Minimal enteral feeds should be initiated with expressed human milk as soon as possible after birth at a starting volume of?

• A. 5-10 mL/kg per day
• B. 10-20 mL/kg per day
• C. 20-30 mL/kg per day
• D. 15-25 mL/kg per day

Answer: (B)

Minimal enteral nutrition uses small, deliberate amounts of milk to gently stimulate the immature gut without overloading it. Starting with expressed human milk is preferred because it provides protective components—immunologic factors, growth promoters, and easy digestibility—that help mature the gut and lower the risk of necrotizing enterocolitis.

A starting volume of about 10-20 mL/kg per day gives enough luminal stimulus to promote gut development and peristalsis while remaining within a safe range for a newborn, especially a preterm infant. As tolerated, feeds are advanced in small increments, typically by about 10-20 mL/kg per day, toward full feeds. Starting at a much lower volume can delay gut maturation, whereas starting too high too early may increase feed intolerance or NEC risk in very preterm babies.