Enteral feeding practices and guideline adherence for very low birth weight infants in Chinese NICUs: a multicentre cross-sectional survey.

OBJECTIVES

This study aimed to investigate the current status of enteral feeding for VLBW infants in NICUs, and to assess compliance with guidelines and evidence.

METHODS

Online survey on enteral feeding practices for VLBW infants was conducted from August to November 2024. The Quick Response Code and link of this survey were distributed to partner institutions of the Shandong Nursing Association. The results were compared with recommendations from the evidence and guidelines on enteral nutrition for VLBW infants.

RESULTS

47 NICUs were invited to participate in this survey. Among these, 32 NICUs (68.1%) had established the standardized feeding protocol specifically designed for VLBW infants. All institutions prioritize breast milk as the preferred choice, but 53.2% of NICUs have breast milk or donated breast milk available as the source of milk for initiating enteral feeding. 39 NICUs (83.0%) initiate enteral feeding within 24 h. 41 NICUs (87.3%) administered enteral feeding every 2-3 h, with a daily volume increase of 13 (2, 15) ml. NICUs defined full enteral feeding based on either caloric or volume targets, established in accordance with guidelines and local experience. Specifically, 27 NICUs (57.4%) defined it as a mean intake of (123.4 ± 21.8) kcal/kg/day, and 37 NICUs (78.7%) defined it as (138.4 ± 35.7) ml/kg/day. Initial enteral feeding volumes and the time required to reach full enteral feeding were managed differently based on birth weight. Human milk fortification was initiated when the infant's intake reached (74.9 ± 33.7) ml/kg/day, but only 20 NICUs (42.6%) adopted it as a routine nutritional support measure. Approximately 30% of institutions routinely measured gastric residual volume. Depending on the volume, gastric residuals were either re-fed to the infant or discarded.

CONCLUSION

While the clinical practices were aligned with evidence and guidelines for VLBW infants, divergence remained in areas such as the use and timing of human milk fortification. This study not only provides regional data but also analyzes implementation gaps between evidence and clinical practice. By analyzing these discrepancies, this study identified deficiencies in nutritional management within NICUs and provides a basis for continuous quality improvement in the care of preterm infants.