Randomized controlled trial of slow vs rapid enteral feeding advancements on the clinical outcomes of preterm infants with birth weight 750-1250 g. Enteral feeding regimens and necrotising enterocolitis in preterm infants: a multicentre case–control study Slow versus rapid enteral feed in preterm neonates with antenatal absent end diastolic flow Prolonging small feeding volumes early in life decreases the incidence of necrotizing enterocolitis in very low birth weight infants. Early enteral feeding and nosocomial sepsis in very low birthweight infants Early human milk feeding is associated with a lower risk of necrotizing enterocolitis in very low birth weight infants Early or Delayed Enteral Feeding for Preterm Growth-Restricted Infants: A Randomized Trial Early versus delayed minimal enteral feeding and risk for necrotizing enterocolitis in preterm growth-restricted infants with abnormal antenatal Doppler results. Does the Enteral Feeding Advancement Affect Short-term Outcomes in Very Low Birth Weight Infants? The Effect of Neutral Oligosaccharides on Reducing the Incidence of Necrotizing Enterocolitis in Preterm infants: A Randomized Clinical Trial Randomized trial of "slow" versus "fast" feed advancements on the incidence of necrotizing enterocolitis in very low birth weight infants. Oral probiotics: Lactobacillus sporogenes for prevention of necrotizing enterocolitis in very low-birth weight infants: a randomized, controlled trial Early versus Late Enteral Feeding in Preterm Intrauterine Growth Restricted Neonates with Antenatal Doppler Abnormalities: An Open-Label Randomized Trial Slow versus fast enteral feed advancement in very low birth weight infants: a randomized control trial. Very early feeding in stable small for gestational age preterm infants: a randomized clinical trial. Randomized, Controlled Trial of Slow Versus Rapid Feeding Volume Advancement in Preterm Infants Cost Savings of Human Milk as a Strategy to Reduce the Incidence of Necrotizing Enterocolitis in Very Low Birth Weight Infants Glutamine-enriched enteral nutrition in very-low-birth-weight infants and effects on feeding tolerance and infectious morbidity: a randomized controlled trial. Randomised controlled trial of an aggressive nutritional regimen in sick very low birthweight infants Comparison of fast- and slow-feeding rate schedules to the development of necrotizing enterocolitis. Efficacy of Probiotics Versus Placebo in the Prevention of Necrotizing Enterocolitis in Preterm Very Low Birth Weight Infants: A Double-Blind Randomized Controlled Trial. Alimentazione del neonato pretermine IUGR: studio multicentrico ADEPT (Abnormal Doppler Enteral Prescription Trial). (Feeding the IUGR premature newborn infant: the multicenter ADEPT study). The Speed of Increasing milk Feeds: a randomised controlled trial
OBJECTIVE To evaluate the effect of slow vs rapid rates of advancement of enteral feed volumes on the clinical outcomes in preterm infants with 750 - 1250 g birth weight . STUDY DESIGN A total of 92 stable neonates 750 - 1250 g and gestational age < 32 weeks were r and omly allocated to enteral feeding advancement of 20 mL/kg/d ( n = 46 ) or 30 mL/kg/d ( n = 46 ) . The primary outcome was days to reach full enteral feeding , defined as 180 mL/kg/d . Secondary outcomes included rates of necrotizing enterocolitis ( NEC ) and culture-proven sepsis , days of parenteral nutrition ( PN ) , length of hospital stay , and growth end points . RESULTS Neonates in the rapid-feeding advancement group achieved full enteral volume of feedings earlier than the slower advancement group . They received significantly fewer days of PN , exhibited a shorter time to regain birth weight , and had a shorter duration of hospital stay . The incidence of NEC and the number of episodes of feeding intolerance were not significantly different between the groups , whereas the incidence of culture-proven late-onset sepsis was significantly less in infants receiving a rapid feeding advancement . Excluding infants who were small for gestational age at birth , the incidence of extrauterine growth restriction was significantly reduced in the rapid-advancement group at 28 days and at hospital discharge . CONCLUSION Rapid enteral feeding advancements in 750 - 1250 g birth weight infants reduce the time to reach full enteral feeding and the use of PN administration . Rapid-advancement enteral feed also decreases extrauterine growth restriction with improved short-term outcomes for these high-risk infants Background : Most preterm infants who develop necrotising enterocolitis ( NEC )  have received enteral feeds . Uncertainty exists about which aspects of the feeding regimen affect the risk of NEC . Aim : To examine associations between various enteral feeding practice s and the development of  NEC  in preterm infants . Methods : Multicentre case – control study . 53 preterm infants with NEC were enrolled together with a gestational age frequency-matched control without NEC from a r and omly selected neonatal unit . Clinical and feeding data were extracted and compared between the groups . Results : Significantly fewer cases than controls had received human breast milk ( 75 % vs 91 % ; OR 0.32 , 95 % CI 0.11 to 0.98 ) . The day on which enteral feeding was started did not differ significantly ( mean ( SD ) days after birth : cases 2.9 ( 2.8 ) and controls 2.8 ( 1.8 ) ) . The mean ( SD ) duration of trophic feeding ( < 1 ml/kg/h ) was significantly shorter in the cases ( 3.3 ( 3.1 ) days ) than controls ( 6.2 ( 6.7 ) days ) ( mean difference ( MD ) −2.9 , 95 % CI −4.9 to −0.9 ) days . Cases were fully fed significantly earlier than controls ( mean ( SD ) days after birth : cases 9.9 ( 4.2 ) and controls 14.3 ( 9.8 ) ; MD −4.4 , 95 % CI −7.3 to −1.5 ) . Conclusions : These data suggest that the duration of trophic feeding and rate of advancement of feed volumes may be modifiable risk factors for NEC in preterm infants . Further r and omised controlled trials are warranted to assess the effect of different rates of feed advancement on the incidence of NEC , as well as other outcomes Abstract Objective : Incidence of feed intolerance ( FI ) and necrotizing enterocolitis ( NEC ) in preterm neonates with Doppler evidence of absent end diastolic flow ( AEDF ) velocities in the fetal umbilical artery when enteral feed volumes were started by 6–72 h and advanced either slowly or rapidly . Methods : Stable inborn neonates , 30–36 weeks gestation , weighing ≥1000 g and with antenatal evidence of AEDF were included in this pilot study . Infants ( stratified in < 1250 g and ≥1250 g birth weight categories ) were allocated under r and omized controlled trial , to receive either slow or rapid advancement of enteral feeding , while initiating the feeds after 6 h of birth if bowel sounds were present . Primary outcome measure was , FI and NEC till day 7 after reaching full feeds . Results : Of 159 eligible infants , 83 were r and omized : 53 infants in the ≥1250 g category ( 28 in rapid and 25 in slow group ) and 30 in the < 1250 g category ( 15 in each group ) . FI was present in 11 % versus 16 % in ≥1250 g ( p = 0.570 ) and 27 % versus 33 % in < 1250 g ( p = 0.690 ) , NEC developed in 8.4 % ( 3 versus 1 ) in ≥1250 g and ( 1 versus 2 ) in < 1250 g , in slow versus rapid feeding . Conclusion : This trial did not find increase in incidence of feed intolerance with very early introduction and rapid advancement of enteral feeds in stable preterm neonates with AEDF and birth weight ≥1250 OBJECTIVE Approximately 90 % of infants who develop necrotizing enterocolitis (  NEC ) do so after being fed . Previous prospect i ve studies have shown that infants given small enteral feedings  for the first 7 to 10 days of feeding do not have an increased risk for NEC compared with those given no feedings . Although neonatologists now commonly increase feeding volumes , no study has compared the risk for NEC between infants fed these small volumes and those fed volumes that are increased slowly . The purpose of this study was to compare the risks and benefits of small and increasing feeding volume . METHODS In a r and omized , controlled trial , we r and omly assigned 141 preterm infants in the newborn intensive care unit to be fed 10 days using 1 of 2 schedules . One group was fed 20 mL/kg/d for the first 10 study days ( minimal ) . The other group ( advancing ) was fed 20 mL/kg/d on study day 1 ; feeding volume was increased by 20 mL/kg/d up to 140 mL/kg/d , which was maintained until study day 10 . The main outcome measure was incidence of NEC ; secondary outcomes were maturation of intestinal motor patterns , time to reach full enteral feedings , and incidence of late sepsis . RESULTS The study was closed early because 7 infants who were assigned to advancing feeding volumes developed NEC , whereas only 1 infant fed minimal feeding volumes did , or 10 % versus 1.4 % . Although infants who were fed minimal volumes established full enteral feeding volumes later than infants who were fed advancing volumes , maturation of intestinal motor patterns and the incidence of late sepsis and feeding intolerance was similar in the 2 groups . CONCLUSION Given that advancing feeding volumes increase the risk of NEC without providing benefits for motor function or feeding tolerance , neonatologists should consider using minimal feeding volumes until future trials assess the safety of advancing feeding volumes Background : The interrelations between early enteral feeding , necrotising enterocolitis ( NEC ) , and nosocomial sepsis ( NS ) remain unclear . Objective : To evaluate the effect of age at the introduction of enteral feeding on the incidence of NS and NEC in very low birthweight ( VLBW < 1500 g ) infants . Methods : Data were collected on the pattern of enteral feeding  and perinatal and neonatal morbidity on all VLBW infants born in one centre during 1995–2001 .  Enteral feeding was compared between infants with and without NS and /or NEC . Results : The study sample included 385 infants . Of these , 163 ( 42 % ) developed NS and 35 ( 9 % ) developed NEC .  Enteral feeding was started at a significantly earlier mean ( SD ) age in infants who did not develop nosocomial sepsis ( 2.8 ( 2.6 ) v 4.8 ( 3.7 ) days , p = 0.0001 ) . Enteral feeding was introduced at the same age in babies who did or did not develop NEC ( 3.1 ( 2 ) v 3.7 ( 3 ) days , p = 0.28 ) . Over the study period , the mean annual age at the start of enteral feeding fell consistently , and this correlated with the mean annual incidence of NS ( r2 = 0.891 , p = 0.007 ) . Multiple logistic regression analysis showed age at start of enteral feeding , respiratory distress syndrome , and birth weight to be the most significant predictors of risk of NS ( p = 0.0005 , p = 0.024 , p = 0.011 ) . Conclusions : Early enteral feeding was associated with a reduced risk of NS but no change in the risk of NEC  in VLBW infants . These findings support the use of early enteral feeding in this high risk population , but this needs to be confirmed in a large r and omised controlled trial Background : Necrotizing enterocolitis ( NEC ) is a frequent cause of mortality and morbidity in very low birth weight ( VLBW ) infants .  Human milk ( HM ) feeding has been associated with lower risk of NEC . However , mothers of VLBW infants often experience insufficient milk production , result ing in mixed feedings of HM and formula . Moreover , medical complications often limit the volume of feeding they can be given . Objective : To determine if high proportions of ( 50 % or greater ) HM enteral feeding within the first 14 days of life are protective against NEC . Method : This was a prospect i ve cohort study of VLBW infants who were grouped according to the HM proportion of enteral feeding in the first 14 days : < 50 % ( low human milk , LHM , n=46 ) and ⩾50 % ( high human milk , HHM , n=156 ) . The outcome of interest was development of NEC ( Bell stage 2 or 3 ) . Logistic regression was used to estimate odds ratios ( OR ) and 95 % confidence intervals ( CI ) and to assess potential confounding due to perinatal risk factors . Result : Two hundred and two infants were studied . Confirmed NEC occurred in 5/46 ( 10.6 % ) of the LHM group , as compared with 5/156 ( 3.2 % ) of the HHM . Gestational age was the only perinatal factor associated with risk of NEC . After adjustment for gestational age , HHM was associated with a lower risk of NEC ( ( OR=0.17 , 95 % CI : 0.04 to 0.68 ) , P=0.01 ) . Conclusion : Enteral feeding containing at least 50 % HM in the first 14 days of life was associated with a sixfold decrease in the odds of NEC BACKGROUND : Growth-restricted preterm infants are at increased risk of developing necrotizing enterocolitis ( NEC ) and initiation of enteral feeding is frequently delayed . There is no evidence that this delay is beneficial and it might further compromise nutrition and growth . METHODS : Infants with gestation below 35 weeks , birth weight below the 10th centile , and abnormal antenatal umbilical artery Doppler waveforms were r and omly allocated to commence enteral feeds “ early , ” on day 2 after birth , or “ late , ” on day 6 . Gradual increase in feeds was guided by a “ feeding prescription ” with rate of increase the same for both groups . Primary outcomes were time to achieve full enteral feeding sustained for 72 hours and NEC . RESULTS : Four hundred four infants were r and omly assigned from 54 hospitals in the United Kingdom and Irel and ( 202 to each group ) . Median gestation was 31 weeks . Full , sustained , enteral feeding was achieved at an earlier age in the early group : median age was 18 days compared with 21 days ( hazard ratio : 1.36 [ 95 % confidence interval : 1.11–1.67 ] ) . There was no evidence of a difference in the incidence of NEC : 18 % in the early group and 15 % in the late group ( relative risk : 1.2 [ 95 % confidence interval : 0.77–1.87 ] ) . Early feeding result ed in shorter duration of parenteral nutrition and high-dependency care , lower incidence of cholestatic jaundice , and improved SD score for weight at discharge . CONCLUSIONS : Early introduction of enteral feeds in growth-restricted preterm infants results in earlier achievement of full enteral feeding and does not appear to increase the risk of NEC We studied the effect of early ( < or = 5 days ) versus delayed ( > or = 6 days ) initiation of minimal enteral feeding ( MEF ) on the incidence of necrotizing enterocolitis ( NEC ) and feeding intolerance in preterm infants with intrauterine growth restriction ( IUGR ) and abnormal antenatal Doppler results . We performed a r and omized , nonblinded pilot trial of infants receiving early or delayed MEF in addition to parenteral feeding within 48 hours of life .  Demographic data , maternal preeclampsia , antenatal steroid exposure , Doppler studies , as well as cases of NEC and feeding intolerance were all recorded . Of the 84 infants enrolled , 81 completed the study : 40 received early ( median age : 2 days , range : 1 to 5 days ) and 41 delayed ( median age : 7 days , range : 6 to 14 days ) MEF . The incidence of NEC and feeding intolerance was not significantly different between groups ( p = 0.353 and p = 0.533 , respectively ) . Birth weight was an independent risk factor for NEC in both groups . Early MEF of preterm infants with IUGR and abnormal antenatal Doppler results may not have a significant effect on the incidence of NEC or feeding intolerance . Furthermore , birth weight seems to be an independent risk factor for the development of NEC , irrespectively of the timing of MEF introduction Background and Objectives : Controversy exists regarding the optimal enteral feeding regimen of very low birth weight infants ( VLBW ) . Rapid advancement of enteral feeding has been associated with an increased rate of necrotizing enterocolitis . In contrast , delaying enteral feeding may have unfavorable effects on nutrition , growth , and neurodevelopment . The aim is to compare the short-term outcomes of VLBW infants in tertiary care centers according to their enteral feeding advancement . Patients and Methods : We prospect ively studied the influence of center-specific enteral feeding advancement in 1430 VLBW infants recruited from 13 tertiary neonatal intensive care units in Germany on short-term outcome parameters . The centers were post hoc stratified to “ rapid advancement to full enteral feeds ” ( median duration of advancement to full enteral feeds ≤12.5 days ; 6 centers ) , that is , rapid advancement ( RA ) , or “ slow advancement to full enteral feeds ” ( median duration of advancement to full enteral feeds > 12.5 days ; 7 centers ) , that is , slow advancement ( SA ) . Results : VLBW infants born in centers with SA ( n = 713 ) had a significantly higher rate of sepsis compared with VLBW infants born in centers with RA ( n = 717 ) , which was particularly evident for late-onset sepsis ( 14.0 % vs 20.4 % ; P = 0.002 ) . Furthermore , more central venous lines ( 48.6 % vs 31.1 % , P < 0.001 ) and antibiotics ( 92.4 % vs 77.7 % , P < 0.001 ) were used in centers with SA . Conclusions : Center differences in enteral feeding advancement occur and may have a significant impact on short-term outcomes such as nosocomial sepsis . Large , multicenter , prospect i ve trials are required to further eluci date the optimal feeding strategy for VLBW infants Background : Necrotizing enterocolitis ( NEC ) is one of the most destructive diseases associated with conditions of neonatal prematurity . Supplementation with enteral prebiotics may reduce the incidence of NEC , especially in infants who fed exclusively with breast-milk . Therefore , we compared the efficacy and safety of enteral supplementation of a prebiotic mixture ( short chain galacto-oligosaccharides/long chain fructo-oligosaccharides [ SCGOS/LCFOS ] ) versus no intervention on incidence of NEC in preterm infants . Methods : In a single-center r and omized control trial 75 preterm infants ( birth weight [ BW ] ≤1500 g , gestational age ≤34 weeks and were not fed with formula ) on 30 ml/kg/day volume of breast-milk were r and omly allocated to have enteral supplementation with a prebiotic mixture ( SCGOS/LCFOS ; 9:1 ) or not receive any prebiotic . The incidence of suspected NEC , feeding intolerance , time to full enteral feeds , duration of hospitalization were investigated . Results : Differences in demographic characteristics were not statistically important . SCGOS/LCFOS mixture significantly reduced the incidence of suspected NEC , ( 1 [ 4.0 % ] vs. 11 [ 22.0 % ] ; hazard ratio : 0.49 [ 95 % confidence interval : 0.29 - 0.84 ] ; P = 0.002 ) , and time to full enteral feeds ( 11 [ 7 - 21 ] vs. 14 [ 8 - 36 ] days ; P - 0.02 ] . Also duration of hospitalization was meaningfully shorter in the prebiotic group ( 16 [ 9 - 45 ] vs. 25 [ 11 - 80 ] ; P - 0.004 ] . Prebiotic oligosaccharides were well tolerated by very low BW ( VLBW ) infants . Conclusions : Enteral supplementation with prebiotic significantly reduced the incidence of NEC in VLBW infants who were fed exclusively breast-milk . This finding suggests that it might have been the complete removal of formula which caused a synergistic effect between nonhuman neutral oligosaccharides ( prebiotic ) and human oligosaccharides OBJECTIVE To determine whether the rate of feed advancement affects the incidence of necrotizing enterocolitis ( NEC ) . STUDY DESIGN Prospect i ve r and omized controlled trial involving 185 formula-fed infants with birth weight 501 to 1500 g and gestational age < /=34 weeks . Infants were r and omized into 2 groups : " slow " ( n = 98 ) , who received 15 cc/kg/d increments ( a 10-day schedule to full feeds ) and " fast " ( n = 87 ) , who received 35 cc/kg/d increments ( a 5-day schedule to full feeds ) of Similac Special Care 20 cal/oz . Feeds were increased only if well tolerated as defined by a protocol . RESULTS The incidence of NEC ( Bell stage > /=II ) was similar in both groups ( slow 13 % and fast 9 % , P = .5 ) . The incidence of perforation ( Bell stage III ) was also similar in both groups ( slow 4 % and fast 2 % , P = .8 ) . Feeds were started at a comparable postnatal age in both groups ( median age : slow 5 days and fast 4 days , P = .9 ) . Although the neonates in the fast group attained full enteral intake earlier ( median days [ 25th and 75th percentiles ] : slow 15 [ 12 , 21 ] and fast 11 [ 8 , 15 ] , P < .001 ) and regained their birth weight earlier ( slow 15 [ 11 , 20 ] and fast 12 [ 8 , 15 ] , P < .05 ) , their ages at discharge were not statistically different ( slow 47 [ 31 , 67 ] and fast 43 [ 29 , 62 ] , P = .3 ) CONCLUSIONS A greater than twofold difference in the rate of feed advancement from 15 cc/kg/d to 35 cc/kg/d did not affect the incidence of NEC > /= stage II . Factors other than feed advancement appear to be more important in the pathogenesis or progression of NEC Background / Objective : The identification of probiotic species involved in gut homeostasis and their potential therapeutic benefits have led to an interest in their use for preventing necrotizing enterocolitis ( NEC ) . Although bifidobacterium and lactobacilli sp. have been used to reduce the incidence of NEC in clinical trials . Lactobacillus sporogenes has not been used in the prevention of NEC in very low-birth weight infants yet . The objective of this study was to evaluate the efficacy of orally administered L sporogenes in reducing the incidence and severity of NEC in very low-birth weight ( VLBW ) infants . Subjects/ Methods : A prospect i ve , blinded , r and omized controlled trial was conducted in preterm infants with a gestational age of <33 weeks or birth weight of < 1500 g. VLBW infants who survived to start enteral feeding were r and omized into two groups The infants in the study group were given L. sporogenes with a dose of 350 000 000 c.f.u . added to breast milk or formula , once a day , starting with the first feed until discharged . The infants in the control group were fed without L. sporogenes supplementation . The primary outcome measurement was death or NEC ( Bell 's stage ⩾2 ) . Results : A total of 221 infants were studied : 110 in the study group and 111 in the control group . There was no significant difference in the incidence of death or NEC between the groups . Feeding intolerance was significantly lower in the probiotics group than in the control group ( 44.5 % ( n : 49 ) vs 63.1 % ( n : 70 ) , respectively ; P=0.006 ) . Conclusions : L. sporogenes supplementation at the dose of 350 000 000 c.f.u/day is not effective in reducing the incidence of death or NEC in VLBW infants , however , it could improve the feeding tolerance Background of the study Enteral feeding in preterm neonates with intrauterine growth restriction ( IUGR ) and absent or reversed end diastolic flow ( AREDF ) on umbilical artery ( UA ) Doppler is delayed owing to an increased risk of necrotizing enterocolitis ( NEC ) . Delaying enteral feeding with longer duration of parenteral nutrition ( PN ) carries an increased risk of sepsis . Objectives To study early versus late feeding in preterm IUGR neonates for time required to attain sufficient feed volume to discontinue PN and increased risk of NEC or feed intolerance ( FI ) . Design Open-label r and omized controlled trial . Setting Tertiary care neonatal unit and fetal-maternal medicine unit in India . Participants Preterm intrauterine growth restricted neonates ' ≤32 weeks with AREDF on UA Doppler enrolled from 1 January 2014 to 31 July 2015 . Intervention R and omized to receive early or late feeding using mothers own or donor breast milk as per a feed initiation and advancement protocol . Primary outcome Time in days required to attain sufficient feed volume allowing discontinuation of PN and incidence of NEC in neonates fed early versus late . Results There were 77 eligible neonates . Sixty-two neonates were included and stratified as extreme preterm ( 27 - 29 weeks ) ( n = 20 ) and very preterm ( 30 - 32 weeks ) ( n = 42 ) . Ten extreme preterm and 21 very preterm neonates were r and omized to each early feeding and late feeding arm . There was a significantly faster attainment of sufficient feeds in the early feeding arm of both the stratified groups [ extreme preterm : median 14 days ( Interquartile range IQR : 12 - 15 ) compared with 18 days ( IQR : 18 - 20 ) , hazard ratio ( HR ) : 1.59 , 95 % CI : 0.626 - 4.078 ; very preterm : 12 days ( IQR : 10 - 14 ) as compared with 16 days ( IQR 15 - 17 ) , HR : 1.89 , 95 % CI : 1.011 - 3.555 ] . There was no difference in the incidence of NEC , FI and combined outcome of NEC and FI . Conclusion Early feeding in preterm IUGR neonates with AREDF on antenatal UA Doppler allowed earlier discontinuation of PN , allowing birth weight to be regained earlier and did not increase the incidence of NEC and FI OBJECTIVE To evaluate the tolerance of rapid advancement of enteral feeds in VLBW babies . SETTING Tertiary teaching hospital . DESIGN R and omized controlled trial . METHODS All stable neonates with birth weight less than 1250 grams were included in the study . The primary outcome variable was the time taken to achieve full enteral feeds ( defined as 180 ml/kg/day ) . The secondary outcome variables were incidence of Necrotizing enterocolitis ( NNEC ) and incidence of apnea . At 48 hours , the infants were r and omized into the slow advancement group ( enteral feeds advanced by increments of 15 ml/kg/day ) or fast advancement group ( enteral feeds advanced by increments of 30 ml/kg/day ) . The monitoring during feeding included daily weight record , two hourly abdominal girth charting , gastric aspirates , apnea , time taken to reach full enteral feedings and for NNEC . RESULTS There were 53 infants who were enrolled for the study ( 27 in the fast advancement group and 26 in the slow advancement group ) . In the fast advancement group , 20 percent completed the trial ; whereas 14 ( 53.8 percent ; ) in the slow advancement group completed the study . The two groups were comparable for birth weights , gestational age , sex , intrauterine growth status , Apgar and CRIB scores . The infants in the fast group reached full enteral intake of 180 ml/kg/day significantly earlier ( 10 + /- 1.8 days ) than in the slow group ( 14.8 + /- 1.5 days ) . The two groups were comparable for episodes of feed intolerance , apnea , NNEC . Infants in the fast group regained birth weight significantly earlier ( median 18 days ) than in the slow advancement group ( median 23 days ) . CONCLUSIONS Stable VLBW neonates can tolerate rapid advancements of enteral feeding without increased risk of adverse effects OBJECTIVE To examine the effect of initiating very early feeding on time-to-reach full feeding in stable , small for gestational age ( SGA ) preterm infants . METHOD Preterm infants with gestational age below 37 weeks and birth weight below the 10(th ) percentile were r and omly allocated to a  very early ( within 24 hours of birth ) feeding regimen or delayed ( after 24 hours of birth ) feeding .  All infants had in utero evidence of absent or reverse diastolic flow . Infants unable to start early feeding were excluded .  Time-to-reach full feeding , feeding progression , and related morbidity were compared .  Electrogastrography ( EGG )  was used to measure pre- and postpr and ial gastric motility on the second and seventh day after feeding initiation . RESULTS Sixty infants were included in the study , 30 in each group . Infants included in the very early feeding regimen achieved full enteral feeding sooner than controls ( 98±80 - 157 vs. 172±123 - 261 hours of age , respectively ; p= 0.004 ) and were discharged home earlier ( p=0.04 ) . No necrotizing enterocolitis ( NEC ) was documented in both study groups . Gastric motility was improved at day seven after feeding initiation in both study groups , with no difference between groups . CONCLUSIONS Stable SGA preterm infants on a very early feeding regimen achieved full enteral feeding and were discharged home significantly earlier than those on a delayed regimen , with no excess morbidity Objectives . To determine whether infants who are fed initially and advanced at 30 mL/kg per day ( intervention ) take fewer days to get to full feedings than those who are fed initially and advanced at 20 mL/kg per day ( control ) , without increasing their incidence of feeding complications and necrotizing enterocolitis ( NEC ) . We also examined whether these infants regain birth weight earlier , have fewer days of intravenous fluids , and a have shorter hospital stay . Methods . A r and omized , controlled , single-center trial was conducted in a Neonatal Intensive Care Unit of a community-based county hospital in Houston , Texas . Infants between 1000 and 2000 g at birth , gestational age ≤35 weeks , and weight appropriate for gestational age were allocated r and omly to feedings of expressed human milk or Enfamil formula starting and advanced at either 30 mL/kg per day or 20 mL/kg per day . Infants remained in the study until discharge or development of stage ≥IIA NEC . Results . A total of 155 infants were enrolled : 72 infants in the intervention group and 83 in the control group . Infants in the intervention group achieved full-volume feedings sooner ( 7 vs 10 days , median ) , regained birth weight faster ( 11 vs 13 days , median ) , and had fewer days of intravenous fluids ( 6 vs 8 days , median ) . Three infants in the intervention group and 2 control infants developed NEC for an overall incidence of 3.2 % ( relative risk : 1.73 ; 95 % confidence interval : 0.30–10.06 ) . Conclusion . Among infants between 1000 and 2000 g at birth , starting and advancing feedings at 30 mL/kg per day seems to be a safe practice and results in fewer days to reach full-volume feedings than using 20 mL/kg per day . This intervention also leads to faster weight gain and fewer days of intravenous fluids Background : Necrotizing enterocolitis ( NEC ) is a costly morbidity in very low birth weight ( VLBW ; < 1,500 g birth weight ) infants that increases hospital length of stay and requires expensive treatments . Objectives : To evaluate the cost of NEC as a function of dose and exposure period of human milk ( HM ) feedings received by VLBW infants during the neonatal intensive care unit ( NICU ) hospitalization and determine the drivers of differences in NICU hospitalization costs for infants with and without NEC . Methods : This study included 291 VLBW infants enrolled in an NIH-funded prospect i ve observational cohort study between February 2008 and July 2012 . We examined the incidence of NEC , NICU hospitalization cost , and cost of individual re sources used during the NICU hospitalization . Results : Twenty-nine ( 10.0 % ) infants developed NEC . The average total NICU hospitalization cost ( in 2012 USD ) was USD 180,163 for infants with NEC and USD 134,494 for infants without NEC ( p = 0.024 ) . NEC was associated with a marginal increase in costs of USD 43,818 , after controlling for demographic characteristics , risk of NEC , and average daily dose of HM during days 1 - 14 ( p < 0.001 ) . Each additional ml/kg/day of HM during days 1 - 14 decreased non-NEC-related NICU costs by USD 534 ( p < 0.001 ) . Conclusions : Avoidance of formula and use of exclusive HM feedings during the first 14 days of life is an effective strategy to reduce the risk of NEC and result ing NICU costs in VLBW infants . Hospitals investing in initiatives to feed exclusive HM during the first 14 days of life could substantially reduce NEC-related NICU hospitalization costs BACKGROUND Glutamine depletion has negative effects on the functional integrity of the gut and leads to immunosuppression .  Very-low-birth-weight ( VLBW ) infants are susceptible to glutamine depletion because nutrition is limited in the first weeks of life . OBJECTIVE The objective was to determine the effect of glutamine-enriched enteral nutrition on feeding tolerance , infectious morbidity , and short-term outcome in VLBW infants . DESIGN In a double-blind r and omized controlled trial , VLBW infants ( gestational age < 32 wk or birth weight < 1500 g ) were allocated to receive enteral glutamine supplementation ( 0.3 g . kg(-1 ) . d(-1 ) ) or isonitrogenous control supplementation ( alanine ) between days 3 and 30 of life . The supplementations were added to breast milk or to preterm formula . The primary endpoint for the study was time to full enteral feeding . Secondary endpoints were other variables of feeding tolerance , infectious morbidity , and short-term outcome . RESULTS Baseline patient and nutritional characteristics were not significantly different in the glutamine-supplemented ( n = 52 ) and the control ( n = 50 ) groups . The median time to full enteral feeding was 13 d ( range : 7 - 31 d ) in the glutamine-supplemented group and 13 d ( range : 6 - 35 d ) in the control group ( hazard ratio : 1.19 ; 95 % CI : 0.79 , 1.79 ; P = 0.40 ) . In the glutamine-supplemented group , 26 of 52 infants ( 50 % ) had > /=1 serious infection compared with 38 of 50 ( 76 % ) in the control group ( odds ratio : 0.32 ; 95 % CI : 0.14 , 0.74 ; P = 0.008 ) . Other variables of feeding tolerance and short-term outcome were not significantly different between groups . CONCLUSIONS Glutamine-enriched enteral nutrition did not improve feeding tolerance or short-term outcome in VLBW infants . However , infectious morbidity was significantly lowered in infants who received glutamine-enriched enteral nutrition AIMS To improve energy intake in sick very low birthweight ( VLBW ) infants ; to decrease growth problems , lessen pulmonary morbidity , shorten hospital stay , and avoid possible feeding related morbidity . Morbidity in VLBW infants thought to be associated with parenteral and enteral feeding includes bronchopulmonary dysplasia , necrotising enterocolitis , septicaemia , cholestasis and osteopenia of prematurity . METHODS A prospect i ve r and omised controlled trial ( RCT ) comparing two types of nutritional intervention was performed involving 125 sick VLBW infants in the setting of a regional neonatal intensive care unit . Babies were r and omly allocated to either an aggressive nutritional regimen ( group A ) or a control group ( group B ) . Babies in group B received a conservative nutritional regimen while group A received a package of more aggressive parenteral and enteral nutrition . Statistical analysis was done using Student’st test , the Mann-Whitney U test , the χ2 test and logistic regression . RESULTS There was an excess of sicker babies in group A , as measured by initial disease severity ( P < 0.01 ) , but mean total energy intakes were significantly higher ( P < 0.001 ) in group A at days 3 to 42 while receiving total or partial parenteral nutrition . Survival and the incidences of bronchopulmonary dysplasia , septicaemia , cholestasis , osteopenia and necrotising enterocolitis were similar in both groups . Growth in early life and at discharge from hospital was significantly better in babies in group A. There were no decreases in pulmonary morbidity or hospital stay . CONCLUSION Nutritional intake in sick VLBW infants can be improved without increasing the risk of adverse clinical or metabolic sequelae . Improved nutritional intake result ed in better growth , both in the early neonatal period and at hospital discharge , but did not decrease pulmonary morbidity or shorten hospital stay NECROTIZING ENTEROCOLITIS is a serious disorder of the newborn infant that rarely occurs before the institution of oral feedings . ' -3 Various feeding practice s have been shown to be important in the pathogenesis of the disease . Low-birth-weight infants fed a hyperosmolar , 650 mOsm/1 , elemental formula  have an increased incidence of NEC when compared to low-birth-weight infants fed a cow milk formula . 4 It has also been suggested that cow milk feedings themselves or the exclusion of breast milk from the diet of small newborn infants may be predisposing factors ? The quantity of feedings in the first weeks of life may also be important , and Krouskop and associates ~ have associated the development of NEC with early institution of oral feedings . In another retrospective study , however , there were no differences between the volume of formula offered NEC patients at the time symptoms developed and infants of similar size and age who did not develop NEC . 1 Conflicting opinions therefore exist regarding the relationship of oral feeding to the development of NEC ; there have been no r and omized , prospect i ve , clinical trials dealing with this issue . The purpose s of this paper are to report the relationship of different feeding practice s in the Intermountain Newborn Intensive Care Center to the incidence of NEC , and the results of a prospect i ve controlled investigation comparing two different feeding schedules in low-birth-weight infants OBJECTIVE To evaluate the efficacy of orally administered probiotics in preventing necrotizing enterocolitis ( NEC ) in preterm very low birth weight ( VLBW ) infants . STUDY DESIGN Ar and omized double blind controlled trial . PLACE AND DURATION OF STUDY The Paediatrics Department of Sylhet M.A.G. Osmani Medical College Hospital , Sylhet Bangladesh , from July 2012 to June 2015 . METHODOLOGY Preterm ( 28 - 33 weeks gestation ) VLBW ( birth weight 1000 - 1499 g ) neonates were enrolled . The study group was fed with probiotics once daily with breast milk from first feeding , and the control group with only breast milk without the addition of probiotics . Both the groups received other st and ard care . The primary outcome was the development of NEC ( stage II and III ) , categorized by modified Bell 's classification . RESULTS In 108 neonates , development of NEC was significantly lower in the study group than that of control group [ 1 ( 1.9 % ) vs. 6 ( 11.5 % ) ; p=0.044 ] . Age of achievement of full oral feeding was significantly earlier in the study group than that in the control group ( 14.88 ±3.15 and 18.80 ±4.32 days ; p < 0.001 ) . Duration of hospital stay was significantly short in the study group compared to the control group ( 15.82 ±2.94 days vs. 19.57 ±4.26 days ; p < 0.001 ) . CONCLUSION Probiotic supplementation reduces the frequency of necrotising enterocolitis in preterm neonates with very low birth weight . It is also associated with faster achievement of full oral feeding and short duration of hospital stay AIM Pregnancies complicated by abnormal antenatal Doppler blood flow often result in the preterm delivery of a growth restricted baby . These babies have a high risk of milk intolerance and necrotising enterocolitis ( 1 ) , and introduction of milk feeds is frequently delayed . Our aim was to determine the effect of early or late introduction on success of achieving full milk feeds and on adverse outcomes including NEC . METHODS Eligible babies with birthweight below 10th centile and gestation below 34 + 6 weeks , born after abnormal antenatal Dopplers , were r and omised between 20 and 48 hours to either early ( 24 - 48 hours ) or late ( 120 - 144 hours ) introduction  of milk feeds .  Babies with major congenital anomaly , in-utero transfusion , multi-organ failure or need for inotropes were excluded . Feed volumes and rate of increase were st and ardised , and were the same for both groups . Daily feed logs were kept . RESULTS 404 babies were r and omised from 56 units in U.K. and Irel and ( 202 in each group ) . There were no important differences between groups at r and omisation . CONCLUSION growth restricted preterm infants born after absent or reversed end-diastolic flow in the umbilical artery who are fed from the second day after birth achieve full feeds faster than those commencing feeds on day six . No difference was been seen in the incidence of NEC , in preliminary analysis . Final data analysis is currently being completed and will be presented at the conference Background In the UK , 1–2 % of infants are born very preterm ( < 32 weeks of gestation ) or have very low birth weight ( < 1500 g ) . Very preterm infants are initially unable to be fed nutritional volumes of milk and therefore require intravenous nutrition . Milk feeding strategies influence several long and short term health outcomes including growth , survival , infection ( associated with intravenous nutrition ) and necrotising enterocolitis ( NEC ) ; with both infection and NEC being key predictive factors of long term disability . Currently there is no consistent strategy for feeding preterm infants across the UK . The SIFT trial will test two speeds of increasing milk feeds with the primary aim of determining effects on survival without moderate or severe neurodevelopmental disability at 24 months of age , corrected for prematurity . The trial will also examine many secondary outcomes including infection , NEC , time taken to reach full feeds and growth . Methods / design Two thous and eight hundred very preterm or very low birth weight infants will be recruited from approximately 30 hospitals across the UK to a r and omised controlled trial . Infants with severe congenital anomaly or no realistic chance of survival will be excluded . Infants will be r and omly allocated to either a faster ( 30 ml/kg/day ) or slower ( 18 ml/kg/day ) rate of increase in milk feeds . Data will be collected during the neonatal hospital stay on weight , infection rates , episodes of NEC , length of stay and time to reach full milk feeds . Long term health outcomes comprising vision , hearing , motor and cognitive impairment will be assessed at 24 months of age ( corrected for prematurity ) using a parent report question naire . Discussion Extensive search es have found no active or proposed studies investigating the rate of increasing milk feeds . The results of this trial will have importance for optimising incremental milk feeding for very preterm and /or very low birth weight infants . No additional re sources will be required to implement an optimal feeding strategy , and therefore if successful , the trial results could rapidly be adopted across the NHS at low cost . Trial registration IS RCT N Registry ; IS RCT N76463425 on 5 March , 2013
Available trial data do not provide evidence that advancing enteral feed volumes at daily increments of 15 to 20 mL/kg ( compared with 30 to 40 mL/kg ) reduces the risk of NEC or death in very preterm or VLBW infants , extremely preterm or ELBW infants , SGA or growth-restricted infants , or infants with antenatal AREDFV .
Advancing the volume of enteral feeds at a slow rate results in several days of delay in establishing full enteral feeds and may increase the risk of invasive infection
BACKGROUND Early enteral feeding practice s are potentially modifiable risk factors for necrotising enterocolitis ( NEC ) in very preterm or very low birth weight ( VLBW ) infants .
Observational studies suggest that conservative feeding regimens , including slowly advancing enteral feed volumes , reduce the risk of NEC .
However , slow feed advancement may delay establishment of full enteral feeding and may be associated with metabolic and infectious morbidities secondary to prolonged exposure to parenteral nutrition .
OBJECTIVES To determine effects of slow rates of enteral feed advancement on the incidence of NEC , mortality , and other morbidities in very preterm or VLBW infants .