Rapid Versus Gradual Advancement of Enteral Feeding in Preterm Low Birth Weight Neonates: A Randomized Controlled Trial

Background: Preterm birth is a major global health concern, causing complications and long-term developmental challenges.Early nutritional intervention improves the growth, development, and health outcomes of premature newborns.The aim of this study was to evaluate impact of rapid enteral feeding advancement on morbidities and mortality among preterm neonates Methods: This was a randomized controlled trial conducted in the Neonatal Unit of Bangladesh Shishu Hospital & Institute among 88 neonates who were randomly assigned in a 1:1 ratio by random allocation software version 2 to receive either rapid enteral feeding advancement group (group A) or gradual enteral feeding advancement group (group B).In both groups, neonates received 5-10 ml enteral nutrition/kg/d on feeding day 1. Results:The median time to achieve full feed was significantly shorter in the rapid group (7.0 vs. 8.5 days, p=0.004), and the duration of parenteral nutrition was also significantly lower (5.0 vs. 7.5 days, p=0.001).Hospital stay was shorter in the rapid group (7.0 vs. 10.0 days, p=0.002).Feed intolerance was more frequent in the rapid group (29.5% vs. 15.9%),though not statistically significant.No significant differences were observed in mortality (p=0.616) or discharge weight (p=0.740) between groups.The findings support rapid feeding as a safe and efficient approach in stable preterm neonates. Conclusion: Rapid enteral feeding advancement enhances early achievement of full enteral feed, reduces the use of parenteral nutrition, and reduces duration of hospital stay in low birth weight preterm neonates compared to gradual advanced enteral nutrition.