Discharge Feeding Algorithm Babies <32 wk or <1500 gm  

Risk Factors Include 

• Anthropometric: ≤1500 g BW GA and/or ≤32 weeks at birth; history of suboptimal weight gain with declining weight percentile or Z-score 1-2 weeks prior to discharge. At ≤37 weeks and/or ≤2 kg at dc
• Biochemical: alkaline phosphatase ≥600 U/L, serum phosphorus ≤5.5 mg/dL
• Nutritional: Total parenteral nutrition ≥4 weeks; total volume intake <130 mL/kg per day; history of intolerance or use of low nutrient density nutrition (e.g., soy, protein hydrolysate, amino acid-based formulas, or unfortified human milk).
• Miscellaneous: Osteopenia of prematurity, radiological evidence of bone demineralization and/or fracture(s); chronic use of mineral-wasting medications (e.g. furosemide)

Tips for After Discharge 

• Consider continuing until at least ~52 wk corrected GA and up to 1 year for neonates born <32 wk GA, or at the discretion of your pediatrician
• Always use CORRECTED GESTATIONAL AGE for growth charts until at least 2 years of age (even for late preterm neonates) If weight gain is suboptimal (declining weight percentile or Z score), increase caloric concentration Lactation support as available
• May need a letter of medical necessity for WIC

Abbreviations 

• PTP24 - Preterm 24 calorie formula * (Enfamil Premature)
• PTDF - Preterm Discharge Formula (Neosure or Enfacare)
• PT30 - Preterm 30 Calorie Formula*
• EBM - Expressed Breast Milk
• BF - Breastfeeding 

*Formula representative will need to be contacted to obtain products for post discharge by hospital representative

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The Neonatology Consensus Statements (“Statements”) are based on a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These Statements are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.  

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