No-one is in a better position to make individual decisions about feeding than the experienced neonatal nurse caring for an infant. Feeding policy and each infant’s nutrition should be managed jointly by nursing and medical staff, while empowering the neonatal nurse to make feeding management decisions when necessary.
Enteral feeding should be introduced gradually and increased with care. Tolerance should be assessed and, whenever possible, infants should be weighed and measured regularly. It is reasonable to begin with 0.5–1 ml/kg/h in a baby of less than 30 weeks’ gestation, increasing by 0.5–1 ml/kg every 6–12 h. In more mature babies, larger starting volumes and a faster rate of progress may be indicated. In a healthy baby, enteral feeds may be given at 75 ml/kg on day 1, 90 ml/kg on day 2, 120 ml/kg on day 3, 135 ml/kg on day 4 and 150 ml/kg on day 5, with subsequent increases up to a maximum of 180 ml/kg/day according to tolerance and growth rate. Preterm formula is usually given at 160 ml/kg/day and fortified breast milk at 160–180 ml/kg/day.
Full nipple feeding from breast or bottle depends upon maturity and health. In most it is achieved at a postmenstrual age of 34–37 weeks.
Source: Forfar and Arneil’s Textbook of Pediatrics, 7E