Randomized controlled trial of slow vs rapid enteral feeding advancements on the clinical outcomes of preterm infants with birth weight 750-1250 g

• Published in: JPEN. Journal of parenteral and enteral nutrition Vol. 37; no. 2; p. 223
• Main Authors: Karagol, Belma Saygili, Zenciroglu, Aysegul, Okumus, Nurullah, Polin, Richard A
• Format: Journal Article
• Language: English
• Published: United States 01.03.2013
• Subjects: Birth Weight; Energy Intake; Enteral Nutrition - methods; Enterocolitis, Necrotizing - epidemiology; Female; Gestational Age; Growth Disorders - prevention & control; Humans; Incidence; Infant, Extremely Low Birth Weight - growth & development; Infant, Newborn; Infant, Premature - growth & development; Infant, Premature, Diseases - epidemiology; Infant, Premature, Diseases - prevention & control; Infant, Very Low Birth Weight - growth & development; Length of Stay; Male; Sepsis - epidemiology; Sepsis - prevention & control; Treatment Outcome
• ISSN: 0148-6071; 1941-2444
• DOI: 10.1177/0148607112449482

To evaluate the effect of slow vs rapid rates of advancement of enteral feed volumes on the clinical outcomes in preterm infants with 750-1250 g birth weight. A total of 92 stable neonates 750-1250 g and gestational age <32 weeks were randomly allocated to enteral feeding advancement of 20 mL/kg/d (n = 46) or 30 mL/kg/d (n = 46). The primary outcome was days to reach full enteral feeding, defined as 180 mL/kg/d. Secondary outcomes included rates of necrotizing enterocolitis (NEC) and culture-proven sepsis, days of parenteral nutrition (PN), length of hospital stay, and growth end points. Neonates in the rapid-feeding advancement group achieved full enteral volume of feedings earlier than the slower advancement group. They received significantly fewer days of PN, exhibited a shorter time to regain birth weight, and had a shorter duration of hospital stay. The incidence of NEC and the number of episodes of feeding intolerance were not significantly different between the groups, whereas the incidence of culture-proven late-onset sepsis was significantly less in infants receiving a rapid feeding advancement. Excluding infants who were small for gestational age at birth, the incidence of extrauterine growth restriction was significantly reduced in the rapid-advancement group at 28 days and at hospital discharge. Rapid enteral feeding advancements in 750-1250 g birth weight infants reduce the time to reach full enteral feeding and the use of PN administration. Rapid-advancement enteral feed also decreases extrauterine growth restriction with improved short-term outcomes for these high-risk infants.