Abdul kasim jaleel ahmed

Formula Feeding in NICU Formula feeding in moderate and late preterm infants (32 to <37 weeks gestation) admitted to the NICU is a nuanced topic. While mother’s own milk remains the gold standard, clinical realities often require consideration of formula. Here’s a concise overview: 1. Preferred Choice: Mother’s Own Milk (MOM) • Immunological protection, reduced risk of NEC (Necrotizing Enterocolitis). • Enhances gut maturity, promotes neurodevelopment. • Should be prioritized with early lactation support and expression within 6 hours of birth. 2. Donor Human Milk (DHM) • Recommended when MOM is unavailable, especially for infants <34 weeks or <1500g. • Often prioritized in high-risk preterms; in moderate/late preterms, availability may be limited. 3. When Formula is Considered? Formula becomes a practical choice when: • MOM and DHM are unavailable or insufficient. • There is a delay in milk expression or maternal illness. • Infant is clinically stable and feeding readiness is appropriate. 4. Type of Formula • Preterm formula (higher calories, protein, minerals) is ideal until term corrected age or appropriate growth is achieved. • Transition to term formula or fortified breast milk once growth stabilizes. 5. Risks of Formula in Preterms • Higher risk of feeding intolerance, NEC, and dysbiosis of gut flora,CMPA. • Greater metabolic load on immature kidneys. 6. Feeding Strategy • Minimal enteral nutrition (MEN) with expressed milk is encouraged even if formula is needed later. • Fortification of MOM can be done based on weight and biochemical parameters. • Individualized feeding plan is essential based on growth, tolerance, and comorbidities. Take-Home Points • Breast milk is best, but formula has a role when human milk is not available. • Use preterm-specific formula when necessary. • Close monitoring of feeding tolerance and growth is vital. • Shared decision-making with parents is key—education about feeding benefits, risks, and plans. Dr A Jaleel Ahamed Coimbatore

Again what this forum recommends

Good one What this forum recommends

Managing hyperglycemia in a newborn requires identifying the underlying cause and addressing it appropriately. Hyperglycemia is generally defined as blood glucose >150-180 mg/dL in neonates, particularly preterm or critically ill infants. Causes of Neonatal Hyperglycemia • Excessive glucose infusion (IV fluids, parenteral nutrition) • Stress response (sepsis, surgery, hypoxia) • Extremely low birth weight (ELBW) or very preterm neonates (immature insulin secretion) • Endocrine disorders (e.g., neonatal diabetes mellitus) • Medications (steroids, caffeine, theophylline) Management Approach 1. Assess and Address the Underlying Cause • Review glucose infusion rate (GIR) • Evaluate for sepsis, hypoxia, or stress-related conditions • Consider endocrine disorders if hyperglycemia is persistent 2. Adjust Glucose Infusion Rate (GIR) • Normal GIR: 4-6 mg/kg/min • Reduce GIR stepwise if glucose levels exceed 180 mg/dL, but avoid hypoglycemia • Target blood glucose <150 mg/dL in neonates 3. Insulin Therapy (If Needed) • Consider only if persistent hyperglycemia (>200-250 mg/dL) despite GIR reduction • Start insulin infusion at 0.05-0.1 U/kg/hr, titrating as needed • Monitor for hypoglycemia and electrolyte imbalances (especially hypokalemia) 4. Monitor and Support • Frequent blood glucose checks (every 4-6 hours initially) • Electrolyte monitoring (Na, K, Ca) • Clinical observation for dehydration, polyuria, weight loss Special Considerations • Preterm infants (<32 weeks): More prone to hyperglycemia; maintain conservative GIR • Septic or stressed neonates: Treat the underlying infection/inflammation • Neonatal diabetes: Rare but requires further endocrine evaluation Dr A Jaleel Ahamed Coimbatore India

Normally we don’t do anything as mentioned Need to differentiate Subgaleal hge which is sometimes fatal if delayed

It is individual practice and case by case scenario, but i will recommond screening for PID in the neonatal period if facilities are there.

First of all this not ABO incompatibility Think of Minor blood groups mismatch and look for active hemolytic state (may be Reti & PS ) may help. THANKS

I have siblings with PIFC Type 3 receiving Vitamin K supplements along with other vitamins

Thanks for sharing & great learning

why the term reflex mentioned instead screening- please clarify

I have not heard about this drug in BPD May be anti inflammatory effects on preterm lung tissue which is recovering from ongoing damage…..

We use Ampicillin and Amikacin kindly review your Gentamicin dosage in this clinical context can you please high light acute kidney injury is it dose related Acute tubular necrosis? please update thank you

Thank you for the information

I agree Rapid genomic testing will definitely throw light on the outcome of critically ill kids

We don’t do evaluations for tongue tie as a part of feeding issues Don’t recommend for the procedure that too in early life many centers commercializing the procedure needs strong EBM support