Based on available evidence, enteral feeds may be advanced in extremely low birth weight (ELBW) infants by

• A. 5 to 10 mL/kg/day
• B. 10 to 15 mL/kg/day
• C. 15 to 25 mL/kg/day
• D. 25 to 35 mL/kg/day

Answer: (C)

Advancing enteral feeds in extremely low birth weight infants is guided by balancing gut maturation and the risk of necrotizing enterocolitis. After starting minimal trophic feeds to prime the gut, the most evidence-supported rate of progression is to increase by about 15 to 25 mL/kg per day once feeds are tolerated. This range speeds toward full enteral nutrition more efficiently than slower schemes, while not showing a clear increase in NEC risk compared with smaller increments in many studies. Tolerance is key: stable vitals, no increasing abdominal distension, and acceptable gastric residuals guide whether to continue with this rate. In practice, begin with small initial volumes and advance within this 15–25 mL/kg/day window as the infant demonstrates good tolerance.