Rapid assessment of feeding intolerance: a systematic approach to reduce time to full enteral feeding in preterm infants

Background: Feeding intolerance (FI) is common in very preterm infants and often leads to unnecessary interruptions in enteral nutrition (EN), delaying full enteral feeding (FEF). The absence of standardized criteria contributes to inconsistent management. We evaluated the impact of a structured protocol-Rapid Assessment of Feeding Intolerance (RAFI)-on FEF achievement in preterm infants. Methods: This single-center, retrospective-prospective superiority cohort study included infants <30 weeks' gestation. Two cohorts were defined: a historical control group (pre-RAFI) and a RAFI group (first implementation phase). The primary outcome was time to FEF (150 mL/kg/day of EN). One-sided statistical tests were used to assess the superiority of RAFI. Stratified analysis was performed for infants with intrauterine growth restriction (IUGR). Results: Sixty infants were included (30 per group). RAFI infants achieved FEF significantly earlier than controls [median 23.0 (IQR 18.0-30.0) vs. 30.0 (24.0-34.5) days; p = 0.041]. Among IUGR infants (n = 14), RAFI group achieved FEF earlier [27.00 (24.00-32.00) vs. 35.00 (34.00-61.00) days; p = 0.036] at earlier post-menstrual age [33.0 (32.5-34.0) vs. 34.0 (34.0-37.5) weeks; p = 0.028] and with a lower weight [1,280 (1,130-1,382) vs. 1,535 (1,325-2,002) g; p = 0.048]. A trend towards a shorter duration of central venous catheter (p = 0.059) and hospital stay (p = 0.064) was observed. Conclusions: RAFI implementation was associated with earlier achievement of FEF, particularly in IUGR infants. These findings suggest that a structured and standardized approach to feeding intolerance assessment may facilitate nutritional advancement in very preterm neonates.