From the Research
Preterm infants should be fed every 2-3 hours, with a total of 8-12 feedings per day, starting with small volumes of 10-20 mL/kg/day and gradually increasing by 10-20 mL/kg/day as tolerated, aiming for a goal of 150-180 mL/kg/day by 7-14 days of life, as supported by the most recent and highest quality study 1. The recommended feeding schedule for preterm infants is crucial for their growth and development.
- Start with small volumes of 10-20 mL/kg/day and gradually increase by 10-20 mL/kg/day as tolerated.
- Aim for a goal of 150-180 mL/kg/day by 7-14 days of life.
- For very preterm infants (<32 weeks gestation), begin with trophic feeds of 10-20 mL/kg/day for the first few days, then advance as tolerated.
- Use breast milk when available, or preterm formula if breast milk is not an option, as breast milk is the best food for preterm babies, however it should be nutritionally enriched by powdered human milk fortifier 2.
- Fortify breast milk with human milk fortifier when the infant reaches 100 mL/kg/day of enteral feeds.
- Monitor for signs of feeding intolerance, such as abdominal distension, increased gastric residuals, or bloody stools, and adjust the feeding schedule accordingly.
- Supplement with parenteral nutrition until full enteral feeds are established, and add vitamins and minerals as needed, particularly vitamin D (400 IU/day), iron (2-4 mg/kg/day starting at 4 weeks of age), and phosphorus. This feeding schedule supports optimal growth and development while minimizing the risk of complications like necrotizing enterocolitis, as frequent, small feedings help preterm infants gradually adapt to enteral nutrition and develop their digestive systems 3. Some studies suggest that responsive feeding may result in slightly slower rates of weight gain, but may also reduce the time taken for infants to transition from enteral tube to oral feeding 3. However, the most recent and highest quality study found no difference between every three-hour and every six-hour oral feeding schedules in terms of time to full oral feeding, respiratory and apnoea rates, growth, and length of stay 1. Therefore, the recommended feeding schedule should prioritize the individual needs of the preterm infant, taking into account their gestational age, weight, and overall health status.