Comparison of Slow Versus Rapid Advancement Feeding Protocols in Very Low Birth Weight Neonates

Abstract

Background: Very low birth weight (VLBW) neonates are at elevated risk of postnatal growth failure, extended hospitalization, and complications such as necrotizing enterocolitis (NEC) and apnea. The optimal rate of enteral feeding advancement in this population remains controversial, with recent evidence questioning the necessity of slow progression protocols. Objective: To compare the clinical outcomes of slow versus rapid advancement feeding protocols in VLBW neonates, specifically assessing time to full enteral feeding, weight gain, apnea incidence, and development of NEC. Methods: This randomized controlled trial enrolled 60 VLBW neonates (birth weight 1000–<1500 g) admitted within 24 hours of life at a tertiary neonatal unit. Participants were randomized to slow (10–15 ml/kg/day) or rapid (15–20 ml/kg/day) advancement groups. All neonates received standardized gut priming prior to protocol initiation. Outcomes included time to full enteral feeding, weight gain, apnea, and NEC, recorded by blinded nursing staff. Data were analyzed using SPSS v23, with stratification for gestational age, gender, birth weight, delivery mode, and milk type; p < 0.05 was considered statistically significant. Results: Rapid advancement significantly reduced time to full enteral feeding (13.2 ± 3.4 vs. 16.1 ± 2.9 days, p = 0.001) and improved weight gain (258 ± 60 g vs. 220 ± 52 g, p = 0.008). Rates of apnea and NEC were lower with rapid advancement, but differences were not statistically significant. Conclusion: Rapid advancement of enteral feeds in VLBW neonates accelerates nutritional recovery without increasing NEC or apnea risk, supporting its use as a safe and effective clinical strategy.