Contents Chapter Topic Page Neonatology Respiratory Cardiology

Composition of various milks
Cow’s Standard Preterm Mature
milk formula formula breastmilk
Carbohydrate
(g/100ml)
4.6 7.5 8.6 7.4
Fat
(g/100ml)
3.9 3.6 4.4 4.2
Protein
(g/100ml)
3.4 1.5 2.0 1.1
Casein/
4:1 2:3 2:3 2:3
lactalbumin ratio
Calories /100ml 67 67 80 70
Na+ (mmol/L) 23 16 33 15
K+ (mmol/L) 40 65 33 64
Ca++ (mg%) 124 46 77 35
PO4 (mg %) 98 33 41 15
Fe++ (mg%) 0.05 0.8 0.67 0.08
3. Strategies of administering enteral feeding
3.1. Orogastric Route : Because neonates are obligate nose breathers
nasogastric tube can obstruct the nasal passage and compromise the baby’s
breathing. Thus orogastric route should be use for babies on tube feeding..
3.2. Continuous vs. intermittent bolus feeding: Studies have shown that bolus
fed babies tolerated their feeds better and gain weight faster. 3 Babies on
continuous feeding have been shown to take longer time to reach full feeding but
there is no difference in days of discharge, somatic growth and incidence of
NEC. 4
3.3. Cup feeding : if baby is able to suckle and mother is not with the baby, cup
feeding is preferable to bottle feeding to prevent nipple confusion (if breast
feeding is intended as the final mode of feeding).
4. When to start milk?
As soon as possible for the well term babies
However in the very preterm infant there is a concern of increase risk of NEC if feeding
is started too early. Studies have suggested that rapid increment in feeding has a higher
risk for NEC than the time at which feeding was started. 5
In the very preterm infant MINIMAL ENTERAL FEEDING (MEN) has been
recommended. The principle behind this is to commence very low volume enteral feeds
on day 1 to 3 of life (i.e. at 5 to 25 mls/kg/day ) for both EBM and formula milk. MEN
enhances DNA gut synthesis hence promotes gastrointestinal growth. This approach
allows earlier establishment of full enteral feeds and shorter hospital stays, without any
concomitant increase in NEC. 6