Impact of a slow feeding advancement protocol on necrotizing enterocolitis incidence in preterm infants: A before‐and‐after study

Necrotizing enterocolitis (NEC) remains a major cause of morbidity and mortality in very low birth weight infants, while the safest rate of enteral feed advancement remains debated. We performed a retrospective single‐center before‐after cohort study in a tertiary neonatal intensive care unit, comparing two feeding strategies in 572 infants (286 per group): faster advancement (20–30 mL/kg/day) from 2015–2018 and slower advancement (10–25 mL/kg every 48 h, weight‐dependent) from 2020–2023. The primary outcome was NEC, defined as Bell stage ≥IIb or diagnosis at surgery. NEC was less frequent in the slower‐advancement era (2.1% vs 7.9%; adjusted p = 0.02). Mortality, late‐onset sepsis, central venous catheter duration, and extrauterine growth restriction were similar. Faster advancement led to earlier full enteral feeding, while discharge weight centiles were comparable. A cautious feeding strategy was associated with lower NEC incidence without evidence of worse infectious or growth outcomes.