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Lookup NU author(s): Professor Nicholas EmbletonORCiD
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© Author(s) (or their employer(s)) 2026. No commercial re-use. See rights and permissions. Published by BMJ Group.Objective To evaluate enteral feeding practices in preterm infants in neonatal intensive care units (NICUs) in high-income countries across three continents, and compare results with a similar survey 13 years earlier. Methods Web-based survey distributed to neonatologists at 258 NICUs across 15 countries in Europe, Australia, New Zealand and Canada, October 2023 and February 2024. Survey domains focused on availability of human milk, onset of enteral feeding, breast milk fortification (BMF), cytomegalovirus (CMV) screening and enteral supplements including probiotics. Results were compared with a similar survey performed in 2010. Results Replies were received from 185 (72%) NICUs. Access to donor human milk (DHM) was high (91%). Across all NICUs, feeds were started on day 1 in 64%, 73% and 85% among infants born <25, 25–27 and 28–31 weeks’ gestation, respectively. Bovine milk-based BMF was routinely used in 88% of NICUs, with large variation in when it was commenced and discontinued. Routine use of human milk-based BMF was uncommon (4%). Maternal CMV status was routinely determined in 33% of all NICUs who then pasteurised or froze milk if the mother was CMV-seropositive. Probiotics were provided in 66% of the NICUs, with large variations in products and birth weight/gestational age criteria. Conclusions Compared with our survey from 2010, more NICUs now start feeding preterm infants on day 1, and DHM availability has increased in some countries. Substantial variation remains in the use of BMF, probiotics and CMV screening. A stronger evidence base is needed to update guidelines, aiming ultimately to improve growth and long-term neurodevelopment.
Author(s): Klingenberg C, Aunsholt L, Van Den Akker CHP, Haertel C, Saenz de Pipaon M, Giannoni E, O'Donnell CPF, Fenton T, Lehtonen L, Bohlin K, Heiring C, Pereira-Da-Silva L, Kuschel CA, Embleton ND
Publication type: Article
Publication status: Published
Journal: Archives of Disease in Childhood: Fetal and Neonatal Edition
Year: 2026
Pages: epub ahead of print
Online publication date: 12/02/2026
Acceptance date: 30/01/2026
ISSN (print): 1359-2998
ISSN (electronic): 1468-2052
Publisher: BMJ Publishing Group
URL: https://doi.org/10.1136/archdischild-2025-329670
DOI: 10.1136/archdischild-2025-329670
PubMed id: 41679961
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