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.