24 Cal Formula

New here on the preemie forum, but thought I would give it a try.
My wife had, Natalie, a 4 lb. 2 oz preemie on 5/7/08 at 35 weeks. After two weeks in the NICU, and another two weeks at home, she is gaining weight and seems to be doing well.
However, the doctor has prescribed Enfamil Lipil 24 cal formula. The baby is breast fed, but is to get one high cal bottle per day.
I did some Googling, and searched the forums here, and found that some are doing a "heavy mix" of regular formula to reach 24 calories per ounce rather than buying the Enfamil 24 cal formula.
So what do you guys think? Is it OK to simply do a heavy mix, or must we order the Enfamil? We've got a cupboard full of powdered formula samples, and would like to use them up.

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When we brought our son home, a 27 weeker, they told us to do the same thing of having one bottle a day of the 24 cal Enfamil. I found that he was having TERRIBLE gas with it so I stopped it completely and only used formula (enfamil gentlease) when we ran out of stored breast milk. He gained weight perfectly with this system, but it's what you feel comfortable with.

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FYI--my baby was also on the NeoSure fortification, which I wasn't crazy about because I wanted him on breastmilk only. He stayed on until he was 3 months old, at which time my dad (a perinatologist) put me in touch with the NICU's preemie infant nutrition specialist, who told me they had been recommending the fortification but that recent studies don't show any benefit for breastfed babies and that I could discontinue using it. She said they were revising their use of it in the NICU, as well (only for fortification of breastmilk). She did say, however, that there is evidence that preemie formulas (Neosure, etc.) are better than regular formulas for preemies on formula. So...if you want to discontinue fortifiying altogether, you should talk to your doctor about the science behind it.

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My son is on Neosure 26 when he comes home they will give me a recipe on how to make but yes you add more formula than water or they do a fortifier. They also have on for breast milk as well.

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we used neosure 22 calorie in combination with expressed breastmilk until she was about 9 months corrected at which time her gastroenterologist had us switch to a regular formula and fortify it to 24 calorie (she is a low volume drinker). preemie formula is supposed to contain more of certain vitamins/minerals that support preemies' rapid catch-up growth and development. if you're interested, i can look up the ratio of powder to water to make 24-calorie concentration...we use liquid concentrate (much easier to mix) and it's 240 mL (8 oz) water per 13 oz can.

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Thanks for all the great advice. We're going to mix to 24 calories and see how it goes for a week.
Thanks again.

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We mixed in 22 cal formula to josh's breastmilk to get it to 24 calories. We only did full formula once I stopped pumping. I don't have the "recipe" handy though. Good luck! We ended up doing 27 calories until he was 15 months old.

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We were told by our ped, who talked to the NICU nutritionist, that the only reason to be on Neosure and breast milk was if our daughter's calcium and phosphorus levels were low or if she was not gaining consistently. Amelia is a slow gainer, but she has gained consistently. She hasn't been on formula since she left the hospital at 2 months old. She is small, but developmentally on track. Just something to consider.

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Same as the previous poster, Mak was on Neosure in addition to the breastmilk for nutritional purposes.

After I ran out of breastmilk he was put on formula alone, It wasn't long until we began to feed him rice cereal mixed with formula and now he is on baby food and still gets formula because it's higher in nutrition than regular milk. He gets the Enfamil Lipil 9 - 24 months and we still have to mix it to the higher cal per ounce level.

I posted the recipe to mix formula to a higher cal per ounce previously on this site, Let me see if I can find the link.

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Here is a link to the entire discussion

And here is my post, including the recipe.

"My baby had the same problem,
Per his pediatrician.... We mixed his formula up in a stronger mix to make it 24 calorie per ounce. We also had to wait months to get in to see the actual dietitian, so his pediatrician told us how to mix it to make it more calorie dense. We also gave him Polyvisol vitamins. But they're high in iron and can cause some constipation issues so I would check with your pediatrician about using them.

He was on Nutramigen and the chart I have from Enfamil brand products says the mix to go 24 cal/ounce is as follows:

From concentrated liquid
One 13 Fl Oz can
+ 9 Fl oz water
= 22 ounces of formula at 24 calories per ounce.

From Powdered formula
two unpacked level scoops of powder
+ 3 1/4 fl ounce water
= 3 3/4 fl ounce infant formula mixed at 24 calories per ounce.


1 unpacked standard measuring cup powdered formula
+ 3 cups of water
= 27 fl oz infant formula mixed at 24 calories per oz.

My Doctor said the same measurements are true for Neosure or Similac formulas.

And it did work! My son was able to chart a steady progress with this mixture. Even though it was still below the curve, After all, he was a micro preemie. And we were told that Being below the curve is Okay as long as they're steadily growing. And grow he did!

When we finally met with the dietitian she even had us continue with exactly what we were doing.
He is now on Enfamil next step 9 - 24 month toddler formula and it's still mixed to the calorie dense standards posted above.

I have always mixed my son's formula with boiled water, in a glass blender.
I've found when it's mixed in a blender it doesn't separate the same way some powdered formulas will do when you just shake or stir them up by hand,


There is also a chart to mix if to 22 cal per ounce if anyone needs it.
For slow growth though, they usually have you go right to 24 cal per ounce."

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Just to clarify, my daughter was never on Neosure. That was the standard advice from the hospital, but since she was gaining and her mineral levels were fine, we need not supplement, and she has only been on breast milk, a multivitamin and an iron supplement (these last 2 given via oral syringe).

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