Parenteral Intake Consensus Recommendations for Growing Preterm Infants in Stable Clinical Condition
<1,000 g Birth Weight/kg/day | 1,000-1,500 g Birth Weight/kg/day | |
|---|---|---|
Water/fluids, mL | ||
100 | 80 | |
Established growth | 140-160 | 140-160 |
Energy, kcal | 90-115 | 90-100 |
Protein, g | ||
Starting phase | 1.5-2.5 | 3.0-3.5 |
Stable phase | 3.0-3.5 | 3.0-3.5 |
Carbohydrate, g | ||
Starting phase | 4-12 | 6-12 |
Stable phase | 10-20 | 10-17 |
Fat, g | ||
Starting phase | 0.5-1 | 1-2 |
Stable phase | 2.5-3 | 2.5-3 |
Linoleic acid: α-linolenic acid = C18:2/C18:3 | 5-9.6 | 5-9.6 |
Vitamin A, IU | 700-1,500 | 700-1,500 |
Vitamin D, IU | 80-400 | 80-400 |
Vitamin E, IU | 2.8-3.5 | 2.8-3.5 |
Vitamin K1, μg | 10 | 10 |
Ascorbate, mg | 15-25 | 15-25 |
Thiamine, mg | 0.35-0.50 | 0.35-0.50 |
Riboflavin, mg | 0.15-0.20 | 0.15-0.20 |
Pyridoxine, mg | 0.15-0.20 | 0.15-0.20 |
Niacin, mg | 4-6.8 | 4-6.8 |
Pantothenate, mg | 2.5 | 2.5 |
Biotin, μg | 5-8 | 5-8 |
Folate, μg | 56 | 56 |
Vitamin B12, μg | 0.3 | 0.3 |
Sodium, mg | 69-115 | 69-115 |
Potassium, mg | 78-117 | 78-117 |
Chloride, mg | 107-177 | 107-177 |
Calcium, mg | 64-140 | 64-140 |
Phosphorus, mg | 50-108 | 50-180 |
Ca:Ph ratio | 1.5-1.7:1 | 1.5-1.7:1 |
Magnesium, mg | 5.0-7.5 | 5.0-7.0 |
Iron, μg | 200-250 | 200-250 |
Zinc, μg | 400-500 | 400-500 |
Copper, μg | 20-40 | 20-40 |
Selenium, μg | 2-3 | 2-3 |
Chromium, μg | 0.05-0.3 | 0.05-0.3 |
Manganese, μg | ≤1 | ≤1 |
Molybdenum, μg | 1 | 1 |
Iodine, μg | 1-10 | 1-10 |
Taurine, mg | 1.88-3.75 | 1.88-3.75 |
Carnitine, mg | ≈2.9 | ≈2.9 |
Inositol, mg | 54 | 54 |
Choline, mg | 14.4-28 | 14.4-28 |
From American Academy of Pediatrics. Pediatric Nutrition. 9th ed. American Academy of Pediatrics; 2025.
Recommended Enteral Nutrient Intake Levels for Enterally Fed Preterm Infants per Kilogram per Day, and per 100 kcal Energy Intake, Compared With Other Recommendations
Nutrient | Current Recommendation (per kg/day)a | LSRO, 2002 (Formula-Fed Infants Only, per kg/day)b | Koletzko Et Al, 2014 (per kg/day)c | ESPGHAN, 2023 (per kg/day)d |
|---|---|---|---|---|
Fluids | 135-200 | NS | 135-200 | 150-180 |
Energy, kcal | 110-130 | 100-141 | 110-130 (85-95 IV) | 115-140 |
Protein, g | 3.5-4.0b | 3.0-4.3 | 3.5-4.5 | 3.5-4.0 |
Lipids, g | 4.55-8.1 | 5.3-6.8 | 4.8-6.6 | 4.8-8.1 |
Linoleic acid, mg | 385-1,540 | 420-1,700 | 385-1,540 | 385-1,540 |
α-Linolenic acid, mg | >55 | 90-270 | >55 | >55 |
DHA, mg | NS | NS | (18-) 55-60 | 30-65 |
EPA, mg | NS | NS | <20 | <20 |
ARA, mg | NS | NS | (18-) 35-45 | 30-100 |
Carbohydrate, g | 11-13 | 11.5-15.0 lactose 4.8-15.0 | 11.6-13.2 | 11-15 |
Sodium, mg | 69-115 | 46.8-75.6 | 69-115 | 69-115 |
Potassium, mg | 78-195 | 72-192 | 78-195 | 90-179 |
Chloride, mg | 105-177 | 72-192 | 105-177 | 105-175 |
Calcium, mg | 120-220 | 148-222 | 120-200 | 60-100 |
Phosphorus, mg | 70-120 | 98-131 | 60-140 | 68-115 |
Magnesium, mg | 8-15 | 8.2-20.4 | 8-15 | 4.8-6 |
Iron, mg | 1-3 | 2-3.6 | 2-3 | 2.0-3.0 |
Zinc, mg | 2-3 | 1.32-1.8 | 1.4-2.5 | 2.0-3.0 |
Copper, μg | 120-230 | 100-230 | 120 | 120-230 |
Selenium, μg | 7-10 | 2.2-6.0 | 5-10 | 7-10 |
Manganese, μg | 1-15 | 7.6-30 | 1-15 | 1-15 |
Fluoride, μg | NS | NS | 1.5-60 | NS |
Iodine, μg | 10-55 | 7.2-42 | 10-55 | 11-55 |
Chromium, ng | 0.03-2.25 | NS | 30-2,250 ng | 30-2,250 |
Molybdenum, μg | 0.3-5 | NS | 0.3-5 | 0.3-5 |
Thiamin, μg | 132-275 | 36-300 | 140-300 | 140-290 |
Riboflavin, μg | 200-430 | 96-744 | 200-400 | 200-400 |
Niacin, mg | 1.1-5.5 | 660-6,000 | 1-5.5 | 0.38-5.5 |
Pantothenic acid, mg | 0.6-2.1 | 360-2,280 | 1.5-2.1 | 0.6-2.2 |
Pyridoxine, μg | 66-275 | 36-300 | 50-300 | 70-290 |
Cobalamin, μg | 0.12-0.6 | 0.096-0.84 | 0.1-0.8 | 0.1-0.6 |
Folic acid, μg | 22-100 | 36-54 | 35-100 | 23-100 |
l-Ascorbic acid, mg | 16.5-41 | 10-45 | 20-55 | 17-43 |
Biotin, μg | 3.3-15 | 1.2-44.4 | 1.5-15 | 3.5-15 |
Vitamin A | 1,332-3,330 IU | 245-456 μg RE | 365-1,000 μg RE | 400-1,000 μg RE |
Vitamin D, IU | (400-1,000 per day, from milk + supplement) | 90-324 | (400-1,000 per day, from milk + supplement) | 400-700 IU/kg per day (<1,000) |
Vitamin E, mg α-TE | 2.2-11 | 2.4-9.6 | 2.2-11 | 2.2-11 |
Vitamin K1, μg | 4.4-28 | 4.8-30 | 4.4-2.8 | 4.4-28 |
Nucleotides, mg | NS | NS | NS | NS |
Choline, mg | >=33 | 8.4-27.6 | 7.3-50 | 8-55 |
Inositol, mg | 4.4-53 | 4.8-52.8 | 4-48 | 4.4-53 |
ARA, arachidonic acid; DHA, docosahexaenoic acid; EPA, eicosapentaenoic acid; ESPGHAN, European Society for Paediatric Gastroenterology, Hepatology and Nutrition; IV, intravenous; LSRO, Life Sciences Research Office; NS, not specified due to insufficient data; RE, retinol equivalents; α-TE, α-tocopherol equivalents.
a Current recommendations adapted from Koletzko B, Wieczorek S, Cheah FC, et al. Recommended nutrient intake levels for preterm infants. World Rev Nutr Diet. 2021;122:191-197; with updates from Fenton TR, Groh-Wargo S, Gura K, et al. Effect of enteral protein amount on growth and health outcomes in very-low-birth-weight preterm infants: phase II of the Pre-B Project and an evidence analysis center systemic review. J Acad Nutr Diet. 2021;121(11):2287-2300.e12; and Fenton TR, Al-Wassia H, Premji SS, Sauve RS. Higher versus lower protein intake in formula-fed low birth weight infants. Cochrane Database Syst Rev. 2020;6(6):CD003959.
b From Klein CJ. Nutrient requirements for preterm infant formulas. J Nutr. 2002;132(6)(suppl 1):1395S-1577S.
c From Hay WW Jr, Brown LD, Denne SC. Energy requirements, protein-energy metabolism and balance, and carbohydrates in preterm infants. In: Koletzko B, Poindexter B, Uauy R, eds. Nutritional Care of Preterm Infants: Scientific Basis and Practical Guidelines. Karger; 2014:64-81.
d From Embleton ND, Moltu SJ, Lapillonne A, et al. Enteral nutrition in preterm infants (2022): a position paper from the ESPGHAN Committee on Nutrition and invited experts. J Pediatr Gastroenterol Nutr. 2023;76(2):248-268.
From American Academy of Pediatrics. Pediatric Nutrition. 9th ed. American Academy of Pediatrics; 2025.
Comparison of Intravenous Lipid Emulsions
Composition | Intralipid | SMOFlipid | Omegaven |
|---|---|---|---|
Soybean | 100% | 30% | 0 |
Coconut (MCT) | 0 | 30% | 0 |
Olive | 0 | 25% | 0 |
Fish | 0 | 15% | 100% |
Phytosterols (mg/L) | 348 | 48 | 0 |
α-Tocopherol (mg/L) | 38 | 200 | 150-296 |
Linoleic acid (18:2) u-6 | 53 | 37.2 | 4.4 |
Arachidonic acid (20:4) u-6 | 0.1 | 1 | 2.1 |
Linolenic acid (18:3) u-3 | 8 | 4.7 | 1.8 |
Eicosapentaenoic acid, EPA (20:5) u-3 | 0 | 4.7 | 19.2 |
Docosahexaenoic acid, DHA (22:6) u-3 | 0 | 4.4 | 12.1 |
MCT, medium-chain triglyceride.
From American Academy of Pediatrics. Pediatric Nutrition. 9th ed. American Academy of Pediatrics; 2025. Adapted from Frazer LC, Gura KM, Bines JE, Puder M, Martin CR. Prevention and management of parenteral nutrition-associated cholestasis and intestinal failure-associated liver disease in the critically ill infant. In: Koletzko B, Cheah FC, Domellöf M, Poindexter BB, Vain N, van Goudoever JB, eds. Nutritional Care of Preterm Infants: Scientific Basis and Practical Guidelines. 2nd ed. Karger; 2021:379-395. SMOFlipid and Omegaven are trademarks of Fresenius Kabi, Inc.
Vitamins Provided With Parenteral Nutrition Solutions
Vitamin | Multivitamin Infusion Pediatric (Pfizer) (per 5 mL) | Infuvite Pediatric (Baxter) (5 mL) |
|---|---|---|
80 mg | 80 mg | |
Vitamin A (retinol) | 0.7 mg 2,300 USP units | 0.7 mg 2,300 USP units |
Vitamin D | 0.01 mg | 400 IU (cholecalciferol) |
Thiamine (vitamin B1) (as the hydrochloride) | 1.20 mg | 1.2 mg |
Riboflavin (vitamin B2) (as riboflavin-5-phosphate sodium) | 1.4 mg | 1.4 mg |
Pyridoxine (vitamin B6) (as the hydrochloride) | 1.0 mg | 1 mg |
Niacinamide | 17.0 mg | 17 mg |
Dexpanthenol (pantothenyl alcohol) | 5 mg | 5 mg |
Vitamin E (d-α-tocopheryl acetate) | 7.0 mg | 7 IU (7 mg) |
Biotin | 0.02 mg | 0.02 mg |
Folic acid | 0.14 mg | 0.14 mg |
Vitamin B12 (cyanocobalamin) | 0.001 mg | 0.001 mg |
Vitamin K1 (phylloquinone)b | 0.2 mg | 0.2 mg |
USP, United States Pharmacopeia.
From American Academy of Pediatrics. Pediatric Nutrition. 9th ed. American Academy of Pediatrics; 2025; and Parenteral nutrition formulations and managing component shortages. In: Ayers P, Bobo E, Hurt R, Mays A, Worthington P, eds. ASPEN Parenteral Nutrition Handbook. 3rd ed. American Society for Parenteral and Enteral Nutrition; 2020:73-94.
Estimation of the Energy Requirement of the Low Birth Weight Infant
Average Estimate Range, kcal/kg per day | |
|---|---|
Energy expended | |
Resting metabolic rate | 40-60 |
2-4 weeks after birth | 35-60 |
>4 weeks after birth | 60-70 |
Activity | 0-5 |
0-5 | |
Synthesis | 15 |
Energy stored | 20-30 |
Energy excreted | 15 |
Energy intake >4 weeks of gestation | 110-140 |
From American Academy of Pediatrics. Pediatric Nutrition. 9th ed. American Academy of Pediatrics; 2025.