[Enteral feeding volume advancement by using a standardized nutritional regimen in preterm infants ≤1,750 g birth weight: a controlled randomized trial].
BACKGROUND
Rapid enteral feeding volume advancement in preterm infants can reduce the use of intravenous fluids. This practice may decrease the hazards of intravenous infusion solutions and potentially the morbidity rate. Several cohort trials demand the standardised nutritional regimen to reduce the complications and the time to reach full enteral feeds.


OBJECTIVE
to determine whether using a standardized nutritional regimen the rapid enteral feeding advancement in preterm infants is practicable without increasing the incidence of feeding complications.


METHODS
A prospective, randomized, controlled trial was performed in 99 preterm infants, birth weight ≤1,750 g. Group ST (standardized nutritional regimen) received breast human milk according to a standardized nutritional regimen. Group IN (individual nutritional regimen) received breast human milk or semi-elemental nutrition (Pregomin(®) Milupa) depending on enteral problems of the infant. The feeding volume advancement in the IN-Group was decided individually. The main outcome measure was time to reach full enteral feedings.


RESULTS
Infants in the ST-Group achieved full enteral feedings after 14.93±9.95 (median 12) d, infants in the IN-Group after 16.23±10.86 (median 14) d. The difference between the groups was significant only in small for gestational age (SGA) infants: ST-Group 10.20±4.78 (median 8.5) vs. IN-Group 16.73±8.57 (Median 15) days (p=0.045). The weight gain was similar in both groups. Infants in ST-Group achieved full enteral feedings having 116% of birth weight, infants in IN-Group 122% of birth weight. This difference was not significant (p=0.195). The incidence of NEC (necrotizing enterocolitis, 4%) and other complications were low in both groups. The diagnosis "feeding complications" was described in IN-Group in 14 vs. 7 infants in ST-Group.


CONCLUSIONS
SGA-infants profit from the enteral feeding advancement by using a standardized nutritional regimen. These infants achieved full enteral feedings sooner then the SGA-infants, who did not feed by using a standardized nutritional regimen. A standardized nutritional regimen can be realized in clinical routine and is by strict clinical observation practicable without increasing the incidence of feeding complications.
Sergeyev
E
E
Abteilung für Neonatologie, Klinik und Poliklinik für Kinder und Jugendliche der Universität Leipzig. elena.sergeyev@medizin.uni-leipzig.de
Gebauer
C
C
Knüpfer
M
M
Pulzer
F
F
Robel-Tillig
E
E
D015331:Cohort Studies; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D005858:Germany; D006801:Humans; D041943:Infant Formula; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000628:therapy*; D019102:Infant, Very Low Birth Weight; D008297:Male; D008895:Milk, Human