Early versus Late Initiation of Enteral Feeding in Premature Infants (28-34 Weeks GA) with Growth Restriction and Absent or Reversed End-Diastolic Flow on Umbilical Artery Doppler: A Randomised Controlled Trial.

The authors conducted an open-label RCT in growth-restricted preterm infants (28-34 wk) with Absent or Reversed end-diastolic flow on Antenatal Umbilical-Artery Doppler (AREDF) to compare early enteral feeding at 6 h (EIEF) with initiation at 48 h (LIEF). Eighty-seven infants were randomised (EIEF 44, LIEF 43). Feeds were advanced daily at 20, 40, 60, 90, 120, and 150 mL/kg/d, respectively, from the day of commencement of feeds. The primary outcome was time to full feeds; secondary outcomes included feed-intolerance (FI), NEC ≥ stage 2b, late-onset sepsis, mortality, and hospital stay. EIEF achieved full feeds earlier than LIEF (median 6 vs. 8 d). Rates of FI (20.9% vs. 25.6%), NEC (0 vs. 4.6%), mortality (6.8% vs. 16.3%), and hospital stay were not statistically different. Late-onset sepsis was lower with EIEF (6.8% vs. 27.9%). Early feeds from 6 h, with careful monitoring, enabled full feeds by day 6 without increasing adverse outcomes. The trial was registered prospectively at CTRI.org on 01/03/2019 (CTRI No. CTRI/2019/03/017899).