Delayed introduction of progressive enteral feeds to prevent necrotising enterocolitis in very low birth weight infants

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There is evidence from randomised controlled trials (RCTs) suggesting that delayed introduction of progressive feeding beyond four days after birth is not associated with increased risk of developing necrotising enterocolitis in very preterm, very low birth weight infants and growth restricted infants. However, delaying the introduction of progressive enteral feeds results in the delay of establishing full enteral feeds although the clinical importance of this is still uncertain. 

The introduction of enteral feeds for very preterm (< 32 weeks) or very low birth weight (< 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.  However, delayed enteral feeding may be associated with diminished gastrointestinal functional adaptation thus increasing the need for prolonged parenteral feeding with its health associated problems. The aim of this review was to determine the effect of delayed introduction of progressive enteral feeds on the incidence of necrotising enterocolitis, mortality and other morbidities in very preterm or very low birth weight infants.

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