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Published on: January 12, 2018
A prospective randomized trial of feeding methods in very low birth weight infants
S M Akintorin1, M Kamat, R S Pildes
1Department of Pediatrics, Cook County Children's Hospital, Chicago, IL 60612, USA.
Insights
Continuous nasogastric gavage (CNG) and intermittent bolus gavage (IBG) feeding methods showed similar outcomes in very low birth weight infants. Neither method significantly improved time to full enteral feeding or reduced feeding intolerance.
Area of Science:
- Neonatal Nutrition
- Pediatric Gastroenterology
Background:
- Optimizing enteral feeding is crucial for the growth and development of very low birth weight (VLBW) infants.
- Different feeding methods, including continuous nasogastric gavage (CNG) and intermittent bolus gavage (IBG), are employed, with varying impacts on feeding tolerance and advancement.
Purpose of the Study:
- To compare the efficacy of continuous nasogastric gavage (CNG) versus intermittent bolus gavage (IBG) in VLBW infants.
- To determine if CNG feeding leads to earlier achievement of full enteral feeds (100 kcal/kg/d) and reduced feeding intolerance (FI) compared to IBG.
Main Methods:
- Eighty VLBW infants (700-1250 g) were randomized into either CNG or IBG feeding groups.
- Feedings were advanced using a standardized protocol until the target of 100 kcal/kg/d was maintained for 48 hours.
- Feeding intolerance was defined as withholding feedings for >12 hours based on predefined criteria.
Main Results:
- No statistically significant difference was observed in the time to reach full enteral feeding between the CNG (17.1 ± 8.9 days) and IBG (15.5 ± 5.5 days) groups.
- Secondary outcomes, including days to regain birth weight, days to reach discharge weight, and the number of feeding intolerance episodes, were comparable between the two feeding methods.
- Feeding intolerance was more prevalent in infants with lower birth weights (
Conclusions:
- The method of feeding (CNG vs. IBG) does not significantly impact key outcomes in VLBW infants when feeding regimens are comparable.
- Clinical practice regarding feeding method choice may not critically affect the rate of enteral feeding advancement or feeding tolerance in this population.
Objective:
To test the hypothesis that very low birth weight infants fed by continuous nasogastric gavage (CNG) would achieve full enteral feedings (100 kcal/kg/d) at an earlier postnatal age and have less feeding intolerance (FI) than infants fed by intermittent bolus gavage (IBG).
Methods:
Eighty infants were stratified by birth weight (700 to 1000 g and 1001 to 1250 g) and randomized into CNG or IBG feeding groups. CNG infants were comparable with IBG in birth weight, gestational age, sex, race, and day of onset of feeding (5.7 +/- 2.1 days vs 5.6 +/- 2.2 days, respectively). Feedings were given as undiluted Similac Special Care formula (Ross Laboratories, Columbus, OH) via a specific protocol designed for each 50 to 100 g birth weight category. Feedings were advanced isoenergetically by a maximum of 25 mL/kg/d until an endpoint of 100/kcal/kg/d for at least 48 hours was reached. An infant whose feedings were withheld for >12 hours based on predetermined criteria was considered to have an episode of FI.
Results:
Infants in the CNG group reached full enteral feeding at 17.1 +/- 8.9 days compared with 15.5 +/- 5.5 days in the IBG group; these were not statistically different. Secondary outcome variables such as days to regain birth weight (CNG, 12.6 +/- 5 days vs IBG, 12.5 +/- 3.7 days), days to reach discharge weight of 2040 g (CNG, 60 +/- 13.4 days vs IBG, 62 +/- 13.6 days), and number of episodes of FI were not significantly different between feeding methods. FI was primarily associated with birth weight
Conclusion:
Feeding methods are associated with similar outcomes when feeding regimens are comparable.
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