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Feeding of very-low-birth-weight infants

Intervention | Last updated: 15 May 2023

Every year, more than 20 million infants are born weighing less than 2.5 kg – over 96% of them in developing countries. These low-birth-weight (LBW) infants are at increased risk of early growth retardation, infectious disease, developmental delay and death during infancy and childhood. Very-low-birth-weight (VLBW) infants - those infants born weighing less than 1.5 kg - are particularly vulnerable to the these adverse outcomes.

Most LBW and VLBW is a consequence of preterm birth, small size for gestational age, or both.

Interventions to improve the feeding of LBW and VLBW infants are likely to improve the immediate and longer-term health and well-being of the individual infant and have a significant impact on neonatal and infant mortality levels in the population.

Many of the considerations in feeding LBW infants also apply to VLBW infants, including breastfeeding when possible, however VLBW infants also have unique nutritional needs as described in the recommendations below.

WHO Recommendations

The recommendations below specifically address VLBW infants who are not sick and with birth weight between 1.0 and 1.5 kg.

VLBW infants who cannot be fed mother's own milk or donor human milk should be given preterm infant formula if they fail to gain weight despite adequate feeding with standard infant formula.

VLBW infants who are fed mother’s own milk or donor human milk should not routinely be given bovine milk-based human milk fortifier (recommendation relevant for resource-limited settings).

VLBW infants who fail to gain weight despite adequate breast milk feeding should be given human-milk fortifiers, preferably those that are human milk based.

VLBW infants should be given 10 ml/kg per day of enteral feeds, preferably expressed breast milk, starting from the first day of life, with the remaining fluid requirement met by intravenous fluids (recommendation relevant for resource-limited settings).

VLBW infants requiring intragastric tube feeding should be given bolus intermittent feeds.

In VLBW infants who need to be given intragastric tube feeding, the intragastric tube may be placed either by oral or nasal route, depending upon the preferences of health-care providers.

In VLBW infants who need to be fed by an alternative oral feeding method or given intragastric tube feeds, feed volumes can be increased by up to 30 ml/kg per day with careful monitoring for feed intolerance.



Evidence

Systematic reviews used to develop the guidelines

Optimal feeding of low-birth-weight infants: technical review

Edmond K, Bahl R. Geneva: World Health Organization; 2006.

Related Cochrane reviews

Delayed introduction of progressive enteral feeds to prevent necrotising enterocolitis in very low birth weight infants

Morgan J, Young L, McGuire W.Cochrane Database of Systematic Reviews 2014, Issue 12. Art. No.: CD001970.

Summary of this review Alternate Text

Slow advancement of enteral feed volumes to prevent necrotising enterocolitis in very low birth weight infants

Oddie SJ, Young L, McGuire W.\rCochrane Database of Systematic Reviews 2017, Issue 8. Art. No.: CD001241.

Summary of this review Alternate Text

Nasal versus oral route for placing feeding tubes in preterm or low birth weight infants

Watson J, McGuire W.Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD003952.

Summary of this review Alternate Text

Multinutrient fortification of human breast milk for preterm infants following hospital discharge

Young L, Embleton ND, McCormick FM, McGuire W.Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD004866.

Summary of this review Alternate Text

Nutrient-enriched formula versus standard formula for preterm infants following hospital discharge

Young L, Embleton ND, McGuire W.Cochrane Database of Systematic Reviews 2016, Issue 12. Art. No.: CD004696.

Summary of this review Alternate Text

Multi-nutrient fortification of human milk for preterm infants

Brown JVE, Embleton ND, Harding JE, McGuire W.Cochrane Database of Systematic Reviews 2016, Issue 5. Art. No.: CD000343.

Summary of this review Alternate Text

Cost-effectiveness Learn More Alternate Text

Relevant cost-effectiveness analyses have not yet been identified.

Category 1 intervention

Guidelines have been recently approved by the WHO Guidelines Review Committee

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