Enteral feeding in preterm newborns – determinants of progression

Abstract

Background: Delay in achieving full enteral feeding (FEF) in preterm newborns is associated with longer hospital stays and greater comorbidities. 

Methods: Medical records review of newborns with gestational age ≤ 32 weeks, born between July 2014 and June 2020. 

Results: 219 patients included, median gestational age – 31 weeks, median birth weight – 1,353 grams. 97% started enteral feeding (EF) in the first 72 hours of life. Substrates used were human milk in 27%, premature formula in 29% and mixed feeding in 49%. Median time of minimal EF – 3 days and to achieve FEF – 7 days. 69% of patients used parenteral nutrition (median time – 8 days). Median central line time – 8 days. Late-onset sepsis, apnea of prematurity, persistent ductus arteriosus, red blood cells transfusion and ventilatory support were associated with a longer time to achieve FEF. 

Conclusion: Our patients introduced EF within the recommended timeline, and early introduction was not associated with necrotizing enterocolitis or difficulties in enteral progression (EP). We reported less time to achieve FEF than other studies. Despite the fact that exclusive human milk was used by a minority of patients, we report higher numbers than other studies. Surprisingly the type of substrate had no impact on EP. Difficulties in EP happened in a minority of patients, and the main cause was feeding intolerance. Severely ill infants took a longer time to achieve FEF. It is important to create guidelines to minimize variability between Units.