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A prospective randomized trial comparing continuous versus intermittent feeding methods in very low birth weight
M A Silvestre1, C A Morbach, Y W Brans
1Department of Pediatrics, Wayne State University School of Medicine, Hutzel Hospital, Detroit, Michigan, USA.
Insights
Continuous versus intermittent feedings show similar growth and nutrient retention in very low birth weight infants. Both feeding methods result in comparable hospital stays for these vulnerable neonates.
Area of Science:
- Neonatal Nutrition
- Pediatric Gastroenterology
- Infant Growth and Development
Background:
- Optimal feeding strategies are crucial for the growth and development of very low birth weight infants.
- Continuous and intermittent feeding methods are commonly employed, but their comparative efficacy requires further elucidation.
Purpose of the Study:
- To compare the effects of continuous versus intermittent nasogastric feedings on physical growth.
- To evaluate gastrointestinal tolerance and macronutrient retention in very low birth weight infants.
Main Methods:
- Randomized assignment of very low birth weight neonates (<1500 gm) to continuous (24-hour) or intermittent (every 3 hours) nasogastric feedings.
- Monitoring of daily weights, intake, weekly anthropometrics, and clinical complications.
- Nitrogen, carbohydrate, and fat balance studies were conducted on a subset of male infants.
Main Results:
- No significant differences were observed in days to regain birth weight, achieve full enteral feedings, or discharge between the two feeding groups.
- Anthropometric measurements at discharge and macronutrient retention rates (nitrogen, fat, carbohydrate) were comparable.
- Continuous feeding did not result in increased feeding-related complications.
Conclusions:
- Very low birth weight infants demonstrate similar growth and macronutrient retention rates regardless of continuous or intermittent feeding methods.
- The length of hospital stay is comparable between infants receiving continuous and intermittent feedings.
- Both feeding modalities are effective for very low birth weight infants, with no significant differences in key developmental outcomes.
Objective:
To compare the effects of continuous versus intermittent feedings on physical growth, gastrointestinal tolerance, and macronutrient retention in very low birth weight infants ( < 1500 gm).
Study Design:
Very low birth weight neonates stratified by birth weight were randomly assigned to either continuous (24-hour) or intermittent (every 3 hours) nasogastric feedings. Feedings with half-strength Similac Special Care formula were initiated between day 2 and 3 and were advanced isoenergetically to goal. Daily weights, volume/caloric intakes, weekly anthropometric and dynamic skin-fold thickness measurements, and data on feeding milestones and clinical complications were collected. Nitrogen, carbohydrate, and fat balance studies were performed on a subset of male subjects.
Results:
Eighty-two neonates with birth weights between 750 and 1500 gm who were born between 27 and 34 weeks of gestation were randomly assigned to continuous (n = 42) and intermittent (n = 40) feeding groups. There were no significant differences in baseline demographics and severity of respiratory distress between groups. There were no significant differences in days to regain birth weight, days to full enteral feedings, days to discharge, and discharge anthropometric measurements between continuously fed and intermittently fed infants, both when evaluated together and according to 250 gm weight intervals. Retention rates of nitrogen, fat, total carbohydrate, and lactose were comparable in the continuously fed (n = 17) and intermittently fed (n = 13) male neonates. Very low birth weight neonates who were fed continuously did not have feeding-related complications.
Conclusion:
Very low birth weight infants achieve similar growth and macronutrient retention rates and have comparable lengths of hospital stay whether they are fed with continuous or intermittent feedings.