Table 1 Evidence-based recommendations used in Preterm Postnatal Follow-up Study of the INTERGROWTH-21st Project
From: Preterm feeding recommendations are achievable in large-scale research studies
The overall goal of this guideline is to promote exclusive breastfeeding of the preterm infant by the time of hospital discharge. | |
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What to feed, in order of preference | 1. Mother’s own milk from the breast. 2. Mother’s expressed breast milk. 3. Donor human milk, if available. 4. Preterm formula. |
How to feed | Orogastric feeding is preferred over a nasogastric tube, especially if the infant has increased work of breathing. Continuous, over-bolus feeds not recommended, no strong evidence for this. Infants should be encouraged to suck at the breast once sucking behavior is observed. |
Feed volume | Start with approximately 80 ml/kg per day. Increase by 10–20 ml/kg per day to a maximum of approximately 160–180 ml/kg per day by the end of the first week of life. |
Feed progression | Most infants >32 weeks’ gestation will tolerate maintenance enteral feeds from the first day of life. Infants <32 weeks’ gestation should be introduced to small amounts of trophic feeds (10–24 ml/kg per day) on first day of life. Infants >32 weeks’ gestation are likely to tolerate faster increases in volume. |
Human milk supplementation | Vitamin D: 400 IU per day. Phosphorus & calcium: some evidence for reducing metabolic bone disease in infants weighing <1,500 g. Iron: 2 mg/kg per day, start by 8 weeks of age. Multi-component fortifiers: Associated with short-term increases in weight gain, linear growth and head growth. No evidence for long-term benefits or adverse effects. |
Duration of exclusive breastfeeding | 6 months in low birth weight infants accompanied by iron supplementation. |