title: Continuous nasogastric milk feeding versus intermittent bolus milk feeding for premature infants less than 1500 grams.
abstract: BACKGROUND
  Milk feedings can be given via nasogastric tube either intermittently, typically over 10 to 20 minutes every two or three hours, or continuously, using an infusion pump. Although theoretical benefits and risks of each method have been proposed, effects on clinically important outcomes remain uncertain.
  
  
  OBJECTIVE
  To examine the evidence regarding the effectiveness of continuous versus intermittent bolus nasogastric milk feeding in premature infants less than 1500 grams.
  
  
  METHODS
  Searches were performed of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 3, 2011), MEDLINE, CINAHL and HealthSTAR up to July 2011.
  
  
  METHODS
  Randomised and quasi-randomised clinical trials comparing continuous versus intermittent bolus nasogastric milk feeding in premature infants less than 1500 grams.
  
  
  METHODS
  Two review authors independently assessed all trials for relevance and methodologic quality. The standard methods of the Cochrane Neonatal Review Group were used to extract data.
  
  
  RESULTS
  Overall, the seven included trials, involving 511 infants, found no differences in time to achieve full enteral feeds between feeding methods (weighted mean difference (WMD) 2 days; 95% CI -0.3 to 3.9) . In the subgroup analysis of those studies comparing continuous nasogastric versus intermittent bolus nasogastric milk feedings the findings remained unchanged (WMD 2 days, 95% CI -0.4 to 4.1). There was no significant difference in somatic growth and incidence of NEC between feeding methods irrespective of tube placement. One study noted a trend toward more apneas during the study period in infants fed by the continuous tube feeding method compared to those fed by intermittent feedings delivered predominantly by orogastric tube placements [mean difference (MD) 14.0 apneas during study period; 95% CI -0.2 to 28.2]. In subgroup analysis based on weight groups, one study suggested that infants less than 1000 grams and 1000 to 1250 grams birth weight gained weight faster when fed by the continuous nasogastric tube feeding method compared to intermittent nasogastric tube feeding method (MD 2.0 g/day; 95% CI 0.5 to 3.5; MD 2.0 g/day; 95% CI 0.2 to 3.8, respectively). A trend toward earlier discharge for infants less than 1000 grams birth weight fed by the continuous tube feeding method compared to intermittent nasogastric tube feeding method (MD -11 days; 95% CI -21.8 to -0.2).
  
  
  CONCLUSIONS
  Small sample sizes, methodologic limitations, inconsistencies in controlling variables that may affect outcomes, and conflicting results of the studies to date make it difficult to make universal recommendations regarding the best tube feeding method for premature infants less than 1500 grams. The clinical benefits and risks of continuous versus intermittent nasogastric tube milk feeding cannot be reliably discerned from the limited information available from randomised trials to date.
authors.affiliation: University of Calgary, Faculty of Nursing, Calgary, Canada. premjis@ucalgary.ca
authors.forename: Shahirose S
authors.initials: SS
authors.lastname: Premji
authors.forename: Lorraine
authors.initials: L
authors.lastname: Chessell
mesh_terms: D000818:Animals; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007441:Intubation, Gastrointestinal / Q000379:methods; D007902:Length of Stay; D008892:Milk; D008895:Milk, Human; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D015430:Weight Gain
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