Does full enteralfeed from day one of life influence weight gain in hemodynamicallystable VLBW babies weighing between 1000-1500 grams as againststandard feeding? - An Open Label Randomised Control Trial.

Preterm neonate should grow similar to the intrauterine growth of the normal fetus of the same gestational age postnatally1. But, most preterm neonates end up in a growth-restricted state during their hospital stay after birth. Currently, postnatal or extra uterine growth failure is a problem in the majority of very low birth weight infants2. Studies have shown that inadequate nutrition during vital stages of development results in decreased number of brain cells and dendritic connections, abnormalities in behavioral and cognitive outcomes. The evidence suggests that early nutrition and neurodevelopment is closely linked and we can improve outcomes by preventing "nutritional insults" during the first weeks after birth2. Introduction of enteral feeding is delayed in these babies due to the fear of feed related issues and owing to poor nutrition they enter into a catabolic state, which results in growth restriction. There is a critical window of opportunity, between birth and birth weight gain, when optimal nutrition has its greatest benefit 3. The unique immunological factors present in the human milk outweigh any issues that can crop due to early feeding in VLBW babies. Maternal milk is the ideal diet for these babies. When mother’s own milk is not available the next best option is the donor milk, because of the lower incidence of necrotising enterocolitis, septicemia and better feeding progression with donor milk when compared to the use of formula feed. Full enteral feeding from day one of life in hemodynamically stable very low birth weight babies with exclusive human milk (both maternal and donor milk) results in fewer days to regain birth weight. There is also no evidence that full enteral feeding has adverse effects particularly on the risk of necrotizing enterocolitis. We conclude that initiating full enteral feeding practice is an effective, feasible, cost effective and safe intervention. There is less chance of NEC even in growth restricted babies with this schedule. Hence it would be prudent to commence full enteral feeding from first day of life and prevent inadequate nutrition in this critical period of growth.