Mix each Gaviscon Infant sachet with 5 ml (1 teaspoon) of cooled boiled water until a smooth paste is formed. Embleton N.D. (2008) When should enteral feeds be started in preterm infants? Paediatrics and Child Health 18[4], 200-201. Corvaglia L., Martini S., Battistini B., Rucci P., Aceti A., Faldella G. (2014) Bolus vs. continuous feeding: effects on splanchnic and cerebral tissue oxygenation in healthy preterm infants. Pediatr Res. 2014 Jul;76(1):81-5 There is no significant difference in somatic growth and incidence of NEC between feeding methods. (32)

Infants born preterm accumulate significant nutrient deficits by the time of discharge from hospital (49, 50). These can manifest as growth deficits that persist through infancy and early childhood (51) into adolescence. (52)DEBM is recommended for all infants <1500g and would be strongly advocated in those infants <1000g and/or <30 weeks gestation. Lucas A, Fewtrell M, Morley R, Lucas P, Baker B, Lister G, et al. Randomized outcome trial of human milk fortification and developmental outcome in preterm infants. Am J Clin Nutr 1996;64(2):142-51. Schanler R.J(1999) Feeding strategies for premature infants: randomized trial of gastrointestinal priming and tube-feeding method. Pediatrics;103(2):434-9 Morgan J., Young L., McGuire W. (2013) Delayed introduction of progressive enteral feeds to prevent necrotising enterocolitis in very low birth weight infants. Cochrane Database Syst Rev. CD001970 Multi-nutrient fortification may be especially important for infants who receive donated (donor) expressed breast milk, which contains lower levels of protein, energy and minerals than their own mother's expressed breast milk. (83)

Infants fed continuously take the same length of time to achieve full feeds as those fed bolus feeds. (27) Probiotic therapy has demonstrated promising efficacy for the prevention of NEC, as evidenced by a very strong treatment effect in favor of probiotic therapy in two recent meta-analyses (40). In an updated systematic review, enteral probiotic supplementation significantly reduced the incidence of severe necrotizing enterocolitis and mortality, with no significant reduction in nosocomial sepsis (41). SMA Gold Prem 2 should only be used following recommendation by a healthcare professional. Your healthcare professional will advise you when to move from SMA Gold Prem 2 to another formula. Wash hands well, shake bottle before use, remove lid and aluminium foil and attach a hygienic teat. Gephart SM1, Weller M. (2014) Colostrum as oral immune therapy to promote neonatal health. Adv Neonatal Care;14(1):44-51

SMA Gold Prem® 2

Separate and add only one sachet (1 g) of SMA Gold Prem ® Breast Milk Fortifier. Do not attempt to mix part of a sachet. Specialised formulas should only be used where absolutely necessary and ideally under the direction of a Paediatric and Neonatal Dietician. Even when premature babies are discharged from hospital, they may still require extra nutrients to ensure optimal growth. ESPGHAN recommends breastfeeding for post-discharge infants where possible and if formula-fed, infants should be given a post-discharge formula (PDF) until at least 40 weeks, and possibly up to 52 weeks, post-conceptional age. 7 Rayyis S.F. Et al (1999) Randomised trial of “slow” versus “fast” feed advancements on the incidemce of necrotising enterocolitis in very low birth weight infants. J Pediatr,134,293-7