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Published on: December 31, 2015
Two-Year Follow-Up of the Different Approaches to Feeding Infants Born Moderate-to-Late Preterm: Determinants of Feed
Subhasish Das1, Frank H Bloomfield1, Tanith Alexander2
1Liggins Institute, University of Auckland, Auckland, New Zealand.
Insights
Introducing early sensory experiences like taste and smell of milk before tube feeding may reduce neurosensory impairment in moderate-and-late preterm infants. Other feeding strategies did not significantly impact outcomes at two years.
Area of Science:
- Neonatal nutrition
- Neurodevelopmental outcomes
- Preterm infant care
Background:
- Moderate-and-late preterm (MLPT) infants (32-35 weeks gestation) are at risk for neurodevelopmental challenges.
- Optimizing feeding strategies is crucial for improving outcomes in this vulnerable population.
- Previous research has explored various nutritional interventions, but the impact of sensory feeding experiences remains less understood.
Purpose of the Study:
- To investigate the effects of different feeding strategies on neurosensory impairment in MLPT infants.
- To evaluate the impact of intravenous amino acids versus dextrose.
- To compare exclusive maternal breastmilk versus milk supplementation.
- To assess the role of early exposure to milk taste and smell before gastric tube feeding.
Main Methods:
- A factorial randomized trial (DIAMOND) involving MLPT infants from New Zealand neonatal units.
- Randomization to different nutritional arms: parenteral amino acids vs. dextrose, exclusive breastmilk vs. supplement, and presence/absence of milk taste/smell before tube feeds.
- Neurosensory impairment, including blindness, deafness, cerebral palsy, and developmental delay (Bayley III scores < 85), assessed at 2 years corrected age.
- Generalized linear mixed models used for outcome comparisons.
Main Results:
- No significant differences in neurosensory impairment or developmental delay were observed between amino acid vs. dextrose groups or between exclusive breastmilk vs. milk supplement groups.
- Infants exposed to milk taste/smell before gastric tube feeds showed a significantly lower rate of neurosensory impairment (21% vs. 31%, aRR 0.7; P=0.02).
- This reduction was primarily driven by a decrease in mild developmental delay, particularly language delay (18% vs. 28%, aRR 0.6; P=0.01).
- Growth, general health, and behavior were similar across all groups.
Conclusions:
- Early parenteral and enteral nutrition strategies did not significantly alter neurosensory outcomes at two years in MLPT infants.
- Exposure to milk taste and smell prior to gastric tube feeding was associated with a reduced risk of neurosensory impairment.
- Further research is warranted to confirm these findings and explore the mechanisms behind this sensory-enhanced feeding benefit.
Objective:
To determine the impact of different feeding strategies in children born moderate-and-late preterm (MLPT) on later neurosensory impairment.
Study Design:
Children born MLPT (320/7-356/7 weeks) recruited to the Different Approaches to Moderate & Late Preterm Nutrition: Determinants of Feed Intolerance, Body Composition, and Development (DIAMOND) factorial randomized trial from New Zealand neonatal units were randomized to intravenous amino acids vs intravenous dextrose, exclusive maternal breastmilk vs milk supplement, and taste/smell of milk before gastric tube feeds or not. Neurosensory impairment (blindness, deafness, cerebral palsy, or developmental delay [Bayley III composite cognitive/language/motor scores <85]) was assessed at 2 years of corrected age. Outcomes were compared using generalized linear mixed models.
Results:
Of 529 eligible children, 425 were assessed at mean (SD) 25.6 (1.9) months. Rates of neurosensory impairment were similar in amino acids vs dextrose and in milk supplement vs maternal breastmilk only groups, but impairments were less frequent in children randomized to taste/smell of milk (43/203 [21%] vs 68/220 [31%]; adjusted risk ratio 0.7; 95% CI 0.5-0.9; P = .02). This difference was primarily attributable to mild developmental delay, particularly language delay (35/199 [18%] vs 61/218 [28%]; adjusted risk ratio 0.6; 95% CI 0.4-0.9; P = .01). Growth, general health, and behavior were similar between groups.
Conclusions:
Early parenteral and enteral nutrition strategies in children born MLPT did not alter outcomes at 2 years. However, exposure to taste/smell of milk before gastric tube feeds was associated with a lower risk of neurosensory impairment.
Trial Registration:
anzctr.org.au Identifier: ACTRN12616001199404 (https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371006&isReview=true).
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