ENTERAL FEEDING GUIDE

FEEDING SCHEDULE

These "guidelines" should assist in establishing adequate enteral feedings rapidly and safely. Deviation from these guidelines should be discussed on rounds.

<1000 gms (Maximum of 150cc/kg/day)

Day	cc/feed	Frequency	Formula
1	1	q8hr	BM or SCF 24 or EPF 24
2	1	q4hr
3	1	q2hr	Add HMF to BM
4	2-3	"	"
5	4-5	"	"
6	6-7	"	"
7	8-9	"	"
8	10-11	"	"

1000-1500 gms (Maximum of 150cc/kg/day)

Day	cc/feed (for q2hr)	Frequency	Formula
1	2-4	q2hr	SCF 24 or EPF 24 or BM+HMF
2	3-10	"	"
3	5-10	At 1200-1300g change to q3h	"
4	7-15	"	"
5	9-18	"	"
6	11-20	"	"
7	13-35	"	"

1500-1800 gm q3hr
(per gavage if infant <34 weeks gestational age)

Day	cc/feed	Frequency	Formula
1	5-10	q3hr	SCF 24 or EPF 24 or BM 24 cal
2	8-15	"	"
3	10-20	"	"
4	15-25	"	"
5	20-30	"	"
6	25-35	"	"
7	30-40	"	"
8	34-45	"	"

FORMULA CHOICES

Infants >1800gms: Breast milk or 20 cal formula

Infants <1800gms:

Breast fed

• Fortify breast milk with human milk fortifier when total enteral feedings are at least 80cc/kg/day If there is an inadequate supply of breast milk, use 24 cal premie formula. The amount of fortifier automatically decreases as the number of breast feedings increase. For infants going home on a combination of breast/bottle feedings, stop fortifier when ad lib feedings are started.

Formula fed

• Start feedings with 24 calorie premie formula with iron. Infants with significant lung disease (requiring fluid restriction, diuretics and/or low flow oxygen) may be discharged home on EPF 24 cal (at the discretion of the attending - this requires special arrangements).
• If the infant needs additional calories but is not on fluid restriction, use Neocare 22 cal formula; consider changing to Neocare when going from alternating bottle/gavage to 2/3 bottle. These infants would then be discharged home on Neocare for at least one month, for follow-up by their referring physician.

When medically indicated for specific intolerance:

• Soy, elemental formula, or lactose-free formula.

VITAMINS AND OTHER SUPPLEMENTS

Iron

• When receiving erythropoeitin, infants should receive iron supplements per protocol. After Epogen has been discontinued (at one month), the 4-6 mg/kg/day of iron should be continued to discharge (but not beyond).

Vitamins

• No vitamins are given other than in hyperalimentation. We do not order vitamins at discharge, but rather leave this to the discretion of the follow-up physician.

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