Enteral nutrition to optimize health and neurodevelopmental outcomes in very preterm infants

Very preterm infants are born before a critical window of nutrient accrual that occurs during the third trimester, resulting in a nutritional deficit that is vital to restore to support further growth and development. Although the gut is underdeveloped, optimizing administration of nutrition via the enteral route has been linked to improved long term outcomes, particularly when mother's own milk is prioritized as the initial source of nutrition.

The goal of this review was to synthesize current evidence on best enteral nutrition practices for very preterm infants focusing on strategies that optimize long term neurodevelopment and infant health outcomes.

This review examines the physiological importance of early enteral nutrition to support growth and neurodevelopment of very preterm infants. Clinical outcomes data related to different types of enteral nutrition sources are reviewed, as well as evidence-based practices regarding initiation of enteral nutrition, advancement, supplementation and fortification. Additionally, limitations in the existing literature are identified to inform future research directions.

The collective evidence reviewed in this manuscript supports early, consistent, and human milk-based enteral nutrition as a central modifiable factor to improve growth, brain development, and long-term neurodevelopmental outcomes. While there are remaining uncertainties regarding the ideal timing for initiation, specific advancement strategies, and fortification methods, the available data supports the following: minimizing enteral fasting, prioritizing mother's own milk, and using protocolized feeding guidelines.