Related Experiment Video
Updated: Aug 24, 2026
A Clinical Trial Assessing the Safety, Efficacy, and Delivery of Olive-Oil-Based Three-Chamber Bags for Parenteral Nutrition
Published on: September 20, 2019
Slow versus fast enteral feed advancement in very low birth weight infants: a randomized control trial
1Neonatal Division, Department of Pediatrics, Maulana Azad Medical College, New Delhi 110 002, India.
Insights
Rapid advancement of enteral feeds is safe for very low birth weight (VLBW) neonates. This feeding strategy helps VLBW infants reach full nutrition faster without increasing risks of necrotizing enterocolitis or apnea.
Area of Science:
- Neonatalogy
- Pediatric Gastroenterology
- Clinical Nutrition
Background:
- Enteral feeding is crucial for VLBW neonates.
- Optimal advancement protocols are debated.
- Previous studies suggest caution in feed escalation.
Purpose of the Study:
- To evaluate the tolerance and safety of rapid advancement of enteral feeds in very low birth weight (VLBW) neonates.
- To compare the time to achieve full enteral feeds between rapid and slow advancement groups.
- To assess the incidence of adverse outcomes such as necrotizing enterocolitis (NEC) and apnea.
Main Methods:
- Randomized controlled trial conducted in a tertiary teaching hospital.
- Inclusion of stable neonates with birth weight < 1250 grams.
- Randomization at 48 hours into fast (30 ml/kg/day) or slow (15 ml/kg/day) enteral feed advancement groups.
- Primary outcome: time to achieve full enteral feeds (180 ml/kg/day). Secondary outcomes: incidence of NEC and apnea.
Main Results:
- Infants in the fast advancement group reached full enteral intake significantly earlier (10 days) compared to the slow group (14.8 days).
- Both groups showed comparable rates of feed intolerance, apnea, and necrotizing enterocolitis.
- Infants in the fast group regained birth weight significantly earlier (median 18 days vs. 23 days).
Conclusions:
- Stable VLBW neonates can safely tolerate rapid advancements in enteral feeding.
- Accelerated feeding protocols do not increase the risk of adverse gastrointestinal or respiratory events.
- Rapid advancement may lead to earlier achievement of full nutrition and faster weight regain in VLBW infants.
Objective:
To evaluate the tolerance of rapid advancement of enteral feeds in VLBW babies.
Setting:
Tertiary teaching hospital.
Design:
Randomized controlled trial.
Methods:
All stable neonates with birth weight less than 1250 grams were included in the study. The primary outcome variable was the time taken to achieve full enteral feeds (defined as 180 ml/kg/day). The secondary outcome variables were incidence of Necrotizing enterocolitis (NNEC) and incidence of apnea. At 48 hours, the infants were randomized into the slow advancement group (enteral feeds advanced by increments of 15 ml/kg/day) or fast advancement group (enteral feeds advanced by increments of 30 ml/kg/day). The monitoring during feeding included daily weight record, two hourly abdominal girth charting, gastric aspirates, apnea, time taken to reach full enteral feedings and for NNEC.
Results:
There were 53 infants who were enrolled for the study (27 in the fast advancement group and 26 in the slow advancement group). In the fast advancement group, 20 percent completed the trial; whereas 14 (53.8 percent;) in the slow advancement group completed the study. The two groups were comparable for birth weights, gestational age, sex, intrauterine growth status, Apgar and CRIB scores. The infants in the fast group reached full enteral intake of 180 ml/kg/day significantly earlier (10 +/- 1.8 days) than in the slow group (14.8 +/- 1.5 days). The two groups were comparable for episodes of feed intolerance, apnea, NNEC. Infants in the fast group regained birth weight significantly earlier (median 18 days) than in the slow advancement group (median 23 days).
Conclusions:
Stable VLBW neonates can tolerate rapid advancements of enteral feeding without increased risk of adverse effects.
Related Concept Videos
01:15Enteral Nutrition II: Nasointestinal and Gastrostomy Feeding
Nasointestinal Feeding
Nasointestinal feeding involves placing a tube through...
01:26Enteral Nutrition I: Orogastric and Nasogastric Feeding
Orogastric (OG) and nasogastric (NG) feeding are two standard methods used for enteral nutrition. Enteral nutrition is often preferred over...