Introduction: Enteral feeding with breast milk offers nutritional and trophic benefits to the extremely low birthweight (ELBW) infant. The timing of the introduction of enteral nutrition to ELBW infants remains controversial because of concerns relating to intestinal immaturity and the risk of necrotising enterocolitis (NEC), although some epidemiological data support breast milk having a protective role. Different studies however quote different rates for the incidence of gastrointestinal (GI) complications in this population.

Aims: To define the incidence of acute GI complications in a population of ELBW managed on a neonatal intensive care unit with a policy of early introduction of enteral nutrition using expressed maternal breast milk.

Methods: We retrospectively reviewed the case records of infants < 1000g birthweight admitted to the neonatal intensive care unit at the Homerton Hospital from 1/1/1992 to 31/12/96 inclusive. Demographic data on each infant were recorded, the timing of initial enteral feeds, type of feed and time to full feeds documented. Babies with acute complications were grouped into those with intestinal perforation and those with NEC subdivided into proven or suspected on the basis of intramural gas on abdominal x-ray.

Results: We identified 238 infants and obtained case records for 196 (82.3%). Mean birthweight was 768.3±134g (range 470-990g) and mean gestation was 25.9±2.1 weeks (range 22-32 weeks). Survival to discharge from our unit was 101/196 (51.5%). Enteral feeds were introduced in 129/196 (66%) at a median time of 4 days (range 1-31 days), full enteral feedings were achieved in 107/129 (87.6%) infants. Maternal milk was the initial feed in 113/129 (87.6%) of infants and at discharge 43% continued to receive some feeds as breast milk. Acute complications were identified in 28/196(14.3%) of the infants, 12 with suspected NEC, 4 with proven NEC and 12 with intestinal perforations.

Conclusion: In this ELBW population the policy of early introduction of maternal breast milk has been successful but serious GI complications remain an important cause of morbidity.