Background: The optimal rate of feeding advancement in preterm LBW infants remains uncertain, especially in low-resource settings. This study aimed to compare feeding intolerance and nutritional outcomes between rapid and gradual feeding protocols. Aim of the Study: The aim of the study was to compare feeding intolerance and nutritional outcomes in preterm low birth weight neonates receiving rapid versus gradual advanced feeding protocols. Methods: This randomized controlled trial at the Department of Neonatology, Bangladesh Shishu Hospital & Institute (BSH&I), Dhaka, from July 2022 to June 2024, included 88 low birth weight preterm neonates. Neonates were randomized to receive either rapid or gradual feeding advancement. Primary outcomes included feed intolerance, sepsis, NEC, hospital stay, and mortality. Data were analyzed using SPSS with a significance level of p < 0.05. Results: The study compared two feeding protocols in preterm low birth weight neonates. There were no significant differences in gestational age or birth weight between the groups. Feed intolerance was more common in group A (29.5%) than in group B (15.9%), but not significantly (p = 0.127). Group A reached full feeds faster (7.0 vs. 8.5 days, p = 0.004) and required less parenteral nutrition (5.0 vs. 7.5 days, p = 0.001). Group B had a longer hospital stay (10.0 vs. 7.0 days, p = 0.002), but no difference in weight at discharge (p = 0.740). Conclusion: Rapid enteral feeding in low-birth-weight preterm neonates improves nutritional outcomes without increasing feed intolerance.