This is a particularly interesting question, and is a largely unknown area. The WHO guidelines mentioned above then go on to point out that future research is required to look into exactly what milk is best to feed to these infants, since the current evidence is sparse. Their recommendations also state that the re-establishing breastfeeding, if possible, is of the utmost priority. When you mention therapeutic milk, do you mean diluted F100 (SDTM)? Protocols based on infant formula are more difficult since each formula differs slightly in terms of calorie and electrolyte content. I understand that formula milk tends to contain 60-70kcal/100ml. Undiluted F100 is not recommended due to the risks of renal impairment and hypernatraemia. I have always used diluted F100 (diluted as per guidelines to 70-75kcal/100ml) in my clinical practice during the initial phases of refeeding these infants. The differences in calorie intake won’t be huge be huge between diluted F100 and many infant formulas. The volumes are then reduced as breastfeeding is re-established, or increased if breastfeeding / alternatives are not available. The baby may not complete the volumes: in this case they are still offered the full volume at each feed and the remaining volume is measured. The next steps depend on whether or not the infant is improving and gaining weight over the subsequent days. If the infant doesn’t gain weight and has a poor appetite, other reasons should be sought out. Take a look at these guidelines also: http://files.ennonline.net/attachments/1108/m13-management-of-severe-acute-malnutrition-entire-modeule.pdf

Assuming it is a SAM <6 without any prospect of being breastfed admitted in the acute phase presenting medical complications, no oedema and able to drink (orally/NGT). I would not increase systematically the amount of infant formula in the first feeds just to meet 100 kcal/kg/d because the risk of fluid overload. Large/infrequent/rapid feeds could also increase the risk of refeeding syndrome, refeeding diarrhoea and refeeding oedema, depending on the infant’s condition on admission. I would start cautious feeding (130-135 ml/kg/day) and observe the infant’s response before increasing progressively the amount to match the table in page 174: http://www.cmamforum.org/Pool/Resources/Example-of-IMAM-protocol-West-Africa-Golden-Grellety-2012-eng.pdf Depending on the infant formula composition, you might not be very far from 100 kcal/k/d though, but I will be careful with providing too much iron, protein and sodium which is not suitable in the acute phase. WHO might want to provide further/different advice?