Advancement of enteral feeding in very-low-birth-weight infants: Global issues and challenges

Authors: PEREZ, KRYSTLE - University Of Washington; VALENTINE, GREGORY - University Of Washington; NANGIA, SUSHMA - Lady Hardinge Medical College & Associated Ssk & Ksc Hospitals; Burrin, Douglas - Doug; MAHESHWARI, AKHIL - Global Newborn Society; ABAYNEH, MAHLET - St Paul’s Hospital Millennium Medical College; WORKNEH, REDEAT - St Paul’s Hospital Millennium Medical College; JEROME, MAGGIE - University Of Alabama At Birmingham; DINERSTEIN, ALEJANDRO - Ramon Sarda Maternal And Infant Hospital; SALAS, ARIEL - University Of Alabama At Birmingham

Submitted to: Newborn
Publication Type: Review Article
Publication Acceptance Date: 9/15/2022
Publication Date: 10/7/2022
Citation: Perez, K., Valentine, G.C., Nangia, S., Burrin, D.G., Maheshwari, A., Abayneh, M., Workneh, R., Jerome, M., Dinerstein, A., Salas, A. 2022. Advancement of enteral feeding in very-low-birth-weight infants: Global issues and challenges. Newborn. https://doi.org/10.5005/jp-journals-11002-0038.
DOI: https://doi.org/10.5005/jp-journals-11002-0038

Interpretive Summary:

Technical 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 high-resource settings is critical to inform optimal feeding strategies of VLBW infants globally.