Early enteral feeding in preterm infants

Area of Science:

• Neonatalogy
• Pediatric Gastroenterology
• Clinical Nutrition

Background:

• Enteral feeding practices for preterm infants vary significantly.
• Early enteral feeding is a modifiable risk factor for necrotising enterocolitis (NEC) and late onset sepsis (LOS).
• High-quality evidence is emerging to guide feeding protocols in preterm neonates.

Purpose of the Study:

• To review current evidence on early enteral feeding in preterm infants.
• To assess the safety and efficacy of different feeding advancement strategies.
• To identify knowledge gaps in feeding high-risk preterm populations.

Main Methods:

• Meta-analyses of randomized controlled trials (RCTs) were examined.
• Data from trials involving clinically stable very preterm and very low birthweight (VLBW) infants were synthesized.
• Limited data on high-risk infants (e.g., small for gestational age, absent/reversed end diastolic flow velocity) were considered.

Main Results:

• Early trophic feeding (within 48h) and progressive feeding (before day 4 at >24 ml/kg/day) are safe for stable VLBW infants, without increased mortality or NEC.
• Evidence suggests progressive enteral feeding initiated within the first 4 days is safe for high-risk preterm infants.
• There is limited evidence comparing bolus versus continuous gavage feeding in stable preterm infants.
• Many trials are unblinded, increasing bias risk for subjective outcomes like NEC and LOS.

Conclusions:

• Current evidence supports early and progressive enteral feeding in stable preterm infants.
• Further research is needed to establish optimal feeding advancement protocols for high-risk preterm infants.
• Future trials should prioritize objective outcomes and blinded assessments to minimize bias.