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 .
Feeding strategies for premature infants: randomized trial of gastrointestinal priming and tube-feeding method.
BACKGROUND Data on enteral feeding management of premature infants are limited and often not the subject of r and omized clinical trials . Several small studies suggest benefits from the early initiation of feeding , but do not assess the combined effects of time of initiation of feeding , tube-feeding method , and type of milk used . Either singly or in combination , these treatments may affect growth , bone mineralization , biochemical measures of nutritional status , and feeding tolerance , and , ultimately , the duration of hospitalization . METHODS A total of 171 premature infants , stratified by gestational age ( 26 to 30 weeks ) and diet ( human milk or preterm formula )  were assigned r and omly among four treatment combinations in a balanced two-way design comparing the presence or absence of gastrointestinal ( GI ) priming for 10 days and continuous infusion versus intermittent bolus tube-feeding . RESULTS The major outcome , time required for infants to attain full oral feeding , was similar among treatments . GI priming was not associated with any measured adverse effect and was associated with better calcium and phosphorus retention , higher serum calcium and alkaline phosphatase activity , and shorter intestinal transit times . The bolus tube-feeding method was associated with significantly less feeding intolerance and greater rate of weight gain than the continuous method . In addition , the greater the quantity of human milk fed , the lower the morbidity . CONCLUSIONS Early GI priming with human milk , using the bolus tube-feeding method , may provide the best advantage for the premature infant
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 .