Background
Meeting Energy Needs of Individual Infants
Many VLBW infants establish appropriate weight gain patterns in the hospital with energy intakes of 120-130 kcal per kg of body weight per day. Infants with cardiac and respiratory problems may have higher energy needs of up to 150 kcal/kg/d.
In full-term, healthy infants energy intakes per unit of body weight fall from about 118 kcal/kg/d at one month of age to about 92 kcal/kg/d at 6 months of age (Fomon, 1993). The DRIs provide equations for estimating energy requirements (EER) for infants and children of normal weight. These equations are based on studies using doubly labeled water and include energy needed for growth. Energy coefficients are included in the equation for children >3 years of age.
Age |
Equation |
0-3 months | (89 x wt - 100) + 175 |
4-6 months | (89 x wt – 100) + 56 |
7-12 months | (89 x wt – 100) + 22 |
13-35 months | (89 x wt – 100) + 20 |
Age |
Weight range (kg) |
EER (total) |
EER (per kg) |
0-3 months | 3.5 - 6 | 386 - 609 | 102 – 110 |
4-6 months | 6.5 - 7.5 | 534 – 663 | 82 – 88 |
7-12 months | 8 - 10 | 634 – 768 | 77 – 79 |
13-35 months |
10 - 14 |
770 – 1166 |
77 – 83 |
Energy needs for VLBW infants may or may not be similar to full-term healthy infants. After the neonatal period, energy needs are influenced by several factors. These include:
One approach to ensuring that energy needs are met is to start with an assumption that the infant will need 120-130 kcal/kg/d. Intake recommendations can then be adjusted as indicated by the individual infant's intake and subsequent growth.
In order to achieve an intake of >120 kcal/kg/d the infant must be able to consume a total of more than 180 cc of formula or breastmilk per kg of body weight per day (2.7 oz formula or breastmilk per pound body weight per day). If this level of intake is not possible due to limitations associated with feeding, alternative methods of meeting energy needs should be considered. See section on Enteral Feeding and Concentrating Formula.
The following table provides indications of the total intake that would be required to provide 120 kcal/kg/d with formulas mixed at both 20 and 24 kcal/oz. Twenty kcal per ounce is assigned as a mean value for human milk as well as the energy density of standard infant formula. To achieve a density of 24 kcal/oz, formula is concentrated or supplements are added to breastmilk (see Concentrating Infant Formula).
To Provide 120 kcal/kg/d | |||
Infant's Weight |
Expected Total Daily Intake (in ounces) |
||
Pounds |
Kg |
20 kcal/oz |
24 kcal/oz |
4.5 |
2 |
12 |
10 |
6 |
2.7 |
16 |
14 |
8 |
3.6 |
22 |
18 |
10 |
4.5 |
27 |
23 |
12 |
5.5 |
32 |
28 |