Optimal timing for introducing enteral nutrition in the neonatal intensive care unit.

OBJECTIVE To identify the optimal time for introducing enteral nutrition to critically ill neonates. METHODS This prospective cohort study included all eligible critically ill neonates who were admitted to a multidisciplinary tertiary neonatal intensive care unit (NICU) between 1st June and 30th November 2013. Nutrient intake and clinical outcomes during NICU stay were recorded. The effect of early (<24 hours after NICU admission) and delayed (>=24 hours) enteral nutrition introduction on clinical outcomes was assessed. RESULTS Energy deficit in critically ill neonates was frequent: 84.7% could not achieve the caloric goal during the NICU stay. Growth retardation was common especially among the preterm: the frequency of neonates whose weight was below the 10th percentile increased significantly from 21.6% on admission to 67.6% at discharge. Compared with delayed enteral nutrition, early enteral nutrition was associated with better median time to starting weight gain (0 vs 6 days, p=0.0002), a lower chance of receiving parenteral nutrition (41.7% vs 95.9%, p<0.0001), shorter NICU stays (196 vs 288 hours, p=0.0001), fewer hours on mechanical ventilation and a lower chance of developing pulmonary infection (37.5% vs 56.0%, p=0.005). The accumulated energy deficit to the subjects who were exposed to delayed nutrition could not be compensated by subsequent nutrition. Neonates who underwent mechanical ventilation had suboptimal nutrient delivery: they took longer to gain weight and were more likely to develop respiratory distress and receive parenteral nutrition. CONCLUSIONS Early enteral nutrition initiation (<24 hours) is recommended. Neonates with mechanical ventilation should be monitored with particular attention.