Even though it is recognized that early enteral feeding is beneficial, there is still hesitation to begin feedings in the early days following birth. One of the strategies that has been extensively studied since the late 1980s is trophic feeding, also referred to as minimal enteral nutrition or gut priming. This method involves giving the infant small volumes of feedings, approximately 10-20 ml kg-1 day-1, for a period of 10-14 days before advancing to full enteral feedings. The benefits found are greater energy intake, earlier attainment of full enteral feedings, improved growth, less PN-related complications, reduced risk of infection, and earlier hospital discharge. Furthermore, infants who received trophic feedings had no increased incidence of NEC. Many clinicians have adapted variations of this practice, some with a shortened period of trophic feeds, others reserving this practice for the smallest, most preterm infants while employing advancement of feeds in larger, more stable infants. Once minimal enteral nutrition has been established and the infant is stable enough to advance feedings, it is generally considered a safe practice to increase feedings by 20 ml kg-1 day-1 while using PN for the balance of intake until an adequate enteral intake has been established and tolerated. Although fast feeding advancement has been associated with NEC, one study has shown no increase in the incidence of NEC amongst preterm infants whose feeds were advanced by 35 ml kg-1 day-1.
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