Early Exclusive Enteral Nutrition in Early Preterm Infants

Early nutritional support of preterm infants born at 30-33 weeks gestation is usually achieved via a combination of parenteral nutrition (PN) and enteral feeding that is advanced over few days to reach full enteral feed. Recent studies suggest that rapid increase of enteral feed volumes results in shorter duration on PN and earlier achievement of full enteral feed without increasing the risk of necrotizing enterocolitis (NEC) or death. Although PN has an important role in nutrition of preterm infants, it is associated with increased risk of metabolic and infectious complications even when it is used for a short period of time. Furthermore, PN mandates the need for peripheral or central intravenous access. Provision of full enteral feed volume that meets reference daily fluid intake from day of birth is used frequently and successfully in stable preterm infants born after 33 weeks. Expanding the use of this regimen to stable preterm infants born at 30-33 weeks gestation may help avoid unnecessary start of intravenous access, prevent complications related to PN, and encourage mother-infant bonding experience.

Inclusion criteria

• Preterm infants born at 30 0/7 - 33 6/7 weeks gestation
• Birth weight greater than 1000 g
• Consent to use donor human milk
• Postnatal age is less than 48 hours from birth
• Infant is ready to start on feeding (as per clinical team) or feeding volume, when already started, is ≤12 ml/kg per day (total) and/or the infant received ≤2 feeds based on current feeding policy or physician descrition (total volume of the received feeds is ≤20 ml/kg per day).

Exclusion criteria

• Cord PH < 7.00 or Cord base access (BE) < -16
• Apgar score < 7 at 5 minute
• Lactate level ≥3 (if done for clinical indication)
• Need for positive pressure ventilation (PPV) for >1 minute.
• Hemodynamic instability (hypotension or poor perfusion at any time in this 48 hours)
• Small for gestational age <3 percentile on Fenton chart and/or fetal absent or reversed umbilical arterial end-diastolic blood flow.
• Major congenital malformation
• Symptomatic or severe hypoglycemia (blood glucose <1.8 mmol/L)
• Infants with moderate to severe respiratory distress.