Skip to main content

Table 4 Feeding guidelines

From: DoMINO: Donor milk for improved neurodevelopmental outcomes

  Supplement to MOM Supplement to MOM
  Pasteurized Human Donor Milk Preterm Formula*
Similac Special Care 20 or 24 kcal/ oz [3.0 g protein/100 kcal] [Abbott Laboratories] or
Enfamil Premature Formula 20 or 24 kcal/oz [3.0 g protein/100 kcal] [Mead Johnson Nutritionals]
Initiation of enteral feeding Day 1-7 Day 1-7
Volume of feeding at initiation 10-20 ml/kg/d (hold volume for 3-5 days) 10-20 ml/kg/d (hold volume for 3–5 days)
Rate of feed advancement 10-25 ml/kg/day 10-25 ml/kg/day
Fortification to commence at >120 ml/kg/day using milk pumped > 7 days after parturition+ Human milk fortifier Not Applicable
Enfamil Human Milk Fortifier, [Mead Johnson Nutritionals] or
Similac Human Milk Fortifier, [Abbott Laboratories]
Volume 140-200 ml/kg/d to achieve a weight gain of > 15 g/kg/day 140-200 ml/kg/d to achieve a weight gain of > 15 g/kg/day
Minimum protein dose to be provided once (or up to 3 days after) volume reaches >150 ml/kg/d 3.0 g/kg/d** 3.0 g/kg/d**
At 24 kcal/oz and weight gain < 15 g/kg/d for 3–7 days Concentrate feeding using a multi-nutrient modular to 26–27 kcal/oz Modular to 26–27 kcal/oz
At 27 kcal/oz and weight gain < 15 g/kg/d for 3–7 days Concentrate feeding using a multi-nutrient modular to 30 kcal/oz Concentrate feeding using a multinutrient modular to 30 kcal/oz
At 30 kcal/oz and weight gain < 15 g/kg/d for 3–7 days Remove from feeding protocol Remove from feeding protocol
  1. *A low or high iron formula will be used for study infants at each NICU depending on the iron content of the human milk fortifier in use to avoid unblinding of feeding assignments.
  2. +Commence supplementation with 200–400 IU vitamin D and 2–4 mg/kg/d elemental iron.
  3. **As infants approach their estimated date of delivery and/or readied for hospital discharge intakes will usually be below this value.