• Enfamil® Human Milk Fortifier Acidified Liquid

Enfamil® Human Milk Fortifier Acidified Liquid

Commercially sterile, milk-based nutritional supplement to be added to expressed breast milk for premature or low-birth-weight infants

Last Updated: Wednesday, December 27, 2017

  • Description/Indication
    • Enfamil Human Milk Fortifier Acidified Liquid is to be added to expressed breast milk for feeding premature or low-birth-weight infants. It provides enriched nutrition needed by these special babies while still allowing them to receive their mother’s milk. Enfamil Human Milk Fortifier Acidified Liquid increases the levels of protein, energy, calcium, phosphorus, iron, vitamin D and other nutrients, producing a diet more suited to the nutritional needs of the rapidly growing premature infant.

  • Product Features
      • Clinically proven to promote growth, including linear growth1,*:
        • ~21% more protein than Enfamil® Human Milk Fortifier Powder
        • Helps premature infants achieve significantly higher achieved weight, length, head circumference and linear growth rate than Enfamil HMF Powder with the same volume intake1
      • 4 g of protein per 100 Cal when mixed with preterm human milk
      • Protein source is partially hydrolyzed whey protein
      • Commercially sterile, single-dose packaging meets AND and CDC feeding preparation guidelines
      • Clinically proven safe and well tolerated in preterm infants1-3,‡:
        • No statistical differences in confirmed NEC (3%), sepsis (12%) or serious adverse events than Enfamil HMF Powder1
      • Shown to significantly improve DHA and ARA status in preterm infants compared to Enfamil HMF Powder4

      * Based on the gold standard for clinical research: randomized, prospective, blinded, controlled clinical trials. † When mixed as directed: EHMFAL + preterm human milk (1 vial + 25 mL). ‡ Studies used EHMFAL vs. Enfamil HMF Powder.

  • Nutrients
    • Product nutrient values and ingredients are subject to change. Please see product label for current information.

      Normal Dilution) Per 4 Vials
      (30 Cal)
      4 Vials Plus 100 mL
      Preterm Breast Milk§
      (97 Cal)
      Per 100 Cal
      Fortified Preterm
      Breast Milk§
      Protein, g 2.2 3.8 4
      Fat, g 2.3 5.8 6
      Linoleic acid, mg 230 710 730
      Carbohydrate, g <1.2 7.9 8.1
      Water, g 15.1 104 107
      Normal Dilution) Per 4 Vials
      (30 Cal)
      4 Vials Plus 100 mL
      Preterm Breast Milk§
      (97 Cal)
      Per 100 Cal
      Fortified Preterm
      Breast Milk§
      Vitamins/Other Nutrients
      Vitamin A, IU 1160 1210 1250
      Vitamin D, IU 188 200 210
      Vitamin E, IU 5.6 6 6.2
      Vitamin K, mcg 5.7 7.7 7.9
      Thiamin (Vitamin B1), mcg 184 193 200
      Riboflavin (Vitamin B2), mcg 260 290 300
      Vitamin B6, mcg 140 146 151
      Vitamin B12, mcg 0.64 0.66 0.68
      Niacin, mcg 3700 3900 4000
      Folic acid (Folacin), mcg 31 34 35
      Pantothenic acid, mcg 920 1150 1190
      Biotin, mcg 3.4 3.9 4
      Vitamin C (Ascorbic acid), mg 15.2 20 21
      Normal Dilution) Per 4 Vials
      (30 Cal)
      4 Vials Plus 100 mL
      Preterm Breast Milk§
      (97 Cal)
      Per 100 Cal
      Fortified Preterm
      Breast Milk§
      Minerals
      Calcium, mg 116 141 145
      Phosphorus, mg 63 78 80
      Magnesium, mg 1.84 5.1 5.3
      Iron, mg 1.76 1.85 1.91
      Zinc, mg 0.96 1.33 1.37
      Manganese, mcg 10 10.4 10.7
      Copper, mcg 60 98 101
      Sodium, mg 27 55 57
      Potassium, mg 45 95 98
      Chloride, mg 28 86 89

      § Calculated using values for preterm human breast milk compiled from multiple published studies; protein value used for preterm human milk is 1.62 g/100 mL5.

  • Nutrient Facts
    • Nutrient Density Per 4 Vials (30 Cal)
      Protein (% Calories) 29
      Fat (% Calories) 65
      Carbohydrate (% Calories) 6
      Potential Renal Solute Load (mOsm/100 Calories)6 33||
      Potential Renal Solute Load (mOsm/4 Vials)6 17.7 per 4 Vials (Concentrate only)
      Lactose-Free No
      Nutrient Density Per 1 Vial Per 4 Vials EHMFAL + Preterm Human Milk (1 Vial + 25 mL)
      Osmolality (mOsm/kg water) 326#
      pH ~4.3 ~4.3 ~4.7

      § Calculated using values for preterm human breast milk compiled from multiple published studies; protein value used for preterm human milk is 1.62 g/100 mL5. || When mixed at normal dilution, 1 vial to 25 mL preterm human milk. ¶ 31 mOsm/120 mL when 4 vials added to 100 mL preterm human milk. # When added to human milk as recommended, EHMFAL increases osmolality by approximately 326 mOsm/kg water.

  • Preterm Human Milk Caloric Recipes
    • Nutrients per 100 Cal      
      ~Cal/fl oz 22 24
      Preterm human milk 50 mL 25 mL
      + + +
      EHMFAL concentrate 5 mL 5 mL
      Final volume, mL 55 30
      Energy, Cal 100 100
      Protein, g 3.3 4
      Fat, g 5.7 6
      Carbohydrate, g 9.3 8.1
      Water, g 118 107
      Nutrients per 100 Cal      
      Vitamins/Other Nutrients
      Vitamin A activity, IU 770 1250
      Vitamin D, IU 124 210
      Vitamin E, IU 3.9 6.2
      Vitamin K, mcg 5.9 7.9
      Thiamin (Vitamin B1), mcg 123 200
      Riboflavin (Vitamin B2), mcg 191 300
      Vitamin B6, mcg 93 151
      Vitamin B12, mcg 0.41 0.68
      Niacin, mcg 2500 4000
      Folic acid (Folacin), mcg 23 35
      Pantothenic acid, mcg 840 1190
      Biotin, mcg 2.7 4
      Vitamin C (Ascorbic acid), mg 14.6 21
      Carnitine, mg 0.85 0.72
      Taurine, mg 4.9 4.1
      Nutrients per 100 Cal      
      Minerals
      Calcium, mg 101 145
      Phosphorus, mg 56 80
      Magnesium, mg 5.1 5.3
      Iron, mg 1.18 1.91
      Zinc, mg 1.04 1.37
      Manganese, mcg 6.5 10.7
      Copper, mcg 83 101
      Iodine, mcg 22 18.4
      Selenium, mcg 2.9 2.5
      Sodium, mg 51 57
      Potassium, mg 89 98
      Chloride, mg 88 89
      Nutrients per 100 Cal      
      Additional Nutrients
      Linoleic acid, mg 730 730
      Linolenic acid, mg 54 60
      ARA, mg 32 38
      DHA, mg 21 24

    • Nutrients per 100 Cal      
      ~Cal/mL 0.74 0.81
      Preterm human milk 50 mL 25 mL
      + + +
      EHMFAL concentrate 5 mL 5 mL
      Final volume, mL 55 30
      Energy, Cal 75 81
      Protein, g 2.5 3.2
      Fat, g 4.2 4.8
      Carbohydrate, g 6.9 6.6
      Water, g 88 87
      Nutrients per 100 Cal      
      Vitamins/Other Nutrients
      Vitamin A activity, IU 570 1010
      Vitamin D, IU 93 167
      Vitamin E, IU 2.9 5
      Vitamin K, mcg 4.4 6.4
      Thiamin (Vitamin B1), mcg 92 161
      Riboflavin (Vitamin B2), mcg 143 240
      Vitamin B6, mcg 69 122
      Vitamin B12, mcg 0.31 0.55
      Niacin, mcg 1880 3300
      Folic acid (Folacin), mcg 17 28
      Pantothenic acid, mcg 630 960
      Biotin, mcg 2 3.3
      Vitamin C (Ascorbic acid), mg 10.9 16.7
      Carnitine, mg 0.64 0.58
      Taurine, mg 3.6 3.3
      Nutrients per 100 Cal      
      Minerals
      Calcium, mg 75 118
      Phosphorus, mg 42 65
      Magnesium, mg 3.8 4.3
      Iron, mg 0.88 1.54
      Zinc, mg 0.77 1.11
      Manganese, mcg 4.9 8.7
      Copper, mcg 62 82
      Iodine, mcg 16.2 14.8
      Selenium, mcg 2.2 2
      Sodium, mg 38 46
      Potassium, mg 66 79
      Chloride, mg 65 72
      Nutrients per 100 Cal      
      Additional Nutrients
      Linoleic acid, mg 540 590
      Linolenic acid, mg 40 48
      ARA, mg 24 31
      DHA, mg 15.6 19.2


  • Term Human Milk Caloric Recipes
    • Nutrients per 100 Cal      
      ~Cal/fl oz 22 24
      Term human milk 50 mL 25 mL
      + + +
      EHMFAL concentrate 5 mL 5 mL
      Final volume, mL 55 30
      Energy, Cal 100 100
      Protein, g 2.4 3.2
      Fat, g 5.6 6
      Carbohydrate, g 10.1 8.9
      Minerals, g 0.57 0.73
      Water, g 118 108
      Nutrients per 100 Cal      
      Vitamins/Other Nutrients
      Vitamin A activity, IU 880 1350
      Vitamin D, IU 116 195
      Vitamin E, IU 4.4 6.6
      Vitamin K, mcg 3.8 6.2
      Thiamin (Vitamin B1), mcg 136 210
      Riboflavin (Vitamin B2), mcg 220 320
      Vitamin B6, mcg 109 165
      Vitamin B12, mcg 0.48 0.74
      Niacin, mcg 2700 4200
      Folic acid (Folacin), mcg 32 43
      Pantothenic acid, mcg 830 1190
      Biotin, mcg 2.9 4.2
      Vitamin C (Ascorbic acid), mg 21 26
      Choline, mg 19.4 16.5
      Inositol, mg 32 27
      Carnitine, mg 0.85 0.72
      Taurine, mg 4.8 4.1
      Total nucleotides, mg 3.4 2.9
      Nutrients per 100 Cal      
      Minerals
      Calcium, mg 98 143
      Phosphorus, mg 54 78
      Magnesium, mg 5.1 5.3
      Iron, mg 1.14 1.88
      Zinc, mg 0.82 1.2
      Manganese, mcg 6.4 10.6
      Copper, mcg 73 93
      Iodine, mcg 18.2 15.5
      Selenium, mcg 2.4 2.1
      Sodium, mg 39 47
      Potassium, mg 85 96
      Chloride, mg 68 73
      Nutrients per 100 Cal      
      Additional Nutrients
      Linoleic acid, mg 830 820
      Linolenic acid, mg 62 67
      ARA, mg 32 38
      DHA, mg 21 24

    • Nutrients per 100 mL      
      Cal/mL 0.74 0.81
      Term human milk 50 mL 25 mL
      + + +
      EHMFAL concentrate 5 mL 5 mL
      Final volume, mL 55 30
      Energy, Cal 75 81
      Protein, g 1.84 2.6
      Fat, g 4.2 4.8
      Carbohydrate, g 7.5 7.2
      Minerals, g 0.43 0.59
      Water, g 89 88
      Nutrients per 100 mL      
      Vitamins/Other Nutrients
      Vitamin A activity, IU 660 1090
      Vitamin D, IU 87 158
      Vitamin E, IU 3.3 5.3
      Vitamin K, mcg 2.8 5
      Thiamin (Vitamin B1), mcg 102 167
      Riboflavin (Vitamin B2), mcg 164 260
      Vitamin B6, mcg 82 133
      Vitamin B12, mcg 0.36 0.6
      Niacin, mcg 2000 3400
      Folic acid (Folacin), mcg 24 35
      Pantothenic acid, mcg 620 960
      Biotin, mcg 2.2 3.4
      Vitamin C (Ascorbic acid), mg 16 21
      Choline, mg 14.5 13.3
      Inositol, mg 24 22
      Carnitine, mg 0.64 0.58
      Taurine, mg 3.6 3.3
      Total nucleotides, mg 2.5 2.3
      Nutrients per 100 mL      
      Minerals
      Calcium, mg 73 116
      Phosphorus, mg 41 63
      Magnesium, mg 3.8 4.3
      Iron, mg 0.85 1.52
      Zinc, mg 0.62 0.97
      Manganese, mcg 4.8 8.6
      Copper, mcg 55 75
      Iodine, mcg 13.6 12.5
      Selenium, mcg 1.82 1.67
      Sodium, mg 29 38
      Potassium, mg 64 78
      Chloride, mg 51 59
      Nutrients per 100 mL      
      Additional Nutrients
      Linoleic acid, mg 620 670
      Linolenic acid, mg 46 54
      ARA, mg 24 31
      DHA, mg 15.6 19.2


  • Product Form
    • Enfamil® Human Milk Fortifier Acidified Liquid is available in an ultra-concentrated liquid.

    • Item #: 146301
      Description: Liquid
      Unit Size: 5 mL vial
      Cal./Unit: 7.5
      Prod. Yield / Unit (fl oz): 5 mL
      Case: 200 vials oer case
      Reimbursement Code: 00087-146341

      HCPCS Code

  • Composition
    • Ingredients: Water, whey protein isolate hydrolysate (milk), medium chain triglycerides (MCT oil), vegetable oil (soy and high oleic sunflower oils) and less than 2%: Mortierella alpina oil**, Crypthecodinium cohnii oil††, pectin, vitamin A palmitate, vitamin E acetate, vitamin D3, vitamin K1, thiamin hydrochloride, riboflavin, vitamin B6 hydrochloride, vitamin B12, niacinamide, folic acid, calcium pantothenate, biotin, ascorbic acid, calcium citrate, calcium phosphate, cupric sulfate, sodium citrate, potassium citrate, calcium chloride, citric acid, ferrous sulfate, magnesium phosphate, zinc sulfate.

      ** A source of arachidonic acid (ARA). †† A source of docosahexaenoic acid (DHA).

  • Potential Allergens
    • Enfamil® Human Milk Fortifier Acidified Liquid contains milk and soy.

  • Preparation of Feedings
    • The baby’s health depends on carefully following the instructions below. Use only as directed by a medical professional. Proper hygiene, preparation, dilution, use and storage are important when preparing infant formula. Although Enfamil® Human Milk Fortifier Powder is formulated for premature infants, powdered infant formulas are not sterile and should NOT be fed to premature infants or infants who might have immune problems unless directed and supervised by a doctor.

      Follow hospital rules or the baby’s doctor’s instructions for the safe handling of human milk.

      To aid mixing, agitate the human milk well. Pour the desired amount into a sterile container and warm to feeding temperature.

      The baby’s doctor will provide instructions for the desired amount of calories to add.

      Add the fortifier to the human milk according to the following charts:

      Enfamil® Human Milk Fortifier Powder

      Additional Calories Desired Human Milk Enfamil Human Milk Fortifier
      2 Calories/fl oz 50 mL 1 packet (0.71 g)
      4 Calories/fl oz 25 mL 1 packet (0.71 g)

      Enfamil® Human Milk Fortifier Acidified Liquid

      Additional Calories Desired Human Milk Enfamil Human Milk Fortifier
      2 Calories/fl oz 50 mL 1 vial
      4 Calories/fl oz 25 mL 1 vial

      Each vial of Enfamil Human Milk Fortifier Acidified Liquid is designed to deliver 5 mL when opened and poured.

      • Shake vial vigorously to mix contents. Firmly hold vial UPRIGHT by bottom tab and slowly twist top off completely. Add fortifier to human milk.
      • Some liquid may remain in cap and vial; disregard this liquid. Discard opened vial and cap promptly. Do not use product that has unusual characteristics.

      Failure to follow these instructions could result in severe harm. Once prepared, fortified breast milk can spoil quickly.

      Either feed fortified human milk immediately or cover and store in refrigerator at 35–40°F (2–4°C) for no longer than 24 hours. Agitate before each use.

      For tube feeding: Once fortified human milk is prepared, it can remain at room temperature for no longer than a total of 4 hours.

      For bottle feeding: Pour only the amount of fortified human milk to be fed into a feeding container and feed immediately. Do not use fortified human milk if it is unrefrigerated for more than a total of 2 hours. After feeding begins, use fortified breast milk within 1 hour or discard.

      WARNING: Do not use a microwave oven to warm the fortified human milk. Serious burns may result.

      WARNING: Not for parenteral (I.V.) use. Fortifier is designed to be mixed with breast milk; do not administer directly.

  • References
    • 1. Moya F, Sisk PM, Walsh KR, et al. A new liquid human milk fortifier and linear growth in preterm infants. Pediatrics. 2012;130:e928-935.

      2. Kurada S, Kamat M, Khilfeh M, et al. Comparison of breast milk with powdered human milk fortifier (PHMF) and Liquid Human Milk Fortifier (LHMF) on nutrition and growth parameters of VLBW infants. Presented at: Pediatric Academic Societies Annual Meeting; May 3-6, 2014; Vancouver, Canada. Abstract 3845.687.

      3. Mayberry L, Wolf S. Tracking nutritional protein management in the preterm infant using Vermont-Oxford benchmarks. FASEB J. 2014;28(1 suppl):LB318.

      4. Berseth CL, Harris CL, Wampler JL, et al. Liquid human milk fortifier significantly improves docosahexaenoic and arachidonic acid status in preterm infants. Prostaglandins Leukot Essent Fatty Acids. 2014;91:97-103.

      5. Data on file, Mead Johnson Nutrition, September 7, 2010.

      6. Fomon SJ, Ziegler EE. Renal solute load and potential renal solute in infancy. J Pediatr. 1999;134:11-14.