Early exclusive milk feeding for premature babies has no negative consequences

02.2026
Author Dr. Martin Claßen, Bremen

The right time to begin oral milk feeding and how quickly use of formula is increased for premature babies continues to vary from one clinic to another. On the one hand, there is the risk of developing necrotising enterocolitis (NEC), while on the other, intravenous hydration poses its own risks.

A large-scale, randomised multicentre study was recently conducted in the UK involving 2,088 premature babies (1,761 mothers) with a gestational age between 30 + 0 and 32 + 6 weeks. Beginning within 3 hours of birth, it compared exclusive feeding with oral milk from day 1 with the traditional, gradual increase in oral milk feeding, complemented by intravenous fluids. The follow-up parameters were time spent in hospital and frequency of hypoglycaemia or NEC.
In both groups, the average birth weight was almost identical (1626 g in the group given milk from day 1, and 1617 g in the control group). The time spent in hospital did not vary significantly (32.4 days [SD 13.3] in the intervention group versus 32.1 days [SD 13.5]). The frequency of NEC was 4 [0.4%] of 1,030 versus 6 [0.6%] of 1,027, and the number of cases where blood sugar levels were < 2.2 mmol/l were 0.6 [SD 1.0] versus 0.5 [0.7].

Comment: It is pleasing to see that some issues that still often provoke emotional reactions when discussed among neonatologists can be resolved once and for all thanks to high-quality studies and the clear evidence they provide. That includes the time and the quantity of oral milk feeding in premature babies (unless they are very small). Previously, we only had small-scale, and in some cases monocentre studies which suggested that starting oral milk feeding early might reduce the amount of time spent in hospital. The multicentre study presented here investigated a large number of children and showed no relevant differences in terms of NEC risk or hypoglycaemia between the group given milk from within hours of birth and the group where oral milk quantities were gradually increased, complemented by intravenous hydration. This is surely a good reason to refrain from using intravenous supplementation in order to avoid unnecessary venepuncture, as the duration of intravenous hydration was significantly lower (14 hours versus 99 hours) in the group fed milk early on. Overall, this can make things simpler and better for everyone: for the premature babies themselves, for medical teams and for parents doing kangaroo care. On average, the time spent in neonatal intensive care was shortened by one day – although it does not mean that newborn premature babies can be released any earlier from hospital. 
Another high-quality study should be conducted to investigate if these results could also apply to extremely premature babies.

Reference:
Ojha S, Beardsley A et al. Full exclusively enteral fluids from day 1 versus gradual feeding in preterm infants (FEED1): an open-label, parallel-group, multicentre, randomised, superiority trial. The Lancet Child Adolesc Health 2025,9: 827–836. DOI: 10.1016/S2352-4642(25)00271-810.1371/journal.pone.0318322]