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A randomized trial of enteral feeding volumes in infants born before 30 weeks' gestation
C A Kuschel1, N Evans, L Askie
1Department of Neonatal Medicine, Royal Prince Alfred Hospital, Camperdown, Australia. CarlK@ahsl.co.nz
Insights
Higher milk volumes (200 mL/kg/day) in extremely premature infants promoted greater weight gain and fat deposition by 35 weeks corrected gestational age (CGA) without increasing morbidity. Individualized feeding volumes are crucial for optimal growth in these vulnerable infants.
Area of Science:
- Neonatal Nutrition
- Pediatric Growth and Development
- Premature Infant Care
Background:
- Extremely premature infants (<30 weeks gestation) require careful nutritional management for optimal postnatal growth.
- Determining appropriate enteral feed volumes is critical to balance growth promotion and potential adverse effects.
Purpose of the Study:
- To compare the impact of two different enteral feed volumes (150 mL/kg/day vs. 200 mL/kg/day) on the postnatal growth of infants born before 30 weeks gestation.
- To assess the effect of these feed volumes on growth parameters at 35 weeks corrected gestational age (CGA) and 1 year of age.
Main Methods:
- A randomized controlled trial involving 54 infants born before 30 weeks gestation who had reached full enteral feeds.
- Infants were assigned to receive either 150 mL/kg/day or 200 mL/kg/day of enteral feeds.
- Primary outcome was growth at 35 weeks CGA, with secondary outcomes including growth at 1 year and morbidity.
Main Results:
- Infants receiving 200 mL/kg/day demonstrated significantly greater daily weight gain (16.7 g/kg/day vs. 15.2 g/kg/day) and were heavier at 35 weeks CGA (2020 g vs. 1885 g).
- A greater arm fat area was observed in the 200 mL/kg/day group at 35 weeks CGA, suggesting increased fat deposition.
- No significant differences in length, head circumference, or growth parameters at 1 year were found; morbidity was similar between groups.
Conclusions:
- Individualized milk volume requirements vary, with some extremely premature infants benefiting from volumes up to 200 mL/kg/day for adequate weight gain and fat deposition.
- Higher milk intakes, providing increased calories and minerals, are associated with improved weight gain and body composition by 35 weeks CGA.
- The findings suggest that a higher target volume may be appropriate for many extremely premature infants, but individual needs should guide feeding regimens.
Objective:
To compare the effect of two volumes of enteral feeds on postnatal growth in infants born before 30 weeks gestation.
Methodology:
Fifty-four infants, less than 30 weeks gestational age, who reached full enteral feeds were randomized to remain on 150 mL/kg per day (150 group) or increase to 200 mL/kg per day (200 group). The primary outcome measure was growth at 35 weeks corrected gestational age (CGA).
Results:
There were no statistically significant differences in demographic or clinical parameters between the study groups at commencement of the study, although there was a trend for infants in the 150 group to be lighter (895 g vs 1020 g, P = 0.27). Milk intakes were increased in 43% of the infants in the 150 group, whereas 54% of the infants in the 200 group required reduced intakes. Infants in the 200 group had greater daily weight gains (16.7 g/kg per day vs 15.2 g/kg per day, P = 0.047) and at 35 weeks CGA were heavier (2020 g vs 1885 g, P = 0.014) and had a greater arm fat area (282 mm2 vs 218 mm2, P = 0.009). There was no difference in length or head circumference at 35 weeks CGA, and no difference in any growth parameter at 1 year of age. Morbidity was not different between the groups.
Conclusions:
The individual milk volume requirements for adequate weight gain without significant adverse effects vary between 150 and 200 mL/kg per day in extremely premature infants. For many infants in both groups, the assigned target volume was not appropriate. Increased milk intakes (and therefore higher caloric and mineral intakes) are associated with increased daily weight gains and a greater weight at 35 weeks CGA. The weight gain may be due to an increase in fat deposition.