Limitations
NRS
A major limitation of this study was the inability to mask clinicians to the randomized treatment, which may have influenced the decision to change the assigned NRS. On the other hand, the presence of well-defined rules for advancement and interruption of feeding as well as for weaning and failure of NRS, and the blinded analysis by biostatisticians from outside the clinical teams ensured the reliability of results. Another limitation was that the study focused on a population of stable infants; thus, the efficacy of the 2 techniques cannot be generalized to their use as a first-intention treatment. However, we designed a pragmatic study in which clinicians could modify or discontinue the respiratory support and enteral nutrition, providing results that are useful in everyday clinical practice.