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Early Total versus Conventional Feeding between 27 and 32 Weeks' Gestation: A Randomized Controlled Trial
Sushma Nangia1, Shriya Akanksha2, Gunjana Kumar2
1Department of Neonatology, Lady Hardinge Medical College and Associated SSK and KSC Hospitals, New Delhi, India, drsnangia@gmail.com.
Insights
Early total enteral feeding (ETEF) in premature neonates (27-32 weeks gestation) significantly speeds up achieving full feeds. This method also reduces complications and hospital stay without increasing feed intolerance or necrotizing enterocolitis (NEC).
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.
Introduction:
The aim of the study was to compare the time of attainment of full enteral feeds in sick neonates between 27 and 32 weeks of gestation receiving early total enteral feeding (ETEF) versus conventional enteral feeding (CEF).
Methods:
In this randomized controlled trial, 183 infants were allocated to either the ETEF (n = 90) or CEF (n = 93) group. In the ETEF group, feeding was initiated as complete enteral feeds, whereas in the CEF group, feeding was initiated as trophic feeding at 20 mL/kg. The rest of the day's requirements for the CEF group were provided as intravenous fluids.
Results:
The ETEF group infants had marginally higher mean birth weight, slightly greater gestational age, fewer infants with SGA at birth, and a lesser need for resuscitation, although these differences were not statistically significant. The neonates in the ETEF group reached full enteral feeds significantly earlier than the CEF group (6.8 ± 1.8 vs. 9.1 ± 4.3 days postnatal age; mean difference -2.3 [-3.2 to -1.3]; p < 0.001). There was a significant reduction in the episodes of feed intolerance and clinical or probable sepsis with significantly higher weight gain at 1 month of age (17.4 vs. 15.5 g/kg/d; p = 0.001), and a shorter duration of hospital stay (25.9 vs. 38.1 days; p = 0.001) in the ETEF as compared to the CEF group. None of the neonates in the ETEF group developed necrotizing enterocolitis (NEC).
Conclusion:
ETEF in sick neonates between 27 and 32 weeks' gestation leads to early attainment of full feeds without increasing the incidence of feed intolerance and NEC. This feeding practice also reduces pre-maturity-associated complications and the duration of hospital stay.
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