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 infants below 29 weeks’ gestation with abnormal antenatal Doppler: analysis from a randomised trial
Objective To describe feeding and gastrointestinal outcomes in growth-restricted infants < 29 weeks ’ gestation and to determine the rate of feed advancement which they tolerate . Design Analysis of prospect ively collected data from a r and omised feeding trial , the Abnormal Doppler Enteral Prescription Trial ( ADEPT ) . Setting 54 neonatal units in the UK and Irel and . Participants 404 preterm , growth-restricted infants with abnormal antenatal Doppler studies from ADEPT . 83 infants < 29 weeks and 312 infants ≥29 weeks ’ gestation were included in this analysis . Interventions In ADEPT , infants were r and omised to start milk ‘ early ’ on day 2 after birth , or ‘ late ’ on day 6 . Subsequent feed advancement followed a regimen , which should have achieved full feeds by day 16 in the early and day 20 in the late group . Main outcome measures Full feeds were achieved later in infants < 29 weeks ; median age 28 days { IQR 22–40 } compared with 19 days { IQR 17–23 } in infants ≥29 weeks ( HR 0.35 , 95 % CI 0.3 to 0.5 ) . The incidence of necrotising enterocolitis was also higher in this group ; 32/83 ( 39 % ) compared to 32/312 ( 10 % ) in those ≥29 weeks ( RR 3.7 , 95 % CI 2.4 to 5.7 ) . Infants < 29 weeks tolerated very little milk for the first 10 days of life and reached full feeds 9 days later than predicted from the trial regimen . Conclusions Growth-restricted infants born < 29 weeks ’ gestation with abnormal antenatal Doppler failed to tolerate even the careful feeding regimen of ADEPT . A slower advancement of feeds may be required for these infants . Trial registration number IS RCT N87351483
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 .