A multicenter retrospective study revealed that the risk of necrotizing enterocolitis (NEC) is increased when full feedings are achieved within four days of initiation of feedings (Pediatr Res 33:313A, 1993). To examine the effect of the rate of feeding advancement on the incidence of NEC, 173 infants with birth weight 501 - 1500 gm and gestational age ≤ 34 weeks were randomized (stratified into four birth weight groups). Exclusion criteria were: Apgar scores < 3 at 5 minutes, life threatening malformation, polycythemia, exchange transfusion, and breast milk feeding. Following the decision by the clinical team to initiate feedings, randomization was performed to two groups: Slow feeders (Slow, n = 90) received 15 cc/kg/day increments (full feedings within 9-10 days) and fast feeders (Fast, n = 83) received 35 cc/kg/day increments (full feedings within 4-5 days). Feedings(Similac Special Care 20) were started on day 6±4 in both groups. Feedings were increased only if well tolerated (residuals < 20%). Birth weight (Slow 1075 ± 268 vs. Fast 1112 ± 257 gm), gestational age(Slow 29 ± 2 vs. Fast 29 ± 2 weeks), gender, race, and prenatal steroid use were comparable in both groups. The incidences of NEC (Bell ≥ II) and NEC with perforation did not differ between the two groups (Table). Postnatal age at full feedings and to regain birth weight were less in the Fast group (M±SD).

Table 1
Full size table

There was no difference in mortality. We conclude that a two-fold difference in the feeding advancement rate in the ranges tested does not affect the incidence of NEC.