Effects of rapid enteral feed advancement with early human milk fortification in preterm infants > 30 weeks gestation in a resource limited setting- a randomized controlled trial

Abstract Objective: To study the effects of rapid enteral feed advancement with early feed fortification in stable very low birth weight (VLBW) infants >30 weeks gestation. Study design: Preterm infants (N=92) were randomized to a) rapid feed advancement-early fortification - REF group (enteral feed advanced at 25-30ml/kg/day, fortification at 50ml/kg/day) or b) slow feed advancement-late fortification-SLF group (feed advanced at 15-20ml/kg/day, fortification at 100ml/kg/day). Results: The primary outcome-time to regain birth weight was significantly lower in REF group (9 days vs 13 days, P=0.02). REF group reached full enteral feeds earlier (6 days vs 9 days, P=0.001), had lower rates of sepsis (13% vs 38%, P=0.007) and shorter hospital stay (10 days vs 15 days, P=0.01). At one year, the median Z-scores for weight [-1.5 vs -2.2, P<0.001] and head circumference [1.1 vs 0, P<0.001) were significantly higher in the REF group. Conclusions: In VLBW infants >30 weeks, rapid feed advancement with early fortification resulted in early postnatal regain of birth weight with positive effects on growth at one year.