TOPLINE: 

In infants born at 30-32 weeks of gestation, feeding full milk from day 1 did not shorten hospital stay compared with gradual feeding, but it was linked to reduced use of intravenous lines and showed no higher risk for necrotizing enterocolitis.

METHODOLOGY:

• Researchers conducted an open-label superiority trial to assess whether preterm infants could be fed only full milk (60-80 mL/kg per day) through gastric tubes immediately after birth without increasing health risks.
• They included 2088 clinically stable infants born at 30-32 weeks of gestation (mean gestational age, 31.7 weeks; 47.6% girls) across 46 neonatal units in the UK between 2019 and 2024.
• Within 3 hours of birth, 1047 infants started full milk fluids, while 1041 infants received gradual milk feeding (maximum of 30 mL/kg per day on day 1) supplemented with intravenous fluids or parenteral nutrition.
• The primary outcome was length of hospital stay. Secondary outcomes included the incidence of necrotizing enterocolitis, rate of hypoglycemia, and survival until hospital discharge.
• Outcomes were reported at hospital discharge and at 6 weeks' corrected age. Longer-term follow-up to 24 months is ongoing.

TAKEAWAY:

• Infants who received full milk stayed in hospital for a mean of 32.4 days and those on gradual feeding stayed for 32.1 days, with no significant difference between the groups.
• Necrotizing enterocolitis occurred in 0.4% of infants in the full milk group and 0.6% in the gradual feeding group, with no significant difference; 99.6% of infants in both groups survived to discharge, and rates of hypoglycemia and serious adverse events were similar.
• Infants on full milk reached full enteral feeds sooner than those on gradual feeding (mean, 7.0 vs 7.9 days), had shorter durations of parenteral or intravenous nutrition, fewer intravenous lines, and fewer days in intensive care.
• Nonadherence to full milk feeds was reported for 37% of infants.

IN PRACTICE:

"Despite over a third of infants not adhering to the feeding intervention as intended and length of stay not being reduced, hospitals or clinicians might still consider implementing an early milk feeding regimen for preterm infants born at 30 to 32 weeks of gestation because of the reduction in intravenous interventions without additional risks of necrotizing enterocolitis," experts wrote in an accompanying comment.

SOURCE:

This study was led by Shalini Ojha, PhD, of School of Medicine at University of Nottingham, UK. It was published online on October 17, 2025, in The Lancet Child & Adolescent Health.

LIMITATIONS: 

Adherence in real world might differ from the trial. Hospitals used local discharge rules; thus, length of stay varied by site.

DISCLOSURES:

This study received funding from UK National Institute of Health and Care Research Health Technology Assessment Programme. The University Hospitals of Derby and Burton National Health Service Foundation Trust additionally sponsored this study. The authors declared no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.