Table 1.

Early feeding strategies [data taken from 5]

Day 0, admission to NICU: begin intravenous nutrition solution
-	A D7.5 + 5% amino acid (AA) solution administered at 60 ml/kg/24 h will provide 3 g AA/kg/24 h and meet most AA requirements for protein synthesis and net protein accretion, even for infants born as early as 25–27 weeks’ gestation
-	Additional fluids can be added as needed for total fluid intake of 80–100 ml/kg/day
-	This approach allows AAs to be started immediately without waiting for ‘TPN’ prescriptions to be formulated
-	This approach also allows for adjustments of total fluids, electrolytes, and glucose without needing to change the TPN prescription
Days 1–2
-	Advance AAs to and keep total protein intake (IV + enteral) at 4.0 g/kg/day (at 24–30 weeks; less for older gestations)
-	Add glucose and lipids ‘as tolerated’, limiting glucose to <10 mg/kg/min and lipid to <3.0 g/kg/day. Adjust glucose and lipid infusions to keep plasma glucose concentrations >50 mg/dl and <100 mg/dl and plasma triglyceride concentrations <150 mg/dl
Days 1–2 and beyond
-	Begin enteral feedings, using colostrum or milk whenever possible
-	Volume and rate of advancement of feedings depend on gestational age, condition, and response, but slow advancement appears safer than rapid advancement