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Early or delayed enteral feeding for preterm growth-restricted infants: a randomized trial

Alison Leaf1, Jon Dorling, Stephen Kempley

  • 1National Institute for Health Research Biomedical Research Centre for Nutrition, Diet, and Lifestyle, Southampton General Hospital, Southampton, UK. a.a.leaf@soton.ac.uk

Pediatrics
|April 12, 2012
PubMed

Insights

Early enteral feeding for growth-restricted preterm infants speeds up full feeding and does not increase necrotizing enterocolitis (NEC) risk. This approach supports better nutrition and growth outcomes for vulnerable newborns.

Area of Science:

  • Neonatalogy
  • Perinatal Medicine
  • Pediatric Gastroenterology

Background:

  • Growth-restricted preterm infants face higher risks of necrotizing enterocolitis (NEC).
  • Delayed enteral feeding is common but lacks evidence of benefit and may hinder nutrition.
  • Optimal feeding strategies are crucial for this high-risk population.

Purpose of the Study:

  • To investigate the impact of early versus late enteral feeding initiation on growth-restricted preterm infants.
  • To assess the primary outcomes of time to full enteral feeding and incidence of NEC.
  • To evaluate secondary outcomes including duration of parenteral nutrition and other complications.

Main Methods:

  • Randomized controlled trial involving preterm infants (<35 weeks gestation, <10th percentile birth weight) with abnormal umbilical artery Doppler.
  • Infants were assigned to commence enteral feeds on day 2 (early) or day 6 (late) after birth.
  • Feeding advancement followed a standardized "feeding prescription"; primary outcomes were time to sustained full enteral feeding and NEC incidence.

Main Results:

  • Early feeding achieved full enteral feeds significantly earlier (median 18 days vs. 21 days).
  • No significant difference in necrotizing enterocolitis (NEC) incidence between early (18%) and late (15%) feeding groups.
  • Early feeding led to shorter parenteral nutrition duration, reduced high-dependency care, and lower cholestatic jaundice incidence.

Conclusions:

  • Early introduction of enteral feeds in growth-restricted preterm infants is safe and effective.
  • This strategy accelerates achievement of full enteral feeding without increasing NEC risk.
  • Early feeding offers potential benefits in reducing parenteral support and other morbidities.
Abstract

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