Guidelines for the Expected Volume of Enteral Feedings for LPT Infants

Boston Medical Center NICU Guidelines (June 2012)National Perinatal Association (2013)Academy of Breastfeeding Medicine (2016; Revision of 2011)
Expected Volume per Feed (mL)Expected mL/kg per dExpected mL/kg per dSupplement Only if Medically Indicated With the Following Volumes, mLSupplementation After Breastfeeding for the Following Volumes, mL
LPT Infants (∼2.0–2.5 kg)≥37 wk or LPT infants ≥2.5 kg
0–24 h after birth∼5–10∼20–30∼0–202–105–10
25–48 h after birth∼10–20∼60∼20–405–1510–30 “thereafter”
49–72 h after birth∼20–30∼80∼6015–30
73–96 h after birth∼30–60∼100∼8030–60
Frequency of feedsOffer ad lib every two hours to every three hours10–12 breastfeeds or 8–10 formula feedings per d8–12 breastfeeds per d
How to supplementBy orogastric or nasogastric tube if infant is unable to take sufficient feedings by bottleSupplementation with feeding tube at breast feeding, cup feeding, finger feeding, or bottle-feedingSupplemental nursing device at the breast, cup feeds, finger feeds, syringe feeds, or bottle depending on clinical situation or maternal preference
What to supplementMother’s milk if available, then donor milk (with consent), then formula (Neosure 22 kcal/oz)In order of preference: expressed breast milk, donor human milk, hydrolyzed formula, or formulaExpressed breast milk, donor milk, or formula
Monitoring dehydrationUse of IV fluids may be considered for significant wt loss, clinical concern for dehydration, hypoglycemia, or any other concern by an attending physicianWt loss of >3% per d or 7% by d 3 merits further evaluationWt loss of >3% per d or 7% by d 3 merits further evaluation
“Weight loss” not definedGoal voids and stools = 3/3 by d 3, 4/4 by d 4, 6/4 by d 6, and beyondGoal of 6 stools by d 4
Stools and/or void frequency not specified
  • Comparing key elements of the LPT infant feeding guidelines at our own institution compared with those by professional organizations.