Authors
Embleton ND, Koletzko B, Fewtrell MS, Domellöf M, Gruszfeld D, van Goudoever H, McNulty A
Preterm infants and parents
Healthcare professionals, neonatal units, hospitals, and health services
Early enteral feeding is established, based on a standard protocol, preferably with mother’s own breast milk.
The goal is to provide an appropriate nutrient supply, support gut adaptation and health, and reduce the risk of growth faltering.
Early enteral feeds are an important component to establishing good nutrition, particularly with mother’s own breast milk (MOM) (see Nutrition). If MOM is not available then either donor human milk (DHM) or formula may be used. There are only limited data from high-quality trials to determine the exact day on which this should be started, but Cochrane reviews support the conclusion that enteral nutrition should be initiated within the first four days of life. (1–3) In high-risk groups there is no advantage to delaying the first feed to day six, compared to day two, while such delays increase the risk of regaining birthweight later and remaining dependant on parenteral supply for longer, with associated risks such as infections. (4) Therefore, recent recommendations advise to start minimal enteral feeding in very preterm infants as soon as possible after birth and no later than within 48 h of age. (5) When a supply of MOM has been established, e.g. at around day 2-3, the amounts of enteral feeds may be increased in stable preterm infants. Advancing the amount of enteral feeding by 30 ml/kg bodyweight is feasible, achieves full enteral feeding earlier and does not induce adverse effects when compared to slower increments. (6) Faster increases are associated with shorter duration of parenteral nutrition, with its associated risks, while no difference in long-term outcome was shown. (7) Feeding advancement at a daily rate of 18-30 ml/kg is advised for very low birthweight infants. (5) Routine gastric residual evaluation has no proven benefit but leads to a marked delay in reaching full enteral feedings and more catheter related infections. (8) The routine checking of gastric residuals is discouraged, and this should be incorporated into standardised feeding guidelines. (5)
For parents and family
A (Low quality)
B (High quality)
Patient information sheet1*
For healthcare professionals
A (Low quality)
B (High quality)
Guideline
B (High quality)
Training documentation
For neonatal unit
B (High quality)
Guideline
A (Low quality)
Audit report2
A (Low quality)
Audit report2
For hospital
B (High quality)
Training documentation
For health service
B (High quality)
Guideline
1The indicator ‘patient information sheet’ is an example for written, detailed information, in which digital solutions are included, such as web-based systems, apps, brochures, information leaflets, and booklets.
2The indicator ‘audit report’ can also be defined as a benchmarking report.
*The TEG Nutrition very much supports the need of good communication with families and regular sharing of key information, but it is not in favour of sharing information on each standard by a “parent information sheet”, which is the term chosen by the Chair Committee. In our view, sharing multiple parent information sheets bears the risk of overloading families with a plethora of written information during a stressful time period, which may not be very helpful. We suggest to consider other means of sharing information.
For parents and family
N/A
For healthcare professionals
N/A
For neonatal unit
N/A
For hospital
N/A
For health service
A (Low quality)
For parents and family
For healthcare professionals
For neonatal unit
For hospital
For health service
September 2022 / 2nd edition / previous edition reviewed by Schlößer R / next revision: 2025
Recommended citation
EFCNI, Embleton ND, Koletzko B et al., European Standards of Care for Newborn Health: Establishment of enteral feeding in preterm infants. 2022.
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