ORIGINAL ARTICLE Australasian neonatal intensive care enteral nutrition survey: Implications for practice Barbara Cormack, 1 John Sinn, 2 Kei Lui 3 and David Tudehope 4 1 Auckland City Hospital, Auckland, New Zealand, 2 Royal North Shore Hospital, 3 Royal Hospital for Women, Sydney, New South Wales and 4 Mater Health Services, South Brisbane, Queensland, Australia Aim: This survey investigated standardised feeding guidelines and nutrition policy in Australasian neonatal intensive care units and compared these with previously published surveys and international consensus nutrition recommendations. Methods: An electronic survey on enteral nutrition comprising a wide range of questions about clinical practice was e-mailed to all 25 Australasian neonatal intensive care unit directors of tertiary perinatal centres. Results: Twenty-five surveys were distributed; 24 (96%) were completed. All respondents preferred breast milk as the first feed. For infants <1000 g, 58% started feeds at 1 mL every 4 hours and 83% started enteral feeds on day 0–2 in the absence of contraindications. The identification of bile-stained gastric aspirates significant enough to withhold feeds varied. Multicomponent breast milk fortifiers were added by 58% when enteral feeds reached 150 mL/kg day, while 21% added these earlier at 120 mL/kg day or less. Iron supplementation was started at 4 weeks by 63% and at 6 weeks by 27%. Only 42% of units had a neonatal dietitian. Of the 24 units who responded, 58% had no written enteral feeding guidelines. Conclusion: Enteral nutrition was initiated earlier than in the past. Great variation remains in clinical practices. Nutritional implications are discussed. Standardisation of feeding guidelines and enteral nutrition policy based on current evidence and international consensus nutrition recommendations may be beneficial and should be encouraged. Key words: enteral; neonatology; nutrition; survey. What is already known on this topic 1 There has been wide variation in enteral feeding practices. 2 Two recent international consensus guidelines now advocate higher recommended nutrient intakes. 3 Standardised feeding guidelines are an important tool to improve nutrition and growth in preterm neonates and may reduce necrotising enterocolitis. What this paper adds 1 Over 50% of Australasian units do not have written enteral feeding guidelines. 2 Some feeding practices are not evidence based. 3 Standardisation of feeding guidelines based on current evi- dence, international nutrition recommendations and current feed/fortifier composition should be encouraged in Australasia. Preterm infants require adequate nutrients to grow well and maintain normal concentrations of blood and tissue nutrients. Meeting these nutrient requirements with current enteral feeding protocols is challenging and large nutritional deficits can accrue. 1,2 As a result, post-natal growth in hospital for most preterm infants falls well below the 10th centile for gestational age; 3 these findings have been associated with less favourable neurodevelopment outcomes. 4 Three recent international consensus guidelines 5–7 advocate higher recommended nutrient intakes (RNIs) than previous guidelines, particularly for extremely low birthweight (ELBW) babies, but despite these changes in published recommenda- tions, neonatologists have been slow to implement changes in their practice. 2,8,9 In 2004, a survey of nutrition practices in Australian neonatal intensive care units (NICUs) found that there was wide variation in enteral feeding practices. 10 The aim of this survey was to investigate current feeding practices in Australasia and compare this with published evidence, consen- sus recommendations and previous feeding practices. Methods Survey administration The study population consisted of NICU medical directors (or a neonatologist to whom the task was delegated) practicing in Australia and New Zealand. In October 2008, an electronic survey about enteral feeding practices, other aspects of neonatal clinical practice, guidelines and services consisting mainly of Correspondence: Ms Barbara Cormack, Auckland City Hospital, Auckland 1003, New Zealand. Fax: +64 9 375 7044; email: bcormack@adhb.govt.nz Conflict of interest: Barbara Cormack serves on scientific advisory boards for Nestle Nutrition Institute, Nutricia and Pfizer Nutrition. John Sinn has been an invited speaker at industry sponsored meetings. David Tudehope and Kei Lui have done consultancy work for Nutricia and Pfizer Nutrition. Accepted for publication 15 December 2011. doi:10.1111/jpc.12016 Journal of Paediatrics and Child Health 49 (2013) E340–E347 © 2012 The Authors Journal of Paediatrics and Child Health © 2012 Paediatrics and Child Health Division (Royal Australasian College of Physicians) E340