Bibliographic information
GuidelineWHO recommendations for care of the preterm or low-birth-weight infant.
Year of Publication2022
Issuing InstitutionWorld Health Organization
Recommendation
Updated
Early initiation of enteral feeding. Preterm and low-birth-weight (LBW) infants, including very preterm (< 32 weeks’ gestation) and very LBW (< 1.5 kg) infants, should be fed as early as possible from the first day after birth. Infants who are able to breastfeed should be put to the breast as soon as possible after birth. Infants who are unable to breastfeed should be given expressed mother’s own milk as soon as it becomes available. If mother’s own milk is not available, donor human milk should be given wherever possible.
Recommended in favor
Strong
Certainty of evidence
Moderate
Notes and Remarks
Remarks
- Enteral feeding includes direct breastfeeding and feeding by cups, naso- or orogastric tubes.
- The trials included in the systematic review mostly did not state the stability of the babies, so careful consideration is needed in applying these recommendations to unstable babies. The GDG considers that initiation of enteral feeding in unstable babies should be based on clinical judgement.
- Infants should be given mother’s own milk wherever possible. The provision of colostrum is especially important. If mother’s own milk is not available, then donor human milk should be given wherever possible. If human milk is not available, infants can be fed formula as this is preferable to delayed initiation of enteral feeding and the use of parenteral nutrition.
- There was no difference in effectiveness by volume of initial feed, so a recommendation was not made on restricting the volume of feed.
- In all but one of the trials, the control group received parenteral nutrition. The benefits of early initiation of enteral feeding may be even greater when the alternatives are intravenous fluids or dextrose water rather than parenteral nutrition.