Impact of slow and fast feeding advancement on intestinal oxygenation in very low birth weight infants

1. All infants received enteral nutrition via intermittent bolus feeding. 2. Feeding intervals were set based on birth weight: infants weighing 1250 grams or less are fed every 2 hours, and those weighing more than 1250 grams was fed every 3 hours. Infants who exhibited signs of feeding intolerance are fed via intermittent prolonged infusion, either over one or two hours. 3. Enteral feeding was administered to preterm infants by a blinded nurse. 4. Minimal enteral nutrition (MEN) was initiated at 10 mL/kg/day on postnatal day 1 and increased to 20 mL/kg/day over the first 3 to 5 postnatal days. 5. Enteral feeding advancement was initiated after 3 to 5 days of minimal enteral nutrition, depending on group allocation (Group 1: slow; Group 2: rapid). 6. Full enteral nutrition was defined as achieving 120 mL/kg/day, and infants were monitored for an additional two days after this point. 7. Splanchnic tissue oxygenation was monitored throughout the intervention period using near-infrared spectroscopy (NIRS). Splanchnic tissue rSO2 was monitored during minimal enteral nutrition, advancement of enteral nutrition and two days after transitioning to full enteral nutrition. 8. NIRS measurements were taken 30 minutes before feeding (baseline), during feeding, and for 30 minutes after feeding. NIRS values were recorded at 30-second intervals, and the mean of these values was calculated. 9. In our clinic, the enteral feeding monitoring protocol recommended by the Turkish Neonatology Society was implemented. ***Adherence to the intervention was monitored by regular review of hospital feeding records. All enteral feeding procedures were carried out by trained nurses according to the Turkish Neonatology Society enteral feeding monitoring protocol.