Balancing Nutrients for Better Outcomes: From Pregnancy to Early Childhood (Oral Session 5)

(OR05-04-25) Early Progressive Enteral Feeding Is Associated With Lower Incidence of Metabolic Bone Disease of Prematurity in Extremely Low Birth Weight Infants

Sunday, June 1, 2025

8:56 AM – 9:06 AM ET

Location: S220 E-G

Presenting Author(s)

Kyoung Eun Joung, MD

Assistant Professor of Pediatrics
Columbia University Vagelos College of Physicians and Surgeons
New York, New York, United States

Disclosure(s): No relevant financial relationship(s) with ineligible companies to disclose.

Co-Author(s)

OM

Olivia Marchioni

Tufts Medical Center
Boston, Massachusetts, United States
MP

Michael Prendergast, MD

Saint Elizabeth's Medical Center/Boston Medical Center Health System
Boston, Massachusetts, United States

Objectives: Extremely low birth weight (ELBW) infants are at risk for hypophosphatemia and metabolic bone disease (MBD) of prematurity. Previous studies have shown that delays in achieving full enteral feeding and prolonged use of total parenteral nutrition (TPN) are risk factors for MBD. However, optimal feeding strategies to decrease the incidence of MBD in ELBW infants remain uncertain. We aimed to evaluate whether early progressive enteral feeding including early initiation of feeding, early fortification, and rapid advancement is associated with lower incidence of early hypophosphatemia within the first week of life and the incidence of MBD during hospitalization in neonatal intensive care unit (NICU).

Methods: We conducted a pre-post comparison study including 122 ELBW infants born at a level 3 NICU before (Period 1, n=61) and after (Period 2, n=61) the introduction of feeding strategies to reflect early initiation of feeding within 12 hours of life, early fortification at 60 mL/kg/day, and feeding advancement up to 30 mL/kg/day.

Results: Time to reach full enteral feeding at 150mL/kg/day was faster in Period 2 (7±3 days) compared with Period 1 (10±6 days, p< 0.01). The duration of TPN was shorter in Period 2 (6±4 days) compared with Period 1 (9±6 days, p< 0.01). The phosphate levels on days of life 3, 4, 5 were significantly higher in Period 2 compared with Period 1 (5.2±1.1 vs. 4.7±1.2 mg/dL, 5.0±1.1 vs. 4.5±1.2 mg/dL, 5.0±1.0 vs. 4.2±1.1 mg/dL respectively), and the incidence of high alkaline phosphatase levels >750 IU/L during NICU hospitalization was lower in Period 2 compared with Period 1 with marginal statistical significance (7.4% in Period 2 vs. 17.2% in Period 1, p=0.16). There was no difference in the calcium levels between Period 1 and Period 2. The incidence of radiographic evidence of MBD including osteopenia and/or fracture was lower in Period 2 (3.3%) compared with Period 1 (6.6%), however, this was not statistically significant (p=0.45). The gestational age and birth weight, the incidence of necrotizing enterocolitis, mortality, and the growth outcomes were not significantly different between the two periods.

Conclusions: Early progressive enteral feeding including a combination of early initiation of enteral feeding and fortification, and rapid advancement may have an important role in preventing MBD of prematurity.

Funding Sources: None