Version June 2024
| Day of life | Feeding | kcal/oz | Feeding volume (mL/kg/day) | PN (mL/kg/day) | Lipids* (mL/kg/day) | Total fluid¶ (mL/kg/day) |
| 1 | EBM | 20 | 20Δ◊ | 70 | 10 | 80 |
| 2 | EBM | 20 | 50 | 50 | 15 | 100 to 120 |
| 3 | EBM | 20 | 80 | 40 | Off lipids | 100 to 120 |
| Or EBM with HMF (if donor human milk-derived fortifier is used)§ | 26 | 80 | 40 | Off lipids | 100 to 120 | |
| 4 | EBM | 20 | 110 | Off PN | 0 | 100 to 120 |
| Or EBM with HMF (if donor human milk-derived fortifier is used) | 26 | 110 | Off PN | 0 | 100 to 120 | |
| 5 | EBM with bovine HMF¥ | 24 | 110 | 0 | 0 | 110 |
| Or EBM with donor human milk-derived fortifier | 26 | 140 | 0 | 0 | 140 | |
| 6 | EBM with bovine HMF | 24 | 140 | 0 | 0 | 140 |
| Or EBM with donor human milk-derived fortifier | 26 | 150 to 160 | 0 | 0 | 150 to 160 | |
| 7 | EBM with bovine HMF‡ | 24 | 150 to 160 | 0 | 0 | 150 to 160 |
| Or EBM with donor human milk-derived fortifier‡ | 26 | 150 to 160 | 0 | 0 | 150 to 160 |
PN: parenteral nutrition; EBM: expressed breast milk; HMF: human milk fortifier; NICU: neonatal intensive care unit.
* Lipid dose refers to 20% emulsion; thus, 10 mL/kg/day = 2 g/kg/day.
¶ Anticipated total fluids include PN, lipids, any other intravenous fluids, medications, and flushes. The volume available for PN may differ depending on volume of medications, flushes, etc. Trophic feeds (20 mL/kg/day) generally do not count towards total fluid.
Δ Begin enteral feeds within 6 to 12 hours of birth if the infant is medically stable (eg, not requiring pressors except low-dose dopamine).
◊ For infants 1000 to 1250 g, we prefer to continue trophic feeds (20 mL/kg/day) for 3 days, then advance as shown in the remainder of this table.
§ If donor human milk-derived HMF is available, we begin to fortify feeds after feeding volume reaches 60 mL/kg/day. This type of HMF adds 6 kcal/oz.
¥ If bovine HMF is used (instead of donor human milk-derived HMF), we begin to fortify feeds after the feeding volume reaches 110 mL/kg/day. If the infant tolerates unfortified feeds at this volume for 1 day, we give fortified feeds at the same volume for 1 day, then continue the advancement schedule with fortified feeds. Bovine HMF is available in liquid or powdered forms (eg, Similac HMF, Enfamil HMF, or Nestle products). These bovine HMFs add 4 kcal/oz. The protein and nutrient content varies somewhat among brands.
‡ When full feeds are reached (150 to 160 mL/kg/day), add a liquid iron supplement (eg, Fer-in-sol), providing 2 to 3 mg/kg of elemental iron (for infants <1500 g birth weight). The infant should be at least 14 days of age for iron supplementation. Also, supplement as needed to provide 200 international units (5 micrograms) per day of vitamin D.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
