SIFTA multi-centre randomised controlled trial of two speeds of daily increment of

milk feeding in very preterm or very low birth weight infants

Milk Feed Guidance

At Randomisation:

• Infant receiving < 30ml/kg/d of milk

• Feeds should be advanced at allocated rate as soon as possible after randomisation

Calculate milk volume on

• Birth Weight or Current Weight (whichever is greater)

Prescribe total milk volume for that day using allocated increment

• e.g. from 30 to 60ml/kg/d (fast) from 30 to 48 ml/kg/d (slow)

Divide this total by the number of feeds you would normally give

• 1 hourly = 24 feeds• 2 hourly = 12 feeds• 3 hourly = 8 feeds

• For ease, rounding to nearest 0.5 ml is acceptable

Online calculator

An online calculator is available via the randomisation program to assist with feed calculations.

https://rct.npeu.ox.ac.uk/siftdemo/feed_schedule.php

For those who like charts

• Larger 24 hour steps (bold) preferred• Smaller 8 hour steps also shown

FAST MILK FEED INCREASE (30 ml/kg/day increment on HOURLY feeds)

DAY DAY 1 DAY 2 DAY 3 DAY 4 DAY 5 DAY 6 & on 6.5ml/kg/feed Continue to

desired feeding volume according

to unit policy 6.25 ml/kg/feed 6ml/kg/feed 5.25ml/kg/feed 5 ml/kg/feed 4.75ml/kg/feed 4ml/kg/feed 3.75 ml/kg/feed 3.5ml/kg/feed 2.75ml/kg/feed 2.5 ml/kg/feed 2.25ml/kg/feed 1.5ml/kg/feed 1.25 ml/kg/feed 1ml/kg/feed

Target ml/kg/day 30 60 90 120 150 150+

In addition to the milk volume being given at the start of increasing the feeds

SLOW MILK FEED INCREASE (18 ml/kg/day increment on HOURLY feeds)DAY DAY 1 DAY 2 DAY 3 DAY 4 DAY 5 DAY 6 DAY 7 DAY 8 DAY 9 & on

6.25 ml/kg/feed 6.25 ml/kg/feed

6 ml/kg/feed Continue to desired feeding

volume according to unit policy

5.75 ml/kg/feed 5.5ml/kg/feed

5.25 ml/kg/feed

5 ml/kg/feed 4.75ml/kg/feed

4.5 ml/kg/feed

4.25ml/kg/feed 4 ml/kg/feed

3.75 ml/kg/feed

3.5ml/kg/feed 3.25ml/kg/feed

3 ml/kg/feed

2.75ml/kg/feed 2.5 ml/kg/feed

2.25 ml/kg/feed

2 ml/kg/feed 1.75ml/kg/feed

1.5 ml/kg/feed

1.25ml/kg/feed 1 ml/kg/feed

0.75 ml/kg/feed

0.5 ml/kg/feedTarget

ml/kg/day 18 36 54 72 90 108 126 144 150+

• Larger 24 hour steps (bold) preferred• Smaller 8 hour steps also shown

In addition to the milk volume being given at the start of increasing the feeds

FAST MILK FEED INCREASE (30 ml/kg/day increment on 2 HOURLY feeds)

DAY DAY 1 DAY 2 DAY 3 DAY 4 DAY 5 DAY 6

13 ml/kg/feed Continue to desired feeding volume

according to unit policy

12.5 ml/kg/feed

12 ml/kg/feed 10.5 ml/kg/feed

10 ml/kg/feed

9.5 ml/kg/feed 8 ml/kg/feed

7.5 ml/kg/feed

7 ml/kg/feed 5.5 ml/kg/feed

5 ml/kg/feed

4.5 ml/kg/feed 3 ml/kg/feed

2.5 ml/kg/feed

2 ml/kg/feedTarget

ml/kg/day 30 60 90 120 150 150+

• Larger 24 hour steps (bold) preferred• Smaller 8 hour steps also shown

In addition to the milk volume being given at the start of increasing the feeds

SLOW MILK FEED INCREASE (18 ml/kg/day increment on 2 HOURLY feeds)DAY DAY 1 DAY 2 DAY 3 DAY 4 DAY 5 DAY 6 DAY 7 DAY 8 DAY 9 & on

12.5ml/kg/feed 12.5 ml/kg/feed

12 ml/kg/feed Continue to desired feeding

volume according to unit

policy

11.5ml/kg/feed 11 ml/kg/feed

10.5 ml/kg/feed

10 ml/kg/feed 9.5 ml/kg/feed

9 ml/kg/feed

8.5 ml/kg/feed 8 ml/kg/feed

7.5 ml/kg/feed

7 ml/kg/feed 6.5ml/kg/feed

6 ml/kg/feed

5.5ml/kg/feed 5 ml/kg/feed

4.5 ml/kg/feed

4 ml/kg/feed 3.5 ml/kg/feed

3 ml/kg/feed

2.5 ml/kg/feed 2 ml/kg/feed

1.5 ml/kg/feed

1 ml/kg/feedTarget

ml/kg/day 18 36 54 72 90 108 126 144 150+

• Larger 24 hour steps (bold) preferred• Smaller 8 hour steps also shown

In addition to the milk volume being given at the start of increasing the feeds

What do I do if…Feeds are stopped?

• Start at previous rate and follow prescribed increment• Start from beginning and follow prescribed increment• Start from beginning and follow unit’s policy

• All treatment and management are at clinician discretion

• Record all data regardless of regimen adopted

Baby has large gastric residuals?

• Clinician discretion – but aim to prevent feeds being stopped or reduced without justification

• Record all data

What do I do if…

Baby misses a days increment?

• Increase at prescribed rate

• Don’t try and make up time

• Record all data

What do I do if…

If the data are recorded then what happened to the baby is captured

Thanks for your attentionBest of luck with the study!

NPEU Clinical Trials Unit Department of Public Health

University of Oxford Old Road Campus

Oxford OX3 7LF

T: 01865 617 919 F: 01865 289 740

E: sift@npeu.ox.ac.uk www.npeu.ox.ac.uk/sift