Osmolality of Commonly Used Medications and Formulas in the Neonatal Intensive Care Unit

Abstract

The objective of the study was to measure the osmolality of medications and special infant formulas commonly used in contemporary neonatal intensive care units. The osmolalities of 75 medications and 20 infant formulas were determined in triplicate by freezing point depression, and the means were reported. A majority of the medications (54 of 75) analyzed had a measured osmolality in excess of 2000 mOsm/kg. Most infant formulas possessed an osmolality within American Academy of Pediatrics (AAP) recommendations (400 mOsm/L), with the exception of powder‐fortified human milk and a protein hydrolysate formula concentrated to 30mL. Final osmolality of infant feedings should be measured or calculated when medications are added and when calories are concentrated beyond 24 kcal/oz. Oral administration of medications, powdered fortification of human milk, and the concentration of some infant formulas may potentiate adverse gastrointestinal effects associated with hyperosmolar feedings and should be postponed until full volume enteral nutrition has been established.