Objective To evaluate the effect of slow versus rapid rates of advancement of enteral feed volumes upon the clinical outcomes in preterm infants with 750–1250g birth weight.

Study Design A total of 92 stable neonates with the birth weight 750–1250g and gestational age less than 32 weeks were randomly allocated to enteral feeding advancement of 20ml/kg/day (n=46) or 30ml/kg/day (n=46). The primary outcome was days to reach full enteral feeding defined as 180ml/kg/day. Secondary outcomes included rates of necrotizing enterocolitis and culture-proven sepsis, days of total parenteral nurition, length of hospital stay and growth end points.

Result Neonates in the rapid feeding advancement group achieved full enteral volume of feedings earlier than the slower advancement group. They received significantly fewer days of parenteral nutrition, exhibited a shorter time to regain birth weight and shorter duration of hospital stay. The incidence of NEC and the number of episodes of feeding intolerance were not significantly different between the groups while the incidence of culture-proven late onset sepsis was significantly less in infants receiving a rapid feeding advancement. Excluding infants who were small for gestational age at birth, the incidence of extrauterine growth restriction was significantly reduced in the rapid advancement group at 28 days and at hospital discharge.

Conclusion Rapid enteral feeding advancements in 750–1250g birth weight infants reduces the time to reach full enteral feeding and the use of TPN administration. Rapid advancement enteral feed also decreases extrauterine growth restriction with improved short-term outcomes for these high-risk infants.