Early enteral feeding of the preterm infant

Questions about when, how, and what to feed the preterm baby elicit many diVerent answers. Balancing the risks of enteral feeding with those of parenteral nutrition is not easy. In contrast with the sophistication of clinical cardiorespiratory monitoring, the day to day assessment of gastrointestinal function is still largely dependent on clinical observation. Moreover the population at risk is extremely heterogeneous with respect to both the prevalence of comorbidity and developmental stage, particularly, in this context, the maturation of intestinal motility. Enteral feeding involves many potentially confounding interventions: route chosen, postnatal or postconceptional age at initiation, frequency of administration, amount given, rate of advancement, and, not least, choice between human milk and formula. Given the complexity of the problem, the small size of most controlled studies, problems with blinding, and the diYculties of defining and measuring outcome, it is hardly surprising that confusion exists.