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Suggested feeding schedules for infants in the neonatal intensive care unit based on birth weight

Suggested feeding schedules for infants in the neonatal intensive care unit based on birth weight
Birth weight (g) Initiation rate (mL/kg/day) When to advance Advancement rate (mL/kg/day)
≤1000 20
  • Maintain initial trophic feeds for 3 days
  • If feeds tolerated, may advance feeds every 24 hours thereafter
 20 to 30*
1001 to 1500 20
  • Maintain initial trophic feeds for 3 days for infants 1001 to 1250 g and for 1 day for infants 1251 to 1500 g
  • If feeds tolerated, may advance feeds every 24 hours thereafter
 30
1501 to 2000 20
  • If feeds tolerated, may advance every 24 hours
 30 to 40
2001 to 2500 25 to 30
  • Advance daily
 30 to 40
>2500 and stable

50 or ad-lib with minimum

(Infants with symptomatic or cyanotic congenital heart disease: 20)

  • Advance daily

    (Infants with symptomatic or cyanotic congenital heart disease may need 20 mL/kg for a longer period of time)
 30 to 40
This schedule reflects our general approach for infants fed expressed breast milk. We use mother's own milk whenever possible. For infants <1500 g birth weight, we use donor milk if mother's own milk is not available. Individual initiation and advancement rates are based on the patient's weight, age, and clinical status. Feedings for infants <1500 g are usually best given on a pump, distributed over 30 to 60 minutes.
* Some institutions may choose to advance feeds on the lower end of this range in infants receiving formula or early fortification (eg, fortifier added when feeding volume reaches 60 mL/kg/day). Other institutions may choose to advance at the higher end of this range (ie, advancing by 30 mL/kg/day) to reach full feeds more quickly and reduce the risks associated with an intravenous catheter and parenteral nutrition.
Adapted with permission from: Guidelines for Acute Care of the Neonate, 26th edition (2018-2019), Fernandes CJ, Pammi M, Katakam L, et al (Eds), Baylor College of Medicine, Houston 2014. Copyright © 2018 Baylor College of Medicine. The content within this table is still current as of the 27th edition of the Guidelines for Acute Care of the Neonate, 2019-2020).
Graphic 118744 Version 4.0

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