Does diet in preterm infants influence clinical outcome?
After several decades of intensive research into feeding preterm infants, it is important to question why there is persisting uncertainty over their dietary management. The evolution of scientific investigation in this field is compared with that in other areas of clinical science, where a three-phase pattern emerges: phase 1, reports of anecdotal observation and clinical experience; phase 2, epidemiological observation and physiological experiment; and phase 3, controlled prospective trials of specific interventions on clinical outcome. It is argued that research into feeding preterm infants has not evolved beyond physiological experiment (phase 2) and that the absence of clinical outcome data (phase 3 research) explains major uncertainties in clinical practice. Data from a large randomized multicentre outcome study of preterm nutrition are used to demonstrate how the wealth of previous and current 'physiological' information cannot be used satisfactorily to predict desirable clinical outcome responses to early diet.
Lucas
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University of Cambridge, England.
D002986:Clinical Trials as Topic; D004032:Diet; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000378:metabolism*; D009751:Nutritional Requirements; D011379:Prognosis; D011897:Random Allocation