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Feeding premature infants while low umbilical artery catheters are in place: a prospective, randomized trial
1Department of Pediatrics, University of Rochester Medical Center, New York.
Insights
Early enteral feeding for premature infants with low umbilical artery catheters (LUACs) does not increase feeding problems or necrotizing enterocolitis. This approach reduces the need for central venous catheters and parenteral nutrition.
Area of Science:
- Neonatalogy
- Pediatric Gastroenterology
- Clinical Nutrition
Background:
- Premature infants often require invasive monitoring, including low umbilical artery catheters (LUACs).
- Timing of enteral feeding initiation in neonates with LUACs is a critical clinical decision.
- Concerns exist regarding potential feeding complications and necrotizing enterocolitis (NEC) with early feeding.
Purpose of the Study:
- To compare feeding problems and NEC incidence in premature infants receiving early vs. late enteral feedings relative to LUAC removal.
- To test the hypothesis of no difference in feeding issues between early and late enteral feeding groups.
Main Methods:
- Prospective, randomized clinical trial involving stable premature infants.
- Early group: enteral feedings initiated while LUACs were in place.
- Late group: enteral feedings initiated 24 hours after LUAC removal.
Main Results:
- No significant differences in gastric residua or abdominal distention between groups.
- Early feeding group showed significantly fewer central venous catheters, sepsis evaluations, and NPO (nothing by mouth) episodes.
- Early group received significantly shorter duration of parenteral nutrition (13 vs. 30 days).
- NEC incidence was 2 cases in the early group vs. 4 cases in the late group.
Conclusions:
- Initiating enteral feedings while LUACs are in place is safe for stable premature infants.
- Early feeding does not increase feeding problems or NEC compared to delayed feeding.
- This practice may reduce the need for central venous access and parenteral nutrition.
Objective:
The objective of this prospective, randomized clinical trial was to test the hypothesis that there is no difference in the frequency of feeding problems and necrotizing enterocolitis between a group of premature infants who received early enteral feedings while low umbilical artery catheters (LUACs) were in place, and a late group who were not fed until 24 hours after removal of LUACs.
Patients And Methods:
Twenty-nine premature infants (born at 28.5 +/- 3.0 SD weeks of gestational age) who were in stable condition received early enteral feedings at a median of 2 days while a LUAC was in place; 31 infants (born at 28.6 +/- 2.7 SD weeks of gestational age) received late enteral feedings at a median of 5 days of age, 24 hours after the removal of the LUAC. Feeding complications and interventions and nutritional characteristics were recorded prospectively.
Results:
There were no differences in the baseline perinatal characteristics of the two groups. The incidence of gastric residua and the incidence of abdominal distention were the same in both groups. The early feeding group had significantly fewer percutaneous central venous catheters, evaluations for sepsis, and episodes of receiving nothing by mouth while a gastric suction tube was in place. Infants in the early group received parenteral alimentation-lipid emulsion infusions for a median of 13 days versus 30 days for the late-fed group (p = 0.0028 by Wilcoxon test). There were two cases of necrotizing enterocolitis in the early group versus four cases in the late group.
Conclusions:
Premature infants in stable condition who receive enteral feedings while LUACs are in place do not have an increased incidence of feeding problems compared with infants who do not receive enteral feedings until 24 hours after removal of LUACs.