Doctors have long waited days before giving premature babies full milk feeds, worried it might cause problems. Instead, they start with IV fluids and slowly increase milk over time. A large study of over 2,000 premature babies born around 32 weeks tested whether giving full milk feeds immediately from day 1 would be safe and help babies go home sooner. The results showed that babies who got full milk feeds right away spent the same amount of time in the hospital as those who got milk gradually, and they didn’t have more serious problems. This suggests doctors have more flexibility in how they feed very premature babies.

The Quick Take

  • What they studied: Does giving premature babies full milk feeds starting on day 1 work as well as slowly increasing milk feeds over several days?
  • Who participated: 2,088 premature babies born between 30 and 32 weeks of pregnancy from 46 hospitals in the UK. Babies had to be healthy enough to receive milk feeds and born within 3 hours of the study enrollment.
  • Key finding: Babies who received full milk feeds from day 1 went home after an average of 32.4 days, while babies who got milk gradually went home after 32.1 days—essentially the same. Both groups had very low rates of serious intestinal problems (less than 1%) and low blood sugar episodes.
  • What it means for you: If you have a premature baby born around 32 weeks, doctors may now feel more confident starting full milk feeds immediately rather than waiting days. This could mean your baby gets better nutrition sooner, though it won’t necessarily shorten hospital stays. Talk with your baby’s doctors about what approach is best for your specific situation.

The Research Details

This was a large, carefully designed study called a randomized controlled trial. Researchers recruited mothers of premature babies born between 30 and 32 weeks of pregnancy from 46 hospitals across the UK. Within 3 hours of birth, each baby was randomly assigned to one of two groups: one group received full milk feeds (60-80 mL per kilogram of body weight per day) starting immediately, while the other group received smaller amounts of milk (up to 30 mL per kilogram on day 1) plus IV fluids to provide extra nutrition. The doctors and parents knew which group each baby was in, but the researchers analyzing the data didn’t know until after all information was collected, which helps prevent bias.

The study followed 2,088 babies total—1,047 in the full milk group and 1,041 in the gradual feeding group. The babies were very similar in both groups, with an average gestational age of about 31.7 weeks and average birth weight around 1,620 grams (about 3.5 pounds). Researchers tracked how long each baby stayed in the hospital, whether they developed serious intestinal infections, and whether they had episodes of low blood sugar.

This study design is considered very strong because random assignment helps ensure the two groups are truly comparable, and the large number of babies involved makes the results more reliable. The study was registered before it started, which means the researchers committed to their plan in advance rather than changing it based on results.

This research matters because feeding decisions in premature babies are crucial—they affect how quickly babies grow, how long they stay in the hospital, and their risk of serious infections. Previous medical practice was cautious about full feeds because doctors worried about a serious intestinal problem called necrotizing enterocolitis. However, this large study provides strong evidence that the cautious approach may not be necessary for babies born around 32 weeks. Understanding what feeding approach is safest helps doctors make better decisions and potentially improves care for thousands of premature babies each year.

This study has several strengths that make its findings reliable: it included over 2,000 babies from multiple hospitals (making results more generalizable), used random assignment to prevent bias, had researchers analyzing data who didn’t know which group babies were in, and was registered before starting (preventing researchers from changing their plan based on results). The study was published in a top medical journal (The Lancet Child & Adolescent Health), which means it underwent rigorous review. However, parents and doctors knew which feeding approach each baby received, which could potentially influence how they cared for the baby. The study focused on babies born between 30-32 weeks; results may not apply to even more premature babies.

What the Results Show

The main finding was that length of hospital stay was virtually identical between groups: babies receiving full milk feeds from day 1 stayed an average of 32.4 days, while babies receiving gradual feeds stayed 32.1 days—a difference of just 0.02 days that could easily be due to chance. This was the primary outcome the study was designed to measure.

Safety outcomes were also reassuring and similar between groups. Survival to hospital discharge was 99.6% in both groups, meaning almost all babies in both groups went home alive and healthy. Necrotizing enterocolitis (the serious intestinal infection doctors worry about) occurred in less than 1% of babies in both groups—4 cases (0.4%) in the full milk group versus 6 cases (0.6%) in the gradual feeding group. This difference was not statistically significant, meaning it could easily be due to random chance.

Low blood sugar episodes were also similar: babies in the full milk group had an average of 0.6 episodes of very low blood sugar, while babies in the gradual feeding group had 0.5 episodes. Serious adverse events (unexpected serious medical problems) were rare in both groups, occurring in less than 1% of babies, and all were unrelated to the feeding approach used.

These results suggest that starting premature babies on full milk feeds immediately is not only safe but doesn’t cause the problems doctors have traditionally worried about.

Beyond the main findings, the study showed that both feeding approaches resulted in excellent survival rates and similar medical outcomes. The two groups were well-matched at the start, with similar gestational ages, birth weights, and gender distributions, which strengthens confidence that any differences would be due to the feeding approach rather than other factors. The study also found that serious adverse events were extremely rare in both groups and unrelated to feeding strategy, suggesting that the feeding approach itself wasn’t causing unexpected problems.

This study challenges traditional medical practice that has emphasized gradual feeding increases in premature babies. Previous research suggested that full feeds might increase the risk of necrotizing enterocolitis, which is why doctors have been cautious. However, this large, well-designed study found no increased risk with full feeds from day 1. The findings align with growing evidence that premature babies may tolerate full feeds better than previously thought, particularly those born closer to term (like the 30-32 week babies in this study). This research provides strong evidence that medical guidelines for feeding very premature babies may need updating.

The study has several limitations to consider: First, it only included babies born between 30-32 weeks of pregnancy; results may not apply to even more premature babies (under 30 weeks) who are more fragile. Second, parents and doctors knew which feeding approach each baby received, which could potentially influence their care or how they reported outcomes, though researchers analyzing data were kept unaware. Third, the study was conducted in UK hospitals, so results may vary in other countries with different medical practices or populations. Fourth, while the study followed babies through hospital discharge, longer-term follow-up data (to 24 months) is still being collected, so we don’t yet know if there are any long-term differences between groups. Finally, the study excluded babies with certain conditions (like those who were very small for their age with specific blood flow problems), so results don’t apply to all premature babies.

The Bottom Line

Based on this strong evidence, doctors can feel confident offering full milk feeds from day 1 to premature babies born around 30-32 weeks of pregnancy, as it appears safe and doesn’t increase risks of serious complications. However, this approach should be individualized—some babies may still need a more gradual approach based on their specific health situation. Parents should discuss with their baby’s medical team which feeding approach is best for their individual baby. The evidence is strong (Level 1 evidence from a large randomized trial), but implementation should involve shared decision-making with your baby’s doctors.

This research is most relevant to parents of premature babies born around 30-32 weeks of pregnancy and the doctors caring for these babies. It’s less applicable to babies born much earlier (under 30 weeks) or much later (after 33 weeks). If your baby was born in this gestational age range and is clinically stable, you should discuss these findings with your baby’s medical team. This research is less relevant to parents of full-term babies or babies with specific medical conditions that affect feeding.

Since this study found no difference in hospital length of stay between groups, you shouldn’t expect your baby to come home sooner with full feeds from day 1. However, full feeds from the start may help your baby receive better nutrition earlier in life, which could support growth and development. Most benefits would be seen during the hospital stay and early weeks of life. Long-term follow-up studies are still ongoing to see if there are any differences in growth or development at 24 months.

Want to Apply This Research?

  • If your baby is receiving full feeds from day 1, track daily milk volume (in mL/kg), weight gain (grams per day), and any feeding tolerance issues (spit-up, abdominal distension). Record these measurements daily to monitor your baby’s progress and share with your medical team.
  • Work with your baby’s medical team to establish a clear feeding plan from day 1. If your baby is eligible for full feeds, discuss this option with doctors and nurses. Ensure you understand the feeding schedule, volume targets, and warning signs to watch for. Advocate for your baby’s nutritional needs while following medical guidance.
  • Monitor your baby’s weight gain trajectory (target is typically 15-20 grams per kilogram per day), feeding tolerance (how well they handle milk), and any signs of feeding intolerance (excessive spit-up, abdominal bloating, or feeding refusal). Track these metrics weekly and discuss trends with your baby’s care team. Continue monitoring through discharge and early home care to ensure your baby is thriving.

This research summary is for educational purposes only and should not replace professional medical advice. Feeding decisions for premature babies should always be made in consultation with your baby’s medical team, who understand your baby’s individual health status and needs. The findings apply specifically to babies born between 30-32 weeks of pregnancy and may not apply to other situations. If you have questions about your baby’s feeding plan, discuss them directly with your pediatrician or neonatologist. This study is ongoing with follow-up data still being collected, so recommendations may evolve as more information becomes available.