Optimising enteral feeding prevents postnatal growth faltering in preterm infants: a retrospective cohort study

Background: Despite advances in neonatal care, many preterm infants continue to experience growth faltering, with long-term consequences. We aimed to identify early, modifiable feeding-related risk factors and develop machine learning models to predict growth faltering at discharge. Methods: We retrospectively analysed 700 preterm infants (≤34 weeks gestational age (GA), ≤1800 g birth weight (BW)) admitted to a single level IV neonatal intensive care unit between 2014 and 2022, representing a relatively homogeneous population with standardised feeding practices. Over 100 demographic, clinical and nutritional variables, including parenteral and enteral intake during the first 28 days, were evaluated. Growth faltering was defined as a longitudinal decline in weight z-score of ≥1.2 SD from birth to 36 weeks postmenstrual age, rather than an absolute cross-sectional threshold. Supervised machine-learning models were trained using a 70% training and 30% testing split. Results: Growth faltering occurred in 17.7% (n=124). Affected infants had lower GA, lower BW and greater oxygen dependence at day of life 28 (all p