1. 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

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

3. 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

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

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

6. For those who like charts Larger 24 hour steps (bold) preferred Smaller 8 hour steps also shown FAST MILK FEED INCREASE (30 ml/kg/day increment on HOURLY feeds) DAY DAY 1DAY 2DAY 3DAY 4DAY 5DAY 6 & on 6.5ml/kg/feed Continue to desired feeding volume according to unit policy 6.25 ml/kg/feed 6ml/kg/feed 5.25ml/kg/feed 5 ml/kg/feed 4.75ml/kg/feed 4ml/kg/feed 3.75 ml/kg/feed 3.5ml/kg/feed 2.75ml/kg/feed 2.5 ml/kg/feed 2.25ml/kg/feed 1.5ml/kg/feed 1.25 ml/kg/feed 1ml/kg/feed Target ml/kg/day 306090120150150+ In addition to the milk volume being given at the start of increasing the feeds

7. SLOW MILK FEED INCREASE (18 ml/kg/day increment on HOURLY feeds) DAY DAY 1DAY 2DAY 3DAY 4DAY 5DAY 6DAY 7DAY 8DAY 9 & on 6.25 ml/kg/feed 6 ml/kg/feed Continue to desired feeding volume according to unit policy 5.75 ml/kg/feed 5.5ml/kg/feed 5.25 ml/kg/feed 5 ml/kg/feed 4.75ml/kg/feed 4.5 ml/kg/feed 4.25ml/kg/feed 4 ml/kg/feed 3.75 ml/kg/feed 3.5ml/kg/feed 3.25ml/kg/feed 3 ml/kg/feed 2.75ml/kg/feed 2.5 ml/kg/feed 2.25 ml/kg/feed 2 ml/kg/feed 1.75ml/kg/feed 1.5 ml/kg/feed 1.25ml/kg/feed 1 ml/kg/feed 0.75 ml/kg/feed 0.5 ml/kg/feed Target ml/kg/day 1836547290108126144150+ Larger 24 hour steps (bold) preferred Smaller 8 hour steps also shown In addition to the milk volume being given at the start of increasing the feeds

8. FAST MILK FEED INCREASE (30 ml/kg/day increment on 2 HOURLY feeds) DAY DAY 1DAY 2DAY 3DAY 4DAY 5DAY 6 13 ml/kg/feed Continue to desired feeding volume according to unit policy 12.5 ml/kg/feed 12 ml/kg/feed 10.5 ml/kg/feed 10 ml/kg/feed 9.5 ml/kg/feed 8 ml/kg/feed 7.5 ml/kg/feed 7 ml/kg/feed 5.5 ml/kg/feed 5 ml/kg/feed 4.5 ml/kg/feed 3 ml/kg/feed 2.5 ml/kg/feed 2 ml/kg/feed Target ml/kg/day 306090120150150+ Larger 24 hour steps (bold) preferred Smaller 8 hour steps also shown In addition to the milk volume being given at the start of increasing the feeds

9. SLOW MILK FEED INCREASE (18 ml/kg/day increment on 2 HOURLY feeds) DAY DAY 1DAY 2DAY 3DAY 4DAY 5DAY 6DAY 7DAY 8DAY 9 & on 12.5ml/kg/feed 12 ml/kg/feed Continue to desired feeding volume according to unit policy 11.5ml/kg/feed 11 ml/kg/feed 10.5 ml/kg/feed 10 ml/kg/feed 9.5 ml/kg/feed 9 ml/kg/feed 8.5 ml/kg/feed 8 ml/kg/feed 7.5 ml/kg/feed 7 ml/kg/feed 6.5ml/kg/feed 6 ml/kg/feed 5.5ml/kg/feed 5 ml/kg/feed 4.5 ml/kg/feed 4 ml/kg/feed 3.5 ml/kg/feed 3 ml/kg/feed 2.5 ml/kg/feed 2 ml/kg/feed 1.5 ml/kg/feed 1 ml/kg/feed Target ml/kg/day 1836547290108126144150+ Larger 24 hour steps (bold) preferred Smaller 8 hour steps also shown In addition to the milk volume being given at the start of increasing the feeds

10. 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

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

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

13. 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