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 .
Randomized, Controlled Trial of Slow Versus Rapid Feeding Volume Advancement in Preterm Infants
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
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 .