Feasibility of exclusive enteral feeds from birth in VLBW infants >1200g-an RCT

Aim To evaluate the feasibility of initiation of exclusive enteral feeds on first day of life in very low birthweight infants >1200g. Methods Haemodynamically stable infants with birthweights 1200-1500g irrespective of gestational age were randomized into two groups. Study group: Enteral feeds 80mL/kg/day started within 1h of birth and increased by 20mL/kg/day to 180mL/kg/day. No intravenous fluids given. Control group: Intravenous fluids 50mL/kg/day started along with enteral feeds 30mL/kg/day within 1h of birth and increased by 20mL/kg/day to 180mL/kg/day. The outcome measures were - primary: time to regain birthweight and secondary: duration of hospital stay, incidence of necrotizing enterocolitis and sepsis. Results Twenty three babies randomized in each group. Infants in study group regained birthweight earlier [mean 5.52days, SD +/- 2.94] compared to those in control group [mean 12.7days, SD +/- 2.25] (p<0.0001). Duration of hospital stay was lower in study group [mean 15.04days, SD +/- 5.26] compared to those in control group [mean 28.04days, SD +/- 6.76] (p<0.0001). No necrotizing enterocolitis detected. Conclusion It is feasible to initiate exclusive enteral feeds from first day of life in stable infants with birthweight between 1200 and 1500g without any parenteral fluid support. It leads to twice as faster regaining of birthweight and halves duration of hospital stay.