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Progression of Enteral Feeding Volumes in Extremely Low Birth Weight Infants in the "Connection Trial"
Josef Neu1, Patricia Ashley2, Vikas Chowdhary3
1Department of Pediatrics, University of Florida Health Shands Children's Hospital, Gainesville, Florida.
Insights
Feeding progression in premature infants is highly variable and influenced by clinical factors. Lower birth weight, gestational age, and Apgar scores are associated with slower enteral feeding advancement.
Area of Science:
- Neonatalogy
- Pediatric Gastroenterology
- Clinical Nutrition
Background:
- Premature infants require careful nutritional support.
- Enteral feeding advancement is a critical aspect of neonatal intensive care.
Purpose of the Study:
- To investigate daily feeding volumes and their association with clinical variables in premature infants.
- To analyze the progression of enteral feeding in extremely low birth weight (ELBW) infants.
Main Methods:
- Analysis of 641 infants with birth weight 510-1000g and gestational age 27 weeks.
- Utilized uni- and multivariable Cox regression models to assess associations.
- Examined total daily enteral (TDE) feeding volumes (10-120 mL/kg/d) and 24 clinical variables.
Main Results:
- Feeding volumes were highly variable, with a median daily increase of 11 mL/kg/d.
- Gastrointestinal and respiratory serious adverse events, along with hypotension, were associated with a lower chance of reaching feeding targets.
- Increased gestational age, birth weight, and Apgar scores correlated with an 8-20% increased chance of reaching feeding volumes.
Conclusions:
- Enteral feeding progression in ELBW infants is variable and cautious.
- Clinical factors significantly influence the rate of feeding advancement.
- The observed feeding progression was slower than typically recommended in feeding protocols.
Objective:
Investigate daily feeding volumes and their association with clinical variables in the early postnatal care of premature infants of the "Connection Trial."
Study Design:
A total of 641 infants of 510 to 1,000-g birth weight (BW, mean: 847 g) and mean 27 weeks' gestational age at birth (GA) were analyzed for total daily enteral (TDE) feeding volumes of 10, 20, 40, 80, and 120 mL/kg/d and their association with 24 clinical variables. Uni- and multivariable Cox regression models were used to calculate hazard ratios (HR) with 95% confidence intervals as a measure of the chance of reaching each of the TDE volumes.
Results:
Daily feeding volumes were highly variable and the median advancement from 10 to 120 mL/kg/d was 11 mL/kg/d. Univariable analyses showed the lowest chance (HR, 0.22-0.81) of reaching the TDE volumes for gastrointestinal (GI) serious adverse events (SAEs), GI perforation, GI obstruction, and necrotizing enterocolitis, as well as respiratory SAEs, persistent ductus arteriosus, and hypotension. Each GA week, 100-g BW, and point in 5-minute Apgar score at birth associated with 8 to 20% increased chance of reaching the TDE volumes. Multivariable analyses showed independent effects for BW, GA, Apgar score, GI SAEs, abdominal symptoms/signs, respiratory SAEs, days on antibiotics, and hypotension.
Conclusion:
This observational analysis demonstrates the variable and cautious progression of enteral feedings in contemporary extremely low BW infants and the extent to which clinical variables associate with this progression.
Key Points:
· Total feedings of 10 and 120 mL/kg/d were reached at median 4 and 14 day of age, respectively, and at a daily increase of 11 mL/kg.. · Each incremental GA week, 100-g BW, and point in 5-minute Apgar score associated with 8 to 20% increased chance of reaching enteral feedings of 10 to 120 mL/kg/d.. · Progression of enteral feeding associated with several clinical events and was slower than advocated in common feeding protocols..
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