title: [Variability in enteral feeding practices of preterm infants among hospitals in the SEN1500 Spanish neonatal network].
abstract: BACKGROUND
  Proper nutrition is one of the primary objectives in the management of preterm infants. However, lack of evidence on the best strategy to achieve this objective has led to a great variability in feeding practices. This variability may be related to the differences in the incidence of complications, such as necrotising enterocolitis (NEC).
  
  
  OBJECTIVE
  The aim of this study is to assess the variability in clinical practice regarding enteral feeding in SEN-1500 Spanish network.
  
  
  METHODS
  An observational study was conducted using a questionnaire sent out in 2013 requesting information about feeding very low birth weight (VLBW) neonates (bank milk, start time, trophic feeding, increases, fortifiers and probiotics).
  
  
  RESULTS
  Responses were received from 60 of the 98 hospitals. The response rate was higher in centres with more than 50VLBW/year (30/31). Just over two-thirds (67%) have feeding protocols, and 52% refer to variability within their unit. A milk bank is available in 25% of the units. First feeding occurs fairly evenly throughout first 48hours, although it is delayed in lower gestational ages, even when there is no haemodynamic failure. In addition to hemodynamic instability there are other situations when the start is delayed (absence of breast milk, CIR, altered umbilical flow, asphyxia), while it is rarely delayed by absence of meconium or maintain an umbilical catheter.Half of those under 25 weeks begin directly with progressive increases instead of trophic feeding. Increases rarely reach 30ml/kg/day. Almost all use fortification and vitamins. There was a significant use of probiotics at the time of the survey.
  
  
  CONCLUSIONS
  There is great variability in enteral nutrition policies in VLBW in Spain. Although some differences are justified by the lack of evidence, there are other interventions that have proven to be effective, such as evidence-based protocols or access to donor milk. Implementation in all the units could reduce the incidence of NEC and improve the nutritional status.
authors.affiliation: Unidad de Gestión Clínica de Neonatología, Hospital Regional Universitario de Málaga, Málaga, España.
authors.forename: María Concepción
authors.initials: MC
authors.lastname: Moreno Algarra
authors.affiliation: Unidad de Gestión Clínica de Neonatología, Hospital Regional Universitario de Málaga, Málaga, España.
authors.forename: Verónica
authors.initials: V
authors.lastname: Fernández Romero
authors.affiliation: Unidad de Gestión Clínica de Neonatología, Hospital Regional Universitario de Málaga, Málaga, España. Electronic address: tomas.sanchez.tamayo@gmail.com.
authors.forename: Tomás
authors.initials: T
authors.lastname: Sánchez Tamayo
authors.affiliation: Unidad de Gestión Clínica de Neonatología, Hospital Regional Universitario de Málaga, Málaga, España.
authors.forename: María Gracia
authors.initials: MG
authors.lastname: Espinosa Fernández
authors.affiliation: Unidad de Gestión Clínica de Neonatología, Hospital Regional Universitario de Málaga, Málaga, España.
authors.forename: Enrique
authors.initials: E
authors.lastname: Salguero García
authors.affiliation: Unidad de Gestión Clínica de Neonatología, Hospital Regional Universitario de Málaga, Málaga, España.
mesh_terms: D003430:Cross-Sectional Studies; D004750:Enteral Nutrition / Q000592:standards*; D019538:Health Care Surveys; D006761:Hospitals; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D013030:Spain
keywords: Enteral nutrition; Enterocolitis necrosante; Necrotising enterocolitis; Nutrición enteral; Nutrición enteral trófica; Premature; Prematuro; Prevención; Prevention; Recién nacido de muy bajo peso; Trophic feeding; Variaciones en la práctica clínica; Variations in clinical practice; Very low birth weight infant