Prolacta Quick Reference Guide
Why do we use Prolacta?
Ø Prolacta is the only human milk based EBM fortifier available. It is used to provide exclusive human milk diets to the smallest, most critically ill premature infants. This will, in theory, lead to better tolerance of feeds and a reduction in NEC. We need to use Prolact+6, which makes 26 kcal/oz. feeds, in order to meet protein needs and promote adequate growth.
INITIATING PROLACTA
Who?
Ø Infants with a birth weight <750 grams qualify for the use of Prolacta
Ø Infants born between 751-1250 grams may use Prolacta after 2 failed attempts of HMF
Ø Prolacta is not intended for infants with a birth weight >1250 grams
When?
Ø Fortify feeds to 26 kcal/oz. once an infant is tolerating ~100ml/kg/day enterally
Ø If tolerance is a major concern, increase to 23 kcal/oz. first, then advance to 26 as tolerated
USING PROLACTA
Once an infant is on EBM+Prolacta:
Ø Feeding volume goal= 135-145 ml/kg/day (provides 122-132 kcal/kg/day)
o Providing >145 ml/kg could lead to increased energy expenditure and inadequate weight gain.
Ø 1mL/day Poly-vi-sol without iron needs to be initiated (no vitamins in Prolacta)
o Vitamin D supplement can be stopped at this time since the MVI contains 400 IUs of Vitamin D. The supplement can be restarted after 1 month of age if alk phos is still >400 u/L.
o DO NOT give Poly-vi-sol with iron- this contains 10mg of iron and would greatly exceed iron needs.
Ø Iron supplement should be started once the infant is 2 weeks old
o Goal= 4 mg/kg/day
WEANING PROLACTA
When?
Ø Prolacta will be used until the infant reaches 34 weeks AND weighs 1500 grams
What to transition to?
Ø Infants receiving MBM will transition to 24 kcal/oz. MBM + SHMF
Ø Infants receiving donor milk will transition to 24 kcal/oz. SCF
Weaning Schedule:
Day 1: Add 1 MBM + SHMF or SCF feeding
Day 2: Add 2 MBM + SHMF or SCF feedings
Day 3: Add 4 MBM + SHMF or SCF feedings
Day 4: Add 6 MBM + SHMF or SCF feedings
Day 5: Transition to all MBM + SHMF or SCF feedings
Once an infant has completed the transition:
Ø Discontinue Poly-vi-sol
Ø Increase feeding volume to 150-160 ml/kg/day
Ø If the infant has transitioned to formula, decrease the iron supplement to 2 mg/kg/day
11/12 JMP