title: Early enteral feeding in very low birth weight infants.
abstract: OBJECTIVE
  Debate exists about when to initiate enteral feeding (EF) in very low birth weight (VLBW) preterm infants. This retrospective study compared the effectiveness of an education-based quality improvement project and the relationship of time of the first EF to necrotizing enterocolitis (NEC) or death incidence and parenteral nutrition (PN) days in VLBW infants.
  VLBW infants born in 2 epochs were compared for hour of the first feed, PN days, NEC or death incidence, and feeding type. The 2 epochs were temporally divided by a quality improvement initiative to standardize initiation of EF in postnatal hours 6-24.
  
  
  RESULTS
  603 VLBW infants were included. Median time of feed initiation decreased from 33 (Epoch 1) to 14h (Epoch 2) (p<0.0001). Median PN days were 14 vs. 12, respectively (p=0.07). The incidence of NEC or death was 13.4% vs. 9.5%, respectively (p=0.14). When controlling for birth weight, gestational age, race, gender, and time period, earlier feed initiation was associated with decreased NEC or death (p=0.003). Evaluation of the relationship of early EF (defined as within the first 24h) in Epoch 2 alone showed that early EF was significantly associated with decreased NEC or death (6.3 vs 15.1%) (RR, 95% CI=0.28, 0.13-0.58) and less PN days (p<0.0001).
  
  
  CONCLUSIONS
  In a VLBW infant cohort, an education-based process improvement initiative decreased time of EF initiation to a median of 14h with no associated increase in NEC or death. In fact, results suggest that earlier feeding is associated with decreased NEC or death.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States. Electronic address: Emily8680@gmail.com.
authors.forename: Emily
authors.initials: E
authors.lastname: Hamilton
authors.affiliation: Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Massey
authors.affiliation: Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States.
authors.forename: Julie
authors.initials: J
authors.lastname: Ross
authors.affiliation: Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States.
authors.forename: Sarah
authors.initials: S
authors.lastname: Taylor
mesh_terms: D001724:Birth Weight; D001942:Breast Feeding / Q000379:methods*; D004750:Enteral Nutrition / Q000379:methods*; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D008297:Male; D008895:Milk, Human; D010288:Parenteral Nutrition / Q000379:methods*; D047928:Premature Birth / Q000401:mortality*; D012189:Retrospective Studies
keywords: Early enteral feeding; Necrotizing enterocolitis; Parenteral nutrition; Prematurity; Very low birth weight infants