title: Does the enteral feeding advancement affect short-term outcomes in very low birth weight infants?
abstract: OBJECTIVE
  Controversy exists regarding the optimal enteral feeding regimen of very low birth weight infants (VLBW). Rapid advancement of enteral feeding has been associated with an increased rate of necrotizing enterocolitis. In contrast, delaying enteral feeding may have unfavorable effects on nutrition, growth, and neurodevelopment. The aim is to compare the short-term outcomes of VLBW infants in tertiary care centers according to their enteral feeding advancement.
  
  
  METHODS
  We prospectively studied the influence of center-specific enteral feeding advancement in 1430 VLBW infants recruited from 13 tertiary neonatal intensive care units in Germany on short-term outcome parameters. The centers were post hoc stratified to "rapid advancement to full enteral feeds" (median duration of advancement to full enteral feeds < or =12.5 days; 6 centers), that is, rapid advancement (RA), or "slow advancement to full enteral feeds" (median duration of advancement to full enteral feeds >12.5 days; 7 centers), that is, slow advancement (SA).
  
  
  RESULTS
  VLBW infants born in centers with SA (n = 713) had a significantly higher rate of sepsis compared with VLBW infants born in centers with RA (n = 717), which was particularly evident for late-onset sepsis (14.0% vs 20.4%; P = 0.002). Furthermore, more central venous lines (48.6% vs 31.1%, P < 0.001) and antibiotics (92.4% vs 77.7%, P < 0.001) were used in centers with SA.
  
  
  CONCLUSIONS
  Center differences in enteral feeding advancement occur and may have a significant impact on short-term outcomes such as nosocomial sepsis. Large, multicenter, prospective trials are required to further elucidate the optimal feeding strategy for VLBW infants.
authors.affiliation: Department of Pediatrics, University of Lübeck, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Härtel
authors.forename: Berit
authors.initials: B
authors.lastname: Haase
authors.forename: Kathryn
authors.initials: K
authors.lastname: Browning-Carmo
authors.forename: Corinna
authors.initials: C
authors.lastname: Gebauer
authors.forename: Evelyn
authors.initials: E
authors.lastname: Kattner
authors.forename: Angela
authors.initials: A
authors.lastname: Kribs
authors.forename: Hugo
authors.initials: H
authors.lastname: Segerer
authors.forename: Norbert
authors.initials: N
authors.lastname: Teig
authors.forename: Axel von der
authors.initials: Av
authors.lastname: Wense
authors.forename: Christian
authors.initials: C
authors.lastname: Wieg
authors.forename: Egbert
authors.initials: E
authors.lastname: Herting
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Göpel