This document provides guidelines for feeding premature and low birth weight infants based on their gestational age and weight. It discusses initiating feeding through intravenous fluids, nasogastric or orogastric tubes, spoon or cup feeding, or breastfeeding. For infants under 1,200g or less than 30 weeks gestation, total parenteral nutrition is usually required. The document also describes techniques for non-nutritive sucking, gavage feeds through nasogastric tubes, and nasojejunal feeding for infants less than 1,500g. Complications of tube feeding like aspiration, infection and blockage are mentioned.

1. Miss. Kalyani r. Saudagar

2. GESTATIONAL
AGE(BIRTH
WEIGHT)
MODE OF FEEDING CAUTION
< 30 weeks (<1,200
g)
Intravenous fluids Use infusion pump
and avoid over
infusion total
parenteral nutrition
(TPN) is usually
required in infants
<28weeks /30–32
weeks (1,200–
1,500g)
Orogastric or
nasogastric feeds
Watch for feed
intolerance and
necrotizing
enterocolitis (NEC)
32–34 weeks (1,500–
1,800g)
Spoon, pala-day or
cup feeding
Avoid aspiration
>34 weeks (>1,800
g)
Cup feeding or
breastfeeding
Monitor weight gain to
assess adequacy of
breastfeeding
Table 1: Mode of initial feeding depending upon the
gestational maturity

3.  Direct breastfeeding should be tried once infant
achieves a gestational maturity of 34 weeks.
 Rooting reflex should be promoted by stimulation
of corners of mouth with soft-brush and by
putting them to breast for non-nutritive sucking
before expressing the breast milk.
 If a baby takes more than 20 minutes to finish
the recommended amount of feed during a trial
of bottle feeding, he/she should preferably be fed
through naso-gastric tube as exertion involved in
sucking will result in poor weight gain.

4. NON- NUTRITIVE SUCKING
 An infant born prematurely develops the sucking
behavior over time to be able to feed on breast.
 It is initiated by allowing the baby to suck on an
empty breast (after expression).
 It may be started right from the time baby is on
gavage feeds.
 It may encourage the development of sucking
behavior, improve digestion of the feed and
reduce the hospital stay

5. GAVAGE FEEDS
Nasogastric Feeding
 Length of polyethylene naso-gastric catheter is 6 Fr,
measured from the external are to the
lobe of the ear and from lobe of the ear to the form
cartilage and marked.
 Position: Head slightly raised with wet catheter (not
lubricated)
 Verify position by aspirating gastric contents and by
injecting air and auscultating over the epi-gastric
region. Outer end of tube is attached to 20 mL
syringe.
 At the end of feed, inject 2 mL of distilled water to
rinse the tube.

6. CONT…..
 Post-feed: Place baby in right lateral position
for another 15–20 minutes.
 Nasogastric (NG) tube may be left in situ for
2–3 days.
 While removing, pinch and pull out gently by
applying negative pressure.

7. CONT……..
 Amount of feed: If baby is stable then feed
should be started at the rate 20–30 mL / kg/
day on first day and provide the stable
amount of fluid (50 mL/ kg/ day) of fluid as
10% dextrose intravenously.
 Slow bolus feed; 2 hourly
 Increase the quantity of enteral feeds
everyday by 20–30 mL / kg/ day

8. NASOJEJUNAL FEEDING
 Nasoduodenal or nasojejunal feeding provides a
simple, noninvasive means of delivering
adequate amount of feed in low birthweight.
 Indicated in babies less than 1,500 g respiratory
distress syndrome, sepsis, asphyxia and
seizures.
 Size: Fr 5 (length 30 inches)
 Insertion is done same as nasogastric feeding;
the infant is turned lateral position. The tube is
further inserted gradually till marked is reached.

9. CONT…….
 Aspirate will show the presence of bile (pH
5–7) when the tube lies in duodenum or
beyond.
 Can be kept for several weeks
 Feed should preferably be iso-or hypo-
osmolar to safeguard against osmotic
diarrhea and dumping syndrome.

10. Advantages
 Minimal risk of aspiration, less chances of
reflex bradycardia due to less vagal
stimulation.
 It is safer and less expensive.

11. Complications
 Compromised airway with respiratory
distress syndrome (RDS), local irritation,
congestion,
and infection of nasal passages
 Blockage due to clogging of feeding tubes
may occur
 Needs frequent supervision.