Guidelines for Neonatal Enteral Feeding

Kathy Quellen, RN, BSN / May 2017

Three regulatory agencies work well together when researching best practices for feeding in the NICU. They are the Academy of Nutrition and Dietetics, the American Society for Parenteral and Enteral Nutrition (ASPEN), and Human Milk Banking Association of North America (HMBANA).

The Academy of Nutrition and Dietetics (formerly known as American Dietetic Association) has excellent guidelines for neonatal and pediatric feeding. Today, I am focusing on the Academy of Nutrition and Dietetics, and some of the specific information they share on this topic.

First, a little background: The Academy was founded as the American Dietetic Association in Cleveland, Ohio, in 1917 during WW1. The founders’ goal was initially to aid the government in food conservation, and to enhance the public’s health and nutrition. Today, it is still committed to helping the public benefit from a healthy lifestyle and even calls its website “Eat Right.” Now known as the Academy of Nutrition and Dietetics, their mission is “Leading the future of dietetics.” This is for everyone – even our youngest citizens in the NICU.

The Academy of Nutrition and Dietetics publishes guidelines every few years with a variety of nutritional recommendations. Feeding in the NICU is addressed in detail in their document, ”Infant Feedings: Guidelines for Preparation of Human Milk and Formula in Health Care Facilities”.  It’s not unusual to find that many regulatory agencies address primarily adult issues, but this is not the case with the Academy of Nutrition and Dietetics Guidelines (or with the ASPEN Guidelines either). I send praises to all that give the NICU and our issues quality time!

The guidelines are put together by a group of clinicians: RD’s, RN’s, and MD’s from distinguished healthcare institutions like CHOP, CHOC, Baylor, Texas Children’s, Nationwide Children’s, and many others.  Many associations like the American Academy of Pediatrics, the American Hospital and Nurses Associations, the FDA, and others also cooperate with drafting the document.

“Infant Feedings: Guidelines for Preparation of Human Milk and Formula in Health Care Facilities” is put together with much support and collaboration from many accomplished and respected individuals and institutions. Its sole purpose is to serve as a reference for best practices with feeding, even with our specific patient population.

Why are the Academy of Nutrition and Dietetics Guidelines important?

What do the Guidelines address, and why should you use it?  As the forward in their document states, “The (Academy of Nutrition and Dietetics Guidelines) provides remarkably detailed guidelines that any hospital or facility providing care for infants and young children should follow to ensure safe preparation, handling and administration of human milk and formulas.”  This statement perfectly summarizes the answer, and really makes a case for NICUs to have on hand as a reference.

Eight primary issues are addressed in the Infant Feedings Guidelines:

  • Physical Facilities
  • Equipment, Utensils and Supplies
  • Personnel
  • Expressed Human Milk
  • Formula Preparation and Handling
  • Delivery and Bedside Management of Infant Feedings
  • Microbiology and Infection Control
  • Quality Assurance

This 144-page document addresses every detail of feeding, from preparation to storage and delivery. If you want to know how to set up your milk preparation room, who to hire to work in the area, how to store breast milk, how to administer any milk orally or enterally and avoid the pitfalls of infection, it’s all in the Guidelines and is readily available for your personal use.

I highly recommend not “reinventing the wheel” when you are looking for any kind of guidance surrounding feeding in the NICU. Use the Academy of Nutrition and Dietetics Guidelines and other well researched and established resources to save yourself time, and possibly improve clinical outcomes. These are well-researched and documented practices from experts in the field, and should definitely find a place in your NICU.

About the Author

Kathy Quellen, RN, BSN, has been a NICU/PICU RN since 1981. She has worked in hospitals all over the U.S., including Georgetown University Hospital, DC Children’s, Cedars Sinai and Children’s Hospital of NJ.  She worked as a Clinical Specialist for Abbott Labs/Hospira and has been a NICU Clinical Specialist for Medela since 2014. She covers hospitals all throughout the western United States.