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Early and exclusive enteral nutrition in infants born very preterm
Jacqueline Razzaghy1, Vivek V Shukla1, Emily Gunawan1
1Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, Alabama, USA.
Insights
Early and exclusive enteral nutrition for very preterm infants significantly increased full feeding days and improved growth. This feeding strategy also led to reduced hospitalisation costs, benefiting vulnerable newborns.
Area of Science:
- Neonatal Nutrition and Gastroenterology
- Perinatal Medicine
- Pediatric Critical Care
Background:
- Optimal nutrition is critical for very preterm infants (280/7-326/7 weeks gestation).
- Early and exclusive enteral nutrition strategies are being investigated to improve outcomes.
- Maternal and donor milk are key sources for neonatal feeding.
Purpose of the Study:
- To evaluate the impact of early and exclusive enteral nutrition using maternal or donor milk.
- To characterise effects on feeding progression, growth, and hospitalisation in very preterm infants.
Main Methods:
- A parallel-group, unmasked randomised controlled trial was conducted in a tertiary neonatal intensive care unit.
- 102 very preterm infants were randomised to receive either higher-volume early enteral nutrition (60-80 mL/kg/day) or standard trophic feeding (20-30 mL/kg/day).
- Primary outcome: full enteral feeding days within 28 days; secondary outcomes: growth, body composition, and hospitalisation length.
Main Results:
- Early, exclusive enteral nutrition significantly increased full enteral feeding days by +2 days (p=0.004).
- Improved fat-free mass-for-age z-scores (+0.5, p=0.02) and length-for-age z-scores (+0.6, p=0.002) were observed at follow-up.
- Hospitalisation costs were significantly reduced in the intervention group (mean difference -$28,754, p=0.04).
Conclusions:
- Early and exclusive enteral nutrition in very preterm infants enhances the achievement of full enteral feeding.
- This feeding approach shows potential for improving fat-free mass accretion and linear growth.
- The strategy may also lead to substantial reductions in hospitalisation costs.
Objective:
To characterise the effects of early and exclusive enteral nutrition with either maternal or donor milk in infants born very preterm (280/7-326/7 weeks of gestation).
Design:
Parallel-group, unmasked randomised controlled trial.
Setting:
Regional, tertiary neonatal intensive care unit.
Participants:
102 infants born very preterm between 2021 and 2022 (51 in each group).
Intervention:
Infants randomised to the intervention group received 60-80 mL/kg/day within the first 36 hours after birth. Infants randomised to the control group received 20-30 mL/kg/day (standard trophic feeding volumes).
Main Outcome Measures:
The primary outcome was the number of full enteral feeding days (>150 mL/kg/day) in the first 28 days after birth. Secondary outcomes included growth and body composition at the end of the first two postnatal weeks, and length of hospitalisation.
Results:
The mean birth weight was 1477 g (SD: 334). Half of the infants were male, and 44% were black. Early and exclusive enteral nutrition increased the number of full enteral feeding days (+2; 0-2 days; p=0.004), the fat-free mass-for-age z-scores at postnatal day 14 (+0.5; 0.1-1.0; p=0.02) and the length-for-age z-scores at the time of hospital discharge (+0.6; 0.2-1.0; p=0.002). Hospitalisation costs differed between groups (mean difference favouring the intervention group: -$28 754; -$647 to -$56 861; p=0.04).
Conclusions:
In infants born very preterm, early and exclusive enteral nutrition increases the number of full enteral feeding days. This feeding practice may also improve fat-free mass accretion, increase length and reduce hospitalisation costs.
Trial Registration Number:
NCT04337710.
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