Feeding tolerance in preterm infants: randomized trial of bolus and continuous feeding

Area of Science:

• Neonatal Nutrition
• Pediatric Gastroenterology
• Infant Feeding Practices

Background:

• Optimizing enteral feeding tolerance is critical for the growth and development of very low birth weight (VLBW) infants.
• Continuous gastric infusion (CGI) and intermittent gastric bolus (IGB) are common methods for delivering nutrition to these vulnerable infants.
• The comparative efficacy of CGI versus IGB in improving feeding tolerance in VLBW infants remains an area of investigation.

Purpose of the Study:

• To evaluate whether continuous gastric infusion (CGI) is better tolerated than intermittent gastric bolus (IGB) in small very low birth weight (VLBW) infants.
• To compare feeding tolerance parameters between VLBW infants receiving CGI and IGB.

Main Methods:

• A two-center, prospective, randomized, unmasked clinical trial was conducted.
• Twenty-eight VLBW infants (birth weight <1250 g) were enrolled and randomized to either IGB or CGI feeding.
• Key outcomes included time to reach full feeds (160 cc/kg/d), daily weight, caloric intake, residual gastric volume, and feeding type.

Main Results:

• Five infants did not complete the study due to mortality (n=4) or protocol violation (n=1).
• Infants randomized to IGB reached full feeds significantly earlier (p=0.03) and experienced less delay in achieving full feeds compared to those in the CGI group.
• No significant differences were observed between the groups regarding birth weight or gestational age.

Conclusions:

• Contrary to the initial hypothesis, gravity-based intermittent gastric bolus (IGB) feeding demonstrated greater effectiveness than continuous gastric infusion (CGI).
• IGB appears to be a more beneficial method for enhancing feeding tolerance in small VLBW infants.
• These findings suggest a potential shift in preferred feeding strategies for improving nutritional outcomes in this population.