SIFT Milk Feed Guidance 14/09/2018 SIFT A multi-centre randomised controlled trial of two speeds of daily increment of milk feeding in very preterm or very low birth weight infants Milk Feed Guidance

At Randomisation: Infant receiving < 30ml/kg/d of milk Feeds should be advanced at allocated rate as soon as possible after randomisation

Calculate milk volume on Birth Weight or Current Weight (whichever is greater) Prescribe total milk volume for that day using allocated increment e.g. from 30 to 60ml/kg/d (fast) from 30 to 48 ml/kg/d (slow) Divide this total by the number of feeds you would normally give 1 hourly = 24 feeds 2 hourly = 12 feeds 3 hourly = 8 feeds For ease, rounding to nearest 0.5 ml is acceptable

Online calculator An online calculator is available via the randomisation program to assist with feed calculations.

https://rct.npeu.ox.ac.uk/siftdemo/feed_schedule.php

https://rct.npeu.ox.ac.uk/siftdemo/feed_schedule.php

FAST MILK FEED INCREASE (30 ml/kg/day increment on HOURLY feeds) For those who like charts FAST MILK FEED INCREASE (30 ml/kg/day increment on HOURLY feeds)

SLOW MILK FEED INCREASE (18 ml/kg/day increment on HOURLY feeds)

FAST MILK FEED INCREASE (30 ml/kg/day increment on 2 HOURLY feeds)

SLOW MILK FEED INCREASE (18 ml/kg/day increment on 2 HOURLY feeds)

What do I do if… Feeds are stopped? Start at previous rate and follow prescribed increment Start from beginning and follow prescribed increment Start from beginning and follow unit’s policy All treatment and management are at clinician discretion Record all data regardless of regimen adopted

What do I do if… Baby has large gastric residuals? Clinician discretion – but aim to prevent feeds being stopped or reduced without justification Record all data

If the data are recorded then what happened 14/09/2018 What do I do if… Baby misses a days increment? Increase at prescribed rate Don’t try and make up time Record all data If the data are recorded then what happened to the baby is captured

Thanks for your attention Best of luck with the study! 14/09/2018 Thanks for your attention Best of luck with the study! NPEU Clinical Trials Unit Department of Public Health University of Oxford Old Road Campus Oxford OX3 7LF T: 01865 617 919 F: 01865 289 740 E: sift@npeu.ox.ac.uk www.npeu.ox.ac.uk/sift