The provision of adequate enteral nutrition is the goal of those caring for the preterm infant. However, a fear of the development of necrotizing enterocolitis, a serious intestinal disease of preterm infants associated with enteral feedings, has influenced feeding practices. Necrotizing enterocolitis (NEC) is a major cause of morbidity and mortality in preterm infants. The incidence of this disease is estimated to be between 8 and 10% of preterm infants. The cause of NEC is considered multifactor-ial including enteral feeds, hypoxia, ischemia, patent ductus arteriosus, and infection. Approximately 90% of infants who develop NEC have been enter-ally fed and several studies have shown that the rapid advancement of enteral feedings is associated with NEC. With the advent of parenteral nutrition, the tendency was to delay enteral feeding for prolonged periods of time in order to prevent this disease and to use parenteral nutrition as the sole source of nutrition. However, it is known that delayed enteral feeding has a negative effect on gastrointestinal structure and function. Lack of enteral nutrition induces gastrointestinal atrophy, depresses gut hormone secretion, and delays the maturation of gastrointestinal motility. There are now numerous studies that demonstrate the benefits of early enteral feeding including the promotion of endocrine adaptation, the accelerated maturation of gut motility patterns, the provision of luminal nutrients, and possible benefits to the immune system. In fact, early enteral nutrition may enhance feeding tolerance and may actually decrease the incidence of NEC.
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