk mencegah alergi) :
NAN HA, Enfamil A+ HA
• Protein terhidrolisa ekstensif; susu semi elemental
(mengandung glukosa polimer, MCT, asam amino) :
Pregestimil, Pepti Yunior, Nutramigen
• Susu elemental bahan dasar asam amino
(mengandung asam amino, MCT : Neocate
c. formula khusus gangguan saluran cerna
• Rendah laktosa/ bebas laktosa : SGM LLM, ,
Bebelac FL, AL 110, Enfamil A+ LF
• Semi elemental : Pregestimil, Peptiyunior
• Bahan dasar kedele : Isomil, Nutrisoya, SGM
soya.
d. kelainan metabolisme bawaan :
• Rendah Phenilalanin (PKU) : Lofenalac
e. Formula gizi kurang : Infantrini (1 kkal/ml) atau
diracik → susu formula + glukosa polimer
(Nutricomp)+ MCT
FORMULA BAYI PREMATUR
• Kandungan energi 75 – 81 kkal/100 ml
• Protein 2 – 2,4 g/100 ml, whey protein
concentrate
• Lemak 4 – 4,4 g/100 ml, MCT 40 - 50 %
• Glukosa polimer 50 – 60 %

• For infants born at <1.5kg

▫ up to 2000-2500gm
 Elemental Infant Formula

• NeoCate
 Protein: Free Amino Acids
 Fat: Long chain

 Carbohydrate: Lactose Free

 Indications for use: Food Allergy

or intolerance to peptides or whole

protein
FORMULA ENTERAL ANAK
 Formula untuk menaikkan BB : Pediasure,
Nutren Yunior, Procal, Bebelac complete,
Nutrini drink, dkk
 Formula semi elemental : Peptamen Yunior
 Rendah/bebas laktosa : Pediasure complete,
nutren optimum
 Lemak tinggi : ketocal
 Susu kedele : proten
FORMULA ENTERAL ANAK
 Formula BCAA tinggi : Aminoleban,
Hepatosol
 Formula rendah protein : Kindergen,
Nephrisol
 Formula serat tinggi : Nutren fiber
 Formula rendah sisa : Ensure
 Know What You Are Feeding
 Caloric density, protein, fat and carbohydrate vitamin and
mineral content.
 Osmolality: goal is for <400mOsm/kg H2O
 Renal Solute Load: Evaluate RSL in context of solute
intake, fluid intake and output. Goal is for less than
300mOsm/l (all infant and pediatric meet this
recommendation when concentrated up to 30 kcal/oz.)
 Evidence Based
 Rationale
 Cost and availability
FORMULA AWAL

Formula/ SGM1/
Nilai gizi 100 ml
Berat (g) 13,2
Jumlah 3
takaran
Energi
Protein