<s>[INST] context: Feeding of a preterm neonate

The aim of nutritional management of a preterm infant is to achieve full enteral feeding as soon as possible.
For pretenn infants of more than 34 weeks of gestation, it is possible that breast or bottle feeding can be adopted as they should be able to coordinate sucking, swallowing and breathing.
But for those younger infants who may have compromised respiration or be neurologically less well developed, this may not be advisable and nutrients may need to be passed into the stomach through a fine tube either through the mouth (oro-gastric tube) or the nose (naso-gastric tube). Nasogastric tube increases the airway impedance and work of breathing, therefore, the orogastric tube is preferred over nasogastric tube.
Breast milk is the food of choice as it is best tolerated and includes other benefits as well as nutrition.
TPN is given to VLBW infants who cannot tolerate gastric tube feeds, have the gastric disease; enteral feeding (by tube) is not possible or just while enteral nutrition is being established. Another important indication for TPN is sick premature/LBW infants which include Infants with:



Significant respiratory distress required assisted ventilation.
Shock requiring isotropic support.
Seizures, renal/cardiac failure
Symptomatic hypoglycemia/hypocalcemia, electrolyte abnormalities.
The surgical condition of GIT, NEC, hydrops


Even in these sick infants, enteral feed should be started as early as possible. [/INST] question: A neonate weighing 1500 grams is delivered at 33 weeks. Which of the following would be the most appropriate method of nutrition for the baby? | options: A: IV fluids and oral feeding B: Orogastric feeding/alternate oral feeding C: Total parenteral nutrition D: IV fluids and assessment/follow-up | answer: B </s>