What is the typical volume range for minimal enteral nutrition (trophic feeding) in ELBW/very preterm infants?

• A. 100–200 mL/kg/day.
• B. 1–2 mL/kg/day.
• C. 10–20 mL/kg/day.
• D. 50–60 mL/kg/day.

Answer: (C)

Minimal enteral nutrition, or trophic feeding, uses small volumes to gently stimulate the immature gut while the infant may still rely on parenteral nutrition. For extremely low birth weight or very preterm infants, the typical starting range is about 10 to 20 mL/kg per day. This amount helps promote gut motility, mucosal maturation, and hormonal and bile flow without delivering a large caloric load or risking feeding intolerance or NEC when the infant is clinically stable and tolerating feeds. In practice, many begin toward the lower end and increase gradually as tolerance is shown, ideally using human milk when possible for its protective benefits.

The other volumes are not used for trophic feeding: 1–2 mL/kg/day would provide negligible gut stimulation, while 50–60 mL/kg/day or higher would approach full feeds and could overwhelm a immature gut, increasing the risk of intolerance or complications.