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


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Dr Sami Ulus Maternity, Children's Education and Research Hospital, Division of Neonatology, Ankara, Turkey. belmakaragol@gmail.com
Belma Saygili
BS
Karagol
Aysegul
A
Zenciroglu
Nurullah
N
Okumus
Richard A
RA
Polin
D001724:Birth Weight; D002149:Energy Intake; D004750:Enteral Nutrition / Q000379:methods*; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology; D005260:Female; D005865:Gestational Age; D006130:Growth Disorders / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D052577:Infant, Extremely Low Birth Weight / Q000254:growth & development*; D007231:Infant, Newborn; D007234:Infant, Premature / Q000254:growth & development*; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000517:prevention & control; D019102:Infant, Very Low Birth Weight / Q000254:growth & development; D007902:Length of Stay; D008297:Male; D018805:Sepsis / Q000453:epidemiology / Q000517:prevention & control*; D016896:Treatment Outcome