Dilemmas in establishing preterm enteral feeding: where do we start and how fast do we go?

Growth and Neurodevelopmental Outcomes of Preterm Infants Born <26 weeks Gestation Before and After Implementation of a Nutrition Care Bundle

“…Conversely, we did not see a reduction in rates of late-onset sepsis as would have been expected. Achieving higher feed volume sooner in preterm infants is essential to reduce morbidities related to prolonged use of parenteral nutrition, especially line-related sepsis, increase benefits associated with the use of human milk (provides bioactive and immunomodulatory components such as enzymes, hormones, growth factors, probiotics, oligosaccharides, exosomes, stem cells) and to allow for earlier enteral nutrient additions to support growth and nutrient retention [31][32][33]. The timing of the addition of the HMF in preterm infants, particularly micro-preterm infants, is controversial.…”

Growth and Neurodevelopmental Outcomes of Preterm Infants Born < 26 Weeks Gestation before and after Implementation of a Nutrition-Care Bundle

“…Conversely, we did not see a reduction in rates of late-onset sepsis as would have been expected. Achieving higher feed volume sooner in preterm infants is essential to reduce morbidities related to prolonged use of parenteral nutrition, especially line-related sepsis, increase benefits associated with the use of human milk (provides bioactive and immunomodulatory components such as enzymes, hormones, growth factors, probiotics, oligosaccharides, exosomes, and stem cells), and to allow for earlier enteral nutrient additions to support growth and nutrient retention [31][32][33]. The timing of the addition of the HMF in preterm infants, particularly micro-preterm infants, is controversial.…”

The Impact of Estimated Energy and Protein Balances on Extrauterine Growth in Preterm Infants

“…Although the definition of EUGR indicating the negatively affected neonatal growth is considered a misnomer [ 53 ], discharge weight below the 10th percentile for age or drop in z-score > 1 SD are considered two acceptable definitions in the literature [ 54 ]. Obviously, new challenging standards are needed to be evaluated against currently used ones before they are implemented, and further studies should be conducted to evaluate the functional impact of such arbitrary cut-offs on long-term outcomes [ 4 , 55 ]. A recent large multicentre study reported a higher incidence of EUGR in non-SGA, extremely preterm infants compared with GAs > 28 weeks [ 56 ].…”

“…These infants are born with low stores of key-nutrients, have poor thermoregulation and frequently experience prematurity-associated morbidity such as respiratory distress syndrome and sepsis, all contributing to their high energy requirements. However, despite their structurally and functionally immature gut, which might slow feeding advancement and delay the time it takes to reach full feeds [ 2 , 3 ], many critically ill infants may receive enteral nutrition far before term-equivalent age [ 4 ].…”