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Systematic review of transpyloric versus gastric tube feeding for preterm infants
1Tayside Institute of Child Health, Ninewells Hospital and Medical School, Dundee DD1 9SY, Scotland, UK. w.mcguire@dundee.ac.uk
Insights
Transpyloric feeding in preterm infants shows no growth benefits and increases gastrointestinal issues and mortality. This feeding method is not recommended due to potential harm.
Area of Science:
- Neonatal Medicine
- Pediatric Nutrition
- Gastroenterology
Background:
- Enteral tube feeding is crucial for preterm infants.
- Feeding routes, gastric versus transpyloric, are debated for efficacy and safety.
- Optimizing nutrition delivery is vital for infant development.
Purpose of the Study:
- To compare transpyloric versus gastric enteral tube feeding in preterm infants.
- To assess effects on feeding tolerance, growth, and development.
- To evaluate the incidence of adverse events associated with each feeding route.
Main Methods:
- Systematic review of randomized controlled trials.
- Searched Cochrane Controlled Trials Register, Medline, and Embase databases.
- Data synthesized using standard Cochrane Neonatal Collaborative Review Group methods.
Main Results:
- Eight trials included; no significant effect on growth or development observed.
- Transpyloric feeding associated with increased gastrointestinal disturbance (RR 1.45, 95% CI 1.05-2.09).
- Transpyloric feeding linked to higher mortality (RR 2.46, 95% CI 1.36-4.46), though one trial had potential bias. No differences in necrotizing enterocolitis, perforation, or aspiration pneumonia.
Conclusions:
- No evidence of feeding benefit from transpyloric route in preterm infants.
- Evidence suggests potential harm, including increased gastrointestinal issues and mortality.
- Transpyloric feeding route is not recommended for preterm infants.
Aim:
To determine if enteral tube feeding by the transpyloric versus the gastric route improves feeding tolerance, and growth and development, without increasing adverse events, in preterm infants.
Methods:
Systematic review of randomised controlled trials. A search was made of the Cochrane Controlled Trials Register (CCTR; 2003, issue 1), Medline (1966 to April 2003), and Embase (1980 to April 2003), and references in previous reviews. The data were extracted, analysed, and synthesised using the standard methods of the Cochrane Neonatal Collaborative Review Group.
Results:
Data were found from eight trials. No evidence of an effect on growth or development was found, but transpyloric feeding was associated with a greater incidence of gastrointestinal disturbance: relative risk (RR) 1.45, 95% confidence interval (CI) 1.05 to 2.09. Transpyloric feeding was also associated with increased mortality: RR 2.46, 95% CI 1.36 to 4.46. However, the trial that contributed most to this finding may have been affected by allocation bias. No significant differences were detected in the incidence of other adverse events, including necrotising enterocolitis, intestinal perforation, and aspiration pneumonia.
Conclusions:
No evidence of benefit was found, but evidence of harm was found. Feeding by the transpyloric route cannot be recommended for preterm infants.
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