Neonatal Nutrition Guideline

 

 Reviewed by Barbara Cormack (Dietitian) and Carl Kuschel
February 2006
Change to Fortifier regime Sept 2009
Born at less than 32 weeks OR birthweight <1800g Born at 32+ weeks AND birthweight 1800+g Additional Notes

Born at <32 weeks
OR
birthweight <1800g

 At any time if growth is inadequate, consider referral to dietitian Transition to Oral Feed Stable Growing Preparation for Discharge At Discharge
Feed IVN then,
Breast milk or term formula		 When 120 ml/kg.day breastmilk reached add Breast Milk Fortifier FM85
(1 pkt per 20ml breast milk)
or
change to Preterm Formula (Nutriprem)

When full feeds are reached change to S26 Breast Milk Fortifier (1 pkt per 50ml breast milk)		 Stop Breast Milk Fortifier or change from preterm formula to term formula when approaching discharge
or
approximately 40 weeks or 2500g, whichever occurs earliest.		 Breast milk or term formula
Frequency Begin at 1ml 2-hourly or as tolerated
Grade up as tolerated
Usually increase feed volume by 1ml, every 12 to 24 hours.
Increase more rapidly once tolerated.		 Grade up to 3-hourly feeds as tolerated
(approximately 1500g)		 Beginning sucking feeds.

If the baby is going to be breast fed, then the first feeds offered should be breast feeds.

3- to 4-hourly or on demand
Feed Volume Increase to 180ml/kg/day 180ml/kg/day

Increase to 200ml/kg/day if poor growth.

 Usual volume is 180ml/kg/day.
Increase to 200ml/kg/day if poor growth. 		Demand volumes
Supplements Start Vitadol C 0.30ml per day when tolerating 1/3 enteral feeds or >50ml/kg/day Continue Vitadol C only until tolerating 180ml/kg/day, then stop.

If volume taken is <180ml/kg/day, add Vitadol C 0.15ml per day

 Start Vitadol C 0.3ml per day.

Start 0.5ml/kg/day Ferrous sulphate elixir once 4 weeks of age.

 Prescribe 0.3ml (10 drops) per day Vitadol C and
0.5ml/kg/day Ferrous sulphate elixir once 4 weeks of age or on discharge, whichever comes earlier.

Note:

  • The recommended daily neonatal intake of Vitamin D is 10μg or 400iU.  This is provided by ≥180ml/kg/day of fortified EBM or preterm formula because breastmilk fortifier and preterm formula have higher levels of vitamins and minerals.
  • Babies having lower volumes of FEBM or preterm formula need Vitadol C 0.15ml daily to meet the recommended Vitamin D intake.
  • Babies on all other feeds (e.g. unfortified EBM, term or hydrolysed formula, which have much lower levels of vitamins and minerals) need Vitamin D 0.3ml daily.

Born at 32+ weeks
AND
birthweight 1800+g

 At any time if growth is inadequate, consider referral to dietitian Transition to Oral Feed Stable Growing Preparation for Discharge At Discharge
Feed Breast milk or term formula Breast milk or term formula Breast milk or term formula Breast milk or term formula
Frequency 3-hourly unless risk of hypoglycaemia 3-hourly feeds 3-hourly feeds or on demand

If the baby is going to be breast fed, then the first feeds offered should be breast feeds.

Demand
Feed Volume Day 1 60-90 ml/kg/day
Day 2 90-120 ml/kg/day
Day 3 120-150 ml/kg/day
Up to 180 ml/kg/day		 180 ml/kg/day

Increase to 200ml/kg/day or more if poor growth

Increase to 200 ml/kg/day if poor growth or on demand Demand volumes
Supplements Nil Nil Nil Nil
(see notes below)

Additional Notes:
  • Some infants with a gestation at birth ≥32 weeks and birthweight ≥1800g may require fortifier or preterm formula for growth.
  • Some infants who are demand feeding will take volumes in excess of 200ml/kg/day of expressed breast milk or term formula.
  • Iron (ferrous sulphate) should be commenced at 4 weeks of age in eligible infants.
    • Usual starting dose 3mg/kg/day of elemental iron (0.5ml/kg/day) but increase dose to 6mg/kg/day in iron-deficient infants.
    • Infants receiving treatment with erythropoietin require iron supplementation on commencement.
  • Vitamin and iron supplements should be continued till the infant is well established on a balanced diet of solids.
    • Some groups recommend that infants should be supplemented until 12 months of age.
  • Iron and/or vitamins may be commenced in some infants who do not fit the above criteria. These may include:
    • Infants at risk of nutritional deficiency, for example – malabsorptive diseases, long term parenteral nutrition, fluid restriction (<160ml/kg/day), gastrointestinal tract losses, and infants of mothers who are known to have or are at risk of nutritional deficiencies.
    • Babies at high-risk of iron deficiency.
  • Note that a small number of infants who do not fulfil the criteria above for iron supplementation may nevertheless develop iron deficiency anaemia within the first few months of life.  A FBC and iron studies should be undertaken to confirm the diagnosis, and supplementation should be instituted.

References

1 Franz AR, Mihatsch WA, Sander S, Kron M, Pohlandt F.  Prospective randomized trial of early versus late enteral iron supplementation in infants with a birth weight of less than 1301 grams.  Pediatrics 2000;106(4):700-6.
2 Klein CJ.  Nutrient requirements for preterm infant formulas.  J Nutr 2002;132(6 Suppl 1):1395S-577S.
3 Hay WW Jr, Lucas A, Heird WC, et al.  Workshop summary: nutrition of the extremely low birth weight infant.  Pediatrics 1999;104;1360-1368.
4 Rao R, Georgieff MK.  Neonatal iron nutrition.  Semin Neonatol 2001;6:425-35.