Doldol Hospital
Feeding small / sick newborns
Feeding small / sick newborns
Small babies, premature babies <36 weeks, and unwell term babies need specific management of their
fluids.
Normal daily maintenance fluids;
< 1.5 kg birth weight
> 1.5 kg birth weight
Newborns > 1.5kg;
Well baby 
Immediate full milk feeding.
First feed give 7.5mls, increase by 7.5mls per feed 3 hourly until full daily volume reached
Sick baby 
Day 1  iv fluids 10% dextrose 24 hours, nil per oral
Day 2  iv fluids (2 parts 10% dextrose to 1 part HS Darrows)
Unless baby very unwell, start milk feeds 7.5mls 3 hourly.
Day 3 onwards  Increase milk feeds by 7.5mls each day if tolerated. Titrate with iv fluids to
ensure full maintenance of fluids given per day. Stop iv fluids once milk feeds
>100mls/kg/day
Newborns < 1.5kg;
All babies 
Day 1  iv fluids 10% dextrose 24 hours, nil per oral.
Day 2  iv fluids (2 parts 10% dextrose to 1 part HS Darrows)
Unless baby very unwell, start feeds 5mls (EBM only) 3 hourly NGT.
Day 3 onwards  Increase milk feeds by 5mls each day if tolerated. Titrate with iv
fluids to ensure full maintenance of fluids given per day. Stop iv fluids once milk feeds
>100mls/kg/day
NB
-
if unsafe/unable to give iv fluids, do 1 hourly NGT feeds
administering iv fluids for neonates can be risky; they should be carefully monitored for hydration status
and fluid overload. They should ideally only be administered by trained NBU nurses
Dr J. Le Geyt, Dr S. Kilonzo
July 2014
Doldol Hospital
Feeding small / sick newborns
EXAMPLE CALCULATIONS;
A well baby 1.9kg …
On 1st day?  (60mls/kg/day = 114mls of milk/ day). Start 7.5mls milk feed 1st feed,
then 15mls 2nd feed. Continue on 15mls for each feed.
2nd day?  (80mls/kg/day= 152mls of milk/day) give 19mls every 3 hours.
A sick baby 1.6kg…
On 1st day?  (60mls/kg/day = 96mls of iv fluids/ day). Nil per oral. Iv 10% dextrose at 4mls/ hour
2nd day?
 (80mls/kg/day= 128 mls total fluid/day)
Start 7.5mls milk feed 3 hourly (total 60mls/day)
Plus
68mls/day iv fluids (2 parts 10% dextrose to 1 part HS Darrows) at 2.8mls/hour
Milk feeding;
-
Even if a baby is nil per oral, mothers should be encouraged to express milk, and have skin-to-skin contact
to promote adequate milk production.
If a baby is safely able to suck/swallow, cup and spoon is preferred to NGT feeding
Once milk feeding has commenced and is tolerated, put baby to breast. Consider stopping/ reducing cup
and spoon feeds once baby is breast feeding well for >15minutes and is gaining weight
Premature babies or those <2kg should only receive EBM milk (no formula milk)
Weights;
In the first week of life, even well babies can lose and then regain up to 10% of their body weight.
Babies should gain about 10g/kg body weight every day after the first week.
Supplements;
All babies <36 weeks or <2kg should receive;
 2.5mls multivitamin once daily (eg mixavit) once on full feeds, for 6 months
 2.5mg folate once weekly, from 2 weeks of age, for 6 months
 2.5mls ferrous fumarate (eg ranferon), from 4 weeks of age, for 3 months
Dr J. Le Geyt, Dr S. Kilonzo
July 2014