Table 2
Summary of feeding guidelines (part I)
| Variable | Studies | |||||
|---|---|---|---|---|---|---|
| Patole et al | Kamitsuka et al | O’Reilly et al | Premji et al | Brown et al | Spritzer et al | |
| MAP, Mean arterial pressure; PDA, patent ductus arteriosus; IUGR, intrauterine growth retardation; NEC, necrotising enterocolitis. | ||||||
| Timing to start feeds | No respiratory assistance or MAP<10 cm, no PDA or sepsis, no need for cardiovascular support | Day 4, 3, 2 (or longer if needed) for neonates weighing 1250–1500 g (A), 1502–2000 g (B) and 2001–2500 g (C) respectively | 1–8 days | Started at day 5–6 of life | Feeds delayed for 5–7 days or longer in complicated deliveries with fetal distress | As soon as possible in well neonates. Delayed by 1 week in presence of ventilation, IUGR or complicated labour/delivery |
| Feeding method | Intermittent bolus gavage feeds by nasogastric tube | Intermittent bolus gavage feeds by nasogastric tube | Intermittent bolus gavage feeds, by gastric tube | Intermittent bolus gavage feeds by nasogastric tube | Intermittent 3 hourly bolus feeds by nasogastric tube | Not clear |
| Feeding type | Expressed breast milk (preferred) or 20 kcal/oz formula (later increased to 24 kcal/oz) | Expressed breast milk (preferred) or half strength formula (later increased to full strength) | Expressed breast milk (preferred) or 20 kcal/oz iron fortified formula | Expressed breast milk (preferred) or 24 kcal/oz formula | Sterile water followed by formula (0.45 cal/ml graded up to 0.80 cal/ml) | Dilute formula, graded gradually to full strength |
| Feed volume at start | 0.5 ml/hour (<28 weeks) or 1 ml/hour (⩾28 weeks) | Group A and B: 3 ml 3 hourly. Group C: 4 ml 3 hourly | Started as minimal enteral feeds (<10–20 ml/kg/day) for 3–4 days and then upgraded by 10–20 ml/kg/day | Maximum ⩾24 ml/kg/day. For <750 g: 1 ml/2 h For ⩾750–<1000 g: 2 ml/2 h. For ⩾1000–<1500 g: 1 ml every 2 h | For <1250 g: 2 ml/2 h. For 1250–1500 g: 3 ml/2 h. For >1500 g: 4 ml/2 h | 20 ml/kg |
| Increment volume | Start with 0.5 ml/12 h for <28 weeks, and 1 ml/12 h for ⩾28 weeks. Increase by 1 ml 8 hourly after reaching 100 ml/kg/day (maximum: 24 ml/kg/day) | Not more than 20 ml/kg/day | 10–20 ml/kg/day | Maximum: ⩽30 ml/kg/day. For <750 g: 1 ml every24 h. For ⩾750–<1000 g: 1 ml every24 h. For ⩾1000–<1500 g: 1 ml every 12 h | Detailed plan provided for reaching 20 ml/8 h (<1250 g), 25 ml/8 h (1250–1500 g), 29 ml/8 h (>1500 g) | 20 ml/kg/day |
| Total maximum volume | 170 ml/kg/day | 150 ml/kg/day | 150 ml/kg/day or 120 kcal/kg/day | Not clear | See above | Not specified |
| Minimal enteral feeds (volume and duration) | Not used | Not used | <10–20 ml/kg/day, continued for 3–4 days (breast milk or preterm formula) | Used only for neonates<1 kg at <24 ml/kg/day, Start within 48 hours of birth, and continued for 5–6 days | Not used | Not used |
| Definition of “feed intolerance” | Specified | Not specified | Specified | Specified | Not specified Plan of action given for apnoea, bradycardia, abdominal distension, gastric retention of formula, occult blood in stools, and for “NEC” or “shock” | Not specified |
| Plan of action for sepsis | Stop feeds for 48 h or until haemodynamic stability | Not specified | Not specified | Not specified | Not specified (see above) | Not specified |
| Plan of action for PDA and indomethacin | Stop feeds until 24 h after completing indomethacin therapy | Not specified | Not specified | Stop feeds during indomethacin therapy | Not specified (see above) | Not specified |
| Plan of action for “large” gastric aspirates | Stop feeds if such aspirates are persistent | Not specified | Stop feeds | Guidelines provided for contacting clinician for decision making | Stop feeds “for a week or two or more till resolution of the problem” | Not specified |
| Plan of action for bile stained gastric aspirates | Stop feeds if such aspirates are persistent | Not specified | Stop feeds | Guidelines provided for contacting clinician for decision making | Not specified | Not specified |
| Policy for umbilical catheters | Catheters were retained as long as they were needed | Not specified | Not specified | Not specified | Not specified | Not specified |
