Nutrition and supplements for infants with birth weight below 2.5 kg

About Feeding and Weight Gain

The daily milk requirement for infants varies, but generally corresponds to about 12–15% of the infant's body weight (120–150 ml/kg). Weight gain is the most important sign that the baby is getting enough food. For low birth weight infants, close monitoring of nutrition and growth is crucial.

• The baby's weight should be checked weekly in the early period after discharge. A typical weekly weight gain is about 100–200 g, although it may be less in the first few weeks.
• Growth in length and head circumference is also important and should be monitored regularly at the child health clinic.

Solid food for preterm infants should be introduced after the baby has reached 3 months corrected age, i.e., sometime between 4–8 months chronological age. The timing should be adapted to each individual baby based on signs of readiness. If the baby shows poor growth and/or appears hungry despite frequent milk feeds, this may be a sign that solid food introduction is appropriate. Regular cow’s milk should only be given from 1 year corrected age.

About Vitamin D

All Norwegian infants are recommended to receive vitamin D supplements. Infant formula is fortified with vitamin D. If the baby receives at least 600 ml of formula daily, no additional vitamin D is needed.

About Iron

Infants with a birth weight under 2.5 kg are at high risk of developing anemia without extra iron supplementation during their first year. Adequate iron intake is also important for brain development.

• Iron supplementation is recommended from about 4 weeks of age until 1 year.
• For infants with birth weight between 2.0 and 2.5 kg, iron may be stopped at 6 months if the baby eats iron-fortified porridge regularly.

Iron may cause dark stools and sometimes stomach discomfort. If there is significant discomfort, the dose can be temporarily reduced. If iron supplementation is stopped (not recommended before 6 months corrected age), hemoglobin (Hb + MCV) and possibly ferritin (iron stores) should be checked by your GP.

Infants Mainly Fed with Breast Milk

Nycoplus D3-Vitamin Drops (1 drop = 2 micrograms vitamin D)

 Available over-the-counter at pharmacies.

• Start and Duration: Begin at 1 week of age
• Dosage: 5 drops (10 micrograms) daily with Nycoplus D3-Vitamin Drops
• Duration: Entire first year of life

Maltofer® Iron Drops 50 mg/ml (1 drop = 2.5 mg iron)

 Available over-the-counter at pharmacies.

• Start: Begin at 4 weeks of age
• Dosage:
  • Up to 3.5 kg: 3 drops daily*
  • 5 kg and above: 4 drops daily*
  • *For infants eating iron-fortified porridge daily: 2 drops daily
• Duration:
  • Birth weight < 2 kg: Entire first year
  • Birth weight 2.0–2.5 kg: 6 months (assuming intake of iron-fortified porridge)

Infants Mainly Fed with Infant Formula

Infant formula is fortified with vitamin D and iron. Recommended supplement doses are therefore lower than for breastfed infants.

Nycoplus D3-Vitamin Drops (1 drop = 2 micrograms vitamin D)

 Available over-the-counter at pharmacies.

• Who: If the baby receives less than 600 ml of formula daily
• Dosage: 3 drops daily with Nycoplus D3-Vitamin Drops
• Duration: Entire first year

Note: Infants receiving more than 600 ml of formula daily do not need vitamin D supplements.

Maltofer® Iron Drops 50 mg/ml (1 drop = 2.5 mg iron)

 Available over-the-counter at pharmacies.

• Who: Infants with birth weight under 2.5 kg
• Start: Begin at 4 weeks of age
• Dosage:
  • Up to 3.5 kg: 2 drops daily*
  • 5 kg and above: 3 drops daily*
  • *For infants eating iron-fortified porridge daily: 2 drops daily
• Duration:
  • Birth weight < 2 kg: Entire first year
  • Birth weight 2.0–2.5 kg: 6 months (assuming intake of iron-fortified porridge)