Controlled Trial of Two Incremental Milk-Feeding Rates in Preterm Infants.
Jon Dorling1, Jane Abbott1, Janet Berrington1
1From the Division of Neonatal-Perinatal Medicine, Dalhousie University, Halifax, NS, Canada (J.D.); and Bliss, London (J.A., M.P.), the National Perinatal Epidemiology Unit Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford (B.B., U.B., O.H., E.J., L.L., O.O., C.P., J.T.), and John Radcliffe Hospital (K.M.), Oxford, the Newcastle Neonatal Service, Royal Victoria Infirmary, Newcastle upon Tyne (J.B., N.E.), the Department of Health Sciences, University of Leicester, Leicester (E.B., S.J.), the National Institute for Health Research Southampton Biomedical Research Centre, Department of Child Health, Southampton (A.L.), the Centre for Reviews and Dissemination, University of York, York (W.M.), the School of Health and Population Sciences, University of Birmingham, Birmingham (T.R.), and the Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh (B.S.) - all in the United Kingdom.
Advancing feeding volumes faster in preterm infants did not significantly impact neurodevelopmental outcomes. This study found no difference in survival without disability between faster and slower milk increment groups.
Area of Science:
- Neonatalogy
- Pediatric Nutrition
- Clinical Trials
Background:
- Observational studies suggest slow enteral feeding increases sepsis risk but reduces necrotizing enterocolitis in preterm infants.
- Randomized trial data on feeding advancement strategies are limited.
Purpose of the Study:
- To compare the neurodevelopmental outcomes of very preterm or very-low-birth-weight infants receiving faster versus slower enteral milk feeding increments.
- To assess the impact of feeding advancement rates on late-onset sepsis and necrotizing enterocolitis.
Main Methods:
- Randomized trial involving 2804 very preterm or very-low-birth-weight infants.
- Infants assigned to faster (30 ml/kg/day) or slower (18 ml/kg/day) milk increments.
- Primary outcome: survival without moderate/severe neurodevelopmental disability at 24 months.
Main Results:
- No significant difference in the primary outcome between faster (65.5%) and slower (68.1%) increment groups (aRR, 0.96; 95% CI, 0.92-1.01).
- Similar rates of late-onset sepsis (29.8% vs. 31.1%) and necrotizing enterocolitis (5.0% vs. 5.6%) were observed in both groups.
Conclusions:
- Advancing milk feeding volumes by 30 ml/kg/day compared to 18 ml/kg/day did not significantly alter neurodevelopmental outcomes at 24 months in very preterm infants.
- Feeding advancement rates did not significantly impact the incidence of late-onset sepsis or necrotizing enterocolitis.
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