Impact of a slow feeding advancement protocol on necrotizing enterocolitis incidence in preterm infants: A before-and-after study.

Necrotizing enterocolitis (NEC) remains a major cause of morbidity and mortality in very low birth weight infants, while the safest rate of enteral feed advancement remains debated. We performed a retrospective single-center before-after cohort study in a tertiary neonatal intensive care unit, comparing two feeding strategies in 572 infants (286 per group): faster advancement (20-30 mL/kg/day) from 2015-2018 and slower advancement (10-25 mL/kg every 48 h, weight-dependent) from 2020-2023. The primary outcome was NEC, defined as Bell stage ≥IIb or diagnosis at surgery. NEC was less frequent in the slower-advancement era (2.1% vs 7.9%; adjusted p = 0.02). Mortality, late-onset sepsis, central venous catheter duration, and extrauterine growth restriction were similar. Faster advancement led to earlier full enteral feeding, while discharge weight centiles were comparable. A cautious feeding strategy was associated with lower NEC incidence without evidence of worse infectious or growth outcomes.