Feeding Intolerance Patterns in Very Low Birth Weight Neonates: A Cohort Study

Abstract

Very low birth weight (VLBW) neonates are frequently affected by feeding intolerance, a heterogeneously defined clinical syndrome encompassing excessive gastric residuals, abdominal distension, emesis, and stool changes that reflects an immature gut's struggle to process enteral nutrition. This article synthesizes the cohort, trial, and systematic-review literature on feeding intolerance in VLBW infants: how it is defined and scored, the physiological substrate of motility immaturity, microbial dysbiosis, and marginal splanchnic perfusion that underlies it, the feeding practices (human milk provision, feed-advancement rate, standardized protocols, probiotic supplementation) shown to modify its incidence, its relationship to and clinical distinction from necrotizing enterocolitis and spontaneous intestinal perforation, emerging biomarker and imaging tools for earlier recognition, and its documented associations with prolonged time to full enteral feeding, extended NICU stay, extrauterine growth restriction, and neurodevelopmental impairment. Read together, the evidence supports standardized, human-milk-centered feeding protocols and probiotic supplementation as the interventions with the clearest benefit, while definitional inconsistency across studies and the absence of validated biomarker thresholds for distinguishing benign intolerance from early necrotizing enterocolitis remain the field's most pressing open problems.