The effects of early enteral feeding, fortification, and rapid feeding advancement in extremely low birth weight infants.

Abstract

Background: Preterm infants are at risk for necrotizing enterocolitis (NEC) and sepsis. Optimal strategies of preterm feeding to achieve full enteral feeding early with minimal duration of central lines without increasing the risk of NEC remain uncertain. We aimed to evaluate if new enteral feeding strategies reflecting early initiation, fortification, and more rapid advancement is beneficial without increasing the risk of NEC.

Methods: We performed a retrospective cohort study including 122 infants born with birth weight < 1000 g during Period 1 (old feeding protocol, n = 61) and Period 2 (new feeding protocol, n = 61) to compare the incidence of NEC, late-onset sepsis, the duration of central line, and the growth outcomes before and after the implementation of feeding strategies to reflect early initiation of feeding within 12 h of life, early fortification at 60 mL/kg/day, and more rapid feeding advancement up to 30 mL/kg/day.

Result: Median time to reach full enteral feeds was decreased from 9 to 6 days (p < 0.001). The duration of central venous catheters was also improved from median 7 to 5 days (p < 0.001). The incidence of NEC was not different (11.5 % in Period 1 vs. 8.2 % in Period 2, p = 0.54). 14 infants (23 %) had late-onset sepsis in Period 1 vs. 8 infants (13.1 %) in Period 2 (p = 0.16). The growth outcome was comparable between the two periods (p = 0.47).

Conclusion: Earlier initiation of enteral feeding and fortification, and more rapid advancement were safely introduced with significantly shorter duration of central lines without increasing the incidence of NEC.