Understanding the Purpose of F-75 and F-100
F-75 and F-100 are specialized therapeutic milk formulas used in the inpatient treatment of severe acute malnutrition (SAM), primarily in children. They are part of a two-phase treatment protocol established by the World Health Organization (WHO), focusing on distinct nutritional needs during a patient's recovery journey.
F-75: The Stabilization Phase
F-75 is a 'starter' formula used during the initial, or stabilization, phase of treatment. In this critical stage, malnourished children are often very ill, and their metabolic systems are fragile. The F-75 formula is designed to address this fragility by providing a moderate amount of carbohydrate and a lower concentration of protein, fat, and sodium. This helps to restore metabolic functions, correct electrolyte imbalances, and prevent complications like hypoglycaemia and heart failure, all without overloading the child's system. This phase typically lasts until the child stabilizes and develops an appetite.
F-100: The Rehabilitation Phase
Once a child has stabilized and their appetite has returned, they transition to the 'catch-up' formula, F-100. F-100 has a higher energy density, along with higher levels of protein and fat, which are necessary for rapid weight gain and rebuilding wasted tissues. This phase aims to restore the child's weight and overall nutritional status. For outpatient care in certain settings, liquid F-100 may be replaced by Ready-to-Use Therapeutic Foods (RUTFs).
How to Prepare F-75 Therapeutic Milk
Proper hygiene and accurate measurement are paramount when preparing F-75 to prevent contamination and ensure the correct nutritional content. Commercially available pre-mixed powder sachets or canisters simplify the process significantly, but standard recipes can be followed if these are unavailable.
Preparation Steps (Using Powder Sachets):
- Hygiene: Wash hands thoroughly and sterilize all equipment, including measuring jugs, whisks, and feeding cups.
- Water: Boil safe drinking water and let it cool for 3–5 minutes until it is not below 70°C.
- Mix: For commercial sachets, add the entire packet to the specified amount of warm, boiled water and mix thoroughly until dissolved. Use the provided scoops for smaller batches, following the specific canister instructions.
- Cool: Allow the prepared milk to cool to feeding temperature before serving.
- Storage: The reconstituted milk must be used within 2 hours or discarded.
How to Prepare F-100 Therapeutic Milk
The preparation process for F-100 is similar to F-75, with crucial differences in the powder-to-water ratios and ingredients depending on the source.
Preparation Steps (Using Powder Sachets):
- Hygiene: As with F-75, ensure all equipment is clean and sanitized, and wash your hands.
- Water: Use safe, boiled water that has been cooled to a temperature not less than 70°C.
- Mix: Add the correct amount of F-100 powder to the specified water volume and mix well. Follow instructions on the canister or sachet, using the provided scoop for smaller quantities.
- Cool: Let the milk cool to a safe feeding temperature before administering.
- Storage: Dispose of any unused milk within 2 hours.
Comparison of F-75 and F-100
| Feature | F-75 | F-100 |
|---|---|---|
| Energy Density | Lower | Higher |
| Protein Content | Low | High |
| Fat Content | Moderate | High |
| Purpose | Stabilize patient, correct imbalances | Promote rapid weight gain |
| Treatment Phase | Stabilization Phase 1 | Rehabilitation Phase 2 |
| Duration | Until appetite returns | Follows stabilization |
| Sodium Content | Low | Higher |
| Osmolarity | Lower | Higher |
| Risk | Lower osmotic load, safer for critically ill | High osmotic load can cause diarrhea if used too early |
Essential Safety and Hygiene Measures
Safe preparation of therapeutic milk is crucial to avoid serious infections in vulnerable, malnourished children.
Critical Steps for Safe Preparation:
- Use Boiled Water: Always use water that has been boiled and cooled to the correct temperature (70°C is recommended to kill bacteria while preserving nutrients).
- Check Temperature: Ensure the final product is cooled to a safe feeding temperature before giving it to the child to prevent burns.
- Strict Hygiene: Sanitize all preparation equipment and maintain a clean working area to prevent bacterial contamination.
- Accurate Measurement: Carefully measure ingredients according to package or WHO instructions. Inaccurate ratios can lead to incorrect nutrient intake and potential complications.
- Time Management: Never use reconstituted milk that has been left for more than 2 hours. Therapeutic milks can act as a growth medium for bacteria if left at room temperature.
- Read the Label: If using commercial products, always follow the manufacturer's specific instructions, as formulations can vary.
Conclusion
F-75 and F-100 are indispensable tools in the management of severe acute malnutrition, each serving a specific, critical role in a patient's recovery journey. The safe and effective use of these therapeutic milks depends entirely on strict adherence to established preparation protocols, including meticulous hygiene, accurate measurement, and careful handling of the reconstituted product. These guidelines, developed by expert organizations like the WHO, are not suggestions but vital rules to ensure the best possible outcomes for the most vulnerable patients. Always remember that these formulas are intended for clinical use under medical supervision, and proper training is required to use them correctly. For more detailed clinical guidelines, consult resources from organizations like the WHO and UNICEF.
Useful Resources
WHO Management of severe malnutrition: a manual for physicians and other senior health workers
