A large multicenter trial demonstrates that babies born eight to ten weeks early can begin full milk feeds through a gastric tube immediately after birth, rather than receiving nutrition exclusively via intravenous lines. The FEED1 trial indicates this approach reduces the number of painful procedures and may shorten time in intensive care without increasing key risks.
Study design and scope
The FEED1 trial enrolled 2,088 infants born between October 2019 and July 2024 across 46 NHS hospitals in the United Kingdom.
Participants were randomized to receive either full milk feeds from birth via a nasogastric or gastric tube or to a conventional regimen consisting of gradually increasing milk feeds with intravenous nutrition as needed.
Primary outcomes focused on safety and medical intervention requirements, with secondary outcomes including duration of hospital stay and incidence of complications such as necrotizing enterocolitis (NEC), hypoglycemia, and infection.
Key findings
Hospital stay: Infants in both arms had similar lengths of hospitalization, approximately 30–35 days.
Interventions and care setting: The full milk-feeding group required fewer medical procedures and less time in intensive care compared with the intravenous-feeding group.
Safety outcomes: There were no significant differences between groups in rates of hypoglycemia, NEC, or infection.
Feeding progression: Infants born at 30–32 weeks gestation typically cannot feed orally and require tube feeds initially; the trial evaluated the safety of starting full milk feeds via tube from birth in this population.
Clinical implications
Procedural burden: Initiating full milk feeds from birth via tube reduces the need for intravenous nutrition and associated invasive procedures.
Care environment: The findings support managing eligible preterm infants in special care units with greater family involvement and early breastfeeding support.
NEC risk: The trial adds to growing evidence that larger milk feeds can be delivered safely to certain stable preterm infants without elevating NEC risk.
Practice guidelines: The results may inform updates to neonatal feeding protocols, particularly for babies born at 30–32 weeks’ gestation who are not severely ill.
Trial sponsorship and support
The trial was sponsored by University Hospitals of Derby and Burton NHS Foundation Trust (UHDB) and coordinated by the Nottingham Clinical Trials Unit at the University of Nottingham.
Funding was provided by the NIHR and supported by Bliss, the UK charity for premature or sick newborns.
The NIHR Health Technology Assessment Programme contributed to the research funding and emphasized the potential quality-of-life improvements for patients and efficiency gains for NHS services.
Access and publication
The FEED1 trial results were published in Lancet Child & Adolescent Health.
The trial’s findings were presented alongside commentary from researchers and patient-family representatives highlighting reduced procedural burden and potential improvements in early bonding and breastfeeding support.
Representative participant perspectives
Case examples from trial families illustrate the practical impact of the approach:
A family with Olivia, born at 31 weeks and six days, described the trial as a source of light during NICU care and expressed hope that the findings would benefit other families.
Another family reported positive experiences with care, clear communication, and smooth transitions from tube feeds to bottle feeding.
Discussion
The FEED1 results contribute to a shifting paradigm in neonatal nutrition for moderately preterm infants. By enabling safe full milk feeds from birth via gastric tube in appropriately stable infants, clinicians may reduce the frequency of invasive feeding interventions and potentially shorten durations in intensive care settings.
The generalizability of these findings to broader preterm populations should consider gestational age, illness severity, and feeding tolerance. Ongoing work may refine criteria for identifying which infants are most likely to benefit from early full milk feeding and which require closer monitoring.
Limitations
While the study included a large sample across multiple centers, individual patient factors such as maternal health, nutritional status, and center-specific NICU practices may influence applicability.
Long-term outcomes beyond hospital discharge, including growth trajectories and neurodevelopmental measures, warrant further investigation.
Conclusions
For preterm infants born eight to ten weeks early who are clinically stable, initiating full milk feeds via a gastric tube from birth is feasible and safe, reducing the need for intravenous nutrition and minimizing painful procedures without increasing adverse events.
These findings support a move toward family-centered care in special care units and may inform future neonatal feeding guidelines to optimize outcomes for preterm infants.
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