Early feed initiation for very preterm infants
The SIFT study began enteral feeding on day 4, after which full enteral feeds were reached over an average of 7 days in the fast group and 11 days in the slow group.(Dorling et al. 2019) Behnke et al began enteral feeds on the first day. Traditionally, neonatal enteral nutrition has been guided by a “fear of feeding”. Since enteral nutrition is a risk factor for NEC, the historical clinical approach was to ensure each day that a preterm infant was “safe” to be fed. However, this practice leads to periods with no enteral intake which differs from the fetal experience in which the gut is continuously exposed to amniotic fluid. This lack of amniotic fluid for the preterm infant impacts gut and immunoregulatory development, and this injury is at least partially ameliorated by feeding human milk bioactives. The potential harm of not feeding preterm infants in the first postnatal days suggests neonatal care should consider a move from a “fear of feeding” to a “fear of not feeding”, and this evolution is supported by the feed tolerance exhibited in the Behnke et al study and others.(Hamilton et al. 2014) Longer duration of parenteral nutrition has also been associated with altered body composition at term corrected age. (Alja’nini et al. 2021) Regardless of the route of nutrient delivery in the early postnatal days, adequate and balanced early nutritional support is key avoid nutrient deficiencies and optimize neurodevelopmental outcomes.