Delayed introduction of progressive enteral feeds to prevent necrotising enterocolitis in very low birth weight infants
Background Enteral feeding for very preterm or very low birth weight (VLBW) infants is often delayed for several days after birth due to concern that early introduction of feeding may not be tolerated and may increase the risk of necrotising enterocolitis. Concerns exist, however, that delaying ente...
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| Veröffentlicht in: | Cochrane database of systematic reviews 2022-01, Vol.2022 (1), p.CD001970-CD001970 |
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| creator | McGuire, William Young, Lauren Oddie, Sam J McGuire, William |
| description | Background
Enteral feeding for very preterm or very low birth weight (VLBW) infants is often delayed for several days after birth due to concern that early introduction of feeding may not be tolerated and may increase the risk of necrotising enterocolitis. Concerns exist, however, that delaying enteral feeding may diminish the functional adaptation of the gastrointestinal tract and prolong the need for parenteral nutrition with its attendant infectious and metabolic risks.
Objectives
To determine the effects of delayed introduction of progressive enteral feeds on the risk of necrotising enterocolitis, mortality and other morbidities in very preterm or VLBW infants.
Search methods
Search strategies were developed by an information specialist in consultation with the review authors. The following databases were searched in October 2021 without date or language restrictions: CENTRAL (2021, Issue 10), MEDLINE via OVID (1946 to October 2021), Embase via OVID (1974 to October 2021), Maternity and Infant Care via OVID (1971 to October 2021), CINAHL (1982 to October 2021). We also searched for eligible trials in clinical trials databases, conference proceedings, previous reviews, and reference lists of retrieved articles.
Selection criteria
Randomised controlled trials that assessed the effects of delayed (four or more days after birth) versus earlier introduction of progressive enteral feeds on necrotising enterocolitis, mortality and other morbidities in very preterm or VLBW infants.
Data collection and analysis
Two review authors separately evaluated trial risk of bias, extracted data, and synthesised effect estimates using risk ratio (RR), risk difference (RD), and mean difference. We used the GRADE approach to assess the certainty of evidence for effects on necrotising enterocolitis, mortality, feed intolerance, and invasive infection.
Main results
We included 14 trials in which a total of 1551 infants participated. Potential sources of bias were lack of clarity on methods to generate random sequences and conceal allocation in half of the trials, and lack of masking of caregivers or investigators in all of the trials. Trials typically defined delayed introduction of progressive enteral feeds as later than four to seven days after birth and early introduction as four days or fewer after birth. Infants in six trials (accounting for about half of all of the participants) had intrauterine growth restriction or circulatory redistribution demonstrated by absent or |
| doi_str_mv | 10.1002/14651858.CD001970.pub6 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8771918</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2621662177</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4736-c560e9b30513bda2f2f979638d3a4e026f6c8e70a361714312426c05871f4b083</originalsourceid><addsrcrecordid>eNqFUU1vGyEURFWqxnH7FyyOudjhYxd2L5USO20jReqlPSOWfdhU68UFbMv_Pqz8IbeXHBDwZt7Mg0FoQsmMEsIeaCFKWpXVbL4ghNaSzDbbRnxAowGYDsjN1fkW3cX4hxAuaiY_oVtekqLOtxHaL6DTB2ix61Pw7dYk53vsLd4EvwwQo9sBhj5B0B22AG3EyWcQdrmIezDBJxddvzySvPGdy4Ush3cQDrjze9y4kFZ4D265Shmwuk_xM_podRfhy2kfo9_fnn_Nf0xff35_mT--Tk0huZiaUhCoG05KyptWM8tsLWvBq5brAggTVpgKJNFcUEkLTlnBhCFlJaktGlLxMfp61M3fs4bW5CnzS9QmuLUOB-W1U_8ivVuppd-pSkpa00Hg_iQQ_N8txKTWLhroOt2D30bFBKMiLykzVRyp-VNiDGAvNpSoITV1Tk2dUxvMRW6cXA95aTvHlAlPR8LedXBQxptVyP7v6P7n8gYgearq</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2621662177</pqid></control><display><type>article</type><title>Delayed introduction of progressive enteral feeds to prevent necrotising enterocolitis in very low birth weight infants</title><source>MEDLINE</source><source>Cochrane Library</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>McGuire, William ; Young, Lauren ; Oddie, Sam J ; McGuire, William</creator><creatorcontrib>McGuire, William ; Young, Lauren ; Oddie, Sam J ; McGuire, William</creatorcontrib><description>Background
Enteral feeding for very preterm or very low birth weight (VLBW) infants is often delayed for several days after birth due to concern that early introduction of feeding may not be tolerated and may increase the risk of necrotising enterocolitis. Concerns exist, however, that delaying enteral feeding may diminish the functional adaptation of the gastrointestinal tract and prolong the need for parenteral nutrition with its attendant infectious and metabolic risks.
Objectives
To determine the effects of delayed introduction of progressive enteral feeds on the risk of necrotising enterocolitis, mortality and other morbidities in very preterm or VLBW infants.
Search methods
Search strategies were developed by an information specialist in consultation with the review authors. The following databases were searched in October 2021 without date or language restrictions: CENTRAL (2021, Issue 10), MEDLINE via OVID (1946 to October 2021), Embase via OVID (1974 to October 2021), Maternity and Infant Care via OVID (1971 to October 2021), CINAHL (1982 to October 2021). We also searched for eligible trials in clinical trials databases, conference proceedings, previous reviews, and reference lists of retrieved articles.
Selection criteria
Randomised controlled trials that assessed the effects of delayed (four or more days after birth) versus earlier introduction of progressive enteral feeds on necrotising enterocolitis, mortality and other morbidities in very preterm or VLBW infants.
Data collection and analysis
Two review authors separately evaluated trial risk of bias, extracted data, and synthesised effect estimates using risk ratio (RR), risk difference (RD), and mean difference. We used the GRADE approach to assess the certainty of evidence for effects on necrotising enterocolitis, mortality, feed intolerance, and invasive infection.
Main results
We included 14 trials in which a total of 1551 infants participated. Potential sources of bias were lack of clarity on methods to generate random sequences and conceal allocation in half of the trials, and lack of masking of caregivers or investigators in all of the trials. Trials typically defined delayed introduction of progressive enteral feeds as later than four to seven days after birth and early introduction as four days or fewer after birth. Infants in six trials (accounting for about half of all of the participants) had intrauterine growth restriction or circulatory redistribution demonstrated by absent or reversed end‐diastolic flow velocities in the fetal aorta or umbilical artery.
Meta‐analyses showed that delayed introduction of progressive enteral feeds may not reduce the risk of necrotising enterocolitis (RR 0.81, 95% confidence interval (CI) 0.58 to 1.14; RD ‐0.02, 95% CI ‐0.04 to 0.01; 13 trials, 1507 infants; low‐certainty evidence due risk of bias and imprecision) nor all‐cause mortality before hospital discharge (RR 0.97, 95% CI 0.70 to 1.36; RD ‐0.00, 95% CI ‐0.03 to 0.03; 12 trials, 1399 infants; low‐certainty evidence due risk of bias and imprecision). Delayed introduction of progressive enteral feeds may slightly reduce the risk of feed intolerance (RR 0.81, 95% CI 0.68 to 0.97; RD ‐0.09, 95% CI ‐0.17 to ‐0.02; number needed to treat for an additional beneficial outcome = 11, 95% CI 6 to 50; 6 trials, 581 infants; low‐certainty evidence due to risk of bias and imprecision) and probably increases the risk of invasive infection (RR 1.44, 95% CI 1.15 to 1.80; RD 0.10, 95% CI 0.04 to 0.15; number needed to treat for a harmful outcome = 10, 95% CI 7 to 25; 7 trials, 872 infants; moderate‐certainty evidence due to risk of bias).
Authors' conclusions
Delaying the introduction of progressive enteral feeds beyond four days after birth (compared with earlier introduction) may not reduce the risk of necrotising enterocolitis or death in very preterm or VLBW infants. Delayed introduction may slightly reduce feed intolerance, and probably increases the risk of invasive infection.</description><identifier>ISSN: 1465-1858</identifier><identifier>EISSN: 1465-1858</identifier><identifier>EISSN: 1469-493X</identifier><identifier>DOI: 10.1002/14651858.CD001970.pub6</identifier><identifier>PMID: 35049036</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>Child health ; Enteral Nutrition ; Enterocolitis, Necrotizing ; Enterocolitis, Necrotizing - epidemiology ; Enterocolitis, Necrotizing - prevention & control ; Feeding the low birthweight infant ; Female ; Fetal Growth Retardation ; Humans ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Medicine General & Introductory Medical Sciences ; Neonatal care ; Nutrition and Metabolism in the High-Risk Neonate ; Pregnancy ; Techniques of feeding</subject><ispartof>Cochrane database of systematic reviews, 2022-01, Vol.2022 (1), p.CD001970-CD001970</ispartof><rights>Copyright © 2022 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4736-c560e9b30513bda2f2f979638d3a4e026f6c8e70a361714312426c05871f4b083</citedby><cites>FETCH-LOGICAL-c4736-c560e9b30513bda2f2f979638d3a4e026f6c8e70a361714312426c05871f4b083</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35049036$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>McGuire, William</creatorcontrib><creatorcontrib>Young, Lauren</creatorcontrib><creatorcontrib>Oddie, Sam J</creatorcontrib><creatorcontrib>McGuire, William</creatorcontrib><title>Delayed introduction of progressive enteral feeds to prevent necrotising enterocolitis in very low birth weight infants</title><title>Cochrane database of systematic reviews</title><addtitle>Cochrane Database Syst Rev</addtitle><description>Background
Enteral feeding for very preterm or very low birth weight (VLBW) infants is often delayed for several days after birth due to concern that early introduction of feeding may not be tolerated and may increase the risk of necrotising enterocolitis. Concerns exist, however, that delaying enteral feeding may diminish the functional adaptation of the gastrointestinal tract and prolong the need for parenteral nutrition with its attendant infectious and metabolic risks.
Objectives
To determine the effects of delayed introduction of progressive enteral feeds on the risk of necrotising enterocolitis, mortality and other morbidities in very preterm or VLBW infants.
Search methods
Search strategies were developed by an information specialist in consultation with the review authors. The following databases were searched in October 2021 without date or language restrictions: CENTRAL (2021, Issue 10), MEDLINE via OVID (1946 to October 2021), Embase via OVID (1974 to October 2021), Maternity and Infant Care via OVID (1971 to October 2021), CINAHL (1982 to October 2021). We also searched for eligible trials in clinical trials databases, conference proceedings, previous reviews, and reference lists of retrieved articles.
Selection criteria
Randomised controlled trials that assessed the effects of delayed (four or more days after birth) versus earlier introduction of progressive enteral feeds on necrotising enterocolitis, mortality and other morbidities in very preterm or VLBW infants.
Data collection and analysis
Two review authors separately evaluated trial risk of bias, extracted data, and synthesised effect estimates using risk ratio (RR), risk difference (RD), and mean difference. We used the GRADE approach to assess the certainty of evidence for effects on necrotising enterocolitis, mortality, feed intolerance, and invasive infection.
Main results
We included 14 trials in which a total of 1551 infants participated. Potential sources of bias were lack of clarity on methods to generate random sequences and conceal allocation in half of the trials, and lack of masking of caregivers or investigators in all of the trials. Trials typically defined delayed introduction of progressive enteral feeds as later than four to seven days after birth and early introduction as four days or fewer after birth. Infants in six trials (accounting for about half of all of the participants) had intrauterine growth restriction or circulatory redistribution demonstrated by absent or reversed end‐diastolic flow velocities in the fetal aorta or umbilical artery.
Meta‐analyses showed that delayed introduction of progressive enteral feeds may not reduce the risk of necrotising enterocolitis (RR 0.81, 95% confidence interval (CI) 0.58 to 1.14; RD ‐0.02, 95% CI ‐0.04 to 0.01; 13 trials, 1507 infants; low‐certainty evidence due risk of bias and imprecision) nor all‐cause mortality before hospital discharge (RR 0.97, 95% CI 0.70 to 1.36; RD ‐0.00, 95% CI ‐0.03 to 0.03; 12 trials, 1399 infants; low‐certainty evidence due risk of bias and imprecision). Delayed introduction of progressive enteral feeds may slightly reduce the risk of feed intolerance (RR 0.81, 95% CI 0.68 to 0.97; RD ‐0.09, 95% CI ‐0.17 to ‐0.02; number needed to treat for an additional beneficial outcome = 11, 95% CI 6 to 50; 6 trials, 581 infants; low‐certainty evidence due to risk of bias and imprecision) and probably increases the risk of invasive infection (RR 1.44, 95% CI 1.15 to 1.80; RD 0.10, 95% CI 0.04 to 0.15; number needed to treat for a harmful outcome = 10, 95% CI 7 to 25; 7 trials, 872 infants; moderate‐certainty evidence due to risk of bias).
Authors' conclusions
Delaying the introduction of progressive enteral feeds beyond four days after birth (compared with earlier introduction) may not reduce the risk of necrotising enterocolitis or death in very preterm or VLBW infants. Delayed introduction may slightly reduce feed intolerance, and probably increases the risk of invasive infection.</description><subject>Child health</subject><subject>Enteral Nutrition</subject><subject>Enterocolitis, Necrotizing</subject><subject>Enterocolitis, Necrotizing - epidemiology</subject><subject>Enterocolitis, Necrotizing - prevention & control</subject><subject>Feeding the low birthweight infant</subject><subject>Female</subject><subject>Fetal Growth Retardation</subject><subject>Humans</subject><subject>Infant, Newborn</subject><subject>Infant, Premature</subject><subject>Infant, Very Low Birth Weight</subject><subject>Medicine General & Introductory Medical Sciences</subject><subject>Neonatal care</subject><subject>Nutrition and Metabolism in the High-Risk Neonate</subject><subject>Pregnancy</subject><subject>Techniques of feeding</subject><issn>1465-1858</issn><issn>1465-1858</issn><issn>1469-493X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>RWY</sourceid><sourceid>EIF</sourceid><recordid>eNqFUU1vGyEURFWqxnH7FyyOudjhYxd2L5USO20jReqlPSOWfdhU68UFbMv_Pqz8IbeXHBDwZt7Mg0FoQsmMEsIeaCFKWpXVbL4ghNaSzDbbRnxAowGYDsjN1fkW3cX4hxAuaiY_oVtekqLOtxHaL6DTB2ix61Pw7dYk53vsLd4EvwwQo9sBhj5B0B22AG3EyWcQdrmIezDBJxddvzySvPGdy4Ush3cQDrjze9y4kFZ4D265Shmwuk_xM_podRfhy2kfo9_fnn_Nf0xff35_mT--Tk0huZiaUhCoG05KyptWM8tsLWvBq5brAggTVpgKJNFcUEkLTlnBhCFlJaktGlLxMfp61M3fs4bW5CnzS9QmuLUOB-W1U_8ivVuppd-pSkpa00Hg_iQQ_N8txKTWLhroOt2D30bFBKMiLykzVRyp-VNiDGAvNpSoITV1Tk2dUxvMRW6cXA95aTvHlAlPR8LedXBQxptVyP7v6P7n8gYgearq</recordid><startdate>20220120</startdate><enddate>20220120</enddate><creator>McGuire, William</creator><creator>Young, Lauren</creator><creator>Oddie, Sam J</creator><creator>McGuire, William</creator><general>John Wiley & Sons, Ltd</general><scope>7PX</scope><scope>RWY</scope><scope>ZYTZH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20220120</creationdate><title>Delayed introduction of progressive enteral feeds to prevent necrotising enterocolitis in very low birth weight infants</title><author>McGuire, William ; Young, Lauren ; Oddie, Sam J ; McGuire, William</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4736-c560e9b30513bda2f2f979638d3a4e026f6c8e70a361714312426c05871f4b083</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Child health</topic><topic>Enteral Nutrition</topic><topic>Enterocolitis, Necrotizing</topic><topic>Enterocolitis, Necrotizing - epidemiology</topic><topic>Enterocolitis, Necrotizing - prevention & control</topic><topic>Feeding the low birthweight infant</topic><topic>Female</topic><topic>Fetal Growth Retardation</topic><topic>Humans</topic><topic>Infant, Newborn</topic><topic>Infant, Premature</topic><topic>Infant, Very Low Birth Weight</topic><topic>Medicine General & Introductory Medical Sciences</topic><topic>Neonatal care</topic><topic>Nutrition and Metabolism in the High-Risk Neonate</topic><topic>Pregnancy</topic><topic>Techniques of feeding</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>McGuire, William</creatorcontrib><creatorcontrib>Young, Lauren</creatorcontrib><creatorcontrib>Oddie, Sam J</creatorcontrib><creatorcontrib>McGuire, William</creatorcontrib><collection>Wiley-Blackwell Cochrane Library</collection><collection>Cochrane Library</collection><collection>Cochrane Library (Open Aceess)</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Cochrane database of systematic reviews</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>McGuire, William</au><au>Young, Lauren</au><au>Oddie, Sam J</au><au>McGuire, William</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Delayed introduction of progressive enteral feeds to prevent necrotising enterocolitis in very low birth weight infants</atitle><jtitle>Cochrane database of systematic reviews</jtitle><addtitle>Cochrane Database Syst Rev</addtitle><date>2022-01-20</date><risdate>2022</risdate><volume>2022</volume><issue>1</issue><spage>CD001970</spage><epage>CD001970</epage><pages>CD001970-CD001970</pages><issn>1465-1858</issn><eissn>1465-1858</eissn><eissn>1469-493X</eissn><abstract>Background
Enteral feeding for very preterm or very low birth weight (VLBW) infants is often delayed for several days after birth due to concern that early introduction of feeding may not be tolerated and may increase the risk of necrotising enterocolitis. Concerns exist, however, that delaying enteral feeding may diminish the functional adaptation of the gastrointestinal tract and prolong the need for parenteral nutrition with its attendant infectious and metabolic risks.
Objectives
To determine the effects of delayed introduction of progressive enteral feeds on the risk of necrotising enterocolitis, mortality and other morbidities in very preterm or VLBW infants.
Search methods
Search strategies were developed by an information specialist in consultation with the review authors. The following databases were searched in October 2021 without date or language restrictions: CENTRAL (2021, Issue 10), MEDLINE via OVID (1946 to October 2021), Embase via OVID (1974 to October 2021), Maternity and Infant Care via OVID (1971 to October 2021), CINAHL (1982 to October 2021). We also searched for eligible trials in clinical trials databases, conference proceedings, previous reviews, and reference lists of retrieved articles.
Selection criteria
Randomised controlled trials that assessed the effects of delayed (four or more days after birth) versus earlier introduction of progressive enteral feeds on necrotising enterocolitis, mortality and other morbidities in very preterm or VLBW infants.
Data collection and analysis
Two review authors separately evaluated trial risk of bias, extracted data, and synthesised effect estimates using risk ratio (RR), risk difference (RD), and mean difference. We used the GRADE approach to assess the certainty of evidence for effects on necrotising enterocolitis, mortality, feed intolerance, and invasive infection.
Main results
We included 14 trials in which a total of 1551 infants participated. Potential sources of bias were lack of clarity on methods to generate random sequences and conceal allocation in half of the trials, and lack of masking of caregivers or investigators in all of the trials. Trials typically defined delayed introduction of progressive enteral feeds as later than four to seven days after birth and early introduction as four days or fewer after birth. Infants in six trials (accounting for about half of all of the participants) had intrauterine growth restriction or circulatory redistribution demonstrated by absent or reversed end‐diastolic flow velocities in the fetal aorta or umbilical artery.
Meta‐analyses showed that delayed introduction of progressive enteral feeds may not reduce the risk of necrotising enterocolitis (RR 0.81, 95% confidence interval (CI) 0.58 to 1.14; RD ‐0.02, 95% CI ‐0.04 to 0.01; 13 trials, 1507 infants; low‐certainty evidence due risk of bias and imprecision) nor all‐cause mortality before hospital discharge (RR 0.97, 95% CI 0.70 to 1.36; RD ‐0.00, 95% CI ‐0.03 to 0.03; 12 trials, 1399 infants; low‐certainty evidence due risk of bias and imprecision). Delayed introduction of progressive enteral feeds may slightly reduce the risk of feed intolerance (RR 0.81, 95% CI 0.68 to 0.97; RD ‐0.09, 95% CI ‐0.17 to ‐0.02; number needed to treat for an additional beneficial outcome = 11, 95% CI 6 to 50; 6 trials, 581 infants; low‐certainty evidence due to risk of bias and imprecision) and probably increases the risk of invasive infection (RR 1.44, 95% CI 1.15 to 1.80; RD 0.10, 95% CI 0.04 to 0.15; number needed to treat for a harmful outcome = 10, 95% CI 7 to 25; 7 trials, 872 infants; moderate‐certainty evidence due to risk of bias).
Authors' conclusions
Delaying the introduction of progressive enteral feeds beyond four days after birth (compared with earlier introduction) may not reduce the risk of necrotising enterocolitis or death in very preterm or VLBW infants. Delayed introduction may slightly reduce feed intolerance, and probably increases the risk of invasive infection.</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>35049036</pmid><doi>10.1002/14651858.CD001970.pub6</doi><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1465-1858 |
| ispartof | Cochrane database of systematic reviews, 2022-01, Vol.2022 (1), p.CD001970-CD001970 |
| issn | 1465-1858 1465-1858 1469-493X |
| language | eng |
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| source | MEDLINE; Cochrane Library; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Child health Enteral Nutrition Enterocolitis, Necrotizing Enterocolitis, Necrotizing - epidemiology Enterocolitis, Necrotizing - prevention & control Feeding the low birthweight infant Female Fetal Growth Retardation Humans Infant, Newborn Infant, Premature Infant, Very Low Birth Weight Medicine General & Introductory Medical Sciences Neonatal care Nutrition and Metabolism in the High-Risk Neonate Pregnancy Techniques of feeding |
| title | Delayed introduction of progressive enteral feeds to prevent necrotising enterocolitis in very low birth weight infants |
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