For a study, researchers sought to see what the best way to start feeding preterm babies who have antenatal Doppler abnormalities is. They looked at randomized controlled trials that compared different ways of starting to feed these babies. They searched databases like PubMed, Embase, Cochrane, CINAHL, Scopus, and Google Scholar for this information on February 25, 2022. They used the Risk of Bias tool, version 2, to assess the risk of bias in these studies. Using the Grading of Recommendations Assessment, Development, and Evaluation approach, the certainty of the evidence was assessed. RevMan 5.4 was used for data analysis. Of the 1,499 unique records identified, 7 studies were eligible for inclusion (6 on feed initiation, 1 on feed advancement). Early enteral feeding did not increase NEC stage 2 or more [risk ratio (RR) 1.12, 95% (CI) 0.71–1.78; 6 studies, 775 participants] and mortality (RR 0.83, 95% CI 0.47–1.48; 5 studies, 642 participants). A trend was noted toward an increase in feeding intolerance (RR 1.23, 95% CI 0.98–1.56; 5 studies, 715 participants). The study found a significant reduction in the age at which preterm neonates could be fed through a tube, the duration of total parental nutrition, and rates of hospital-acquired infections. Feeding through a tube rapidly led to an earlier age at which full enteral feeds were given without affecting other outcomes. The certainty of the evidence was low overall. However, heterogeneity was not significant. There was low-certainty evidence that early feed initiation in preterm neonates with antenatal Doppler abnormalities does not increase rates of NEC and mortality. There is insufficient data on the speed of feed advancement.