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About: Gestational Age-Based
How it works. Each tier is keyed only to corrected GA at the start of feeds. Birth weight is recorded but not used to assign the tier.
When to choose this mode. Best for NICUs whose advancement culture prioritizes physiologic maturity (gut motility, suck-swallow coordination, feeding tolerance) over size. Common in centers following JHACH, Children's Minnesota, or ESPGHAN-style guidelines.
Trade-off. A 1700 g LGA 26-weeker and an 800 g 26-weeker are treated identically — appropriate when GA is trusted, less so for growth-discordant infants.
About: Birth Weight-Based
How it works. Each tier is keyed only to birth weight; GA is recorded but not used to assign the tier.
When to choose this mode. Simple, fast, and the most widely-validated approach in randomized data (Oddie 2017 Cochrane, Dorling 2019 SIFT). Common in community-level NICUs and units that want a single, unambiguous bedside lookup.
Trade-off. A 900 g 32-week SGA infant is bucketed with the smallest, most immature group — which may be more conservative than their gut maturity warrants.
About: Combined Criteria (GA + Weight)
How it works. Every tier defines both a weight range and a GA range. An infant is evaluated against both axes and assigned to whichever tier yields the more conservative advancement. Weight or GA can pull the infant down a tier; neither can pull them up.
Worked example 1 — SGA (900 g, 32 weeks). By GA alone (32 wk) this infant might land in a moderate-volume tier. By weight alone (900 g) they land in the most conservative tier. The protocol assigns the conservative tier — protecting an SGA gut that may be less mature than the GA suggests.
Worked example 2 — LGA (1700 g, 26 weeks). By weight alone (1700 g) this infant might qualify for a higher-volume tier. By GA alone (26 wk) they land in the most conservative tier. The protocol again assigns the conservative tier — size doesn't override the immaturity of a 26-weeker's gut.
When to choose this mode. Recommended when growth-discordant infants (SGA, LGA, IUGR) are common and you want the protocol — not bedside judgment — to default to the safer trajectory. Used by CHOP and similar academic centers.
Trade-off. More conservative on average; advancement may be slower than strictly necessary for some infants. Mitigated by IUGR/AREDF settings configured later in the wizard.
Configure IUGR/AREDF modification strategy.
Initial product and transition triggers.
Acute contraindications and clinical notes.
Configure weight or gestational age feeding tiers.
Gestational Age-Based Tiers
| GA Range (weeks) | Wt Floor (g) | Tier Name | Trophic Days | Trophic Vol (ml/kg/d) |
Trophic Max (ml/kg/d) |
Adv Rate (ml/kg/d) |
Max Vol (ml/kg/d) |
Interval | Fort Start (ml/kg/d) |
Actions |
|---|
Birth Weight-Based Tiers
| Weight Range (g) | Tier Name | Trophic Days | Trophic Vol (ml/kg/d) |
Trophic Max (ml/kg/d) |
Adv Rate (ml/kg/d) |
Max Vol (ml/kg/d) |
Interval | Fort Start (ml/kg/d) |
Actions |
|---|
Volume limits, rounding, milestones, and safety warnings.
Institution-specific clinical instructions.
Define quality metrics to track for this protocol.
Feeding tolerance monitoring and gastric residual policy.
Delivery method and milk hierarchy.
Readiness assessment and transition criteria.
Growth velocity targets and escalation strategy.
Family engagement content.
Auto-populated citations and custom references.
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Calculated Tier:
Tier: -
Trophic Phase: -
Advancement Rate: -
Days to Full Feeds (Per Protocol): -