Nutrition for Neonates Undergoing Surgery for CHD — Initiate Oral Feeds — Clinical Pathway: Inpatient

Nutrition for Neonates with Congenital Heart Disease Clinical Pathway — CICU

Initiate Oral Feeds

Newborn Oral Feeding Guidelines

  • Determine mother’s feeding plan.
  • Human milk (maternal or donor) preferred. If mom is not available for direct breastfeeding, bottle-feed expressed maternal colostrum, donor breast milk or standard term formula are appropriate alternatives, following volume guidelines below.
  • Job Aid: Holding and Mobility Guidelines in the Cardiac Center for Feeding out of Bed — View Job Aid
  • Document feed tolerance in infant driven feeding rows in EPIC.
  • All feeding orders should be ad lib with no minimum goals.
  • Infant determines amount, frequency, and length of feeding based on Infant Driven Feeding.
  • Do not supplement oral intake with NG.

General Facts on Newborn Feeding

  • Approximately 5-30 mL of colostrum are produced in the first 24 hours of life.
  • Lactogenesis II (milk coming in) occurs between postpartum day 2 and 4.
  • A newborn usually signals to feed every 1 to 3 hours (timed from the start of one feeding to the start of the next feed).
  • Average newborn stomach size in 5 mL/kg.

Average Newborn Feed Volume every 3 hours

Birth Weight
DOL 1
DOL 2
DOL 3
DOL 4
2.5-3 kg
12-15 mL
17-20 mL
23-25 mL
28-30 mL
3.1-3.5 kg
16-18 mL
21-23 mL
26-28 mL
31-33 mL
3.6-4 kg
18-20 mL
23-25 mL
28-30 mL
33-35 mL

Exclusive Breastfeeding

  • Feeding on demand.
  • Pre-/post-breast feeding weights are not necessary until lactogenesis II occurs.
  • Continue parenteral nutrition @ 80-100 mL/kg/day until maternal lactogenesis II occurs and newborn is demonstrating adequate intake with breastfeeding, at which time parenteral nutrition may be discontinued.

References

  • Dollberg, S. et al. A comparison of intakes of breast-fed and bottle-fed infants during the first two days of life. J of American College of nutrition 2001; 20(3):209-211.
  • Santoro, W. et al. Colostrum ingested during the first day of life by exclusively breastfed healthy newborn infants. J Pediatr 2010; 156:29-32.

* Some content taken with permission from the “Newborn POAL Feeding Guidelines to Support Breastfeeding” by Dana Bartholomew, Taryn Edwards, and the Neo-Surgery Operations Committee (2014)