title: New clinical practice guideline on enteral feeding in very low birth weight infants; second part.
abstract: BACKGROUND
  The nutrition of very low birth weight (VLBW) infants is aimed at promoting a similar growth to that occurring in the uterus. However, in practice this is difficult to achieve and extrauterine growth restriction is frequent. The current tendency is to avoid this restriction by means of early parenteral and enteral nutrition. Nonetheless, uncertainty about many of the practices related with nutrition has resulted in a great variation in the way it is undertaken. In 2009 and 2011 in our hospital there was an unexpected increase in necrotizing enterocolitis. To check to see wether our nutrition policy was involved, we underlook a systematic review and drewup clinical practice guidelines (CPG) about enteral feeding in VLBW infants. New considerations about the duration of the fortification and the use of probiotics have led to an update of these CPG.
  
  
  METHODS
  A total of 21 clinical questions were designed dealing with the type of milk, starting age, mode of administration, rate and volume of the increments, fortification, use of probiotics and protocol. Afete conducting a systematic search of the available evidence, the information was contrasted and summarized in order to draw up the recommendations. The quality of the evidence and the strength of the recommendations were determined from the SIGN scale.
  
  
  CONCLUSIONS
  These CPG aim to help physicians in their decision making. The protocolized application of well-proven measurements reduces the variation in clinical practice and improves results.
authors.affiliation: Hospital Regional Universitario de Málaga. "Grupo multidisciplinar de investigación pediátrica". Unidad de Gestión Clínica de Neonatología. Málaga. España.. mgespinosaf@gmail.com.
authors.forename: María Gracia
authors.initials: MG
authors.lastname: Espinosa Fernandez
authors.affiliation: Hospital Regional Universitario de Málaga. "Grupo multidisciplinar de investigación pediátrica". Unidad de Gestión Clínica de Neonatología. Málaga. España. Universidad de Málaga, Facultad de Medicina. Campus de Teatinos. Málaga. España.. tomas.sanchez.tamayo@gmail.com.
authors.forename: Tomás
authors.initials: T
authors.lastname: Sánchez-Tamayo
authors.affiliation: Hospital Regional Universitario de Málaga. "Grupo multidisciplinar de investigación pediátrica". Unidad de Gestión Clínica de Neonatología. Málaga. España.. ma.moreno.al@gmail.com.
authors.forename: María C
authors.initials: MC
authors.lastname: Moreno Algarra
authors.affiliation: Hospital Regional Universitario de Málaga. "Grupo multidisciplinar de investigación pediátrica". Unidad de Gestión Clínica de Neonatología. Málaga. España.. veronicafernandez565@hotmail.com.
authors.forename: Verónica
authors.initials: V
authors.lastname: Fernández Romero
authors.affiliation: Hospital Regional Universitario de Málaga. "Grupo multidisciplinar de investigación pediátrica". Unidad de Gestión Clínica de Neonatología. Málaga. España.. jose.vallejo.sspa@juntadeandalucia.es.
authors.forename: José
authors.initials: J
authors.lastname: Vallejo Triano
authors.affiliation: Hospital Regional Universitario de Málaga. "Grupo multidisciplinar de investigación pediátrica". Unidad de Gestión Clínica de Neonatología. Málaga. España.. eliastamo@hotmail.com.
authors.forename: Elías
authors.initials: E
authors.lastname: Tapia Moreno
authors.affiliation: Hospital Regional Universitario de Málaga. "Grupo multidisciplinar de investigación pediátrica". Unidad de Gestión Clínica de Neonatología. Málaga. España.. ensalgar@yahoo.es.
authors.forename: Enrique
authors.initials: E
authors.lastname: Salguero García
mesh_terms: D004750:Enteral Nutrition / Q000592:standards*; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires