Trophic feeding initiation and its predictors in preterm neonates admitted to Neonatal Intensive Care Units:
Mehuba Hassen1, Mekonen Adimasu Kebede2, Erdaw Tachbele2
1Black Lion Hospital, College of Health Sciences, Addis Ababa University, Ethiopia.
Insights
Delayed trophic feeding initiation in preterm neonates occurred at a median of 41 hours, significantly later than recommended. Factors like low gestational age and respiratory distress syndrome contributed to delays, highlighting the need for timely intervention.
Area of Science:
- Neonatal Intensive Care
- Pediatric Nutrition
- Clinical Research
Background:
- Delayed trophic feeding initiation poses significant risks for neonates.
- Limited data exists on feeding initiation practices in current healthcare settings.
Purpose of the Study:
- To determine the time to trophic feeding initiation in preterm neonates.
- To identify factors contributing to delayed trophic feeding.
Main Methods:
- Prospective cohort study of 153 neonates in NICU.
- Data collected via Kobo, analyzed using STATA.
- Kaplan-Meier curves and Cox proportional hazards models employed.
Main Results:
- 85% of neonates initiated trophic feeding; median initiation time was 41 hours.
- Incidence rate of trophic feeding initiation was 1.9 per 100 person-hours.
- Factors associated with delay included gestational age <34 weeks, low APGAR scores, small for gestational age, cesarean delivery, out-born status, RDS, and hemodynamic instability.
Conclusions:
- Significant delays in trophic feeding initiation were observed, exceeding the 24-hour guideline.
- Several clinical factors were identified as significantly associated with delayed feeding.
- Healthcare providers should prioritize initiating trophic feeding within 24 hours for all neonates, irrespective of risk factors.
Background:
Delayed trophic feeding initiation is a significant risk for physical and neurological complications in neonates; however, data on feeding initiation in the current study setting are limited.
Objective:
This study aimed to determine the time to initiation of trophic feeding and to identify reasons for delayed initiation among preterm neonates.
Methods:
A prospective cohort study was conducted among 153 neonates admitted to Neonatal Intensive Care Units from February to April 20, 2023. Data were collected via Kobo and analyzed with STATA. Kaplan-Meier survival curves and Cox proportional hazards models were used for analysis.
Primary And Secondary Outcomes:
Median time and rate of trophic feeding initiation were estimated using Kaplan-Meier and simple frequency statistics, respectively, and adjusted hazard ratio with 95% confidence interval was used to identify factors for delayed initiation.
Results:
Among 153 neonates followed for 6853 person-hours, 85% initiated trophic feeding. The incidence rate of trophic feeding initiating was 1.9/100 person-hours with a median time of 41 h (95% confidence interval: 31-45). Delayed initiation was significantly associated with gestational age <34 weeks (adjusted hazard ratio: 0.54, 95% confidence interval: 0.37-0.79), first min APGAR score <7 (adjusted hazard ratio: 0.4, 95% confidence interval: 0.25-0.65), fifth min APGAR score <7 (adjusted hazard ratio: 0.51, 95% confidence interval: 0.34-0.79), small for gestational age (adjusted hazard ratio: 0.54, 95% confidence interval: 0.33-0.88), cesarean delivery (adjusted hazard ratio: 0.47, 95% confidence interval: 0.31-0.71), being out-born (adjusted hazard ratio: 0.50, 95% confidence interval: 0.30-0.83), respiratory distress syndrome (adjusted hazard ratio: 0.63, 95% confidence interval: 0.43-0.94), and hemodynamic instability (adjusted hazard ratio: 0.46, 95% confidence interval: 0.31-0.68).
Conclusion:
The study found a significant delay in trophic feeding initiation, despite guidelines recommending within 24 h. Gestational age <34 weeks, low APGAR scores, small for gestational age, cesarean delivery, being out-born, respiratory distress syndrome, and hemodynamic instability were associated factors. The authors emphasize the need for healthcare workers to begin trophic feeding within 24 h, regardless of these factors. They also recommend conducting larger studies nationwide to strengthen the evidence on this issue.
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