For infants with failure to thrive

Concentrating
standard infant formula

1 extra scoop
of formula

Tolerability
trouble

1 extra scoop
of formula

Slow catch-up
growth

1 extra scoop
of formula

Malnutrition

tolerability
trouble

Tolerability
trouble

Delayed catch-up
to growth goals

Suboptimal
protein

Surgery
delayed

Incorrect nutrient
delivery

Outcomes at risk

It’s time to
raise the
standard.

This summer, discover a new standard of care for formula-fed infants with failure to thrive (FTT): Fortini™

Nutricia – a worldwide leader in medical nutrition for more than 100 years – is dedicated to helping provide a strong start for your most vulnerable patients. With Fortini™, we’ve been helping babies thrive for over 20 years, and have experience in 30 countries. Now, we’re proud to bring Fortini™ to the United States.

Specifically calibrated for the unique needs of infants with FTT:

Fortini is indicated for term infants from birth up to 18 months of age (or 19.8 lbs/9 kg) with or at risk of growth failure, increased energy requirements, and/or fluid restrictions due to conditions such as congenital heart disease, chronic lung disease, respiratory syncytial virus, neurological syndrome or neuro-disabilities, cystic fibrosis and non-disease-related FTT.

Backed by 8 peer-reviewed publications,1-8
Fortini is clinically shown to support catch-up growth.1,7,8

Using a nutrient- and energy-dense feed has revolutionized our practice.

Dr. Luise Marino (PhD)
Clinical Academic Pediatric Dietitian
Southampton General Hospital

It’s time to sample Fortini—and see for yourself how it’s raising the standard.

Sign up to try Fortini, and stay up-to-date with exclusive clinical content and information on this care-changing approach to managing FTT.

    Infants with FTT can’t afford any more obstacles to thriving and health

    Concentrating standard infant formula has been among the most common options for infants with FTT in the United States. But this approach often falls short of expert guidelines, and has been considered sub-standard in other countries for decades–because it has so many drawbacks.

    Infographic:
    See the disappointing data that comes with concentrating formula

    How the standard of concentrating and fortifying standard infant formula is putting outcomes at risk

    infographicContent Unbalanced nutrition 6 Although concentrating and fortifying can help achieve higher calorie levels, they do not produce a balance of nutrients tailored for babies with FTT. Mix-ups and contamination When mixing powdered formulas, there’s always a danger of mistakes 17-19 or external contamination. 20-22 And the risk of errors, burden on caregivers, and extra staff time, only increase when adding extra formula, fortifying, or supplementing with modular nutrition products. 5 Inadequate hydration 4 Concentrating infant formula may come with concerns about inadequate hydration and even dehydration due to insufficient free water and high potential renal solute load (PRSL). 9,12,13 Insufficient protein 3 Standard infant formulas typically provide ≈8% of calories in the form of protein, even when concentrated – this falls short of the WHO/FAO/UNU target of 9-12% to support catch-up growth with appropriate lean tissue gain. 16 The step-up slowdown 2 To reduce risk of tolerability issues, many infants are slowly transitioned to higher- calorie feeds to reach their goal calorie level, 10,11 losing precious time to the incremental “step-up method.” This slow approach may impede weight gain, which is especially worrisome in babies for whom pivotal procedures are delayed until they reach a healthier weight. 14,15 T roubling tolerability 1 Concentrating powdered infant formula increases osmolality, 9 which can be hard for infants to tolerate. 10,11 Hyperosmolar feeds can bring concern of osmotic diarrhea, 9,12,13 delaying catch-up goals.
    Troubling tolerability

    Concentrating powdered infant formula increases osmolality,9 which can be hard for infants to tolerate.10,11 Hyperosmolar feeds can bring concern of osmotic diarrhea,9,12,13 delaying catch-up goals.

    The step-up slowdown

    To reduce risk of tolerability issues, many infants are slowly transitioned to higher-calorie feeds to reach their goal calorie level,10,11 losing precious time to the incremental “step-up method.” This slow approach may impede weight gain, which is especially worrisome in babies for whom pivotal procedures are delayed until they reach a healthier weight.14,15

    Insufficient protein

    Standard infant formulas typically provide ≈8% of calories in the form of protein, even when concentrated – this falls short of the WHO/FAO/UNU target of 9-12% to support catch-up growth with appropriate lean tissue gain.16

    Inadequate hydration

    Concentrating infant formula may come with concerns about inadequate hydration and even dehydration due to insufficient free water and high potential renal solute load (PRSL).9,12,13

    Mix-ups and contamination

    When mixing powdered formulas, there’s always a danger of mistakes17-19 or external contamination.20-22 And the risk of errors, burden on caregivers, and extra staff time, only increase when adding extra formula, fortifying, or supplementing with modular nutrition products.

    Unbalanced nutrition

    Although concentrating and fortifying can help achieve higher calorie levels, they do not produce a balance of nutrients tailored for babies with FTT.

    Fortini was purposefully designed to help you stay ahead of these shortcomings, so you can give term infants with FTT the extra calories and complete nutrition they need to catch up.

    Failure.
    We’re coming for you.

    In the meantime, be sure to check out the wealth of resources below—so you can learn more about managing infants with poor growth, including the shortcomings of concentrating and fortifying infant formulas, and be primed to foster the transition from faltering to flourishing.

    Webinar
    How to achieve optimal growth in infants with congenital heart diesase?
    with Dr. Chitra Ravishankar (MD) & Dr. Luise Marino (PhD)
    Webinar
    Navigating the journey of infants with or at risk of poor growth. Are we doing enough?
    with Dr. Maria Mascarenhas (MD) & Chris Smith (SRD MBDA)
    Infographic
    See the disappointing data that comes with concentrating formula
    Video
    The added urgency of congenital heart disease (CHD)
    Dr. Luise Marino (PhD)
    Video
    A revolutionary, ready-to-use solution is coming
    with Dr. Luise Marino (PhD)
    Download
    Nutrition should never have to wait
    Video
    Why is protein/energy ratio so important in faltering growth?
    with Dr. Rosan Meyer (PhD)
    Video
    The real-world impact of poor weight gain
    with Dr. Luise Marino (PhD)
    Video
    Clinical studies on the use of high protein energy feeds
    with Dr. Rosan Meyer (PhD)
    Video
    The importance of proper protein
    with Dr. Luise Marino (PhD)
    Video
    The drawbacks of an imbalanced feed
    with Dr. Luise Marino (PhD)
    Video
    There’s a better way
    with Dr. Luise Marino (PhD)
    Video
    The profound consequences of concentrating mistakes
    with Dr. Luise Marino (PhD)

    *Known as Infatrini outside the U.S.
    World Health Organization; Food and Agriculture Organization of the United Nations; United Nations University. Protein and amino acid requirements in human nutrition: report of a joint FAO/WHO/UNU expert consultation. 2007.

    References: 1. Clarke SE, et al. Randomized comparison of a nutrient-dense formula with an energy-supplemented formula for infants with faltering growth. J Hum Nutr Diet. 2007;20:329-39. 2. van Waardenburg DA, et al. Critically ill infants benefit from early administration of protein and energy-enriched formula: a randomized controlled trial. Clin Nutr. 2009;28:249-55. 3. Cui Y, et al. Effects and tolerance of protein and energy-enriched formula in infants following congenital heart surgery: a randomized controlled trial. JPEN J Parenter Enteral Nutr. 2018;42:196-204. 4. Evans S, et al. Should high-energy infant formula be given at full strength from its first day of usage? J Hum Nutr Diet. 2006;19:191-7. 5. de Betue CT, et al. Increased protein-energy intake promotes anabolism in critically ill infants with viral bronchiolitis: a double-blind randomised controlled trial. Arch Dis Child. 2011;96:817-22. 6. de Betue CT, et al. Arginine appearance and nitric oxide synthesis in critically ill infants can be increased with a protein-energy-enriched enteral formula. Am J Clin Nutr. 2013;98:907-16. 7. Eveleens RD, et al. Weight improvement with the use of protein and energy enriched nutritional formula in infants with a prolonged PICU stay. J Hum Nutr Diet. 2019;32:3-10. 8. Scheeffer VA, et al. Tolerability and effects of the use of energy-enriched infant formula after congenital heart surgery: a randomized controlled trial. JPEN J Parenter Enteral Nutr. 2020;44:348-54. 9. Steele JR, et al. Determining the osmolality of over-concentrated and supplemented infant formulas. J Hum Nutr Diet. 2013;26:32-7. 10. Slicker J, et al. Nutrition algorithms for infants with hypoplastic left heart syndrome; birth through the first interstage period. Congenit Heart Dis. 2013;8:89-102. 11. Roman B. Nourishing little hearts: nutritional implications for congenital heart defects. Pract Gastroenterol. 2011;35:11-34. 12. Pereira-da-Silva L, et al. Osmolality of preterm formulas supplemented with nonprotein energy supplements. Eur J Clin Nutr. 2008;62:274-8. 13. Fomon SJ, et al. Renal solute load and potential renal solute load in infancy. J Pediatr. 1999;134:11-4. 14. Reddy VM. Low birth weight and very low birth weight neonates with congenital heart disease: timing of surgery, reasons for delaying or not delaying surgery. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2013;16:13-20. 15. Alsoufi B, et al. Low-weight infants are at increased mortality risk after palliative or corrective cardiac surgery. J Thorac Cardiovasc Surg. 2014;148:2508-14.e1. 16. World Health Organization; Food and Agriculture Organization of the United Nations; United Nations University. Protein and amino acid requirements in human nutrition: report of a joint FAO/WHO/UNU expert consultation. 2007. 17. Renfrew MJ, et al. Formula feed preparation: helping reduce the risks; a systematic review. Arch Dis Child. 2003;88:855-8. 18. Plaster SE, et al. Variability of infant formula scoop weights. J Am Diet Assoc. 1996;96:A-64. 19. Altazan AD, et al. Unintentional error in formula preparation and its simulated impact on infant weight and adiposity. Pediatr Obes. 2019;14:e12564. 20. Rocha Carvalho ML, et al. Hazard analysis and critical control point system approach in the evaluation of environmental and procedural sources of contamination of enteral feedings in three hospitals. JPEN J Parenter Enteral Nutr. 2000;24:296-303. 21. Fagerman KE. Limiting bacterial contamination of enteral nutrient solutions: 6- year history with reduction of contamination at two Institutions. Nutr Clin Pract. 1992;7:31-6. 22. Labiner-Wolfe J, et al. Infant formula-handling education and safety. Pediatrics. 2008;122 Suppl 2:S85-90.