Introducing enteral feeds in the high-risk preterm infant

Establishing enteral feeding in high-risk, very preterm infants is difficult: they are born at a time of rapid growth and development, yet immaturity of gut and metabolic function makes it difficult to accumulate adequate nutrients. Parenteral nutrition will provide the bulk of nutrients in the first few weeks while the preterm infant gut adapts. Intestinal function, nutritional substrate and microbial environment all interact to enable this to happen, and imbalance of these components may result in the serious condition of necrotising enterocolitis. Mother's breast milk is the safest feed and there is no evidence that delaying the introduction of small volumes is of benefit. Volumes can gradually be increased as tolerated and nutrient intakes optimised with addition of supplements or breast-milk fortifier to minimise the extent of extrauterine growth restriction.