Optimising enteral nutrition in very low birth weight infants: a narrative review with evidence-based recommendations

Preterm infants have higher nutritional requirements than term neonates and are vulnerable to extrauterine growth restriction. Providing adequate nutritional support during the initial few weeks of life plays a crucial role in improving the short- and long-term outcomes of these infants. Emerging evidence on enteral feeding emphasises rapid feed advancement, early total enteral feeding and early human milk (HM) fortification for preterm babies. The objective of this review was to summarise the latest evidence around enteral nutrition in very low birth weight or very preterm infants (<32 weeks’ gestation) and provide evidence-based recommendations for practice. The strength of recommendations was graded using the Oxford Centre for Evidence-Based Medicine criteria. This review provides clinical practice guidelines on the following key domains: (1) feed initiation strategies including oral immune therapy, minimal enteral nutrition and early total enteral feeds; (2) type of milk for feeding preterm infants; (3) feed advancement strategies and standardised feeding regimen; (4) various approaches to HM fortification and (5) multivitamin and mineral supplementation. This updated review will serve as a practical guide for clinicians and dietitians in handling the difficulties related to the nutritional management of preterm infants and improving clinical outcomes.