[Enteral feeding volume advancement by using a standardized nutritional regimen in preterm infants ≤1,750 g birth
E Sergeyev1, C Gebauer, M Knüpfer
1Abteilung für Neonatologie, Klinik und Poliklinik für Kinder und Jugendliche der Universität Leipzig. elena.sergeyev@medizin.uni-leipzig.de
Insights
A standardized nutritional regimen helps preterm infants reach full enteral feedings faster, especially those small for gestational age (SGA). This approach is practical in clinical settings without increasing feeding complications.
Area of Science:
- Neonatal Nutrition
- Pediatric Gastroenterology
- Clinical Nutrition
Context:
- Rapid enteral feeding advancement in preterm infants can reduce intravenous fluid use and associated risks.
- Standardized nutritional regimens are increasingly recognized for potentially reducing complications and time to full enteral feeds.
- Optimizing nutrition in preterm infants is crucial for growth and development.
Purpose:
- To evaluate the feasibility of rapid enteral feeding advancement in preterm infants using a standardized nutritional regimen.
- To determine if a standardized regimen increases feeding complications compared to individual adjustments.
- To assess the impact of a standardized regimen on the time to reach full enteral feedings.
Summary:
- A randomized controlled trial involving 99 preterm infants (birth weight ≤1,750 g) compared a standardized nutritional regimen (ST-Group) with an individual regimen (IN-Group).
- Infants in the ST-Group reached full enteral feedings significantly faster than those in the IN-Group, particularly small for gestational age (SGA) infants (p=0.045).
- Both groups showed similar weight gain, and the incidence of necrotizing enterocolitis and other complications was low, indicating the safety of the standardized approach.
Impact:
- Standardized nutritional regimens are effective and practicable for advancing enteral feeding in preterm infants, especially SGA infants.
- This approach can shorten the time to achieve full enteral nutrition, potentially reducing reliance on intravenous therapies.
- The findings support the implementation of standardized feeding protocols in neonatal intensive care units to improve outcomes for preterm infants.
Background:
Rapid enteral feeding volume advancement in preterm infants can reduce the use of intravenous fluids. This practice may decrease the hazards of intravenous infusion solutions and potentially the morbidity rate. Several cohort trials demand the standardised nutritional regimen to reduce the complications and the time to reach full enteral feeds.
Aim:
to determine whether using a standardized nutritional regimen the rapid enteral feeding advancement in preterm infants is practicable without increasing the incidence of feeding complications.
Patients And Methods:
A prospective, randomized, controlled trial was performed in 99 preterm infants, birth weight ≤1,750 g. Group ST (standardized nutritional regimen) received breast human milk according to a standardized nutritional regimen. Group IN (individual nutritional regimen) received breast human milk or semi-elemental nutrition (Pregomin(®) Milupa) depending on enteral problems of the infant. The feeding volume advancement in the IN-Group was decided individually. The main outcome measure was time to reach full enteral feedings.
Results:
Infants in the ST-Group achieved full enteral feedings after 14.93±9.95 (median 12) d, infants in the IN-Group after 16.23±10.86 (median 14) d. The difference between the groups was significant only in small for gestational age (SGA) infants: ST-Group 10.20±4.78 (median 8.5) vs. IN-Group 16.73±8.57 (Median 15) days (p=0.045). The weight gain was similar in both groups. Infants in ST-Group achieved full enteral feedings having 116% of birth weight, infants in IN-Group 122% of birth weight. This difference was not significant (p=0.195). The incidence of NEC (necrotizing enterocolitis, 4%) and other complications were low in both groups. The diagnosis "feeding complications" was described in IN-Group in 14 vs. 7 infants in ST-Group.
Conclusions:
SGA-infants profit from the enteral feeding advancement by using a standardized nutritional regimen. These infants achieved full enteral feedings sooner then the SGA-infants, who did not feed by using a standardized nutritional regimen. A standardized nutritional regimen can be realized in clinical routine and is by strict clinical observation practicable without increasing the incidence of feeding complications.
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