Neonatal feeding
Extreme preterm feeding
(<1200 gm <30 wks)
Trophic feeding (gut priming) 7 -14 day
•On 2nd - 3rd day if stable ( no hypotension )
•OGT feeding
•Initial feedings with D5w x 3 feedings
•Diluted, premature formula (1/4 -1/2-3/4 strength)
•1ml /6h x2 days --> lml/4h x2d -> 1ml /2h x2d->2ml /2h x2d
Nutritive feeding
•OGT feeding
•Full strength premature formula
•2ml/2h advance Imi /24 -12h as tolerated.
•Maximum increment 20 ml/kg /day.
•Max. OGT feeding 120 Kcal/kg [150ml/kg premature formula ,180ml /kg standard formula].
•D/C IVF when reaching to maximum OGT feeding.
•Use premature formula up to 1.8 kg [some advice up to 2kg]
•At 1.6kg start oral feeding on demand.
•Start TPN /PRN on 3rd -5th day and increase gradually until OGT feeding is established then decrease gradually.
(growing preterms).
•At > 34 wks (corrected age) D/C Aminophylline
•At 1.6 kg start oral feeding on demand.
•At 1.7kg cot care.
•At 1.8 kg for discharge.
•Supportive therapy for full feeders & continue for 2 mo. after discharge. Folic acid 50 mcq( 0.5ml) OD Iron drops 7.5mg (0.3ml) OD. polyvisol drops .............(0.5ml) OD (diluted)
•CBC , Serum electrolyte weekly.
•Fundoscopy by the age of 1 mo <&when required.
•Neurosongraphy within few days of admission and after 2 weeks.
•Advancement of milk feeding :
1ml /24 hrs = 12 ml /day
lml/12hrs = 24 ml/day
lml/8hrs = 36ml /day
Neonatal feeding
1200 -1500 gm (30-32 wks )
• OGT feeding
• Initial feedings D5w x 2 feedings
• diluted PT formula for 1 wk then advance for full strength.
• 2 ml / kg / 2 hrs advance 1ml /12hrs(2ml/24 hrs)as tolorated.
• Maximum increment 20 ml /kg /day.
• Maximum OGT feeding 150 ml /kg/day (PT formula)
• D/C IVF when reach to full feeding.
• At 1.6kg start oral feeding on demand.
1500 - 2000 gm (32 -34wks)
• Bottle feeding if > 1.6 kg or >34 wks & neurologically intact
• OGT feeding
• Initial feeding with D5w xl feeding
• Diluted PT formula x 24 hrs, infant > 1.8kg standard formula
• 2.5 ml /kg /2hrs advance 1 ml /12 -8 hrs (2-3 ml/24 hrs)as tolerated
>2000 gm (>34 wks )
• Bottle feeding if neurologically intact.
• OGT feeding.
• initial feeding with D5w x 1 feeding.
• standard formula
• 5ml /kg /2hrs advance 2-5 ml /24 hrs as tolerated
Advancement of milk feeding
1ml/24his = 12 ml/day
lml/24hrs=12ml/day
lml/24hrs=24ml/day 2ml/24hrs=24ml/day
lml/8hrs=36ml/day 3ml/24hrs=36ml/day
lml/6hrs = 48ml/day 4ml/24hrs = 48ml/day
5ml/24hrs =60ml/day
Rapid feeding protocol
* Initial feeding D5w x 3 feeding.
*<1.S kg 3ml/3hrs premature formula diluted xlwk-advance(2-3ml/24h)
*1.5 -2 kg 5 ml /3hrs premature formula undiluted.advance(3-5ml/24h)
*>2kg 10 ml /3hrs standared foumula. advance(5-8mi/24h)
* Advance 20ml/kg / day till 150ml/kg/day (PT formula - standerd).
*D/C IVF when reaching to full feeding
+Vomiting, Abdomminal distention, residual >30% ---Intolerance.
+Bottle feeding at 1.6 kg or 34 wks & neurologically intact
*Advancement :{ 8 feeds/day}
1 ml / 24h = 8 ml / day (1 ml / each feed)
2 ml / 24h = 16 ml / day (2 ml / each feed)
3 ml / 24h = 24 ml / day (3 ml / each feed)
4 ml / 24h = 24 ml / day (4 ml / each feed)
5 ml / 24h = 24 ml / day (5 ml / each feed)
6 ml / 24h = 24 ml / day (6 ml / each feed)
7 ml / 24h = 24 ml / day (7 ml / each feed)
8 ml / 24h = 24 ml / day (8 ml / each feed)
* Ex: wt 1.49 kg , start 3ml / 3h Advance 2-3 ml / 24h?
( day 1 ) 3-3-3-3-3-3-3-3
( day 2 ) 5-5-5-5-5-5-5-5
( day 3 ) 7-7-7-7-7-7-7-7
( day 4 ) 10-10-10-10-10-10-10-10
( day 5 ) 13--13-13-13-13-13-13-13 up to (25-28 ml / 3h)
Dr. Kamel Hassan
Best Regards
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