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Dilemmas in initiation of very preterm infant enteral feeds—when, what, how?

Journal of Perinatology volume 43, pages 108–113 (2023)Cite this article

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Abstract

With limited clinical evidence available to guide common nutritional decisions, significant variation exists in approaches to enteral feeding for very preterm infants, specifically when feedings are initiated, what is fed, and the method used for feedings. Preclinical studies have highlighted the benefits associated with avoiding nil per os and providing early-stage mother’s own milk or colostrum. However, these recommended approaches are often mutually exclusive due to the delays in lactation associated with very preterm delivery, resulting in uncertainty regarding which approach should be prioritized. Few studies have evaluated feeding frequency in preterm infants, with limited generalizability to extremely preterm infants. Therefore, even evidence-based approaches to very preterm infant feed initiation can differ. Future research is needed to identify optimal strategies for enteral nutrition in very preterm infants, but, until then, evidence-informed approaches may vary depending on each neonatal intensive care unit’s assessment of risk and benefit.

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Fig. 1: Effects of Colostrum vs NPO on the very preterm infant’s gastrointestinal tract.

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Authors and Affiliations

  1. Department of Pediatrics, Division of Neonatology, Rush University Medical Center, 1653 West Congress Parkway, Pavilion 354, Chicago, IL, USA

    Aloka L. Patel

  2. Department of Pediatrics, Division of Neonatology, Yale School of Medicine, 333 Cedar St., New Haven, CT, 06520-8064, USA

    Sarah N. Taylor

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ALP was responsible for the conception, design, drafting, and review of the manuscript, and approved the final version. SNT was responsible for the conception, design, drafting, and review of the manuscript, and approved the final version.

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Correspondence to Aloka L. Patel.

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ALP has no competing interests. SNT has received an honorarium from Astarte Medical and a consultation fee from Alcresta Therapeutics.

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Patel, A.L., Taylor, S.N. Dilemmas in initiation of very preterm infant enteral feeds—when, what, how?. J Perinatol 43, 108–113 (2023). https://doi.org/10.1038/s41372-022-01564-6

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