Monitoring micronutrients in children with complex, multiple diagnoses on Amino Acid Formulas (AAF)

Children with complex systematic disease involving multiple diagnosis who are on AAFs and have any of the following risk factors for developing bone disease:

• History of prematurity^2-4
• Gastrointestinal disease^2-4
• Use of proton pump inhibitors and/or jejunal feeding^2-4
• Immobility⁴

• Children with complex systematic disease involving multiple diagnosis and intestinal disease or a history of prematurity have the potential to develop hypophosphatemia and bone disease^2-4
• Medically complex children may have increased micronutrient losses, a reduced absorptive capacity and/or higher micronutrient demands impacting micronutrient status^2-6
• It can be difficult to establish the micronutrient status of a medically complex child through dietary assessment alone and so reliable blood markers can be helpful⁷.

Monitoring may be required earlier or more frequently where there is a clinical concern, or with children that are likely to have/with known unstable micronutrient profiles. Serum levels of micronutrients, particularly phosphorus, should be routinely monitored by clinicians when Neocate is used as a primary or sole source or nutrition for patients with complex systemic diseaseinvolving multiple diagnoses and intestinal disease, *especially in combination with tube feeding and/or a history of prematurity. Neocate** formulas are intended for use under medical supervision.

*A retrospective review identified case studies of patients on primary or sole source of nutrition with diagnoses covering multiple systems, including congenital gastrointestinal anomalies and GI surgeries (such as necrotizing enterocolitis, esophageal atresia, tracheoesophagael fistula); neurological conditions (such as seizures intraventricular hemorrhage, hydrocephalus); respiratory (lung disease, tracheostomy, aspiration); cardiac (congenital heart disease); and other systemic conditions, often in conjunction with tube feeding and/or a history of prematurity².

**Neocate is an amino acid-based formula for the dietary management of cow’s milk allergy, multiple food protein allergies, and other conditions where an amino acid diet is recommended.