Very preterm (less than 32 weeks' gestation) or very low birth weight (less than 1500 g) infants are at risk of developing a severe bowel disorder called necrotising enterocolitis, where parts of the bowel become inflamed and start to die. One possible way to prevent this condition is to delay the introduction of milk feeds until several days (or longer) after birth.
We search scientific databases for clinical trials assessing the effect of delayed (more than four days after birth) versus earlier introduction of progressive enteral feeds (where breast or formula milk is fed directly by a tube into the stomach) on the incidence of necrotising enterocolitis, death and general health in very low birth weight infants. The evidence is current to September 2014.
We found nine trials with 1106 infants that assessed the effect of delayed rather than early introduction of milk feeds for very preterm or very low birth weight infants. Data from these trials did not provide any evidence that delaying enteral feeding reduces the risk of necrotising enterocolitis.
Quality of the evidence
The included trials were generally of reasonable methodological quality but, in common with other trials of feeding interventions in infants, it was not possible to mask carers and clinical assessors to the given treatment.