HIJAM-HMF

A READY RECKONER HMF

Indias HMF 1gm per Sachet

1 When to recommend?
In neonates with birth weight below 1800 grams (ESPGHAN
2009 guideline)
Agostoni C, Buonocore G, Carnielli VP, De- Curtis M. Enteral
nutrient supply forpreterminfants:commentary from the European
Society for Paediatric Gastroenterology, Hepatology, and Nutrition
Committee on Nutrition. J Pediatr Gastroenterol Nutr 2010; 50:85
91

2 What are the benefits?

Improvements in weight gain (+2.33 g/kg/d; 95%CI 1.73,
2.93), linear growth (+0.12 cm/week; 95%CI 0.07, 0.18), and
head growth (+0.12 cm/week; 95%CI 0.07, 0.16).
Kuschel CA, Harding JE. Multicomponent fortifed human milk for
promoting growth in preterm infants (Cochrane Review).
Cochrane Library 2004; 3.Better test scores in the fortifed group
by 2.2 points for the Bailey Mental Development Index, by 2.4
points for the Psychomotor Development Index, and by 3.1 points
for social maturity at 18 months.Lucas A, Fewtrell MS, Morley R,
et al. Randomized outcome trial of human milk fortifcation and
development outcome in preterm infants. Am J Clin Nutr 1996;
64: 14251

3 At what age of the neonate HMF should be added?

HMF 1 sachet in 25 ml of expressed breast milk should be
added when the neonate starts accepting 100ml/kg of feeds.

4 How long the reconstituted EBM + HMF can be

stored?
It can be stored for 8 hours at 2-80C

5 When should HMF be stopped?

If the baby is on direct breast feeds at the time of discharge,
HMF fortification is usually discontinued as it interferes with
direct breast feeds. If baby is on expressed breast milk, then
HMF should be continued till baby achieves its birth
percentile on growth charts. Conventionally in such cases
HMF is continued till 40 weeks.

6. What is the most important advantages of HIJAMHMF?

a) HIJAM-HMF provides 1gm protein per 100 ml of milk and
protein intake has shown to have impact not only on short
term growth but also on long term neurological outcome.
b) It provides high iron content 1.44mg (4 sachets)
c) Osmolality is with in safe limits.
d) Vitamin D content 400IU (4 sachets)

Comparison of various available:

Nutrient

ESPGHAN
(/kg/day)

Human
Milk
(100ml)

Similac
(4 Pkts of
1gm)

Enfimil
(4 Pkts of
1gm)

Lactodex
(2 Pkts of
2gm)

Energy, Cal

110-135

67

14

14

15

HIJAMHMF
(4 Pkts of
1gm)
14

Protein, g

3.5-4.5

1.1

1.1

0.4

Fat, g

4.8-6.6

3.5

0.36

0.2

Carbohydrat
e, g

11.6-13.2

7.0

1.80

0.2

0.2

Vitamin A, IU

13203300

48

620

950

240

620

Vitamin D,
IU/day

800-1000

120

150

76

400

Vitamin E, IU

2.2-11

3.2

4.6

2.5

2.48

Vitamin K,
mcg

4.4-28

8.3

4.4

2.2

2.2

Vitamin C,
mg

11-46

25

12

10

10

Calcium,
mg(mEq)

120-140

25.3

117(5.84)

90

100

100

Phosphorus
mg (mEq)

60-90

14.5

67(2.16)

50

50

50

0.35

1.44

XXX

1.44

Iron, mg

2-3

Sodium,
mg(mEq)

69-115

15(0.65)

16

3.5

16

Potassium,
mg(mEq)

66-132

63(1.61)

29

7.8

7.8

+95

+35

No data

+25

Osmolality
(mosm/kg

water)

7. Does use of HMF increase the risk of Necrotizing

enterocolitis?
Systematic review comparing infants fed unfortified and
fortified HM did not show any significantly increased risk of
NEC in infants receiving Fortified Human Milk (RR 1.33, 95%
CI 0.7 to 2.5)
Kreissl A, Zwiauer V, Repa A, Binder C, Haninger N, Jilma B, Berger A,
Haiden N. Effect of fortifiers and additional protein on the osmolarity of
human milk: is it still safe for the premature infant? J
PediatrGastroenterolNutr. 2013;57(4):432-7
8. Use of HIJAM-HMF makes the treatment costly or
cost effective?
Unlike the developed countries where the cost of HMF is
prohibitive, HIJAM- HMF TM comes with a reasonable cost and
would help further cost cutting by decreasing the hospital
stay.

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