Effect of oral colostrum application every 2 hours and 4 hours in order to achieve trophic feeding in preterm
A T Indriani1, S Wandita2, E L Haksari2
1Universitas Sebelas Maret, Faculty of Medicine, Indonesia. tantriindrianiastri@gmail.com;astri_tan3@stafff.uns.ac.id.
Insights
Applying oral colostrum every 4 hours to preterm infants did not significantly speed up trophic feeding compared to every 2 hours. This finding suggests frequency may not be critical for initiating enteral nutrition in neonates.
Area of Science:
- Neonatalogy
- Pediatric Gastroenterology
- Nutritional Science
Background:
- Enteral feeding in preterm neonates begins with trophic feeding (10-25mL/kg/day) via orogastric tube.
- Oral colostrum application is a safe, effective, and economical therapy with protective anti-inflammatory, immunomodulatory, and antimicrobial effects.
- The optimal frequency for oral colostrum administration in preterm infants remains undetermined.
Purpose of the Study:
- To evaluate the impact of oral colostrum application every 2 versus 4 hours on achieving trophic feeding in preterm infants.
- To compare the time to achieve trophic feeding between different oral colostrum administration frequencies.
- To assess the safety and efficacy of varying oral colostrum application schedules.
Main Methods:
- A randomized controlled trial with an open-label design was conducted.
- Very-low-birth-weight neonates were randomized into two groups: oral colostrum every 2 hours or every 4 hours.
- The primary outcome was the time to achieve trophic feeding; necrotizing enterocolitis, sepsis, and hsPDA were monitored.
Main Results:
- Forty neonates were analyzed (20 per group).
- The group receiving colostrum every 4 hours achieved trophic feeding 0.47 days faster than the group receiving it every 2 hours.
- This difference in time to trophic feeding was not statistically significant (p=0.703).
Conclusions:
- There is no statistically significant difference in achieving trophic feeding in preterm neonates (less than 34 weeks) when colostrum is administered every 2 or 4 hours.
- The frequency of oral colostrum application does not appear to significantly impact the initiation of trophic feeding in this population.
- Further research may explore other factors influencing trophic feeding attainment.
Introduction:
Enteral feeding in preterm neonates starts with trophic feeding, which is the practice of feeding minute volumes of enteral feeds (starting at 10-25mL/kg/day) through an orogastric tube. Colostrum has protective effects, such as anti-inflammatory, immunomodulatory, and antimicrobial effects. The oral colostrum application is a safe, effective and economical therapy. However, the most optimal frequency of the oral colostrum application is not yet conclusive. This study aims to evaluate the effects of applying colostrum orally every 4 and 2 hours in order to achieve trophic feeding in preterm infants.
Materials And Methods:
In this randomized controlled trial with an open-label design, very-low-birth-weight neonates admitted to RSUP Dr. Sardjito from March to August 2023 were allocated to receive oral colostrum applications either every two hours or every four hours. Subjects were randomized into study groups using a random block size of four through computer-generated in a 1:1 ratio. The primary outcome was the time to achieve trophic feeding. The extraneous variables were necrotizing enterocolitis, sepsis, hemodynamically significant Patent Ductus Arteriosus (hsPDA) and gender. Data analysis was conducted using SPSS.
Results:
A total of 40 neonates were analyzed for primary outcome. Of these, 20 neonates received oral colostrum applications every 2 hours, and the other 20 subjects were fed every 4 hours. Bivariate analysis showed that colostrum application given every 4 hours achieved the trophic feeding 0.47 day faster than the colostrum application every 2 hours. However, the difference between the two feeding methods was not statistically significant (p=0.703).
Conclusion:
There is no significant difference in achieving trophic feeding in preterm neonates (less than 34 weeks) whether the colostrum was given every 2 or 4 hours.
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