As we move into the second year of the nutrition project, future work will be centered around a few of the Potentially Better Practices (PBPs) from the tool kit sections on enteral nutrition.  

The first PBP focuses on the early initiation of enteral feedings.  These minimal enteral feedings (5-25 ml/kg/day) should be initiated within 1-2 days of birth except when there are clear contraindications such as a congenital anomaly precluding feeding (for example, omphalocele or gastroschisis), or evidence of GI dysfunction (as with hypoxic-ischemic compromise or shock).  Early enteral feedings stimulate gut maturation, hormone release and motility.  Beneficial effects of minimal enteral feedings include shorter time to full feeds, faster weight gain, less feeding intolerance, less need for phototherapy, enhanced maturation of small intestine function, decreased length of stay, significant reduction in serious infections, and a lower incidence of extrauterine growth restriction.  

The second PBP discusses that enteral feedings should be advanced until they are providing adequate nutrition to sustain optimal growth, ideally 15-20 grams/kg/day.  For infants who are being fed human milk, this could mean an intake higher than the historic 150 ml/ky/day, depending on the caloric density of the mom's or donor's milk, given to these infants in order to establish optimal growth.  The total feeding volume should be individualized to each baby to achieve optimal growth.