In extremely low birth weight infants, a reasonable approach is to advance enteral feeds by

• A. 5 to 10 mL/kg/day
• B. 15 to 25 mL/kg/day
• C. 25 to 35 mL/kg/day
• D. 35 to 45 mL/kg/day

Answer: (B)

In extremely low birth weight infants, the gut is immature and vulnerable, so feeds are advanced gradually to promote maturation while reducing the risk of NEC. A moderate increment—about 15 to 25 mL/kg/day—strikes a balance between promoting growth and avoiding overloading the immature gut. Start with small trophic or minimal feeds (often 10-20 mL/kg/day, especially with human milk) and increase by roughly 15-25 mL/kg/day as tolerated. Watch carefully for signs of feeding intolerance or distress (abdominal distension, residuals, vomiting, changes in stool, or systemic signs). Slower increments (5-10 mL/kg/day) can delay full feeds, while larger leaps (25-35 or 35-45 mL/kg/day) may raise NEC risk in this population. Therefore, advancing by 15-25 mL/kg/day is the best approach.