What is the evidence-based recommendation for initiating enteral feeds in neonates at risk of NEC?

What is the evidence-based recommendation for initiating enteral feeds in neonates at risk of NEC?

• A. Begin on the day of birth with human milk if possible
• B. Withhold feeds for 2 weeks
• C. Initiate only after signs of NEC
• D. Use formula as preferred feed

Answer: (A)

Starting enteral feeds early with human milk supports gut maturation and lowers NEC risk in neonates at risk. Human milk provides protective immune factors, growth factors, and prebiotic components that help the gut barrier, promote a healthy microbiome, and reduce inflammation. Initiating feeds on the day of birth using maternal milk when possible gives the gut a gentle, ongoing stimulus that fosters maturation and reduces the need for prolonged parenteral nutrition. If maternal milk isn’t available, donor human milk is preferred over formula because it preserves those protective effects. Delaying feeds for weeks deprives the gut of this early nourishment and can worsen outcomes, and starting feeds only after signs of NEC is too late for prevention. Formula is associated with a higher NEC risk in at-risk neonates, so it should be used with caution and only when human milk isn’t an option.

Starting enteral feeds early with human milk supports gut maturation and lowers NEC risk in neonates at risk. Human milk provides protective immune factors, growth factors, and prebiotic components that help the gut barrier, promote a healthy microbiome, and reduce inflammation. Initiating feeds on the day of birth using maternal milk when possible gives the gut a gentle, ongoing stimulus that fosters maturation and reduces the need for prolonged parenteral nutrition. If maternal milk isn’t available, donor human milk is preferred over formula because it preserves those protective effects. Delaying feeds for weeks deprives the gut of this early nourishment and can worsen outcomes, and starting feeds only after signs of NEC is too late for prevention. Formula is associated with a higher NEC risk in at-risk neonates, so it should be used with caution and only when human milk isn’t an option.