A reasonable approach to advancing enteral feeds in very low birth weight (VLBW) infants is to increase by

• A. 10 to 20 mL/kg/day
• B. 20 to 30 mL/kg/day
• C. 30 to 40 mL/kg/day
• D. 5 to 10 mL/kg/day

Answer: (B)

Advancing feeds in very low birth weight infants aims to promote gut maturation while keeping the risk of feeding intolerance and NEC low. A practical and commonly used pace is to increase enteral feeds by about 20–30 mL/kg/day, provided the infant tolerates the feeds well. This rate is fast enough to shorten dependence on parenteral nutrition and support growth, yet not so aggressive that the immature gut is overwhelmed.

If tolerance remains good (no significant abdominal distension, persistent large residuals, vomiting, or instability), you can progress toward full feeds at this rate. Slower advancement, such as 5–10 mL/kg/day, would prolong dependence on PN and delay growth, while stepping up by 30–40 mL/kg/day could exceed the gut’s capacity in many VLBW infants and raise risk. Monitor closely and adjust based on signs of intolerance.