Understanding the purpose of therapeutic milk
Therapeutic milk formulas are a cornerstone of inpatient treatment for severe acute malnutrition (SAM), particularly in young children with complications. They are not standard infant formulas but are carefully formulated to address the fragile metabolic state of severely malnourished individuals. Instead of immediately providing high-energy, high-protein food, which can overwhelm a compromised system and lead to potentially fatal refeeding syndrome, therapeutic milk follows a two-phase protocol. The World Health Organization (WHO) and other humanitarian agencies, such as UNICEF, have developed and standardized these formulas to improve patient outcomes.
The stabilization phase with F-75
The first stage of treating complicated SAM patients is the stabilization phase, which typically lasts from two to seven days. During this period, the primary goal is not weight gain but to correct electrolyte imbalances, restore metabolic function, and manage medical complications like infections. This is where the therapeutic milk formula F-75 comes into play.
- Low Energy Density: The formula is designed to provide a low energy density of approximately 75 kcal per 100 ml. This low-energy intake prevents the metabolic shock of refeeding syndrome by not overtaxing the body's fragile systems.
- Modified Macronutrients: F-75 is intentionally low in protein, fat, and sodium but high in carbohydrates. This ratio helps restore cellular membrane function without stressing the kidneys or liver. For example, it contains less than 50% of the protein from dairy sources.
- Rich in Micronutrients: The formula is fortified with essential vitamins and minerals crucial for recovery, though older formulations of F-75 have been identified as potentially low in thiamine for critically ill patients.
- Medical Supervision: Due to the complex needs of patients in this phase, F-75 must only be administered under close medical supervision in a hospital or therapeutic feeding center.
The rehabilitation phase with F-100
Once a patient with SAM is stabilized and has regained their appetite, they progress to the rehabilitation phase. This is the period for nutritional recovery and rapid catch-up weight gain. The F-100 therapeutic milk formula is used during this phase and is designed to provide a much higher energy and protein content.
- High Energy Density: F-100 provides a higher energy density of approximately 100 kcal per 100 ml, supporting the rapid growth required for recovery.
- High Macronutrient Levels: Unlike F-75, F-100 has higher levels of protein and fat to facilitate tissue repair and weight gain. The protein content is significantly higher, around 10-12% of total energy, compared to F-75's 4-7%.
- Fortified Composition: It includes a complete vitamin and mineral mix to replenish nutritional stores depleted during malnutrition.
- Medical Oversight: Like F-75, F-100 must be used under medical supervision. Once a patient is sufficiently recovered, they may transition to a ready-to-use therapeutic food (RUTF), such as Plumpy'Nut, for continued outpatient care.
Comparison of F-75 and F-100 formulas
| Feature | F-75 Therapeutic Milk | F-100 Therapeutic Milk |
|---|---|---|
| Energy Density | 75 kcal / 100 ml | 100 kcal / 100 ml |
| Treatment Phase | Stabilization Phase (Phase 1) | Rehabilitation Phase (Phase 2) |
| Primary Goal | Correct metabolism, stabilize condition | Promote rapid weight gain and recovery |
| Protein Content | Low (approx. 4-7% total energy) | High (approx. 10-12% total energy) |
| Fat Content | Low (approx. 25-35% total energy) | High (approx. 45-60% total energy) |
| Use Case | Complicated SAM patients with medical issues and poor appetite | Stable SAM patients who have regained appetite |
Proper preparation and administration
Given the delicate health of the patients, the preparation of therapeutic milk is critically important to prevent contamination and ensure proper nutritional value. Organizations like UNICEF provide clear guidance for health workers on how to safely reconstitute the milk from its powdered form.
- Use Safe Water: The powder should be mixed with clean, boiled water that has been cooled to approximately 70°C to minimize contamination risks.
- Follow Ratios Precisely: Use the provided scoop and follow the manufacturer's instructions carefully to ensure the correct energy density is achieved. Adding too much or too little water can be dangerous for the patient.
- Hygienic Practices: Hand washing and cleaning all utensils and surfaces are mandatory to prevent bacterial growth, especially since the product is milk-based.
- Limited Storage Time: Reconstituted therapeutic milk should be used promptly. Unicef recommends using reconstituted F-100 within two hours at room temperature or 24 hours if refrigerated.
- Not for Home Use: Therapeutic milk is not intended for distribution to families for home use due to the high risk of improper preparation and administration without medical supervision.
Potential risks and considerations
While life-saving, therapeutic milk formulas carry specific risks that must be managed by trained health personnel.
- Refeeding Syndrome: The most significant risk in the initial stabilization phase is refeeding syndrome, caused by the rapid reintroduction of food to a severely malnourished person. The low-protein, low-energy F-75 formula is designed specifically to mitigate this risk, but careful monitoring is still required.
- Thiamine Deficiency: Historically, the thiamine content of F-75 has been a concern, particularly for critically ill patients. Monitoring for potential thiamine deficiency and providing supplements is an important part of the management protocol.
- Contamination: Improper mixing and storage in unhygienic conditions can lead to bacterial contamination, posing a significant risk of infection to already vulnerable patients.
- Inappropriate Use: Using these specialized formulas for well-nourished children or outside of a controlled medical environment is dangerous and inappropriate.
Conclusion
Therapeutic milk formulas, specifically F-75 and F-100, are meticulously designed products essential for the inpatient management of severe acute malnutrition. They are a critical component of the phased nutritional recovery protocol established by the World Health Organization. F-75 addresses the immediate stabilization of a patient's compromised metabolic functions, while F-100 facilitates the high-energy rehabilitation phase. Their administration requires strict medical supervision and adherence to specific preparation protocols to ensure safety and effectiveness. By understanding what these specialized formulas are and how they function, healthcare professionals can better provide life-saving care to the world's most vulnerable children. You can find more detailed guidance from the World Health Organization (WHO) and other humanitarian health organizations.
