Advancement of Enteral Feeding in Very-low-birth-weight Infants: Global Issues and Challenges

Abstract

In very-low-birth-weight (VLBW) infants, the initiation of enteral feedings is frequently delayed and the feeding volumes are advanced very slowly. Clinicians often express concerns about gut immaturity and consequent increased risk of feeding intolerance, spontaneous intestinal perforation (SIP), and necrotizing enterocolitis (NEC). Late initiation and ultracautious advancement of enteral feedings are seen all over the world, despite known associations with a prolonged need for central venous access and increased risk of sepsis, which is one of the leading causes of neonatal mortality. Promoting early establishment of full enteral feeding, particularly when maternal or donor milk is available, can improve neonatal outcomes, particularly the incidence of central-line-associated bacterial infections, the length of hospital stay, and survival. This review highlights current evidence for maximizing enteral feeding strategies for VLBW infants in various settings. Specifically, we will outline the physiologic evidence for early and continued enteral feedings in VLBW infants, discuss considerations for the initiation and advancement of enteral feedings, and highlight future areas of research focused on these issues. Consideration for the evidence from low-as well as highresource settings is critical to inform optimal feeding strategies of VLBW infants globally.