Early Total versus Conventional Feeding between 27 and 32 Weeks' Gestation: A Randomized Controlled Trial

Area of Science:

• Neonatalogy
• Pediatric Gastroenterology
• Clinical Nutrition

Background:

• Premature neonates (27-32 weeks gestation) often face challenges with enteral feeding.
• Conventional enteral feeding (CEF) involves gradual advancement, while early total enteral feeding (ETEF) aims for quicker full feeds.
• Optimizing feeding strategies is crucial for improving outcomes in sick neonates.

Purpose of the Study:

• To compare the time to achieve full enteral feeds in sick neonates (27-32 weeks gestation) between ETEF and CEF.
• To evaluate the incidence of feed intolerance, sepsis, and necrotizing enterocolitis (NEC) in both feeding groups.
• To assess weight gain and duration of hospital stay associated with ETEF versus CEF.

Main Methods:

• A randomized controlled trial involving 183 infants (27-32 weeks gestation).
• Infants were allocated to either ETEF (initiated as complete enteral feeds) or CEF (initiated as trophic feeding).
• Data collected included time to full feeds, feed intolerance, sepsis, weight gain, NEC incidence, and hospital stay duration.

Main Results:

• Neonates in the ETEF group reached full enteral feeds significantly earlier (6.8 days) than the CEF group (9.1 days).
• ETEF was associated with reduced feed intolerance, sepsis episodes, higher weight gain, and shorter hospital stays.
• No neonates in the ETEF group developed necrotizing enterocolitis (NEC).

Conclusions:

• Early total enteral feeding (ETEF) is safe and effective for sick neonates between 27-32 weeks gestation.
• ETEF accelerates the attainment of full feeds without increasing feed intolerance or NEC.
• This feeding approach improves prematurity-associated complications and reduces hospital stay duration.