Background: SARS-CoV-2, the virus responsible for COVID-19, is highly contagious and can cause serious respiratory illness. Research indicates that pregnant women may be at risk for more severe SARS-CoV-2 infection, and COVID-19 may lead to preterm deliveries.  In the era of COVID-19, immediate and safe trophic feeding for preterm neonates. Trophic feeding is a small volume, hypo-caloric feeding, gut priming or minimal enteral feeding acclimate the immature gut of enteral fasting preterm neonates. The total fasting or delayed starting of Trophic feeding causes gut disuse and atrophy; resulted in short and long-term physical and neurological sequels which is significantly associated with an increased risk of neonatal mortality.

Objective: To estimate the time to start trophic feeding and its predictors among preterm neonates admitted in the neonatal intensive care unit of Debre Markos, Felege Hiwot, and Tibebe Ghion comprehensive hospitals, Northwest Ethiopia, 2020

Methods: An institutional based prospective follow-up study was conducted among 210 neonates admitted at selected study hospitals. The data were collected; entered into Epi data 3.1 and exported to Stata 14.1 for further analysis. Descriptive statistics were used to characterize the study population. Kaplan-Meier and log-rank test was used to estimate survival time and to compare survival curves between groups of predictors respectively. Then, after checking assumptions, both bi-variable and multivariable Cox regression models were fitted. An adjusted hazard ratio with 95% confidence interval at a P-value <0.05 was used as a measure effect.

Result: A total of 210 neonates were followed for a total of 10136 person-hours of risk time and 191 (90.95%) of neonates were started trophic feeding.  The overall incidence of starting trophic feeding was 2 per 100 (95% CI: 0.02, 0.022) person-hours observations. The median survival time until start of trophic feeding was 42+ 46 hours IQR (95% CI: 36, 48). First minute APGAR score of seven and above (AHR: 1.53, 95% CI: 1.11, 2.11), birth weight of ≥1500 grams (AHR: 1.48, 95% CI: 1.06, 2.06), starting TF with mother’s milk (AHR: 1.54, 95% CI: 1.11, 2.15), being inborn (AHR: 1.478, 95% CI: 1.061, 2.058), respiratory distress syndrome (AHR:2.11, 95% CI: 1.57, 2.83), hemodynamic instability (AHR: 2.71,  95% CI: 1.688, 4.323) and neonates passed meconium within the first 24 hours of birth (AHR: 2.54, 95% CI: 1.63, 3.93) were found to be statistically significant predictors of time to start TF.

Conclusion and Recommendation: The median time to start trophic feeding is longer than the recommended time of national NICU guideline of Ethiopian ministry of health. To hasten starting time of trophic feeding, early prevention and management of maternal and neonatal problems should be strengthened; and trophic feeding service had better align with the national guideline.

Keyword: Trophic feeding, enteral feeding, preterm neonates