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Two-hourly vs Three-hourly Feeding in Very Low Birthweight Neonates: A Randomized Controlled Trial. BACKGROUND: There is no consensus regarding the feeding interval in very low birth weight (VLBW) babies. If 2-hourly feeding schedule is feasible without increasing harm to the neonate, the nursing time consumed in the feeding of VLBW babies can be reduced. OBJECTIVE: To study whether 3-hourly feeding is non-inferior to 2-hourly feeding with respect to time to reach full feeds in VLBW neonates. DESIGN: Open-label, randomized controlled trial. SUBJECTS: 350 Neonates weighing between 1000 to 1500 grams, in whom feed could be started within 96 hours of life randomized to either 2-hourly or 3-hourly feeding schedule. PRIMARY OUTCOME: Time to achieve full enteral feed. RESULTS: The primary outcome of time to achieve full enteral feed was comparable in the two feeding schedule groups (median 5 days IQR 4-6 days in both groups; P=0.665). Among the secondary outcomes, there were no significant differences in incidence of hypoglycemia (RR 0.86; 95% CI: 0.29-2.5) feed intolerance (RR 1.08: 95% CI: 0.5-2.3), and necrotizing enterocolitis (RR 0.8; 95% CI: 0.22-2.3) in both the groups. CONCLUSIONS: Three hourly feeding does not increase the risk of hypoglycemia, necrotizing enterocolitis or feed intolerance.