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Early progressive feeding in extremely preterm infants: a randomized trial

Ariel A Salas1, Peng Li2, Kelli Parks1

  • 1Department of Pediatrics, School of Medicine; and Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL.

The American Journal of Clinical Nutrition
|March 13, 2018
PubMed

Insights

Early progressive feeding significantly increases full enteral feeding days for extremely preterm infants. This approach also reduces the need for parenteral nutrition and central venous access in this vulnerable population.

Area of Science:

  • Neonatalogy
  • Pediatric Gastroenterology
  • Clinical Nutrition

Background:

  • Extremely preterm infants (≤28 weeks gestation) often receive delayed feeding due to insufficient evidence on early progressive feeding protocols.
  • Early progressive feeding, involving small increments in feeding volumes shortly after birth, is under investigation for its benefits.

Purpose of the Study:

  • To determine the feasibility and efficacy of early progressive feeding in extremely preterm infants.
  • To evaluate the impact of early versus delayed feeding initiation on key neonatal outcomes.

Main Methods:

  • A single-center randomized trial involving 60 extremely preterm infants (median gestational age 26 weeks).
  • Infants were assigned to either an early progressive feeding group or a delayed progressive feeding group (after 4 days of trophic feeds).
  • Primary outcome: number of full enteral feeding days within the first month; Secondary outcomes: death, NEC, sepsis, growth, parenteral nutrition use, and central venous access.

Main Results:

  • Early progressive feeding significantly increased the number of full enteral feeding days by a median of 2 days (P=0.02).
  • Reduced use of parenteral nutrition and need for central venous access were observed in the early feeding group.
  • No significant differences were found in culture-proven sepsis, restricted growth at 36 weeks postmenstrual age, or the composite outcome of NEC or death.

Conclusions:

  • Early progressive feeding is effective in increasing enteral feeding attainment in extremely preterm infants.
  • This feeding strategy reduces the reliance on parenteral nutrition and central venous access.
  • Further research may explore optimizing protocols to further improve outcomes like growth and reduce complications.
Abstract

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