Table 2

 Summary of feeding guidelines (part I)

VariableStudies
Patole et alKamitsuka et alO’Reilly et alPremji et alBrown et alSpritzer et al
MAP, Mean arterial pressure; PDA, patent ductus arteriosus; IUGR, intrauterine growth retardation; NEC, necrotising enterocolitis.
Timing to start feedsNo respiratory assistance or MAP<10 cm, no PDA or sepsis, no need for cardiovascular supportDay 4, 3, 2 (or longer if needed) for neonates weighing 1250–1500 g (A), 1502–2000 g (B) and 2001–2500 g (C) respectively1–8 daysStarted at day 5–6 of lifeFeeds delayed for 5–7 days or longer in complicated deliveries with fetal distressAs soon as possible in well neonates. Delayed by 1 week in presence of ventilation, IUGR or complicated labour/delivery
Feeding methodIntermittent bolus gavage feeds by nasogastric tubeIntermittent bolus gavage feeds by nasogastric tubeIntermittent bolus gavage feeds, by gastric tubeIntermittent bolus gavage feeds by nasogastric tubeIntermittent 3 hourly bolus feeds by nasogastric tubeNot clear
Feeding typeExpressed 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 formulaExpressed breast milk (preferred) or 24 kcal/oz formulaSterile 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 start0.5 ml/hour (<28 weeks) or 1 ml/hour (⩾28 weeks)Group A and B: 3 ml 3 hourly. Group C: 4 ml 3 hourlyStarted as minimal enteral feeds (<10–20 ml/kg/day) for 3–4 days and then upgraded by 10–20 ml/kg/dayMaximum ⩾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 hFor <1250 g: 2 ml/2 h. For 1250–1500 g: 3 ml/2 h. For >1500 g: 4 ml/2 h20 ml/kg
Increment volumeStart 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/day10–20 ml/kg/dayMaximum: ⩽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 hDetailed 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 volume170 ml/kg/day150 ml/kg/day150 ml/kg/day or 120 kcal/kg/dayNot clearSee aboveNot specified
Minimal enteral feeds (volume and duration)Not usedNot 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 daysNot usedNot used
Definition of “feed intolerance”SpecifiedNot specifiedSpecifiedSpecifiedNot 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 sepsisStop feeds for 48 h or until haemodynamic stabilityNot specifiedNot specifiedNot specifiedNot specified (see above)Not specified
Plan of action for PDA and indomethacinStop feeds until 24 h after completing indomethacin therapyNot specifiedNot specifiedStop feeds during indomethacin therapyNot specified (see above)Not specified
Plan of action for “large” gastric aspiratesStop feeds if such aspirates are persistentNot specifiedStop feedsGuidelines provided for contacting clinician for decision makingStop feeds “for a week or two or more till resolution of the problem”Not specified
Plan of action for bile stained gastric aspiratesStop feeds if such aspirates are persistentNot specifiedStop feedsGuidelines provided for contacting clinician for decision makingNot specifiedNot specified
Policy for umbilical cathetersCatheters were retained as long as they were neededNot specifiedNot specifiedNot specifiedNot specifiedNot specified