Impact of a slow feeding advancement protocol on necrotizing enterocolitis incidence in preterm infants: A before-and-after study
In brief
Slower feeding advancement reduces NEC to 2% versus 8% with faster feeds
In a single-center before-after study of 572 very low birth weight infants, a weight-dependent protocol advancing feeds every 48 hours lowered necrotizing enterocolitis from 7.9% to 2.1% without raising mortality, late-onset sepsis, catheter duration or growth restriction, although full feeds were achieved later. The result supports a more cautious feed schedule, but confirmation in larger multicenter trials is required.
- Journal
- Journal of pediatric gastroenterology and nutrition (Q1)
- Published
- 1 September 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Samuele Caruggi, Andrea Calandrino, Marcella Battaglini, Francesca Baudi, Barbara Lionetti, Federica Mongelli, et al.
- PMID
- 42681858
- DOI
- 10.1002/jpn3.70559
Why clinicians should know about it
- Picked for Neonatology (paper of the day, 6 September 2026): Slower feeding reduced NEC incidence
Abstract
Necrotizing enterocolitis (NEC) remains a major cause of morbidity and mortality in very low birth weight infants, while the safest rate of enteral feed advancement remains debated. We performed a retrospective single-center before-after cohort study in a tertiary neonatal intensive care unit, comparing two feeding strategies in 572 infants (286 per group): faster advancement (20-30 mL/kg/day) from 2015-2018 and slower advancement (10-25 mL/kg every 48 h, weight-dependent) from 2020-2023. The primary outcome was NEC, defined as Bell stage ≥IIb or diagnosis at surgery. NEC was less frequent in the slower-advancement era (2.1% vs 7.9%; adjusted p = 0.02). Mortality, late-onset sepsis, central venous catheter duration, and extrauterine growth restriction were similar. Faster advancement led to earlier full enteral feeding, while discharge weight centiles were comparable. A cautious feeding strategy was associated with lower NEC incidence without evidence of worse infectious or growth outcomes.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.