Early or Delayed Enteral Feeding for Preterm Growth-Restricted Infants: A Randomized Trial


Leaf A et al. – Early introduction of enteral feeds in growth–restricted preterm infants results in earlier achievement of full enteral feeding and does not appear to increase the risk of necrotizing enterocolitis (NEC).


  • Infants with gestation below 35 weeks, birth weight below the 10th centile, and abnormal antenatal umbilical artery Doppler waveforms were randomly allocated to commence enteral feeds “early,” on day 2 after birth, or “late,” on day 6.
  • Gradual increase in feeds was guided by a “feeding prescription” with rate of increase the same for both groups.
  • Primary outcomes were time to achieve full enteral feeding sustained for 72 hours and NEC.


  • Four hundred four infants were randomly assigned from 54 hospitals in the United Kingdom and Ireland (202 to each group).
  • Median gestation was 31 weeks. Full, sustained, enteral feeding was achieved at an earlier age in the early group: median age was 18 days compared with 21 days (hazard ratio: 1.36 [95% confidence interval: 1.11–1.67]).
  • There was no evidence of a difference in the incidence of NEC: 18% in the early group and 15% in the late group (relative risk: 1.2 [95% confidence interval: 0.77–1.87]). Early feeding resulted in shorter duration of parenteral nutrition and high-dependency care, lower incidence of cholestatic jaundice, and improved SD score for weight at discharge.

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