Enteral nutrition practices among very preterm infants in neonatal units: a cross-country comparative study

Purpose: The objective of this study was to delineate and compare enteral nutrition (EN) practices among neonatal units across the Arabian Gulf countries. Design/methodology/approach: A cross-sectional study was conducted by recruiting 255 clinicians working in neonatal units in the Arabian Gulf countries. Findings: Out of 255 invited clinicians, 73 (29%) participated in the survey. Neonatal units used varied EN strategies, where feeding practices exhibited variability. The majority (74%) of units had a local standard feeding protocol, while 18% followed international protocols, and 8% did not adhere to a specific protocol. When maternal milk was not used, the main alternatives were preterm formula (67%) and predigested formula (14%). The age at which the first EN was commenced and the reported advancement rate showed significant variations among different units (p < 0.001). The initiation of fortification was primarily driven by reaching a specific enteral volume (commonly reported as 100 mL/kg/day) and addressing poor postnatal growth. Fortification practices did not differ significantly among professions, except for the initial fortification strength, where none of the dietitians and only 8.3% of neonatologists preferred full strength, compared to 28.6% and 21.4% of medical residents and nurses, respectively (p = 0.033). Originality/value: This study marks the first exploration of EN practices in neonatal units, examining their local and cross-country variations. It provides valuable insights to guide local trials and foster global collaboration among neonatal units to establish a unified knowledge base, standardized practices and promote research and innovation, ultimately contributing to optimal feeding practices for very preterm infants.