SIFT. Milk Feed Guidance. At Randomisation: Infant receiving < 30ml/kg/d of milk

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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 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) Online calculator An online calculator is available via the randomisation program to assist with feed calculations. 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 1

2 Initial information Initial information Working weight (g): the working weight (g) at randomisation Working weight (g): the working weight (g) at randomisation Initial feed volume (ml/kg/day): the feed volume (ml/kg/day) given to the infant in the 24 hour period preceding randomisation There are 2 options for calculating a newly randomised infant s Initial feed volume (ml/kg/day) for use in the milk feed calculator: 1 If the infant has received milk for more than 6 hours of the preceding 24 hour period: add up the total amount of milk received in the last 24 hours and divide by the current working weight to give you the overall ml/kg/day. 2 If the infant has received only a very small amount of milk (e.g. for < 6 hours): simply enter 0 ml/kg/day. 2

3 Hours between feeds: the interval at which your unit increases feeds Hours between feeds: the interval at which your unit increases feeds Increment (ml): the size of each increment (ml) that you wish to increase by Hours between feeds: the interval at which your unit increases feeds Increment (ml): the size of each increment (ml) that you wish to increase by Start time of feeding day: the start time of your normal 24 hour feeding period Hours between feeds: the interval at which your unit increases feeds Increment (ml): the size of each increment (ml) that you wish to increase by Start time of feeding day: the start time of your normal 24 hour feeding period Feed no of first increment: the feed number at which you wish to start increasing For example, if your feed day starts at 8am but you have randomised at noon and will be increasing from 1pm, you would enter 5 for Feed no of first increment so that the increase will start at 1pm on the first day of the feeding schedule. If starting immediately, leave as 1. 3

4 Daily features Daily features The Initial feed volume (ml/kg/day) reflects the milk volume that was prescribed the previous day The Day Summary shows the milk volume that was expected, actually given, and prescribed for that particular day as well as the difference between the actual and prescribed. Daily features You may wish to adjust the infant s working weight after randomisation and can do so in the Working weight box under the relevant day It also shows the rate that was expected, actual, and prescribed for that particular day 4

5 You may wish to adjust the infant s working weight after randomisation and can do so in the Working weight box under the relevant day You may wish to adjust the amount of milk actually given to the infant and can do so in the Actual (ml) box under the relevant day When the working weight is adjusted, the subsequent milk feed volumes will adjust in accordance with the weight change. You may wish to adjust the amount of milk actually given to the infant and can do so in the Actual (ml) box under the relevant day You can add or remove days from the milk feed calculator by selecting the + or - button respectively For example if the infant goes nil by mouth for 4 hours from noon until 4pm, you enter 0 in each Actual (ml) box and the Volume (ml) will adjust itself to reflect this and the subsequent milk feed volume will adjust as well. 5

6 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) 6

7 Feeds are stopped? What do I do if 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 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 Record all data regardless of regimen adopted 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! NPEU Clinical Trials Unit Department of Public Health University of Oxford Old Road Campus Oxford OX3 7LF T: F: E: sift@npeu.ox.ac.uk 7