The evidence available from r and omised controlled trials suggested that delaying the introduction of progressive enteral feeds beyond four days after birth did not reduce the risk of developing NEC in very preterm or VLBW infants , including growth-restricted infants .
Delaying the introduction of progressive enteral feeds result ed in a few days ' delay in establishing full enteral feeds but the clinical importance of this effect was unclear .
BACKGROUND The introduction of enteral feeds for very preterm ( less than 32 weeks ' gestation ) or very low birth weight ( VLBW ; less than 1500 g ) infants is often delayed for several days or longer after birth due to concern that early introduction may not be tolerated and may increase the risk of necrotising enterocolitis ( NEC ) .
However , delaying enteral feeding could diminish the functional adaptation of the gastrointestinal tract and prolong the need for parenteral nutrition with its attendant infectious and metabolic risks .
OBJECTIVES To determine the effect of delayed introduction of progressive enteral feeds on the incidence of NEC , mortality and other morbidities in very preterm or VLBW infants .
Fetal cerebral blood flow redistribution in late gestation: identification of compromise in small fetuses with normal umbilical artery Doppler.
OBJECTIVE To evaluate the role of middle cerebral artery Doppler in small fetuses during the late third trimester . DESIGN Prospect i ve observational study of structurally normal fetuses with an estimated fetal weight < 5th percentile for gestation . Perinatal outcome was determined using a structured data sheet sent to each referring obstetrician . SUBJECTS Structurally normal fetuses at 35 or more weeks of gestation referred during a 2-year period to the fetal growth clinic of a regional fetal medicine unit in North London . Fetuses with aneuploidy and /or major structural abnormalities were excluded . METHODS  Umbilical artery and middle cerebral artery ( MCA ) Doppler waveforms  were recorded and considered abnormal if above 95th or below 5th percentiles , respectively . Amniotic fluid was considered reduced if the maximum vertical cord-free pool was < 2 cm . The placenta was considered mature if the Grannum grade was II or III . The head circumference (HC)/abdominal circumference ( AC ) ratio was considered abnormal if > 95th percentile for gestation . Fetal growth , amniotic fluid , biophysical profile score and umbilical artery Doppler  were used to advise the referring obstetrician about fetal well-being and he/she independently decided both the timing and mode of delivery . RESULTS Forty-seven fetuses fulfilled the entry criteria . Thirty-four ( 72 % ) demonstrated normal umbilical artery Doppler waveforms . Sixteen ( 34 % ) demonstrated middle cerebral artery redistribution , of which nine ( 56 % ) had normal umbilical artery Doppler waveforms . MCA blood flow redistribution was associated with an increased incidence of cesarean delivery and need for neonatal admission . Of all gray-scale parameters , an elevated HC/AC ratio has the strongest association with MCA blood flow redistribution ( 15/16 vs. 1/31 ; P < 0.01 ) . CONCLUSIONS MCA Doppler may be a useful tool to assess the health of small fetuses in the late third trimester . Redistribution may occur in the presence of normal umbilical artery Doppler and should be suspected when the HC/AC ratio is elevated
The evidence available from r and omised controlled trials suggested that delaying the introduction of progressive enteral feeds beyond four days after birth did not reduce the risk of developing NEC in very preterm or VLBW infants , including growth-restricted infants .
Delaying the introduction of progressive enteral feeds result ed in a few days ' delay in establishing full enteral feeds but the clinical importance of this effect was unclear .
BACKGROUND The introduction of enteral feeds for very preterm ( less than 32 weeks ' gestation ) or very low birth weight ( VLBW ; less than 1500 g ) infants is often delayed for several days or longer after birth due to concern that early introduction may not be tolerated and may increase the risk of necrotising enterocolitis ( NEC ) .
However , delaying enteral feeding could diminish the functional adaptation of the gastrointestinal tract and prolong the need for parenteral nutrition with its attendant infectious and metabolic risks .
OBJECTIVES To determine the effect of delayed introduction of progressive enteral feeds on the incidence of NEC , mortality and other morbidities in very preterm or VLBW infants .