Gavage Feeding Practices in VLBW Infants: Physiological Aspects and Clinical Implications

The goal of enteral nutrition in preterm infants is to adequately support growth without compromising the integrity of the immature gut. Gavage feeds given both by intermittent bolus and continuous infusion have been used in NICUs for years. There is no clear evidence that one method improves clinical outcome over the other, leading to practice variations that are often empirical and subject to clinician preference. This article reviews the physiological effects of the feeding method on gut perfusion, motility, energy expenditure, and interoceptive stress with special regard to anabolism and bioavailability of nutrients. Bolus feeding is followed by insulin surges, enhanced protein synthesis, and improved intestinal growth. Infusion feeding leads to a mature pattern of duodenal contractions and less energy expenditure but is associated with significant loss of key nutrients. An individualized approach based on physiological needs of preterm infants may improve feeding tolerance in this population.