ORIGINAL RESEARCH article
Front. Pediatr.
Sec. Neonatology
This article is part of the Research TopicNeonatal Nutrition Under the Lens: Immunological Protection, Feeding Safety, and Public HealthView all articles
Rapid Assessment of Feeding Intolerance: a Systematic Approach to Reduce Time to Full Enteral Feeding in Preterm Infants
Provisionally accepted
Elena Maggiora1,2
Francesco Cresi1,2
Giulia Maiocco1,3*
Chiara Peila1,2
Barbara Vania1Elisa Rossi1,3
Antonio W. Danilo Gavilanes4
Diego Gazzolo5
Alessandra Coscia1,2- 1Neonatology and Neonatal Intensive Care Unit, Sant'Anna Hospital, Città della Salute e della Scienza, Turin, Italy
- 2Department of Public Health and Pediatrics, University of Turin, Turin, Italy
- 3Department of Public Health and Pediatrics, Postgraduate School of Pediatrics, University of Turin, Turin, Italy
- 4Department of Pediatrics and Neonatology, Maastricht University, Maastricht, Netherlands
- 5Neonatal Intensive Care Unit, G. D’Annunzio University of Chieti, Chieti, Italy
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Background: Feeding intolerance (FI) is common in very preterm infants and often leads to unnecessary interruptions in enteral nutrition (EN), delaying full enteral feeding (FEF). The absence of standardized criteria contributes to inconsistent management. We evaluated the impact of a structured protocol—Rapid Assessment of Feeding Intolerance (RAFI)—on FEF achievement in preterm infants. Methods: This single-center, retrospective-prospective superiority cohort study included infants <30 weeks' gestation. Two cohorts were defined: a historical control group (pre-RAFI) and a RAFI group (first implementation phase). The primary outcome was time to FEF (150 mL/kg/day of EN). One-sided statistical tests were used to assess the superiority of RAFI. Stratified analysis was performed for infants with intrauterine growth restriction (IUGR). Results: Sixty infants were included (30 per group). RAFI infants achieved FEF significantly earlier than controls (median 23.0 [IQR 18.0–30.0] vs 30.0 [24.0–34.5] days; p = 0.041). Among IUGR infants (n = 14), RAFI group achieved FEF earlier (27.00 [24.00–32.00] vs 35.00 [34.00–61.00] days; p = 0.036) at earlier post-menstrual age (33.0 [32.5–34.0] vs 34.0 [34.0–37.5] weeks; p = 0.028) and with a lower weight (1280 [1130–1382] vs 1535 [1325–2002] g; p = 0.048). A trend towards a shorter duration of central venous catheter (p = 0.059) and hospital stay (p = 0.064) was observed. Conclusions: RAFI implementation was associated with earlier achievement of FEF, particularly in IUGR infants. These findings suggest that a structured and standardized approach to feeding intolerance assessment may facilitate nutritional advancement in very preterm neonates.
Keywords: Enteral Nutrition3, feeding intolerance1, full enteral feeding4, intrauterine growth restriction5, very preterm infants2
Received: 27 Nov 2025; Accepted: 16 Feb 2026.
Copyright: © 2026 Maggiora, Cresi, Maiocco, Peila, Vania, Rossi, Gavilanes, Gazzolo and Coscia. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Giulia Maiocco
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