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Early progressive feeding in extremely preterm infants: a randomized trial.

Ariel A Salas1, Peng Li2, Kelli Parks1

  • 1Department of Pediatrics, School of Medicine; and Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL.

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Early progressive feeding significantly increases full enteral feeding days for extremely preterm infants. This approach also reduces the need for parenteral nutrition and central venous access in this vulnerable population.

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Area of Science:

  • Neonatalogy
  • Pediatric Gastroenterology
  • Clinical Nutrition

Background:

  • Extremely preterm infants (≤28 weeks gestation) often receive delayed feeding due to insufficient evidence on early progressive feeding protocols.
  • Early progressive feeding, involving small increments in feeding volumes shortly after birth, is under investigation for its benefits.

Purpose of the Study:

  • To determine the feasibility and efficacy of early progressive feeding in extremely preterm infants.
  • To evaluate the impact of early versus delayed feeding initiation on key neonatal outcomes.

Main Methods:

  • A single-center randomized trial involving 60 extremely preterm infants (median gestational age 26 weeks).
  • Infants were assigned to either an early progressive feeding group or a delayed progressive feeding group (after 4 days of trophic feeds).
  • Primary outcome: number of full enteral feeding days within the first month; Secondary outcomes: death, NEC, sepsis, growth, parenteral nutrition use, and central venous access.

Main Results:

  • Early progressive feeding significantly increased the number of full enteral feeding days by a median of 2 days (P=0.02).
  • Reduced use of parenteral nutrition and need for central venous access were observed in the early feeding group.
  • No significant differences were found in culture-proven sepsis, restricted growth at 36 weeks postmenstrual age, or the composite outcome of NEC or death.

Conclusions:

  • Early progressive feeding is effective in increasing enteral feeding attainment in extremely preterm infants.
  • This feeding strategy reduces the reliance on parenteral nutrition and central venous access.
  • Further research may explore optimizing protocols to further improve outcomes like growth and reduce complications.