Are the current feeding volumes adequate for the growth of very preterm neonates?

Postnatal growth failure, a common problem in very preterm neonates associated with adverse neurodevelopmental outcome, has recently been shown not to be inevitable. There is a wide discussion regarding feeding practices of very preterm neonates, specifically regarding feeding volumes and nutrients supply to avoid postnatal growth failure. Current guidelines recommend an energy intake of 115-140 kcal /kg per d with a considerably higher upper limit of 160 kcal/kg per d. The feeding volume corresponding to this energy supply is not higher than 200 ml/kg in most cases. From the other side, randomised and observational studies used higher feeding volumes, and these were associated with better weight gain and growth, while no complications were noted. Taking into account the above, nutritional practices should be individualised in each very and extremely preterm infant trying to reduce postnatal growth failure, pointing out that available data are inconclusive regarding the effect of high-volume feeds on growth. Large clinical trials are necessary to conclude in the best feeding practices of very preterm neonates.

Automated summary

Postnatal growth failure in very preterm neonates, which is associated with adverse neurodevelopmental outcomes, is not inevitable, and feeding practices play a crucial role in preventing it. Current guidelines recommend an energy intake of 115-140 kcal/kg per day but allow a higher limit of 160 kcal/kg. While some studies suggest that higher feeding volumes are associated with better weight gain and growth without complications, available data on the effect of high-volume feeds on growth are inconclusive. Large clinical trials are needed to determine the best feeding practices for very preterm neonates.