Cost-consequence analysis of early full milk feeding versus gradual feeding with intravenous support in preterm infants: results from the FEED1 trial

Clinical Snapshot

Key Findings

• P Value: p=0.141 for cost difference

• Effect Size: Non-significant reduction in hospital stay and costs

• Primary Outcome: Length of hospital stay: mean difference -0.050 days

• Nnt Or Sensitivity: Not applicable - no significant clinical benefit demonstrated

• Confidence Interval: Length of stay: -0.638 to 0.538 days; Cost difference: -£1562 to £223

Clinical Application

Highly feasible intervention requiring minimal additional resources or training Directly applicable to Australian NICUs; may inform feeding protocols and resource allocation decisions Preterm infants 30-32 weeks gestation in tertiary neonatal units

Abstract

OBJECTIVE: To assess the economic consequences of initiating full milk feeds from birth compared with intravenous fluids with gradual feeding in infants born preterm. DESIGN: Within-trial economic evaluation alongside a prospective, multicentre, randomised controlled trial (Fluids Exclusively Enteral from Day 1). A cost-consequence approach was used (revised from the planned cost-effectiveness analysis to avoid double counting length of stay within costs). SETTING: 46 UK National Health Service (NHS) neonatal units. PATIENTS: Preterm infants born at 30+0to 32+6 weeks' gestation. INTERVENTIONS: Infants were allocated to either full milk feeds or gradual feeding with intravenous support within 3 hours of birth. MAIN OUTCOME MEASURE: Resource use and costs were captured from birth to 6 weeks' corrected age. Costs were assessed from an NHS and personal social services perspective. The primary clinical outcome was length of hospital stay. RESULTS: 2088 infants were enrolled. There was no statistically significant difference in mean (95% CI) length of hospital stay between groups (-0.050 days (-0.638 to 0.538)). Mean total costs were £670 lower in the full milk group (95% CI: -£1562 to £223; p=0.141). Subgroup analyses suggested lower costs among infants born at 30 weeks' gestation and those below the 10th birth weight centile; no evidence of interaction was found. CONCLUSIONS: Initiating full milk feeds from birth was associated with a modest reduction in costs compared with gradual feeding. While overall hospital stays and costs were not significantly reduced, early full feeding may offer economic advantages in selected subgroups. Further research is needed to assess long-term outcomes. TRIAL REGISTRATION NUMBER: ISRCTN89654042.

References

1. 1.Naghdi, S., Ojha, S., Dorling, J., Anderson, J., Gale, C., Hall, S. S., Johnson, M. J., Johnson, S., Kenyon, C., McGuire, W., Meakin, G., Mitchell, E., Montgomery, A., Oddie, S. J., Ogollah, R., Partlett, C., Su, Y., Walker, K. F., & Mistry, H. (2026). Cost-consequence analysis of early full milk feeding versus gradual feeding with intravenous support in preterm infants: results from the FEED1 trial. Archives of Disease in Childhood. Fetal and Neonatal Edition. https://doi.org/10.1136/archdischild-2025-329964