INSTITUTION OF ENTERAL FEEDINGS ON THE FI RST DAY OF LIFE INCREASES FEEDING TOLERANCE IN VERY-LOW-BIRTH-WEIGHT INFANTS

Background: Early institution of enteral feedings in very low birth we ight infants is still controversial, since early enteral feedings have been associated with necrotizing enterocolitis. Methods: We compared retrospectively the clinical data, the total and enteral fluid intake, the total and enterally received calories in 180 very low birth weigh t infants (birth weight less than or equal to 1500 g, gestational age mostly less than or equal to 30 weeks). Group A consisted of 85 infant s, who started on hydrolysate formula feeds on day 1, group B of 95 in fants, who started on formula feed on day 2 or later when stable. Both groups received breastmilk when available. Results: Apgar scores, ges tational age (group A: 27 +/- 2; group B: 28 +/- 2), birth weight (gro up A: 978 +/- 230; group B: 1035 +/- 490), percent of ventilated infan ts and incidence of patent Ductus arteriosus were similar, Group A ach ieved full enteral feedings on day 16 +/- 8, whereas group B on day 27 +/- 15 (P < 0.0001). Total fluids and calories received were not sign ificantly different but group A received significantly more calories e nterally through the entire study period (P < 0.009). The incidence of necrotizing enterocolitis was similar (group A: 7 (8%) cases; group B : 10 (11%) cases). Conclusion: VLBW infants can start on enteral feedi ngs on the first day of life without increased incidence of necrotizin g enterocolitis. Starting with small enteral feedings on the first day of life will increase subsequent feeding tolerance and achieve full e nteral intake earlier.