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Trophic feedings for parenterally fed infants.
1Pediatrics, University of Texas at Houston Medical School, 6431 Fannin, Suite 2.106, Houston, TX 77030, USA. Jon.E.Tyson@uth.tmc.edu
The Cochrane Database of Systematic Reviews
|July 22, 2005
Summary
Trophic feedings for high-risk neonates may reduce hospital stay and time to full feedings but do not significantly impact necrotizing enterocolitis risk. Further large trials are needed to confirm benefits and safety.
Area of Science:
- Neonatal Nutrition and Gastroenterology
- Clinical Trial Analysis
- High-Risk Infant Care
Background:
- High-risk neonates often receive prolonged parenteral nutrition due to concerns about necrotizing enterocolitis (NEC).
- Trophic feedings, a strategy of minimal enteral intake, were developed to improve feeding tolerance and reduce time to full feedings.
- The comparative effectiveness of trophic feedings versus no enteral intake or advancing feedings requires robust clinical evidence.
Purpose of the Study:
- To evaluate the impact of trophic feedings versus no enteral nutrition on feeding tolerance and outcomes in high-risk neonates.
- To compare trophic feedings with initial regimens involving greater enteral nutrient intake in high-risk neonates.
- To assess effects on neonatal outcomes, including feeding tolerance and necrotizing enterocolitis.
Main Methods:
- Systematic review and meta-analysis of randomized and quasi-randomized controlled trials.
- Searches included MEDLINE, CINAHL, and Cochrane Central Register of Controlled Trials up to June 2004.
- Included trials compared trophic feedings (< = 25 kcal/kg/d for > = 5d) against no enteral intake or greater enteral intake regimens.
Main Results:
- Trophic feedings, compared to no enteral intake, reduced days to full feeding, days feedings were held, and total hospital stay.
- No significant difference in necrotizing enterocolitis (NEC) was observed between trophic and no feedings, though an increase is not excluded (RR 1.16).
- Compared to advancing feedings, trophic feedings led to more days to full feeding and a trend towards longer hospital stay, with a marginally significant reduction in NEC (RR 0.14).
Conclusions:
- Greater enteral intake (trophic or advancing feedings) was associated with faster progression to full feedings and shorter hospital stays.
- A potential increase in NEC incidence was observed with greater enteral intake, though not statistically significant in all comparisons.
- Limitations including small sample sizes and heterogeneity necessitate large, multi-center trials to definitively assess optimal early feeding strategies for high-risk neonates.