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Table 4.4.4 Daily nutritional requirements via sickest infants on parenteral nutrition. Very small
parenteral or enteral nutrition amounts of feed of ≤24 mL feed/kg per day are
given. Meanwhile parenteral nutrition provides all
Parenteral Enteral the nutrition for the infants.
nutrition nutrition for
infants 1–1.8 kg The benefits of trophic feeding include:
Fluids (mL/kg) 150–220
135–200 ●● gut priming
Energy (kcal/kg) 90–100 110–135
3.5–4.0 ●● a reduced dependence on parenteral nutrition as
Protein (g protein/ 3.2–3.8 there is a more rapid tolerance to enteral feeds
kg) 69–115
66–132 ●● lower peak bilirubin and alkaline phosphatase
Sodium (mg/kg) 69–115 120–140 levels
60–90
Potassium (mg/kg) 78–177 ●● enhanced gut motility
8–15
Calcium (mg/kg) 60–80 ●● increased lactase activity
2000–3000
Phosphorus (mg/kg) 45–60 40–100 ●● less hyperglycaemia

Magnesium (mg/ 4.3–7.2 150–400 ●● reduced rate of sepsis.
kg) 2.2–11
4.4–28 Maternal breast milk is the first choice for trophic
Iron (µg/kg) 100–120 140–300 feeding but where this is unavailable and the infant
200–400 is thought to be at risk of developing necrotizing
Vitamin A (µgRE/ 210–450 enterocolitis, donor breast milk may be used if
kg) available. If neither source of breast milk is
available, a preterm formula milk (discussed
Vitamin D (IU) 800–1000 below) can be used.

Vitamin E (mg/kg) 2.8–3.5 Increasing enteral feeds will commence once
clinicians are confident that the infant is tolerating
Vitamin K (µg/kg) 10 trophic feeds. There is no consensus on the best way
to advance feeds but there is evidence that the use of
Thiamine (µg/kg) 200–350 standardized feeding regimens on the neonatal unit
can help prevent necrotizing enterocolitis.
Riboflavin (µg/kg) 150–200
Breast Milk
Figure 4.4.2 A young baby with a nasogastric
tube The health benefits of breast milk for term infants
also apply to preterm infants and are described in
Chapter 4.1. Additional specific benefits for
preterm infants include:

●● reduced incidence of necrotizing enterocolitis

●● reduced incidence of sepsis

●● improved neurodevelopmental outcomes

●● associated with later improved bone
mineralization.