Slow versus Rapid Advancement of Enteral Feeding in Preterm Infants Less than 34 Weeks: A Randomized Controlled Trial

Abstract

per day have been reported as safe in a prospective study [7], but several retrospective studies have suggested that advancing feedings rapidly is associated with an increased risk for NEC [9,10]. In 1 of these studies, feeding increments were as high as 40 to 50mL/kg per day [9]. Conversely, a relatively more rapid advancement of enteral feedings in preterm infants may improve their growth and nutritional status, decrease the need for and hazards of intravenous infusion solutions, and potential ly shorten the length of hospitalization. Rayyis et al. [8], reported no difference in the incidence of feeding intolerance or NEC in infants who received 35 mL versus 15 mL feeding advancements. We exam ined whether infants who were fed initially and advanced at 30 mL/ kg per day take fewer days to get to full feedings than those who were fed initially and advanced at 20 mL/kg per day, without increases in their incidence of feeding complications and NEC. Also, we studied whether infants who were fed the higher volume regain birth weight earlier, have fewer days of intravenous fluids, and have a shorter hos pital stay than those who were advanced at the slower rate. Abstract Background Enteral feeding routines are not well defined in preterm neonates. Controversy exists regarding when feedings should be started, whether minimal enteral feedings should be used routinely in small preterm infants and how fast to advance enteral feedings. Objective To evaluate the effect of slow vs rapid rates of advancement of enteral feeding volumes on the clinical outcomes in preterm babies less than 34 weeks. A randomized, controlled, single-center trial was conducted in a Neonatal Unit of Dhaka Shishu (Children) Hospital. Infants between 1200 gm and < 2500 gm at birth, gestational age < 34 weeks, and weight appropriate for gestational age were allocated randomly to feedings of expressed human milk and advanced at either 30 mL/ kg per day or 20 mL/kg per day. Infant’s remained in the study until discharge. A total of 300 infants were enrolled, 150 infants in the rapid group and 150 in the slow group. Enteral feeding advancements were well tolerated by the intervention group of stable preterm neonates like that of control group both in birth weight <1500 gm and in birth weight (1500 gm - < 2500 gm) study populations (67.27 % vs. 68.42 % and 68.42 % vs. 64.28 %, p value > 0.05). Infants in the intervention group achieved full volume feedings sooner (9.33 days vs. 14.66 days) and (9.12 days vs. 15.5 days), p value < 0.05. Eighteen infants in the intervention group and fifteen in control group were died due to sepsis which was statistically not significant. There was no incidence of NEC in birth weight (1500 gm - < 2500 gm) study populations in both groups. No statistical differences in the proportion of infants with feed interruption or feed intolerance. Rapid enteral feeding advancements in preterm babies < 34 weeks reduce the time to reach full enteral feeding and the use of PN administration. Rapid-advancement enteral feed also improved short-term outcomes for these high-risk infants.