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Beneficial effects of early hypocaloric enteral feeding on neonatal gastrointestinal function: preliminary report of
1Department of Pediatrics, Case Western Reserve University, Rainbow Babies and Childrens Hospital, Cleveland, OH 44106.
Insights
Early hypocaloric enteral feedings for premature infants significantly improved outcomes, reducing jaundice and bone disease. These beneficial effects were observed without increased complications, leading to faster full enteral feeding.
Area of Science:
- Neonatology
- Pediatric Gastroenterology
- Infant Nutrition
Background:
- Premature infants often require nutritional support due to immature digestive systems.
- Parenteral nutrition is common but associated with complications.
- Early enteral feeding is hypothesized to mitigate some of these issues.
Purpose of the Study:
- To evaluate the impact of early-onset hypocaloric enteral nutrition on very low birth weight infants.
- To compare outcomes between infants receiving early enteral feeds and those on complete bowel rest.
Main Methods:
- Prospective randomized trial comparing early enteral feedings (post-natal 48 hours) with no enteral feedings for 9 days.
- Both groups initially received parenteral nutrition.
- Infant outcomes including feeding progression, bilirubin levels, phototherapy duration, cholestasis, and markers of metabolic bone disease were assessed.
Main Results:
- The early enteral feeding group reached full enteral feeds significantly faster (31.2 vs 47.3 days).
- Reduced indirect hyperbilirubinemia, less cholestasis (6.7% vs 33%), and lower peak direct bilirubin levels were observed.
- Decreased incidence of osteopenia of prematurity and lower alkaline phosphatase activity were noted in the early feeding group.
Conclusions:
- Early hypocaloric enteral nutrition is beneficial for very low birth weight infants.
- It positively impacts hyperbilirubinemia, cholestatic jaundice, and metabolic bone disease.
- Initiating enteral feeds early accelerates feeding progression without increasing complications.
Abstract:
In a prospective randomized trial, we studied the effects of early hypocaloric enteral feedings (PO) begun at 48 hours of age in 19 infants compared with 20 infants who received no enteral feedings (NPO) for at least the first 9 days of life. Both groups initially received the majority of their calories by parenteral alimentation. The groups were similar with respect to birth weight, gestational age, sex, Apgar score, and major neonatal diagnoses. The early enteral feeds proved to be significantly beneficial without an increased incidence of complications. The PO group reached full enteral feedings faster than the NPO group (31.2 vs 47.3 days). The PO group had a greater decline in serum bilirubin concentration over the first 2 weeks of life and spent less time under phototherapy (6.8 vs 9.5 days). Less cholestasis was observed among the PO infants (6.7% vs 33%), and peak direct bilirubin levels were also lower (0.7 vs 2.5 mg/dL). Osteopenia of prematurity, manifested by significantly lower alkaline phosphatase activity, was also decreased in the PO group, perhaps because of greater calcium intake during the first month among PO infants (1.3 vs 0.8 g). Compared with complete bowel rest, early onset of hypocaloric enteral feedings has beneficial effects on indirect hyperbilirubinemia, cholestatic jaundice, and metabolic bone disease of very low birth weight infants.