Enteral Feeding Progression Trajectories in the First Two Postnatal Weeks Are Associated with Motor Neurodevelopment at 24 Months in Preterm Infants: A Multicenter Cohort Study

Background/Objectives: Preterm infants are at substantial risk of neurodevelopmental impairment. Current guidelines recommend gradual advancement of enteral feeds during the first postnatal weeks, but the rate that is optimal for the individual infant remains uncertain. We modeled the day-by-day balance between enteral and parenteral nutrition during the first two postnatal weeks as longitudinal trajectory phenotypes and examined their association with neurodevelopment at 24 months of corrected age.

Methods

Retrospective multi-center observational cohort of preterm infants (gestational age < 32 completed weeks or birth weight < 1500 g) from two centers managed under closely aligned nutritional protocols. The daily enteral-to-total-energy ratio on postnatal days 0–7 and 14 was clustered by K-means (K = 3) into parenteral-dominant (C0), moderate-progression (C1) and rapid-progression (C2) phenotypes. The primary outcome was the Bayley-III Motor composite at 24 months; Cognitive and Language composites at 24 months and the Motor composite at 12–18 months were additional outcomes. Linear mixed-effects models were adjusted for gestational age, birth-weight z-score and sex, with a random intercept for center.