Newborn Feeding Guide

Formula milk should be prepared in bottles in quantities enough for a single feeding or for up to 4 hours if using continuous feeding via gastric tube. Refrigerated formula can be stored for up to 24 hours but should be used within 4 hours after opening.

Preparing and Giving Formula Milk:

Bottle Feeding:

• Use small nipples for premature babies, soft nipples for weak feeders, and regular nipples for strong feeders.

Preparation:

• Follow the doctor’s instructions regarding the formula type, concentration, and quantity.

Required Equipment:

• Bottle sterilizer or a large pot for boiling bottles.
• Bottles with nipples and caps.
• Kettle for boiling water.
• Sterile tray.
• Bottle tongs.
• Bottle brush.
• Liquid soap for washing bottles.
• Infant formula (check expiration date).
• Formula scoop.
• Knife.
• Clean cotton pad.

Steps:

1. Wash hands properly.
2. Boil the necessary amount of water plus 60ml extra to compensate for evaporation. Boil for one minute to sterilize.
3. Let the water cool to room temperature.
4. Pour the required amount of warm water into sterilized bottles.
5. Add the correct formula amount using a leveled scoop.
6. Shake well to mix.
7. Test the temperature by dropping a few drops on the inner wrist before feeding.
8. Cool the formula if needed by placing the bottle in cold water.

Feeding Steps:

1. Wash hands properly.
2. Verify baby’s full name and medical number, type of formula, and amount.
3. Measure abdominal circumference as instructed.
4. Ensure the baby is fully awake.
5. Hold the baby as if breastfeeding.
6. Place a cotton pad on the baby’s chest.
7. Stimulate the baby’s lips with the nipple; once the baby opens its mouth, gently insert the nipple.
8. Keep the nipple filled with milk at a 45-degree angle to avoid air intake.
9. Maintain eye contact and emotional bonding with the baby.
10. Encourage burping mid-feed and after feeding to prevent gas.
11. Lay the baby on the right side to prevent choking and reduce stomach pressure.
12. Clean the baby’s mouth with sterile saline-soaked gauze to prevent fungal growth.
13. Discard any remaining milk—do not reuse.
14. Wash hands properly.
15. Record the amount of milk consumed, any vomiting, or abnormal signs (e.g., bluish skin) and inform the doctor.

Feeding via Nasogastric Tube:

Required Equipment:

• Sterile feeding tube (size 6 for preemies <1500g, size 8 for larger babies).
• Syringe (10-20ml).
• Clean towel.
• Stethoscope.

• Warm formula per doctor’s instructions.
• Adhesive tape for fixation.
• Sterile water ampoules.
• Bottle nipple with cotton filling.
• Sterile gloves.
• Waste disposal bins (black & red bags, sharps box).

Tube Insertion Steps:

1. Wash hands properly.
2. Open the sterile feeding tube package.
3. Wear sterile gloves.
4. Measure the tube length from nose/mouth to the earlobe, then from earlobe to the bottom of the sternum, marking with tape.
5. Insert the tube while positioning the baby’s head at a 30° angle.
6. If resistance, choking, or blue discoloration occurs, immediately remove the tube and retry.
7. Verify correct placement by injecting 0.5-1ml air and listening for gurgling sounds in the stomach with a stethoscope.
8. Secure the tube with adhesive tape.

Continuous Drip Feeding and Intravenous Nutrition

1. Continuous Drip Feeding:

This method is preferred for:

• Newborns with severe gastroesophageal reflux (GERD).
• Low birth weight infants weighing less than 1000g at birth.

Preparation of Feeds:

• Follow the doctor's instructions regarding formula type, concentration, and quantity.

Feeding Procedure:

1. Draw the required amount of milk into a syringe.
2. Attach the syringe to a syringe pump, then connect it to the feeding tube using a syringe extension.
3. Set the pump speed to the required drip rate per hour as per the doctor's instructions.
4. Administer the feed using the syringe pump.
5. Change milk containers (syringes) and connecting extensions every 4 hours to prevent milk exposure to room temperature for too long.