Enteral feeding: how, when, how much?

In a NICU early enteral feeding is usually possible only when the newborn clinical conditions permit it. Because of the frequent need of umbilical/central catheters, they usually start with parenteral feeding and/or with minimal enteral feeding (trophic feeding). This kind of management is even more frequent in VLBWIs, in which the risk of NEC is very high. In this work we describe a model of early enteral exclusive feeding (EEEF) based on the use of banking human milk followed by mother In the Centre of Neonatology of Trento, as in other milk. Centers, the newborns weighing less than 750 g or with a GE <27 weeks, are treated with parenteral nutrition and minimal enteral feeding. The newborn weighing 750-1249g and with GE >26 weeks define a group in which we find critical neonates, who can not be treated with enteral feeding, and neonates whose clinical conditions permit EEEF. In particular, in a period of 16 years (1994-2009) in Trento, 308 newborns weighing 750-1249 g and GE >26 weeks were admitted. The 90.9% has been treated with prenatal steroids, the 91.9% was inborn, the 96.1% survived. In the 59.1% of the cases (175) we gave EEEF. We could continue with a complete EEEF in the 40.2% of the total (119 cases). The characteristics of these neonates and our centre management, based mainly on early use of banking human milk and mother milk, are detailed described.