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

Journal of Perinatology volume 45, pages 650–656 (2025)Cite this article

Subjects

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 25–30 ml/kg/day, fortification at 50 ml/kg/day) or b) slow feed advancement-late fortification-SLF group (feed advanced at 15–20 ml/kg/day, fortification at 100 ml/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 preterm 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.

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Fig. 1: Flow diagram showing the study selection process.
Fig. 2: Kaplan–Meier survival curves comparing the number of days to regain birth weight in the REF (Rapid advancement- early fortification) group as compared to the SLF (Slow advancement- late fortification) group.
Fig. 3: Comparison of calorie protein intake in the study groups in the first two weeks of age.

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Data availability

Data are presented in this paper and in the online supplementary material. Correspondence and requests for data should be addressed to Anitha Ananthan.

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Acknowledgements

The authors thank the Dean, Dr Sangeeta Ravat for permitting to publish the manuscript.

Author information

Authors and Affiliations

  1. Department of Neonatology, Seth GS medical College and King Edward Memorial Hospital, Mumbai, India

    Anitha Ananthan, Ganesh Bhatkar & Muthu Vijayanathan

  2. Department of Neonatology, Surya Hospitals, Mumbai, India

    Haribalakrishna Balasubramanian

  3. Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA

    Lakshmi Srinivasan

Authors
  1. Anitha Ananthan
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  2. Ganesh Bhatkar
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  4. Muthu Vijayanathan
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Contributions

Anitha Ananthan: Writing–review & editing, Supervision, Methodology, Formal analysis, Conceptualization. Ganesh Bhatkar: Writing– original draft, Methodology, Formal analysis, Data curation. Haribalakrishna Balasubramanian: Writing–review and editing, Formal analysis, conceptualization. Muthu Vijayanathan: Methodology, Data curation. Lakshmi Srinivasan: Writing– review & editing, Validation.

Corresponding author

Correspondence to Anitha Ananthan.

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The authors declare no competing interests.

Ethics approval and consent to participate

The study was approved by the Institutional Ethics Committee and participants were enrolled after obtaining written informed consent. The study was conducted as per the Declaration of Helsinki. All methods were performed in accordance with the relevant guidelines and regulations.

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Ananthan, A., Bhatkar, G., Balasubramanian, H. et al. Effects of rapid enteral feed advancement with early human milk fortification in very low birth weight preterm infants > 30 weeks gestation in a resource limited setting- a randomized controlled trial. J Perinatol 45, 650–656 (2025). https://doi.org/10.1038/s41372-024-02164-2

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