Just when you thought it was safe to go back to the formula aisle, Mead Johnson introduces Nutramigen AA. This is an amino acid-based infant formula for babies with severe milk protein allergy. Amino acid-based formulas differ from standard formulas in that their protein is treated and completely broken down into its most basic element, the amino acid (thus the “AA” in the name). Nutramigen AA will take its place next to two amino acid-based infant formulas currently available on the market, Neocate and Elecare. These formulas are sometimes called elemental or ultrahydrolyzed formulas.
So does Nutramigen AA bring anything new to the table? It wouldn’t appear that way. From a protein allergy perspective, all three amino acid-based formulas on the market are identical – after all, totally broken down protein is totally broken down protein. It doesn’t get any more basic than that. SHS, the manufacturer of Neocate, does suggest that their product is the only amino acid-based formula manufactured in a 100% dairy-free environment. Otherwise, there are some slight differences in the fat composition between the three, but this is unlikely to be relevant for most babies. Nutramigen AA has higher levels of DHA than Neocate and Elecare although all meet minimum standards for DHA/ARA.
So who needs an amino acid-based formula? Babies with severe milk protein allergy who have failed an adequate trial of extensively hydrolysed formula (EHF) such as Alimentum or Nutramigen. If protein allergy has been diagnosed on clinical grounds (some combination of diarrhea, bleeding, cramping / “colic”, feeding intolerance, eczematous rash, elevated eosinophils in the blood and failure to thrive) and a trial of EHF formula has failed to change a baby’s clinical status after 3-4 weeks, an amino acid-based formula may be indicated. In some cases we consider endoscopy to confirm the diagnosis before committing a family to a $600/month formula habit.
Here’s my concern: Amino acid-based formulas are infrequently indicated during infancy. But desperate docs make desperate changes when faced with desperate parents. And with a competitive field of formulas, aggressive marketing could push their use beyond what’s really necessary. Formula roulette can be costly if severe, intractable protein allergy hasn’t been firmly established. Infant formula demand is often supplier induced – look at lactose-free and low-iron formula. Hopefully parents and doctors won’t be lured where they don’t belong.
On the upside, competition in the formula marketplace can create the potential for cost savings to parents. That is, of course, if Neocate and its Spartan sales force can sustain itself against Mead Johnson’s marketing machine. Don’t touch that dial.