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Randomised controlled study of clinical outcome following trophic feeding
1Regional Neonatal Intensive Care Unit, St James's University Hospital, Leeds. rob.mcclure@msexc.addenbrookes.anglox.nhs.uk
Insights
Trophic feeding significantly improved clinical outcomes in critically ill preterm infants. This intervention led to better growth, reduced sepsis, and shorter hospital stays for vulnerable newborns.
Area of Science:
- Neonatal Medicine
- Pediatric Gastroenterology
- Critical Care Pediatrics
Background:
- Preterm infants often require ventilatory support and parenteral nutrition due to immaturity.
- Optimizing nutrition is crucial for improving outcomes in sick neonates.
- The role of early trophic feeding in this population requires further investigation.
Purpose of the Study:
- To evaluate the impact of early trophic feeding on the clinical outcomes of ill preterm infants.
- To compare infants receiving trophic feeds alongside parenteral nutrition versus those receiving parenteral nutrition alone.
Main Methods:
- A prospective, randomized controlled study involving 100 preterm infants (<1750g birth weight) requiring ventilatory support.
- Infants received either trophic feeding (0.5-1 ml/h from day 3) plus parenteral nutrition or parenteral nutrition alone.
- Clinical outcomes including growth, sepsis incidence, and hospital stay were assessed.
Main Results:
- Trophic feeding group showed significantly increased energy intake and weight gain.
- Reduced incidence of culture-confirmed sepsis and earlier tolerance of full milk feeds were observed.
- Shorter duration of respiratory support and hospital stay were noted in the trophic feeding group.
Conclusions:
- Early trophic feeding is beneficial for ill preterm infants receiving parenteral nutrition.
- This feeding strategy enhances growth, reduces infection risk, and improves overall clinical outcomes.
- Trophic feeding represents a valuable intervention in neonatal intensive care.
Aims:
To determine the effect of trophic feeding on clinical outcome in ill preterm infants.
Methods:
A randomised, controlled, prospective study of 100 preterm infants, weighing less than 1750 g at birth and requiring ventilatory support and parenteral nutrition, was performed. Group TF (48 infants) received trophic feeding from day 3 (0.5-1 ml/h) along with parenteral nutrition until ventilatory support finished. Group C (52 infants) received parenteral nutrition alone. "Nutritive" milk feeding was then introduced to both groups. Clinical outcomes measured included total energy intake and growth over the first six postnatal weeks, sepsis incidence, liver function, milk tolerance, duration of respiratory support, duration of hospital stay and complication incidence.
Results:
Groups were well matched for birthweight, gestation and CRIB scores. Infants in group TF had significantly greater energy intake, mean difference 41.4 (95% confidence interval 9, 73.7) kcal/kg p=0.02; weight gain, 130 (CI 1, 250) g p = 0.02; head circumference gain, mean difference 0.7 (CI 0.1, 1.3) cm, p = 0.04; fewer episodes of culture confirmed sepsis, mean difference -0.7 (-1.3, -0.2) episodes, p = 0.04; less parenteral nutrition, mean difference -11.5 (CI -20, -3) days, p = 0. 03; tolerated full milk feeds (165 ml/kg/day) earlier, mean difference -11.2 (CI -19, -3) days, p = 0.03; reduced requirement for supplemental oxygen, mean difference -22.4 (CI-41.5, -3.3) days, p = 0.02; and were discharged home earlier, mean difference -22.1 (CI -42.1, -2.2) days, p = 0.04. There was no significant difference in the relative risk of any complication.
Conclusions:
Trophic feeding improves clinical outcome in ill preterm infants requiring parenteral nutrition.