Feeding intolerance in premature infants may be an early sign of necrotizing enterocolitis (NEC), sepsis, or other serious conditions, or may result from immature gastrointestinal function. We sought to characterize more fully the incidence and presentation of this abnormality, and its association with pathologic conditions. We reviewed the records of all 42 infants of gestational age (GA) 24-29 weeks admitted to our NICU during a two month period. All infants were inborn and all initially required mechanical ventilation. Feeds were generally started on day 3-7, and interrupted for 3-48 hours if signs of feeding intolerance were observed. Three infants died before starting feeds. Each surviving infant's course was reviewed for episodes of interrupted feeds (IF) before reaching full volume feedings (150 ml/kg/d), the reasons for IF, and the day full feeds was reached.Table

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Feeds were interrupted for gastric residuals (22), visible bowel loops(34), increased abdominal girth (41), bilious aspirates (13), vomiting (1), and heme-positive stool or gastric residual (21). Feedings were also stopped for respiratory distress (24), or for symptomatic patent ductus arteriosus(16). Two infants had NEC, and 1 had malrotation. All infants less than 29 weeks gestation had feeding intolerance leading to interruption of feeds. Surveillance for pathologic conditions is needed, but common manifestations of feeding intolerance, such as delayed gastric emptying or diminished intestinal motility, suggest the potential for therapeutic intervention.