title: Two-hourly versus 3-hourly feeding for very low birthweight infants: a randomised controlled trial Early versus Late Enteral Feeding in Preterm Intrauterine Growth Restricted Neonates with Antenatal Doppler Abnormalities: An Open-Label Randomized Trial Prolonging small feeding volumes early in life decreases the incidence of necrotizing enterocolitis in very low birth weight infants. Randomized Controlled Trial on Effect of Intermittent Early Versus Late Kangaroo Mother Care on Human Milk Feeding in Low-Birth-Weight Neonates Does necrotising enterocolitis impact the neurodevelopmental and growth outcomes in preterm infants with birthweight < or =1250 g? The Speed of Increasing milk Feeds: a randomised controlled trial Early enteral feeding and nosocomial sepsis in very low birthweight infants Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection. Continuous feeding promotes gastrointestinal tolerance and growth in very low birth weight infants. Breast milk and neonatal necrotising enterocolitis Does the Enteral Feeding Advancement Affect Short-term Outcomes in Very Low Birth Weight Infants? 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 Comparison of fast- and slow-feeding rate schedules to the development of necrotizing enterocolitis. National Institute of Child Health and Human Development Randomized, Controlled Trial of Slow Versus Rapid Feeding Volume Advancement in Preterm Infants The significance of gastric residuals in the early enteral feeding advancement of extremely low birth weight infants. Randomized trial of "slow" versus "fast" feed advancements on the incidence of necrotizing enterocolitis in very low birth weight infants. Predischarge morbidities in extremely and very low-birth-weight infants in Spanish neonatal units. Randomized controlled trial of slow vs rapid enteral feeding advancements on the clinical outcomes of preterm infants with birth weight 750-1250 g. Slow versus fast enteral feed advancement in very low birth weight infants: a randomized control trial.
abstract: Objective To determine whether feeding with 2-hourly or 3-hourly feeding interval reduces the time to achieve full enteral feeding and to compare their outcome in very low birthweight preterm infants . Design Parallel-group r and omised controlled trial with a 1:1 allocation ratio . Setting Two regional tertiary neonatal intensive care units . Patients 150 preterm infants less than 35 weeks gestation with birth weight between 1.0 and 1.5 kg were recruited . Interventions Infants were enrolled to either 2-hourly or 3-hourly interval feeding after r and omisation . Blinding was not possible due to the nature of the intervention . Main outcome measures The primary outcome was time to achieve full enteral feeding ( ≥100 mL/kg/day ) . Secondary outcomes include time to regain birth weight , episode of feeding intolerance , peak serum bilirubin levels , duration of phototherapy , episode of necrotising enterocolitis , nosocomial sepsis and gastro-oesophageal reflux . Results 72 infants were available for primary outcome analysis in each group as three were excluded due to death — three deaths in each group . The mean time to full enteral feeding was 11.3 days in the 3-hourly group and 10.2 days in the 2-hourly group ( mean difference 1.1 days ; 95 % CI −0.4 to 2.5 ; p=0.14 ) . The mean time to regain birth weight was shorter in 3-hourly group ( 12.9 vs 14.8 days , p=0.04 ) . Other subgroup analyses did not reveal additional significant results . No difference in adverse events was found between the groups . Conclusion 3-hourly feeding was comparable with 2-hourly feeding to achieve full enteral feeding without any evidence of increased adverse events . Trial registration number ACTRN12611000676910 , pre- result 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 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 : Breastfeeding at discharge among sick low-birth-weight ( LBW ) infants is low despite counseling and intervention like kangaroo mother care ( KMC ) . Research aim : The aim was to study the effects of early initiation of KMC on exclusive human milk feeding , growth , mortality , and morbidities in LBW neonates compared with late initiation of KMC during the hospital stay and postdischarge . Methods : A r and omized controlled trial was conducted in level 2 and 3 areas of a tertiary care neonatal unit over 15 months . Inborn neonates weighing 1 to 1.8 kg and hemodynamically stable were r and omized to receive either  early KMC , initiated within the first 4 days of life , or late KMC ( off respiratory support and intravenous fluids ) . Follow-up was until 1 month postdischarge . Outcomes were proportion of infants achieving exclusive human milk feeding and direct breastfeeding , growth , mortality and morbidities during hospital stay , and postdischarge feeding and KMC practice s until 1 month . Results : The early  KMC  group ( n = 80 ) achieved significantly higher exclusive human milk feeding ( 86 % vs. 45 % , p < .001 ) and direct breastfeeding ( 49 % vs. 30 % , p = .021 ) in hospital and almost exclusive human milk feeding ( 73 % vs. 36 % , p < .001 ) until 1 month postdischarge than the late KMC group ( n = 80 ) . The incidence of apnea ( 11.9 % vs. 20 % , p = .027 ) and recurrent apnea requiring ventilation ( 8.8 % vs. 15 % , p = .02 ) were significantly reduced in the early KMC group . There was no significant difference in mortality , morbidities , and growth during the hospital stay and postdischarge . Conclusion : Early KMC significantly increased exclusive human milk feeding and direct breastfeeding in LBW infants AIM To compare the long-term growth and neurodevelopmental outcomes at 36 months adjusted age in preterm infants ( birthweight ( BW ) < or = 1250 g ) with necrotising enterocolitis ( NEC ) with BW-matched controls . METHODS This is a case control study performed at a regional tertiary care neonatal intensive care unit . Infants with stage II or III NEC admitted to a regional tertiary care neonatal unit between 1995 and 2000 were identified . Each infant with NEC was matched by BW ( + /-100 g ) to next two infants admitted in the unit without NEC . Growth and neurodevelopmental outcomes at 36 months are compared . RESULTS In total , 51 infants with NEC and 102 controls met study eligibility criteria and 146/153 ( 94.3 % ) were prospect ively followed for 36 months . Infants with NEC had more culture-proven sepsis ( 35.3 % vs. 10.8 % , P < 0.001 ) ; patent ductus arteriosus requiring therapy ( 64.7 % vs. 45 % , P = 0.02 ) , chronic lung disease ( 60.7 % vs. 45 % , P = 0.04 ) and longer hospital stay ( 84 days vs. 71 days , P < 0.0001 ) . There were no significant differences in growth outcomes between the two groups at 36 months . Overall 24 % of infants with NEC had one major neurodevelopmental disability compared with 10 % among control infants . Infants who developed NEC had significantly higher cognitive delay ( i.e. cognitive index < 70 ) and visual impairment . A logistic regression model identified NEC as a predictor of cognitive delay . CONCLUSION Preterm infants who develop NEC are at a significantly higher risk for developing neurodevelopmental disability . We recommend close neurodevelopmental follow up for all < or = 1250 g infants who develop stage II or III NEC 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 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 CONTEXT Neonatal infections are frequent complications of extremely low-birth-weight ( ELBW ) infants receiving intensive care . OBJECTIVE To determine if neonatal infections in ELBW infants are associated with increased risks of adverse neurodevelopmental and growth sequelae in early childhood . DESIGN , SETTING , AND PARTICIPANTS Infants weighing 401 to 1000 g at birth ( born in 1993 - 2001 ) were enrolled in a prospect ively collected very low-birth-weight registry at academic medical centers participating in the National Institute of Child Health and Human Development Neonatal Research Network .  Neurodevelopmental and growth outcomes were assessed at a comprehensive follow-up visit at 18 to 22 months of corrected gestational age and compared by infection group . Eighty percent of survivors completed the follow-up visit and 6093 infants were studied . Registry data were used to classify infants by type of infection : uninfected ( n = 2161 ) , clinical infection alone ( n = 1538 ) , sepsis ( n = 1922 ) , sepsis and necrotizing enterocolitis ( n = 279 ) , or meningitis with or without sepsis ( n = 193 ) . MAIN OUTCOME MEASURES Cognitive and neuromotor development , neurologic status , vision and hearing , and growth ( weight , length , and head circumference ) were assessed at follow-up . RESULTS The majority of ELBW survivors ( 65 % ) had at least 1 infection during their hospitalization after birth . Compared with uninfected infants , those in each of the 4 infection groups were significantly more likely to have adverse neurodevelopmental outcomes at follow-up , including cerebral palsy ( range of significant odds ratios [ ORs ] , 1.4 - 1.7 ) , low Bayley Scales of Infant Development II scores on the mental development index ( ORs , 1.3 - 1.6 ) and psychomotor development index ( ORs , 1.5 - 2.4 ) , and vision impairment ( ORs , 1.3 - 2.2 ) . Infection in the neonatal period was also associated with impaired head growth , a known predictor of poor neurodevelopmental outcome . CONCLUSIONS This large cohort study suggests that neonatal infections among ELBW infants are associated with poor neurodevelopmental and growth outcomes in early childhood . Additional studies are needed to eluci date the pathogenesis of brain injury in infants with infection so that novel interventions to improve these outcomes can be explored OBJECTIVE To compare the effects of continuous versus intermittent feeding on gastrointestinal tolerance and growth in very low birth weight ( VLBW ) infants . STUDY DESIGN In a r and omized , controlled trial conducted at 3 neonatal units , 70 premature infants with a gestational age 24 to 29 weeks and birth weight < 1200 g were assigned to 1 of 3 feeding methods : continuous nasogastric feeding , intermittent nasogastric feeding , or intermittent orogastric feeding . Feeding was initiated within 30 hours of birth . Daily enteral and parenteral volumes , caloric and protein intakes , growth , enteral intolerance , and clinical complications were recorded . Cox regression analysis was used to determine primary outcome , the time to achieve full enteral feeding . RESULTS The continuously fed infants achieved full enteral feeding significantly faster than the intermittently fed infants ( hazard ratio [ HR ] = 1.86 ; 95 % confidence interval [ CI ] = 1.07 to 3.22 ) . In stratified analysis according to birth weight , the improvement was even more pronounced in the smallest infants , those with birth weight < or = 850 g ( adjusted HR = 4.13 ; 95 % CI = 1.48 to 11.53 ) . Growth rate was significantly faster in the continuously fed infants ( P = .002 ) . CONCLUSION In VLBW infants , continuous feeding seems to be better than intermittent feeding with regard to gastrointestinal tolerance and growth In a prospect i ve multicentre study on 926 preterm infants formally assigned to their early diet , necrotising enterocolitis developed in 51 ( 5.5 % ) .  Mortality was 26 % in stringently confirmed cases . In exclusively  formula-fed  babies confirmed disease was 6 - 10 times more common than in those fed breast milk alone and 3 times more common than in those who received formula plus breast milk . Pasteurised donor milk seemed to be as protective as raw maternal milk . Among babies born at more than 30 weeks ' gestation confirmed necrotising enterocolitis was rare in those whose diet included breast milk ; it was 20 times more common in those fed formula only . Other risk factors included very low  gestational age , respiratory disease , umbilical artery catheterisation , and polycythaemia . In formula-fed but not breast-milk-fed infants , delayed enteral feeding was associated with a lower frequency of necrotising enterocolitis . With the fall in the use of breast milk in British neonatal units , exclusive formula feeding could account for an estimated 500 extra cases of necrotising enterocolitis each year . About 100 of these infants would die 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 : 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 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 The National Institute of Child Health and Human Development conducts and supports research on all stages of human development from preconception to adulthood in order to better underst and the health of children , youths , adults , families , and communities . Health and human development information is made easily available on the site with a simple A to Z list , along with clinical trials and health education campaign information . Links to clinical trials , news releases , publications , and related web sites are also available , as well as information on research being conducted at present and supported by the National Institute of Child Health and Human Development 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 OBJECTIVE To evaluate whether the mean gastric residual volume ( GRV ) and green gastric residuals ( GR ) themselves are significant predictors of feeding intolerance in the early enteral feeding advancement in extremely low birth weight ( ELBW ; < 1000 g ) infants . DESIGN Ninety-nine ELBW infants were fed following a st and ardized protocol ( day 3 - -14 ) . At 48 hours of age , milk feeding was started ( 12 mL/kg/d increments , 12 meals per day ) . GR were checked before each feeding , and a GRV up to 2 mL/3 mL in infants less-than-or-equal750 g/>750 g was tolerated . In cases of increased GRV , feedings were reduced or withheld . The color of GR was assessed as clear , milky , green-clear , green-cloudy , blood-stained , or hemorrhagic . Multiple regression analysis was used to study the effect of the mean GRV and the color of GR on the feeding volume on day 14 ( V14 ) . RESULTS The median V14 was 103 mL/kg/d ( 0 - -166 ) . V14 increased with an increasing percentage of milky GR , whereas the mean GRV and the color green did not have a significant effect . CONCLUSIONS 1 ) Early enteral feeding could be established in ELBW infants . The critical GRV seems to be above 2 mL/3 mL because there was no significant negative correlation between the mean GRV and V14 . 2 ) Green GR were not negatively correlated with V14 and should not slow down the advancement of feeding volumes in absence of other clinical signs and symptoms 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 We sought to describe neonatal morbidities and therapeutic interventions in very low-birth-weight ( VLBW ) and extremely low-birth-weight ( ELBW ) infants cared for in Spanish hospitals . We preformed a prospect i ve collection of data covering the perinatal period until discharge by the SEN1500 network . This network , set up by the Spanish Society of Neonatology , targets VLBW and ELBW infants ( 400 to 1500 g ) admitted to neonatal units in Spanish hospitals . Data were recorded in electronic form and controlled for possible errors or inconsistencies before analysis . We report data for 8836 neonates admitted to 48 neonatal units from January 2002 to December 2005 .  Prenatal steroids were given to significantly more newborns in 2003 to 2005 ( 79.4 % ) than in 2002 ( 73.4 % ) , although the remaining perinatal data examined failed to significantly vary . Delivery was by cesarean section in 69.8 % of cases but significantly lower ( 35.9 % ) for infants under a postmenstrual age of 26 weeks . Hyaline membrane disease was diagnosed in 53.9 % of the newborns and bronchopulmonary dysplasia ( BPD ) in 10.46 % .  Mechanical ventilation  was employed in 69.1 % , surfactant in 50.3 % , and steroids for BPD in 5.3 % . Intraventricular hemorrhage grade s 3 to 4 ( 8.1 % ) and cystic leukomalacia ( 2.6 % ) were the most relevant brain ultrasonography findings . Rates of early- and late-onset septicemia were 5 % and 29.4 % , respectively . Further diagnoses were necrotizing enterocolitis ( NEC ; 6.9 % ) and persistent ductus arteriosus ( PDA ; 24.2 % ) ; 40.6 % of the cases of NEC and 15.3 % of those of PDA required surgery . In addition , 26.6 % of the newborns required supplementary oxygen at 28 days of life . The number of newborns who had not recovered their birth weight at this age fell from 3.1 % in 2002 to 1.5 % in 2005 . Rates of prenatal steroid use , cesarean delivery , and main morbidities were comparable to figures cited for other patient series , although our BPD rate was among the lowest reported and nosocomial sepsis rate among the highest 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 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
target: 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: 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 .