Extrauterine Growth Restriction: What Is the Evidence for Better Nutritional Practices in the Neonatal Intensive Care Unit?



NAINR. 2014;14(3):92-98. 

In This Article

Minimal Enteral Feedings (MEF)

MEF may be defined as trophic feedings or feedings given at small volumes to stimulate development of the immature gastrointestinal (GI) tract.[7] These feedings are not meant to be nutritive rather they are meant to prepare the GI tract for later nutritional feedings. Therefore, MEF is started at 10–20 ml kg−1 day−1 usually within the first few days of life and are maintained at the same rate for 5–7 days depending on the small premature infant's clinical condition.

MEF is now a standard of care in most NICUs across the country. Initially MEF was met with resistant due to the fear of causing necrotizing enterocolitis (NEC). Current evidence has shown that delaying enteral feedings in small premature infants does not prevent NEC.

In the Cochrane Review Database, two systematic reviews have been conducted to assess the effect of MEF on the incidence of NEC. The first review by Bombell et al. included nine RCTs in order to determine the effect of early trophic feedings (feeding volumes up to 24 ml kg−1 day−1 initiated within the first 96 hours of age and continued for at least one week) versus fasting on growth, feeding intolerance, the incidence of NEC, and mortality. The nine RCTs included over 700 VLBW infants and the meta-analysis did not detect a significant effect on the incidence of NEC. The authors also concluded that insufficient evidence existed to determine whether early trophic feedings had any effect on GI tract development, later feeding tolerance, or growth and development.[27]

The second review by Morgan et al. included seven RCTs to determine the effect of delaying the introduction of progressive enteral feedings more than four days after birth on the incidence of NEC and mortality. The review consisted of about 900 VLBW infants in which no evidence was found to support that delaying progressive enteral feedings beyond four days of age affects the risk of developing NEC in VLBW infants. In fact, Morgan et. al. found in their review, that delaying progression of feedings past four days of life delayed the establishment of full enteral feedings by a few days.[28]

The evidence presented in these two systematic reviews strongly supports the use of MEF in VLBW infants. The early introduction of MEF does not increase the incidence of NEC nor does delaying advancement of enteral feedings past four days of age. Therefore, MEF should be initiated within the first few days of life as part of an early aggressive nutritional regimen to prevent EUGR in small premature infants.