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Feeding Regimen

Recommended Supplementation

Preterm Infants

Human milk fortified with HMF

BW <2500 g: Iron (2 mg/kg/d) beginning after age 2 weeks until age 1 year

BW >2500 g: No recommendation for higher iron needs for this group

Unfortified human milk

All: Multivitamin (1 mL/d)

BW <2500 g: Iron (2 mg/kg/d) beginning after age 2 weeks until age 1 year

BW >2500 g: No recommendation for higher iron needs for this group

Premature iron-fortified formula

None indicated

Premature iron-fortified transitional formula

None indicated

Term iron-fortified formula (weight <3 kg)

Multivitamin (1 mL/d) until weight >3 kg

Term Infants

Human milk exclusively

Iron (1 mg/kg/d) starting at age 4–6 months

Triple vitamin (A, D, C) at 1 mL/d within the first few days of life

Term iron-fortified formula (weight >3kg)

Not indicated

*HMF is not to be used at discharge.

Reproduced with permission from Pediatric Nutrition Reference Guide, 8th ed:57.

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Chandran L & Gelfer P. Breastfeeding: the essential principles. Pediatr Rev 2006; 27(11):409.

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American Academy of Pediatrics Policy Statement. Pediatrics 2005;115(2):496.

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Contraindications to Breastfeeding

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  • Galactosemia in an infant
  • Active maternal illegal drug use
  • Active, untreated maternal tuberculosis (The mother should be separated from her infant, expressing milk for the baby to be fed via bottle. After treatment has begun and the mother is allowed to be with her infant, she can resume breastfeeding.)
  • Maternal HIV infection (in developed countries), maternal HTLV type I or II infection
  • Active HSV lesions on the breast; feeding can be continued on the unaffected breast
  • Maternal use of certain radioactive isotopes, cancer chemotherapy agents, and a small number of other medications (see below)

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Medications and Breastfeeding

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  • Extensive list of dangerous and safe drugs in breastfeeding: American Academy of Pediatrics Policy Statement in Pediatrics 2001;108(3):776 and at LactMed http://toxnet.nlm.nih.gov

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Normal Voiding and Stooling While Breastfeeding

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  • Nurse at least 8 to 12 times a day or every 1 to 3 hours for the first week(s) of breastfeeding.
  • Have no more than one 4-hour sleep period in 24 hours during the first week of breastfeeding.

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Storage of Human Breast Milk

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Location

Temperature

Duration

Comments

Countertop

≤77°F (≤25°C)

6–8 h

Cover all containers and keep as cool as possible; likelihood of contamination ↑ without refrigeration

Insulated cooler bag

5°-39°F (-15°–4°C)

24 h

Keep ice packs in contact with milk container at all times

Refrigerator

39°F (4°C)

5 d

Store milk in back of refrigerator

Freezer

Freezer portion of refrigerator

5°F (-15°C)

2 weeks

Store milk in back of freezer; over time, the lipids in milk degrade

Freezer portion of refrigerator with separate doors

0°F (-18°C)

3–6 mo

Upright deep freezer

-4°F (-20°C)

6–12 mo

Reproduced with permission from Pediatric Nutrition Reference Guide, 8th ed:41.

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Reconstituted commercial formula from powder or liquid should be refrigerated immediately and discarded after 24 hours.

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