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Very low birthweight infants receive less enteral feeding than what is prescribed
Lotta Immeli1, Pauliina M Mäkelä1, Markus Leskinen1
1Pediatric Research Center, Children's Hospital, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
Insights
Enteral feeding for very low birthweight (VLBW) infants is often not administered as prescribed. This deviation from recommendations may significantly contribute to slow feeding progression in these vulnerable newborns.
Area of Science:
- Neonatalogy
- Pediatric Nutrition
- Clinical Implementation Science
Background:
- Feeding very low birthweight (VLBW) infants (<1500g) presents significant clinical challenges.
- Optimizing enteral feeding is crucial for the growth and development of VLBW infants.
Purpose of the Study:
- To investigate the adherence to prescribed enteral feeding protocols in VLBW infants.
- To identify factors associated with delayed enteral feeding progression in this population.
Main Methods:
- Retrospective cohort study of 516 VLBW infants born before 32 weeks gestation (2005-2013).
- Nutritional data collected from birth to 14-28 days of life.
- Analysis of factors influencing enteral feeding implementation and progression.
Main Results:
- Enteral feeding progression was slower than recommended, with significant deviations from prescribed amounts, particularly during parenteral nutrition.
- Factors associated with slower progression included higher gastric residual volumes, delayed stool passage, prolonged opiate use, patent ductus arteriosus, and respiratory distress syndrome.
Conclusions:
- Enteral feeding in VLBW infants is frequently not administered according to prescribed guidelines.
- Non-adherence to feeding protocols may be a key factor contributing to the slow progression of enteral feeding in VLBW infants.
Aim:
Feeding a very low birthweight (VLBW, <1500 g) infant is challenging. Our aims were to study how prescribed enteral feeding is implemented in VLBW infants and to identify factors associating with slow enteral feeding progression.
Methods:
Our retrospective cohort included 516 VLBW infants born before 32 weeks of gestation during 2005-2013 and admitted to Children's Hospital, Helsinki, Finland, for at least the two first weeks of life. Nutritional data were collected from birth until the age of 14-28 days, depending on the length of stay.
Results:
We found that enteral feeding progressed slower than recommended and implementation differed from the prescriptions, especially during the parenteral nutrition phase (milk intake 10-20 mL/kg/day): 71% [40-100], median [IQR], of the prescribed enteral milk was administered. The full prescribed amount was less likely administered if a higher volume of gastric residual was aspirated or if the infant did not pass stool during the same day. Longer opiate use, patent ductus arteriosus, respiratory distress syndrome and slower passage of the first meconium associated with slower enteral feeding progression.
Conclusion:
Enteral feeding of a VLBW infant is often not administered as prescribed, which possibly plays a significant role in the slow progression of enteral feeding.
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