The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) is recognised globally as a leading authority on nutrition in preterm infants. ESPGHAN regularly produces position papers on a wide range of topics relevant to neonatal practice, including:

• parenteral nutrition
• probiotics
• feeding in critical illness
• use of donor human milk
• feeding in late and moderately preterm infants.

The 2022 position paper: what does it cover?

ESPGHAN produced a position paper focusing on enteral feeding and nutrition in preterm infants in 2010, and this was updated in 2022. The paper aimed to cover a range of topics but noted that for multiple areas of practice, there is a lack of high-quality evidence from randomised controlled trials (RCTs). Without this type of evidence, it is difficult to be certain of practice that optimises both short and long-term outcomes. The position paper, therefore, often relies on expert consensus and short-term physiological studies, and notes that there may be multiple areas of practice where deviations from these ‘recommendations’ would be considered appropriate.

Nevertheless, healthcare professionals must be consistent and base their clinical practice on some form of evidence. There is good evidence that unit-based guidelines improve growth out-comes and reduce complications such as necrotising enterocolitis.

The 2022 ESPGHAN position paper provides enteral intake recommendations for macronutrients (protein, fat, carbohydrate and water) and micronutrients (electrolytes, minerals, vitamins, trace elements, etc.) It also provides recommendations for feeding practice (speed of feed increases, transition from parenteral nutrition, use of gastric tubes, bolus feeds, etc), growth, use of supplemental bionutrients and fortification of breast milk.

The 2022 ESPGHAN position paper.

The importance of involving parents at all stages is emphasised. The position paper is available via open access1 and is supported by extensive supplementary digital content that is also freely available – there are 18 additional sections with more extensive information on the paper development process, the basis for human milk nutrient estimates, basic physiology and literature reviews.

The online learning course, hosted on Future Learn.

An online learning course

ESPGHAN produced the position paper to provide guidance to healthcare professionals rather than aiming to produce a textbook. However, a key aim of ESPGHAN is providing high-quality education and as such, an online learning course was created to accompany the position paper.

The course was written by the authors of the position paper and contains text content, audio clips, summary videos and quizzes. It contains sections written by parents and supported by the European Foundation for the Care of Newborn Infants (EFCNI). Since the course launched in November 2022, over 1,400 learners from more than 90 countries around the world have joined. It is designed to promote interactive conversations and there are over 500 active discussions that learners can connect with. Funding for the course was provided by ESPGHAN; there is no external commercial or industry involvement.

This ‘massive open online course’ (MOOC) is hosted on Future Learn, a digital education platform, meaning it is globally accessible at no cost for the duration required to complete the course (three hours of learning per week, for four weeks). Permanent access to the course is available to those learners wishing to upgrade. The course can be accessed at www.futurelearn.com/admin/courses/espghan-recommendation-for-enteral-nutrition-in-preterm-infants or by scanning the QR code.