title: A historic cohort study on accelerated advancement of enteral feeding volumes in very premature infants.
abstract: BACKGROUND
  The optimal rate of enteral feeding (EF) advancement in very low birth weight infants is under debate.
  
  
  OBJECTIVE
  To evaluate the effects of accelerated EF advancement on the time to full enteral feeds, on early postnatal growth as well as on the frequency of necrotizing enterocolitis (NEC) and focal intestinal perforation (FIP) in very premature infants.
  
  
  METHODS
  In a retrospective single-center historic cohort study, infants with a gestational age <32 weeks at birth and birth weight <1,500 g, born between January 1, 2006, and December 31, 2007 (n = 136), were compared with infants born between January 1, 2010, and December 31, 2010 (n = 88). In 2006/2007, enteral feeds were initiated on day 1 with 10-15 ml/kg/day and advanced by 15-20 ml/kg/day. In 2010, enteral feeds were initiated with 20 ml/kg/day on day 1 and advanced by 25-30 ml/kg/day. Full enteral feeds were defined as ≥ 140 ml/kg/day. Data are presented as median (P25-P75).
  
  
  RESULTS
  The time to establish full enteral feeds was shorter in 2010: 8 (7-11) days in 2006/2007 versus 6 (5-9) days in 2010. The incidences of NEC and FIP were 2.7 and 4.1% in 2006/2007 and 3.3 and 2.2% in 2010, respectively. Weight gain was not affected by the rate of EF advancement. Higher parenteral protein intake during week 1 in 2006/2007 was associated with better head circumference growth.
  
  
  CONCLUSIONS
  The new approach was associated with a significantly shorter period to establish full enteral feeds. No difference in the incidence of FIP or NEC was observed; however, the study was underpowered to detect small but possibly important differences.
authors.affiliation: Department of Neonatology, University Children's Hospital Tübingen, Tübingen, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Maas
authors.forename: S
authors.initials: S
authors.lastname: Mitt
authors.forename: A
authors.initials: A
authors.lastname: Full
authors.forename: J
authors.initials: J
authors.lastname: Arand
authors.forename: W
authors.initials: W
authors.lastname: Bernhard
authors.forename: C F
authors.initials: CF
authors.lastname: Poets
authors.forename: A R
authors.initials: AR
authors.lastname: Franz
mesh_terms: D000054:Acceleration; D002657:Child Development / Q000502:physiology; D015331:Cohort Studies; D004750:Enteral Nutrition / Q000379:methods*; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn / Q000254:growth & development; D007234:Infant, Premature / Q000254:growth & development / Q000502:physiology; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D019102:Infant, Very Low Birth Weight / Q000254:growth & development / Q000502:physiology; D008297:Male; D062407:Meals / Q000502:physiology; D012189:Retrospective Studies