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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