Feeding intolerance and necrotizing enterocolitis are relatively common occurrences in very low birthweight infants in the NICU. Fear of these disorders can significantly affect decisions regarding initiation, advancement, and withholding of enteral feedings. Lack of sufficient enteral feedings and complications related to parenteral nutrition increase neonatal morbidity, thereby emphasizing the need for safe evidence-based feeding decisions and guidelines. Unfortunately, evidence to guide feeding practices is often limited, making clinical decisions and the formulation of guidelines difficult. This article discusses controversies regarding the enteral feeding of very low birthweight infants and includes current scientific evidence supporting and/or refuting specific feeding practices.

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