Feeding Premature Babies a Little Faster: A Study on Milk, the Gut, and Oxygen

A plain-language look at a two-hospital study measuring how the gut handles slow versus faster milk increases in premature babies

A study of 60 premature babies born at 28 to 32 weeks found that increasing their daily milk feeds a little faster helped them reach full feeds sooner, with no cases of the serious bowel disease NEC and no more feeding problems than a slower schedule. Using a painless light sensor on the skin, researchers also showed that faster feeding did not reduce the oxygen reaching the babies' gut — if anything, the gut's oxygen response was slightly stronger [1].

Why This Question Matters

When a baby is born many weeks early, one of the first daily challenges is milk. A premature baby's stomach and intestines are still immature, so nurses and doctors introduce milk gradually, increasing the amount a little each day until the baby is fully fed by mouth or feeding tube and no longer needs nutrition through a vein. The everyday question is how fast to make those increases. Go slowly and you feel safer, but the baby stays on intravenous nutrition and a small plastic line into a vein for longer — and those lines can lead to infections and liver strain [2]. Go faster and you shorten that risky period, but generations of caregivers worried that pushing milk too quickly might overwhelm the fragile gut.

How Families and Doctors Used to Face This

For a long time, caution won by default. Older studies had suggested that bigger daily jumps in milk might be linked to necrotising enterocolitis, or NEC — a dangerous condition in which part of the bowel becomes inflamed and can be seriously damaged [3]. Out of that fear grew the tradition of "trophic feeding": giving tiny volumes of milk for several days to gently wake up the gut before increasing amounts, an approach that some studies associated with less NEC [4]. Reviews of hospitals that used careful, standardised slow-feeding routines seemed to back this up [5]. So for years, "slow and steady" felt like the responsible choice, even though it kept babies tethered to intravenous lines longer.

More recently, that picture has changed. When researchers pooled together the best trials, they found that increasing feeds faster did not raise the risk of NEC or death in very small babies [6]. A large analysis comparing different feeding approaches in babies born at or before 32 weeks reached the same reassuring conclusion [7]. The debate shifted from "is faster dangerous?" toward "how do we know the gut is coping?" That is exactly what this new study set out to measure directly.

What the Researchers Did

The study took place at two hospitals in Istanbul, Türkiye, over about a year [1]. Sixty premature babies, all born between 28 and 32 weeks, were divided at random into two groups. One group had their milk increased slowly — by 20 millilitres per kilogram of the baby's weight each day. The other group increased faster — by 30 millilitres per kilogram each day. Everything else about their care was kept the same, and both groups started with a few days of very small "starter" feeds before the increases began [1].

The clever part was how the team watched the gut. They used a technology called near-infrared spectroscopy, or NIRS — a soft sticker-like sensor placed on the skin that shines harmless light through the tissue to estimate how much oxygen is reaching an organ underneath. It causes no pain and requires no needle or blood test [8]. One sensor sat on the forehead to watch the brain, and one on the lower belly to watch the intestines. By comparing the two, the researchers could tell whether the gut was getting its fair share of oxygen or whether blood was being diverted away from it. They took readings just before, during, and after feeds, at three stages: during the tiny starter feeds, during the daily increases, and after the babies had reached full feeds [1]. This kind of gut monitoring builds on earlier work showing that these belly sensors reflect real blood flow to the intestine [9],[10].

What They Found

The results were encouraging on every front that matters to a family. Babies in the faster group reached full feeds sooner, meaning they could come off intravenous nutrition earlier [1]. Just as importantly, no baby in either group developed NEC, and feeding problems were no more common with faster feeding: about one in four babies overall (14 of 60) had some feeding intolerance — such as a bloated tummy, vomiting, or milk staying in the stomach — but this was split evenly between the groups, with slightly more in the slow group, not the fast one [1].

When the team looked at the gut-oxygen readings, they found that feeding actually raised the oxygen reaching the intestine in both groups — the opposite of the old fear that the gut would be starved. And when they measured how much each baby's own gut-oxygen level climbed after a feed compared with before, the rise was a little bigger in the faster group [1]. In plain terms: feeding a premature baby faster did not shortchange the gut; it seemed to bring a healthy surge of oxygen along with the milk, much as a meal draws extra blood flow to the intestines in all of us.

There was one more useful discovery. The babies who did struggle with feeds tended to have lower gut-oxygen readings all along — before, during, and even after they eventually reached full feeds. These babies were also, on average, the smallest and most premature [1]. This suggests that a low gut-oxygen signal might one day serve as an early warning sign, helping the team spot which babies need extra caution. The researchers even sketched out a simple scoring idea based on a baby's gestational age, birth weight, and gut-oxygen readings — but they were careful to call this a preliminary idea that needs testing in larger studies before anyone relies on it [1].

It helps to understand what "full feeds" and NEC actually mean, because they sit at the heart of this study. Reaching full feeds means a baby is getting all of their nutrition as milk — through the mouth or a small feeding tube into the stomach — and no longer needs a drip of nutrition into a vein. Getting there sooner is a genuine milestone: it means the intravenous line can come out, which lowers the chance of infection and lets the gut do the job it is meant to do. NEC, the condition everyone is trying to avoid, is an illness in which part of a premature baby's bowel becomes inflamed and injured; it is uncommon but serious, and the fear of triggering it is the main reason feeds have traditionally been increased so cautiously. In this study, watching the gut's oxygen supply in real time was a way of checking, moment to moment, whether the faster schedule was stressing the bowel — and it was not.

Another reassuring detail is how ordinary the faster schedule really was. "Faster" here did not mean rushing or skipping the gentle start; both groups began with several days of tiny starter feeds, and the milk was given as small, spaced-out feeds rather than a continuous drip. The only difference was how much the daily amount went up — 30 versus 20 millilitres per kilogram. In other words, this was a careful, measured kind of faster, the sort a NICU team can apply within its normal routines, not an aggressive push.

What This Means for Families and Their Baby's Care

If your baby was born moderately premature — around 28 to 32 weeks — and is otherwise stable, this study offers reassurance that a somewhat faster feeding schedule is a reasonable, safe choice that can help your baby come off intravenous lines sooner. It fits with the larger body of evidence that faster feeding does not increase the risk of NEC in babies of this maturity, and with trials showing faster feeding gets babies to full nutrition more quickly without extra complications [11].

A few honest cautions come with that reassurance. This was a small study, and — importantly — it did not include the very tiniest babies, those born before 28 weeks, or babies who were unusually small for their gestational age. Those are exactly the babies for whom feeding decisions are most delicate, so these findings should not be stretched to cover them [1]. The gut-oxygen sensor, while promising, is still mainly a research and monitoring tool rather than something that decides how fast any individual baby should be fed. And the reassuring "no NEC" result, while genuinely good news, partly reflects the fact that this group of babies was at lower risk to begin with.

What Researchers Are Working On Next

The natural next step is a larger study that includes the smallest and most vulnerable premature babies, to see whether faster feeding is just as safe for them and whether the gut-oxygen sensor can reliably flag the babies who need extra care [1]. Researchers also want to confirm the proposed early-warning score in new groups of babies before it could be used at the bedside. For now, the takeaway for families is a hopeful one: for moderately premature babies, feeding a little faster appears to be safe, gets them to full feeds sooner, and does not leave the gut short of oxygen. It is a small, careful example of how newborn care keeps replacing old fears with real measurements.

References

  1. Bilgen HS, et al. Effect of Slow Versus Rapid Advancement of Enteral Feeding on Intestinal Oxygenation in Preterm Infants. Children (Basel). 2025;12(11):1527. doi:10.3390/children12111527 ↩
  2. Ramani M, Ambalavanan N. Feeding practices and necrotizing enterocolitis. Clin Perinatol. 2013;40:1–10. doi:10.1016/j.clp.2012.12.001 ↩
  3. McKeown RE, Marsh TD, Amarnath U, et al. Role of delayed feeding and of feeding increments in necrotizing enterocolitis. J Pediatr. 1992;121:764–770. doi:10.1016/S0022-3476(05)81913-481913-4) ↩
  4. Berseth CL, Bisquera JA, Paje VU. Prolonging small feeding volumes early in life decreases the incidence of necrotizing enterocolitis in very low birth weight infants. Pediatrics. 2003;111:529–534. doi:10.1542/peds.111.3.529 ↩
  5. Patole SK, de Klerk N. Impact of standardised feeding regimens on incidence of neonatal necrotising enterocolitis: a systematic review and meta-analysis of observational studies. Arch Dis Child Fetal Neonatal Ed. 2005;90:F147–F151. doi:10.1136/adc.2004.059741 ↩
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  7. Ramaswamy VV, Bandyopadhyay T, Ahmed J, et al. Enteral Feeding Strategies in Preterm Neonates ≤32 weeks Gestational Age: A Systematic Review and Network Meta-Analysis. Ann Nutr Metab. 2021;77:204–220. doi:10.1159/000516640 ↩
  8. Marin T, Moore J. Understanding near-infrared spectroscopy. Adv Neonatal Care. 2011;11:382–388. doi:10.1097/ANC.0b013e3182337ebb ↩
  9. Gillam-Krakauer M, Cochran CM, Slaughter JC, et al. Correlation of abdominal rSO2 with superior mesenteric artery velocities in preterm infants. J Perinatol. 2013;33:609–612. doi:10.1038/jp.2013.3 ↩
  10. Kuik SJ, van Zoonen AGJF, Bos AF, et al. The effect of enteral bolus feeding on regional intestinal oxygen saturation in preterm infants is age-dependent. BMC Pediatr. 2019;19:404. doi:10.1186/s12887-019-1805-z ↩
  11. Modi M, Ramji S, Jain A, Kumar P, Gupta N. Early Aggressive Enteral Feeding in Neonates Weighing 750–1250 Grams: A Randomized Controlled Trial. Indian Pediatr. 2019;56:294–298. doi:10.1007/s13312-019-1517-3 ↩