Feeding your baby

General information about Breastfeeding

Breastfeeding Your Baby: How to Express and Store Your Milk

Breastfeeding Your Baby: The First Weeks of Breastfeeding

Breastfeeding Your Baby: How to Tell if Your Baby is Getting Enough Milk

Breastfeeding Your Baby How to Care For Leaking Breasts

Breastfeeding Your Baby: How to Care for Plugged Ducts or Breast Infections

Standard Recommendations for Infants Discharged from Kaiser Santa Clara NICU

Please keep in mind that these recommendations are general guidelines and that some infants may require different feeding regimens based on their medical condition.

Enfamil EnfaCare Lipil (made by Mead Johnson) and NeoSure (part of Similac line, made by Ross) are both considered "nutrient-enriched" or "preterm discharge" formulas. They provide 22 kcal/oz when mixed according to the instructions printed on the label and contain extra calories, protein, vitamins and minerals needed for optimal growth in growing premies. According to the American Academy of Pediatrics, the use of preterm discharge formulas results in a greater weight gain, length growth, and bone mineral content compared with the use of term infant formulas. Breast milk and standard term formula are 20 kcal/oz.

Please note that soy protein based formulas should not be fed routinely to low birth weight preterm infants, according to the American Academy of Pediatrics Committee on Nutrition. Soy formulas result in suboptimal bone mineralization (osteopenia) even with supplemental calcium and vitamin D. There is also some concern for aluminum toxicity and less optimal growth.

Infants of birthweight <1800 grams and/or born at <34 weeks gestation:

• Breastfeed or give expressed breast milk on demand approximately every 3 hours and give 2 feedings per day of 24 kcal/oz NeoSure or Enfamil EnfaCare Lipil preterm formula by bottle for the first 9-12 months of age. The fortified preterm formula will provide the additional minerals and protein needed for "catch-up" growth.

• If breast milk is not available, give 22 kcal/oz NeoSure or Enfamil EnfaCare Lipil preterm formula.

• Give Trivisol 1 ml orally once daily to provide Vitamin D supplementation (to prevent rickets). Continue Trivisol for the first 12 months of age if breast milk provides > 50% of diet. May stop if your baby is taking at least 32 ounces per day of infant forumla.

• At approximately one month after discharge from the NICU, your pediatrician may order certain blood tests (Alkaline phosphatase and Phosphorus levels) to monitor your baby's bone mineralization.

• If breast milk provides >50% of diet, give Ferinsol drops (iron) or Trivisol with iron drops until approximately 6 months of age (around when iron-fortified cereal is introduced). Check with your baby's doctor regarding dosage (2-4mg/kg/day elemental iron).

Infants born at 34-35 weeks gestation:

• Breastfeed or give expressed breast milk on demand approximately every 3 hours and give 2 feedings per day of 24 kcal/oz NeoSure or Enfamil EnfaCare Lipil preterm formula by bottle for the first 3 months of age. The fortified formula will provide the additional minerals and protein needed for "catch-up" growth.

• If breast milk is not available, give 22 kcal/oz NeoSure or Enfamil EnfaCare Lipil preterm formula.

• Give Trivisol 1 ml orally once daily to provide Vitamin D supplementation (to prevent rickets). Continue Trivisol for the first 12 months of age if breast milk provides > 50% of diet. May stop if your baby is taking at least 32 ounces per day of infant forumla.

• At approximately one month after discharge from the NICU, your pediatrician may order certain blood tests (Alkaline phosphatase and Phosphorus levels) to monitor your baby's bone mineralization.

• Iron supplementation is not usually needed, unless indicated by medical condition (check with infant's doctor).

Infants >35weeks gestation:

• Breastfeed or bottle feed with expressed breast milk or standard term infant formula on demand. Some infants may be discharged home on fortified breastmilk or formula for additional calories.

• g=Give Trivisol 1 ml orally once daily to provide Vitamin D supplementation (to prevent rickets). If breast milk provides >50% of diet, continue Trivisol for the first 12 months of age. May stop if infant is taking at least 32 ounces per day of infant formula.

• Iron supplementation is not usually needed, unless indicated by medical condition (check with infant's doctor).

Standard Discharge Recipes

Preterm Formulas

• 22 kcal/oz NeoSure or Enfamil EnfaCare Lipil preterm formula: one level scoop of formula powder to 2 ounces (60 ml) water.

• 24 kcal/oz NeoSure or Enfamil EnfaCare Lipil preterm formula: three level scoops of formula powder to 5.5 ounces (165 ml) water.

Term Formulas

• 20 kcal/oz standard term formula (i.e. Similac, Enfamil, Pregestimil, Nutramigen): one level scoop of formula powder to 2 ounces (60 ml) of water

• 22 kcal/oz standard term formula: 3 level scoops of formula powder to 5.5 ounces (165 ml) water.

• 24 kcal/oz standard term formula: 3 level scoops of formula powder to 5 ounces (150 ml) water.

Special Discharge Recipes for Fortified Maternal Breastmilk
(use only as directed by your baby's physician)

22 kcal/oz fortified Maternal Breastmilk:

• Using EnfaCare Lipil or NeoSure preterm formula powder: 1/2 level teaspoon to 90 ml breastmilk.

• Using Term formula powder: 1/2 level teaspoon to 100 ml breastmilk.

24 kcal/oz fortified Maternal Breastmilk:

• Using EnfaCare Lipil or NeoSure preterm formula powder: 1 level teaspoon to 70 ml breastmilk.

• Using Term formula powder: 1 level teaspoon to 100 ml breastmilk.

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