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Comparison of Three Modalities of Feeding in Preterm Infants ≤32 Weeks and ≤1,250 G: A Randomized Controlled Trial
Vijay Kumar1, Anup Thakur2, Pankaj Garg2
1Department of Neonatology, Institute of Medical Sciences and Sum Hospital, Bhubaneswar, Odisha, India.
Insights
Establishing early enteral feeds for preterm infants is crucial but can lead to feeding intolerance. This study found no significant difference in the time to reach full enteral feeds among continuous infusion, intermittent bolus by infusion, and intermittent bolus by gravity methods in very preterm infants.
Area of Science:
- Neonatalogy
- Pediatric Gastroenterology
- Clinical Nutrition
Background:
- Early enteral nutrition is vital for very preterm infants but can be complicated by feeding intolerance.
- Optimal feeding methods for establishing early full enteral feeds in preterm infants remain unclear, with limited evidence supporting specific approaches.
Purpose of the Study:
- To compare the efficacy of three enteral feeding modalities—continuous infusion (CI), intermittent bolus by infusion (IBI), and intermittent bolus by gravity (IBG)—in preterm infants.
- To determine the impact of these feeding methods on the time to reach full enteral feeds (180 mL/kg/d) and the incidence of feeding intolerance.
Main Methods:
- A randomized controlled trial involving 146 preterm infants (≤32 weeks gestation, ≤1,250g birth weight) allocated to CI, IBI, or IBG groups.
- Feeds were administered continuously over 24 hours (CI), intermittently every 2 hours over 15 minutes via infusion pump (IBI), or by gravity over 10-30 minutes (IBG).
- The intervention continued until infants achieved direct breast or cup feeds.
Main Results:
- No significant differences were observed in the time to reach full enteral feeds among the CI, IBI, and IBG groups (median [IQR]: 13 [10-16], 11.5 [9-17], and 13 [9.5-14.2] days, respectively; p=0.71).
- The incidence of feeding intolerance was similar across the groups (51.2% CI, 52.6% IBI, 64.7% IBG; p=0.45).
- No significant differences were found in rates of necrotizing enterocolitis, bronchopulmonary dysplasia, intraventricular hemorrhage, patent ductus arteriosus, retinopathy of prematurity, or growth parameters at discharge.
Conclusions:
- In preterm infants (≤32 weeks gestation, ≤1,250g), continuous infusion, intermittent bolus by infusion, and intermittent bolus by gravity feeding methods result in comparable times to achieve full enteral feeds.
- These findings suggest that the choice of feeding modality among CI, IBI, and IBG does not significantly impact the time to reach full feeds or the occurrence of feeding intolerance in this vulnerable population.
Objective:
Early establishment of enteral feeds is desirable in very preterm infants, but it may be associated with feeding intolerance. Several feeding methods have been studied with no strong evidence to suggest the preferred feeding method to establish early full enteral feeds. We studied three modalities of feeding in preterm infants ≤32 weeks and ≤1,250 g: continuous infusion (CI), intermittent bolus by infusion (IBI), and intermittent bolus by gravity (IBG) for their effect on time to reach full enteral feeds of 180 mL/kg/d.
Study Design:
We randomized 146 infants, 49 infants in each CI and IBI group and 48 infants in the IBG group. In the CI group, feeds were delivered by an infusion pump continuously over 24 hours. In the IBI group, feeds were given every 2 hours and infused over 15 minutes by an infusion pump. In the IBG group, feeds were delivered by gravity over 10 to 30 minutes. The intervention was continued till infants reached direct breast/cup feeds.
Results:
The mean (standard deviation) gestation in CI, IBI, and IBG groups were 28.4 (2.2), 28.5(1.9), and 28.6 (1.8) weeks, respectively. The time to reach full feeds in CI, IBI, and IBG were not significantly different (median [interquartile range]: 13 [10-16], 11.5 [9-17], and 13 [9.5-14.2] d, respectively, p = 0.71). The proportions of infants who developed feeding intolerance in CI, IBI, and IBG were similar (n [%]: 21 [51.2%], 20 [52.6%], and 22 [64.7%], respectively, p = 0.45). There was no difference in necrotizing enterocolitis ≥2 (p = 0.80), bronchopulmonary dysplasia (p = 0.86), intraventricular hemorrhage ≥2 (p = 0.35), patent ductus arteriosus requiring treatment (p = 0.44), retinopathy of prematurity requiring treatment (p = 0.51), and growth parameters at discharge.
Conclusion:
In preterm infants, ≤32 weeks of gestation and birth weight ≤1,250 g, there was no difference in time to reach full enteral feeds in the three modalities of feeding. This study is registered with Clinical Trials Registry India (CTRI) and the registration number is CTRI/2017/06/008792.
Key Points:
· Gavage feeding in preterm infants is either continuous or intermittent bolus feeding.. · Intermittent bolus feeding was evaluated in a controlled time by infusion over 15 minutes.. · The time to reach full feeds was comparable for all three methods..
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